community health nursing_cs
DESCRIPTION
case study on CHNTRANSCRIPT
III. FAMILY PROFILE
Head of the Family : Mr. x
Date of Birth : x
Age : 28 years old
Address : x
School Attainment : x
Religion : Iglesia ni Kristo
Citizenship : Filipino
Occupation : x
Family Income : 5000/month
Name of Wife : Mrs. x
Date of Birth : x
Age : x
Address : x
School Attainment : x)
Religion : x
Citizenship : Filipino
Occupation : x
Family Income : none
Blood Pressure : 100/70 mmHg
Temperature : 36.3 Degrees Celsius
Respiratory Rate : 20 cpm
Pulse Rate : 65 bpm
Head of the Familyc Family Members: 6
Address: c
I. Members of the households
Family
Member
Number
Name Relation to Head/
Civil Status
Sex Birth date
Month Year
Highest
Education
Completed
Occupation
/Type of
Work
1 x x F x 1980 College Level Housewife
2 x x M x 2002 Grade 1 N/A
3 x x F x 2004 Not At School Yet N/A
4 x
x M x 2006 Not At
School Yet
N/A
5 x
x F x 1990 High school
Graduate
None
IMMUNIZATION RECORD
Immunization of Children: (Done at Bulua Health Center)
Name BCG DPT OPV HEPA B MEASLES
1.x √ √ √ √ √ √ √ √ √
√ √
2. x
√ √ √ √ √ √ √ √ √ √ √
3. x
√ √ √ √ √ √ √ √ √ √ √
4x √ √ √ √ √ √ √ √ √ √ √
5. x √ √ √ √ √ √ √ √ √ √ √
6. x √ √ √ √ √ √ √ √ √ √ √
FAMILY PLANNING USED: CONTRACEPTIVE PILLS
IV. HEALTH HISTORY
Mr. x
Mrx, the head of the family, is a soldier assigned x and goes home only
every 3 months. He started to smoke when he was 20 years old with a
minimum of 10 sticks per day and is an occasional drinker. For the
past years, he suffered minor illnesses only such as cough and fever.
According to his wife, he just takes Paracetamol 500mg 1 tab q4h and
herbal plants namely Lagundi for minor illness such as fever and
cough. As claimed by the wife, Mrx doesn’t have any heredofamilial
diseases on both paternal and maternal side.
Mrs. x
Mrsx, the wife did not complained of any health problems. She has
given Normal vaginal delivery to all her 3 children x wherein she also
had her pre-natal check ups when she was pregnant. She started to
use a family planning method after her 2nd child was born and chose
PILLS. But she claimed that she did not like taking the contraceptive
pills regularly because of its side effects such as dizziness. She said,
she would just take the pills, 1 week before her husband comes home.
x
x is the eldest child of the x family. Unfortunately I was not able to
assess him regularly because he is at school. But according to her
mother x is a healthy child with complete immunizations.
x
x is the 2nd child and I always meet her on each of my visit. She is a
charming child with complete immunizations also. Her mother said that
she only suffers minor illness like fever and colds and was given
medications such as Calpol , 1 tsp every 4 hours.
.x
x is the third child and has complete immunizations. Her mother said
that he has recently suffered cough and colds for 3 days so she self
medicated x with Carbocisteine, 1 tsp. 3 x a day. As I assessed x, I
noticed that there are a lot of mosquito bites on his legs. When I asked
the mother about it, she said that she has not done anything with the
problem yet.
x
x is the sister of Mrs. x. She stays with the x family to help and
assist her sister in rearing the children since her brother-in- law is
working away from home. She did not complain of any discomforts and
said that they don’t have any heredofamilial disease. For the past
months, she suffered minor illness only like cough and colds. When
asked what medications she took that time, she said she make used of
Lagundi leaves to cure her illness.
IMCI Assessment
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Date: xChild’s Name: x Age: 12 months Sex: M Weight: 9 kg Temp: 36.8C
ASK: What are the child’s problems? IMosquito bite Initial visit: √ Follow-up visit: _________ASSESS (Circle all signs present)
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHING CONVULSIONS
YES__ NO
√
DOES THE CHILD HAVE COUGH OR DIGFFICULT BREATHING? YES_√__ NO * For how long? _______ days * Count the breath in one minute. 40 breaths per minute. Fast breathing?
Look for chest indrawing. Look for chest stridor.
No pneumonia
COUGH OR COLDS
DOES THE CHILD HAVE DIARRHEA? YES___ NO √ * For how long? _____ days * Look at the young infant’s general condition. Is the infant: * Is there blood in the stool? Abnormally sleepy or difficult to awaken Restless or irritable? * Look for sunken eyes. * Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)? Slowly?
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? LOOK AND FEEL: * Has the child visited/travelled or * Look or feel stiff neck stayed overnight in a malaria area in the * Look for runny nose past 4 weeks? If malaria risk, obtain a blood smear. + P1 Pv - done THEN ASK: Look for signs of MEASLES * For how long has the child had fever? 2 days * Generalized rash and * If more than 7 days, has fever been present every day? * One of these; cough, runny nose, or * Has the child had measles within the last 3 months? red eyes If the child has measles now or within the last 3 months:
Look for the mouth ulcers. If yes, are they deep and extensive? Look for pus draining from the eye. Look for clouding of the cornea.
ASSESS DENGUE HEMORRHAGIC FEVER THEN ASK:* Has the child had any bleeding from the nose or LOOK AND FEEL: gums or in the vomitus or stool? * Look for the bleeding from nose or gums * Has the child had black vomitus or black stool? * Look for skin petechiae * Has the child had persistent abdominal pain? * Feel for cold and clammy extremities. * Has the child had persistent vomiting? * Check capillary refill. 2 seconds.
* Perform tourniquet test if child is 6 months or older AND has no other signs AND has fever for more than 3 days.
DOES THE CHILD HAVE EAR PROBLEM? YES___ NO√ * Is there ear pain? * Look for pus draining from the ear * Is there ear discharge? * Feel for tender swelling behind the ear. If yes, for how long? _____ daysTHEN CHECK FOR MALNUTRITION and ANEMIA
Look for visible severe wasting. Look for edema of both feet. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? Determine weight for age. Very low?
No anemia and not very low weight
CHECK FOR CHILD’S IMMUNIZATION STATUS Circle immunization needed today.
√ √ √ √ BCG DPT1 OPV1 HEP B1
√ √ √ √ DPT2 OPV2 HEP B2 MEASLES
√ √ √ DPT3 OPV3 HEP B3
Return for next Immunizatio
n on:
None (Date)
CHECK THE VITAMIN A SUPPLEMENT 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 CHILD’S FEEDING If child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old.
* Do you breastfeed you child? Yes___ No__√_
If Yes, how many times in 24 hours? __7__times. Do you breastfeed during the night? Yes___ No_√__
* Does the child take any other food or fluids? Yes___ No_√__ If Yes, what food or fluids? ___________________________________________________________ * How many times per day? _____times. What do you use to feed the child? ____________________ If very low weight for age, How large are the servings? _____________________________________ Does the child receive his/her own serving? _No- Who feeds the child and how? Mother through bottle fed and spoons
* During the illness, has the child’s feeding changed? Yes___ No_√__ If Yes, how?
Feeding Problems:
ASSESS CARE FOR DEVELOPMENT: Ask questions about how the mother cares for her child. Compare the mother’s answers to the Recommendations for Care and Development for the child’s age. * How do you play with your child? * How do you communicate with your child?
Care and Developme
nt Problems:
Lack of time for care on the part of
mother due to number of children
to be tended to
ASSESS OTHER PROBLEMS Insect bite wounds
Treatments:
NO PNEUMONIA COUGH AND COLDS – Soothe the throat and relieve the cough with safe
remedy. Advised mother when to return immediately. Follow up in 5 days if not improving.
NO ANEMIA AND NOT VERY LOW WEIGHT – If the child is less than 2 years old, assess
the child’s feeding counsel the mother on feeding according to the FOOD box on the
COUNSEL THE MOTHER chart. If feeding is a problem, follow up in 5 days. Advised mother
when to return immediately.
EENT[ ] impaired vision [ ] blind[ ] pain [ ] redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion [x] teethAssess eyes, ears, nosethroat for abnormality [ ] no problemRESP[ ] asymmetric [ ] tachypnea[ ] apnea [ ] rales [ ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, depth, pattern,breath sounds, comfort [ ] no problemCARDIO VASCULAR[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort[ x ] no problemGASTRO INTESTINAL TRACT[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowingbowel sounds, comfort [x] no problemGENITO – URINARY and GYNE[ ] pain [ ] urine color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturiaAssess urine frequency, control, color, odor, comfort/Gyn-bleeding discharge [ x] no problemNEURO[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] gripAssess motor function, sensation, LOC, strength,grip, gait, coordination, orientation, speech[ x ] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] deformity[ ] wound [ ] rash [ ] skin color [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis[ ] diaphoretic [ ] moistAssess mobility, motion gait, alignment, joint function
V.PRESENT HEALTH STATUS
x
EENT[ ] impaired vision [ ] blind[ ] pain [ ] redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion [x] teethAssess eyes, ears, nosethroat for abnormality [ ] no problemRESP[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ x ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, depth, pattern, breath sounds, comfort [ ] no problemCARDIO VASCULAR[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [ x ] no problemGASTRO INTESTINAL TRACT[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowingbowel sounds, comfort [x] no problemGENITO – URINARY and GYNE[ ] pain [ ] urine color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturiaAssess urine frequency, control, color, odor, comfort/Gyn-bleeding discharge [ ] no problemNEURO[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] gripAssess motor function, sensation, LOC, strength,grip, gait, coordination, orientation, speech [ x ] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic [ ] moistAssess mobility, motion gait, alignment, joint functionSkin color, texture, turgor, integrity [ ] no problem
VITAL SIGNS
1st visit (Jan. 23, 2009) PR:74 bpm RR: 20 cpm BP:100/70 mmHg T: 36.8 C 2nd visit (Jan. 30, 2009) PR:80 bpm RR: 18cpm BP: 100/70mmHg T: 37.1 C3rd visit (Feb. 13, 2009) PR:75 bpm RR: 16 cpm BP: 90/70mmHg T: 37. 3 C 4th visit (Feb. 20, 2009) PR:68 bpm RR: 17 cpm BP:100/70mmHg T: 37 C
x
EENT[ ] impaired vision [ ] blind[ ] pain [ ] redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion [ ] teethAssess eyes, ears, nosethroat for abnormality [ ] no problemRESP[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, depth, pattern, breath sounds, comfort [ ] no problemCARDIO VASCULAR[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [ ] no problemGASTRO INTESTINAL TRACT[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowingbowel sounds, comfort [x] no problemGENITO – URINARY and GYNE[ ] pain [ ] urine color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturiaAssess urine frequency, control, color, odor, comfort/Gyn-bleeding discharge [ ] no problemNEURO[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] gripAssess motor function, sensation, LOC, strength,grip, gait, coordination, orientation, speech [ x ] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic [ ] moistAssess mobility, motion gait, alignment, joint functionSkin color, texture, turgor, integrity [ ] no problem
VITAL SIGNS
1st visit (Jan. 23, 2009) PR:84 bpm RR: 20 cpm T: 36.5 C 2nd visit (Jan. 30, 2009) PR:80 bpm RR: 22cpm T: 37.1 C3rd visit (Feb. 13, 2009) PR:85 bpm RR: 20 cpm T: 37. 2 C 4th visit (Feb. 20, 2009) PR:88 bpm RR: 21 cpm T: 37 C
x
EENT[ ] impaired vision [ ] blind[ ] pain [ ] redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion [x] teethAssess eyes, ears, nosethroat for abnormality [ ] no problemRESP[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ x ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, depth, pattern, breath sounds, comfort [ ] no problemCARDIO VASCULAR[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [ x ] no problemGASTRO INTESTINAL TRACT[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowingbowel sounds, comfort [x] no problemGENITO – URINARY and GYNE[ ] pain [ ] urine color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturiaAssess urine frequency, control, color, odor, comfort/Gyn-bleeding discharge [ ] no problemNEURO[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] gripAssess motor function, sensation, LOC, strength,grip, gait, coordination, orientation, speech [ x ] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic [ ] moistAssess mobility, motion gait, alignment, joint functionSkin color, texture, turgor, integrity [ ] no problem
VITAL SIGNS
1st visit (Jan. 23, 2009) PR:84 bpm RR: 20 cpm T: 36.9 C 2nd visit (Jan. 30, 2009) PR:88 bpm RR: 20cpm T: 37.1 C3rd visit (Feb. 13, 2009) PR:85 bpm RR: 22 cpm T: 37.2 C 4th visit (Feb. 20, 2009) PR:88 bpm RR: 26 cpm T: 37.3 C
x
VITAL SIGNS
1st visit (Jan. 23, 2009) PR:94 bpm RR: 31 cpm T: 37 C 2nd visit (Jan. 30, 2009) PR:90 bpm RR: 40cpm T: 37.1 C3rd visit (Feb. 13, 2009) PR:95 bpm RR: 30 cpm T: 37. 2 C 4th visit (Feb. 20, 2009) PR:98 bpm RR: 30 cpm T: 37.1 C
x
EENT[ ] impaired vision [ ] blind[ ] pain [ ] redden throat for abnormality [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion [x] teethAssess eyes, ears, nose [ ] no problemRESP[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ x pain [ ] cyanoticAssess resp. rate, rhythm, depth, pattern, breath sounds, comfort [ ] no problemCARDIO VASCULAR[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [x ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [ ] no problemGASTRO INTESTINAL TRACT[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowingbowel sounds, comfort [ ] no problemGENITO – URINARY and GYNE[ ] pain [ ] urine color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturiaAssess urine frequency, control, color, odor, comfort/Gyn-bleeding discharge [ ] no problemNEURO[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] gripAssess motor function, sensation, LOC, strength,grip, gait, coordination, orientation, speech [ x ] no problemMUSCULOSKELETAL 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
VITAL SIGNS
1st visit (Jan. 23, 2009) PR:74 bpm RR: 20 cpm BP: 90/70 mmHg T: 36.9 C 2nd visit (Jan. 30, 2009) PR:68 bpm RR: 22cpm BP: 100/70mmHg T: 37C3rd visit (Feb. 13, 2009) PR:65 bpm RR: 16 cpm BP: 90/60mmHg T: 37 C th visit (Feb. 20, 2009) PR:68 bpm RR: 18 cpm BP:90/60mmHg T: 37.2 C
HOME AND ENVIRONMENT
1. Housing
A. Adequacy of living space
The house of our client is primarily made up of wood with a length of 7
meters and a width of 5 meters. Not enough for a family with 6 members. A
bamboo floor was created to make it elevated especially during rainy seasons
and a wooden stair serves as their access to the house. They don t own the
house where they stay. They pay P800/ month for the house rent. The nearest
neighbor is 5 meters away and the land area is muddy and watery during rainy
seasons. There lightning facility is through x and they pay P550.00 per month for
their current bill.
B. Sleeping Arrangement
The house was divided into three areas, one bedroom, a living room and a
kitchen. When the husband is around, the sister-in- law together with the two
eldest children sleeps in the living room so that the couple and the youngest
child sleeps in the bedroom. They don’t use any mosquito net as a protective
measure against mosquito bites and their windows are unscreened.
C. Presence of breeding or resting sites of vectors of diseases
The surrounding of the house is dirty, there are flies flying around because
there is no proper maintenance of cleanliness. The untrimmed plants and trees
could serve as the breeding place of mosquitoes.
If you take a look inside the house, things are not properly arranged and
cleaned which could also serve as breeding places for cockroaches and rats.
D. Presence of accident hazards
The house is totally made up of wood that is prone to fire. It is 1 ft elevated
from the ground to protect it during rainy seasons. But the wooden floor is not
that strong to support the weight of the whole family and the wooden stairs that
serves as the access to the house is hazardous for the children.
E. Food storage and cooking facilities
Their kitchen is outside the house and their cooking area is made up of
wood. They utilize firewood, which is stored at the side of the cooking area, for
their cooking needs. The kitchen is dirty because proper maintenance is not
observed.
They have a refrigerator which serves as their storage area for their left
over foods. But the unwashed plates on their dishwashing sink is not good for it
harbors growth of microorganisms.
F. Water Supply
Their source of water supply for drinking is the faucet supplied by
NAWASA and they pay P200 a month for their water bill. They also get the water
for household chores on the same faucet.
G. Toilet facility
The family has a water sealed toilet located inside the house. It is well
maintained by the mother but the toilet door is just covered by a cloth in which it
doe not allow privacy for anyone who will use the toilet.
H. Garbage disposal
Their means of garbage disposal is by placing it on a large plastic bag so
it will be gathered until it is full then a garbage collection at Zone 5 is done every
Wednesday. But the children are not trained on proper waste disposal and would
just throw their garbage anywhere.
I. Drainage system
The family has no drainage system .
2. Kind of neighborhood
x is a very peaceful place especially during weekdays when the children
are in school. The air is not polluted and the land area is wet and muddy during
rainy days and dusty during sunny days. The community people were very warm
and participative. Mostly, their source of income is through farming and working
in government agencies.
Some houses are closely built to each other that is why it’s not a surprise
that the community people were really bonded to each other and by just
mentioning the family name, we could already have an idea where to find them
since they were aware of the location.
3. Social and Health facilities
In the area, they have their recreational facility which is a basketball court
located x. There, we can also find the Barangay hall and the health center which
is offering an immunization and consultation every Tuesday and Pre–natal
check-ups during Thursdays. Significant community activities are also being held
in there.
The community people gather every Friday at 2pm for their weekly Zonal
meeting at xesidence xl spearheaded by the zone leader and the division leader.
They also have a church where they can attend mass during Sundays at Zone 2.
The children go to school x.
4. Communication and Transportation Facilities available
The family owns a television and a radio in their house where they could
listen to and be updated of the latest news about available health services and
other health issues. They could ride a motorela or a sikad with a fare of P5.00 if
they would go somewhere around Igpit and ride a jeepney with a P15.00 fare if
they will go to the city proper.
VII. FAMILY COPING INDEX
The objective of this indicator is to present a benchmark for approximating
the nursing needs of a 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. In public health
nursing, the family cannot be seen only as a factor that affects health; rather, the
family is the patient.
Legendary:
5 - Complete Competence
3 - Moderate Competence
1 - No Competence
Area Rate Justification
1. Physical Indepen-dence- the ability to move about, get out of bed and perform activities
3The husband is busy of his work as a soldier and barely comes home. So the wife mostly attends to the needs of their children’s needs. 1 out of their 3 children were already able to perform their daily routines.
2. Therapeutic Indepen-dence- Includes all of the procedures or treatment prescribed for the care of illness.
3The mother said that, whenever one of the members of her family got sick they sometimes visit the health center to have check up & ask for their medication, because they have limited financial resources and time.
3. Knowledge of Health Condition- Concerned with the particular health condition
5 The family has some general knowledge of the disease condition such that caring of its member with common colds and was able to grasped the underlying principles of proper caring such as proper hygiene and right food to eat.
4. Application of Princi-ples of General Hy-giene 3
The family is rated 3 because the children has adequate clothing, in good grooming and hygiene, adequate and balanced diet (less on protein source such as meat). Their garbage is properly thrown in right place but the children are not trained about waste segregation. hey have unwashed dishes that can lead to presence of flies over the area. They have inadequate living space for children to sleep and play. There is no drainage system in their area
5. Health Attitudes- Refers to the family regarding their health care in general including preventive measures and care of illness.
3The family accepts health care in some degree but with reservation. The mother seeks prenatal care during her previous pregnancy. The family does not seek help of the medical professionals during time of illness and prefer to self medicate. Mrs. Bautista not taking the pills regularly is a problem for she might get pregnant again.
6. Emotional Compe-tence- Maturity & integrity which the members of the family are able to meet unusual stresses and problems of life, plan for a happy and fruitful living
3The family is considered to be in the low class level but despite of that they’re still hoping and trying to uplift their condition to live their life with love and security..
7. Family Living- family does things together, each member acts for the good of the family as a whole
5 The father has a stable job and is doing his best to provide the needs of her children. Although the family has misunderstanding but it was then tolerated and settled. As a whole, the family was able to get along with each other and show respect and affection with each other though sometimes children have misunderstandings and tantrums.
8. Physical Environment- Home, community They have inadequate living space, adequate
and working environment.
3 personal belongings and utensils. They have cluttered and dirty kitchen. They have food storage facilities but they have unwashed dishes in their kitchen. As to their methods of storing water, they just put it in a jars and gallons less likely unsanitary, and without sterilizing the water for drinking consumption. There is presence of untrimmed plant and trees in the surrounding area of their house and could be breeding ground for mosquitoes.
9. Use of Community Facilities
- degree of the family use and awareness of available community facilities for health education and welfare to physician
5The family is aware of the availability of the community facilities. They are also aware of the free medications and immunizations that they could avail and are making use of it.
VIII. SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM
Home and Sanitation Condition
1. House is made up of wood and light materials.
2. Inadequate living space
3. Stairs without banisters
4. Windows not screened
Toilet
Functional Toilet; water sealed
Garbage Disposal
Waste segregation not practiced
Make use of placing the garbage in one
plastic bag and open dumping .
1. Presence of vectors for diseases such as mosquitoes and flies
No drainage system observed
Stagnant water under their house
Breeding ground and haven for mosquitoes1.) Accident hazards as a Health Threat
2.) Poor home/environment condition as a Health Threat3.) Accident hazards as a Heath Threat3.) Entry point of vectors as a Health Threat
Water from washing of utensils and clothes
drains down the ground
1.) Privacy issues as a Foreseeable Crisis. Poor home/ environmental sanitation as a Health Threat
1. Comfort room not completely covered with the use of a cloth to serve as the door.
ENVIRONMENTAL
Drainage System
Physical Genetic
Mr. Bautista smokes about 10 sticks/ day and drinks alcoholic
beverages occasionally.
All the children have mosquito bites on legs.
None
Unhealthy lifestyle and personal habits/ practices as a Health Threat
Some members of the family had the following:
Unhealthy lifestyle and personal habits/practices as a Health Threat
BIOLOGICAL
Mosquito bites as a Health Deficit
The 3rd child has a cough and colds
Failure to thrive/develop according to normal rate as a Health Deficit
Mother does not take pills regularly because of the side effects
FATHER MOTHER
SoldierHousewife
P5000/month and no other sources of income
Poor Governance
Low Budget given by DOH
Lesser Allocation
Lesser supply for
free medical supplies
Lesser access to
health services
1.) No adequate knowledge on family planning as a Health Threat
Cultural
None
SOCIAL
PoliticalEconomic
Non-use of protective measures
Unhealthy lifestyle and personal habits/practices as a Health Threat
IX. FAMILY CARE PLAN
CUESHEALTH
PROBLEMFAMILY NURSING
PROBLEMGOAL OF
CAREOBJECTIVES OF
CARE
INTERVENTION PLANEVALUATIONNURSING
INTERVENTIONSMODE OF CONTACT
RESOURCES NEEDED
Subjective:“ Gi sip on ug gi ubo si Jhon Ivan 3 na ka adlaw karun” as verbalized by Mrs. Bautista
Objective:
Jhon Ivan:RR- 40cpm
Presence of rales sound as auscultated
Non-productive cough noted
COUGH AND COLDS as a
Health Deficit
Inability to decide about taking appropriate actions due to failure to comprehend the nature, magnitude and scope of the problem
Inability to provide adequate nursing care to the sick member of the family due to:
Lack of knowledge about the health condition
Inadequate re-sources for care specifically financial resources
After nursing intervention, the family will be able to take appropriate action to manage health condition to the sick member
After nursing intervention, the family will be able to Know the follow-
ing interventions for cough and colds
- Encourage the sick members as well as to the mother to increase their fluid intake
-Discuss with t he family to use alternative medicine such as lagundi and kalamansi for cough
-Encourage the sick members about deep breathing exercise
-Encourage the family approach in the nearest health center if symptoms will worsen.
Home Visit Materials resources; visual aids on disease transmission
Human Resources: Time and effort of both the nurse and the family.
Financial Resources; Money for the nurse transportation
After nursing intervention, the family was able to take appropriate action to manage health condition to the sick member
CUESHEALTH
PROBLEMFAMILY NURSING
PROBLEMGOAL OF
CAREOBJECTIVES
OF CARE
INTERVENTION PLANEVALUATIONNURSING
INTERVENTIONSMODE OF CONTACT
RESOURCES NEEDED
Subjective:
‘’ Daghan lage ug pinaakan sa lamok ilang tiil’” as verbalized by he mother
Objective:
Presence of mosquito bites on both lower extremities
MOSQUITO BITES as a
HEALTH DEFICIT
Inability to provide adequate nursing care to the children with mosquito bites due to:
Lack of knowledge about the condition
Inadequate knowledge of the nature and extent of nursing care needed
Inadequate family re-sources for care specifi-cally respon-sible family member and financial re-sources
After nursing intervention, the mosquito bites of the children will heal in one month.
After nursing intervention, the family will know and be able to apply therapeutic measures, including skin care, to manage adequately the mosquito bites on the children.
1. Involve all the children in discussing about the nature of mosquito, the disease it can cause and the proper care needed
2. Discuss with the family possible ways of providing adequate prevention of mosquito bites utilizing less expensive drugs and supplies
3. Demonstrate to the mother and other member of the family the preparation of Akapulko Ointment and its application to the affected skin
4. Emphasize the importance of proper sanitation and cleanliness
5. Explore with the family possible ways to implement measures to eliminate the breeding place of mosquitoes.
Home Visit Materials resources: visual aids and low cost supplies to manage/treat scabiesHuman Resources: Time and effort of both the nurse and the family.Financial Resources; Money for the nurse transportation and teaching aids
After nursing intervention, the family was able to know and apply therapeutic measures, including skin care, to manage adequately the mosquito bites of the children.
CUESHEALTH
PROBLEMFAMILY NURSING
PROBLEMGOAL OF
CAREOBJECTIVES OF
CARE
INTERVENTION PLAN EVALUATION
NURSING INTERVENTIONS
MODE OF CONTACT
RESOURCES NEEDED
Subjective:“Wala man mi kanal diri” as verbalized by the mother.
Objective:
-no drainage system-presence of stagnant water
ABSENCE OF DRAINAGE
as a HEALTH THREAT
Inability to provide a home environment conducive to health maintenance and personal development due to: Lack of knowledge of
the importance of having a drainage and proper sanitation
Inability to recognize the absence of drainage as a HEALTH THREAT due to ignorance of the possible diseases acquired from it.
After nursing intervention, the family will have a drainage of their own in 2 weeks time
After nursing interventions, the family will have drainage of their own and appreciate the presence of drainage in their house.
1. Encourage the family to make drainage.
2. Discuss to the family members the importance of having drainage.
3. Stress that the following diseases that could be acquired from having no drainage: a.) Diarrhea b.) Malaria c.) Scabies
4.) Discuss the complications of the aforementioned diseases and stressed that Prevention is better than Cure
Home Visit Materials resources; visual aids on Transmission of Diseases.Human Resources: Time and effort of both the nurse and the family.Financial Resources; Money for the nurse transportation
After nursing intervention, the family was able to have a proper drainage system.
CUESHEALTH
PROBLEMFAMILY NURSING
PROBLEMGOAL OF
CAREOBJECTIVES OF
CARE
INTERVENTION PLANEVALUATIONNURSING
INTERVENTIONSMODE OF CONTACT
RESOURCES NEEDED
Subjective::“Ga tipokon lang namo ang basura”as verbalized by the mother.
Objectives:-presence of scattered garbage- open dumping of garbage disposal noted
IMPROPER GARBAGE
DISPOSAL as a HEALTH THREAT
Inability to provide a home environment conducive to health maintenance and personal development due to:
Lack of adequate knowledge on the importance of proper sanitation
Inability to recognize improper garbage disposal as a HEALTH THREAT due to ignorance of the possible diseases acquired from it.
After nursing intervention, the family will be able to segregate their garbage.
After nursing intervention, the family will:
Understand the impor-tance of proper garbage dis-posal.
Segregate their garbage into biodegrad-able and non biodegrad-able.
1. Discuss to the family the benefits that they could get out of having a compost pit.
2. Teach the family members the proper way of segregation of garbage.
3. Discuss with the family the diseases that they could get for having improper garbage disposal.
Home Visit Materials resources: area and materials for the compost pit making such as shovel, crowbar, etcHuman Resources: Time and effort of both the nurse and the family.Financial Resources; Money for the nurse transportation
After nursing intervention, the family was able to segregate their garbage.
CUESHEALTH
PROBLEMFAMILY NURSING
PROBLEMGOAL OF
CAREOBJECTIVES OF
CARE
INTERVENTION PLANEVALUATIONNURSING
INTERVENTIONSMODE OF CONTACT
RESOURCES NEEDED
Subjective:“Medyo gabok na gyud ni amo balay gi butang butangan ra gani ni namo ug ali para dili mahulog ang bata” as verbalized by the mother
Objectives:Presence of unsafe stairs and floor
ACCIDENT HAZARD as a
HEALTH THREAT
Inability to recognize the presence of the condition or problem due to inadequate knowledgeInability to provide home environment conducive to health maintenance ad personal development due to :
Inadequate family resources specifi-cally financial re-sources
Lack of knowledge of preventive mea-sures.
After nursing intervention, the family will take the necessary action to improve home environment so as to prevent accident
After nursing intervention, the family will: Generate a
budget for repair of stairs and unsafe floor.
Learn the benefits of improving their home environment
Free from accident hazard Mr. Bautista
will take ac-tion to ad-dress this problem
1 Encourage the family to earn money for the repair of stairs and unsafe floor
2.Dicuss with the family the benefits of improving tier home environment
3.Stress out to the family that prevention is better than cure
4.Encourage Mrs. Bautista to encourage her husband to repair the stairs and unsafe floor
Home Visit Materials resources: materials needed for carpentry such as hammer, iron nails, etcHuman Resources: Time and effort of both the nurse and the familyFinancial Resources: Money for the nurse transportation
After nursing intervention, the family was able to take the necessary action to improve home environment so as to prevent accident
CUESHEALTH
PROBLEMFAMILY NURSING
PROBLEMGOAL OF
CAREOBJECTIVES OF
CARE
INTERVENTION PLANEVALUATIONNURSING
INTERVENTIONSMODE OF CONTACT
RESOURCES NEEDED
Subjective:‘’Daghan daghan pud lamok labi na ug gabii as verbalized by the mother
Objective:-Presence of
stagnant
water
-House surrounded by banana trees and other plants
POOR HOME ENVIRONMENT: PRESENCE OF BREEDING SITES OF INSECTS, RODENTS AND VECTORS as a HEALTH THREAT
Inability to provide a home environment that are conducive to health maintenance and personal development due to:
lack of knowl-edge about im-portance of good sanitation
lack of skills in carrying out measures to im-prove sanitary condition
After nursing intervention, the family will be able to improve sanitary condition to eliminate risk for vector borne diseases
After nursing intervention, the family will be able:
Identify and possible breeding sites of in-sects, ro-dents and vectors.
Demonstrate ways of elim-inate breed-ing sites of vectors.
Take mea-sures in maintaining the sanitary surroundings
1. Encourage the
family about
importance of clean
environment.
2. Discuss the health
problems that may
result due to
unsanitary
environment
3.Demonstrate to
the family about
methods in
eliminating the
breeding sites
.
Home Visit Materials resources: visual aidsHuman Resources: Time and effort of both the nurse and the familyFinancial Resources: Money for the nurse transportation
After nursing interventions, the family was able to improve their sanitary environment to avoid health problems specifically on vector borne diseases
X. ACTUAL IMPLIMENTATION
First Visit (January 23, 2009)
A life of a nurse will be irrelevant if she will be unable to make changes on the
lives of the people that are gathered around her everyday. As I arrived at x I
immediately roam around to find a family for my care plan. There I saw Mrs. Bautista
outside their home. I hurriedly approached her and asked her some questions
basing on the criteria of the care study. I was glad to know that her family qualifies
for that certain criteria. I immediately introduced myself to the family members,
asked for their approval, stated for my purposes and duration of visit, and
established good rapport with them. Fortunately, they permitted me to conduct my
care study with her family.
I interviewed Mrsx with regards to the names, birthdays, educational
attainment, occupation, monthly income, religion, and heredo-familial diseases of the
family. I was then informed that her husband is working away from home and comes
home only every 3 months. I took their vitals signs and assessed the children who
are present since the eldest child is at school. Immediately, I saw many shortcoming
of the family which may lead to serious problems. I then instantly gave my initial
health teaching on the importance of keeping their house clean and safe. When
asked where they get the water they used for drinking, the mother answered that the
water is supplied by NAWASA and they pay a minimum bill of P200 a month. I was
able to roam around the place and saw areas that could serve as breeding places
for mosquitoes and other vectors of diseases. I taught the mother ways to minimize
and eradicate breeding places of vectors of disease by keeping their environment
clean always. I also observed that the children are having mosquito bites on both
lower extremities.
Second Visit (January 30, 2009)
On my 2nd day of assessment, I continue to gather-up important data for the
study and for my actual implementation. I also gave partial health teachings
regarding the proper care for mosquito bites. The family was able also to understand
the teachings i made with them. I have learned that Mrs. x is using contraceptive
pills as means of family planning method but I was surprised to know when she
admitted that she does not regularly take her pills because of the undesirable side
effects. She also stated that she only takes pills 1 week before her husband comes
home. I taught her about the advantages and disadvantages of noncompliance to
her contraceptive pills and she seems to understand it. I encourage her to inquire in
the Health Center about other family planning methods available and change her
family planning method.
I also observed that the youngest child is having cough and colds during my
2nd visit and he is having fast breathing. I then assessed the child and taught the
mother about the things she must do and also educate her of how to manage of
some of the child illness.
Third Visit (February 13, 2009)
On my 3rd day of visit, I have seen that proper sanitation was one of the health
problems so I imparted health teaching regarding proper sanitation. I have taught the
mother that she could segregate the waste into biodegradable and non-
biodegradable. She was also encouraged to train her children regarding proper
waste disposal while they are still young.
I also encouraged Mrs. x to encourage the repair of the wooden stairs by
paying somebody to do the labor for her. Saving a budget for the repair of the
wooden stairs was discussed so that the mother will have an idea how to solve the
problem on the hazardous stairs. Then we also stressed out that having drainage is
important to avoid diseases such as diarrhea and malaria so she was advised to let
some neighbor do the drainage for her since her husband is not around.
Fourth Visit (February 20, 2009)
The 4th visit is my last visit to my family client since time is not enough to
cover the 6 visits. This last visit will serve as my evaluation to see if my health
teachings to the family were effective. Based on my evaluation, the family is now
ready to make decisions to make appropriate actions and mobilize resources
independently for the health of the family. Though, some of my goals and plans is
still on going, I am looking forward that the family will continue what they have
started. I reviewed what we have health teach to them and stressed out the
important things for them to remember.
With the family’s cooperation during the whole community exposure, I
extended my gratitude to them by giving them some food supply for the children.
Furthermore, an evaluation was conducted in order to know if there are
improvements in their health status, and health seeking behavior
XI. EVALUATION
As part of our requirement as nursing students of Liceo de Cagayan
University, we were exposed at x
I was able to render care to the Bautista family for 4 home visits at x. During
those visitations, the family was being assessed and various problems were being
identified which needed attention in order to improve the family living condition. In
those problems I had able to identified, I was able to give nursing care based on the
knowledge that I learned from school.
After giving them the interventions, the family became knowledgeable of the
importance of ones health and the importance of having a clean safe and disease
free environment.
This experience made me realized the true essence of being a health care
provider. I was able to experience rendering care not just to this certain family but
also to the community people and its not easy. But even if this is so, I felt challenged
and I enjoyed the times when we were walking under the scorching heat of the sun.
Blending with the community people and mingling with them gave me a feeling of
satisfaction to be accepted as health care providers. I was able to touch and made
even a difference to the lives of the family I cared for and so with those people in the
community.
XII. BIBLIOGRAHPY
Community Health Nursing Service Section, National League of Philippine
Government Nurses, Inc.,Community Health Nursing Services in the Philip-
pines, 9th Ed.
Maglaya, Arceli, Nursing Practice in the Community, 4th Ed.Argonanta Corpo-
ration, Marikina City, Philippines, 2004.
Kozier et al, Fundamentals of Nursing, 5th Ed. Pearson Education Asia Ptc.
Ltd., Singapore, 2002.
Lippincott et al, Manual of Nursing Practice, 7th Ed. Philippines Edition. Gop-
son Papers Ltd, Noida, India, 2001.
Integrated Management of Childhood Illness, Department of Health
Doenges, M. E., et al., Nurses Pocket Guide: Diagnosis, Interventions, and
Rationales, 9th Edition.
Sparks and Taylor. Nursing Diagnosis Reference Manual; 6th Edition. Copy-
right 2005 by Lippincott Williams and Wilkins