family case study2
TRANSCRIPT
Family Case StudyYvanne Ronald A. Agno
Kevin Van Eric O. SaballoRoselle E. Anino
Hannah Berry T. AlegadoPhoebe Lyn S. Brusas
San Pedro College12C. Gusman St., Davao City
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Saturday, April 8, 2023
IntroductionVoughn
Introduction“The family is the corner stone of our society. More than any
other force it shapes the attitude, the hopes, the ambitions, and the values of the child. And when the family collapses it is the children that are usually damaged. When it happens on a massive scale the community itself is crippled. So, unless we work to strengthen the family, to create conditions under which most parents will stay together, all the rest - schools, playgrounds, and public assistance, and private concern- will never be enough”
-Lyndon Baines Johnson
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IntroductionThe FAMILY: This is the core and unit of service in Community Health Nursing (CHN). As student nurses,
we focus on the optimum health of the family as a whole and provide our holistic health teachings as a teaching role of each student nurses, that imparting information, bombarding those inputs with them and reinforcing changes in behavior.
What is family? According to Burgees and Locke, the family is a group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and communicating with each other in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister and creating a common culture. This, we would regard as a fundamental description of a family.
Where does a family starts? For Winston Churchill, it starts with a young man falling in love with a girl and no superior alternative has yet been found. Yes, that may be proper. But in this modern world, family may become more intricate than just the nuclear basis. Families are too intimate as close tied to stick with the trouble-free definition. It is more about nurturing one another and respecting each other’s lives. The family and the home basically is the only place where one truly belongs.
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Introduction Health: The World Health Organization (WHO) defines health as a “state of
complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. And this definition of health was been clearly modified to include the ability to lead a “socially and economically productive life”. Individuals need to function at its optimum level and as its best, even with such disease and infirmity, if one is able to manage and tolerate such stressors and continue to function at the highest possible level he could attain, the one is considered to be healthy. A family must indeed be healthy to function properly their role. Thus, making each member of the family contributes through role functioning for the welfare, goodness and effectiveness of the family as unit of service in the community and basic unit of society.
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IntroductionAs student nurses, we are active not only in the hospital set-up but also in health
promotion in the community. We not only play the roles of providing care, applying nursing procedures for the practice of our profession but also to create a big impact through rendering out our health teachings for them to generate knowledge and acquire in alleviating such problems occurring in their family and in the community. We help them to achieve optimum wellness and provide continuous care for physical and social environment. It somehow adds to the development of the nation since there are some people cannot afford private health services. By means of the community health nurses and public health centers, health services are now accessible and affordable. We reach out to the community in order to be of assistance to them. The only factor that would probably turn the world around is the client’s volition and enthusiasm to participate.
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IntroductionThis case study focuses on the Basco Family. They belong to the traditional family structure. Thus,
they are a nuclear family. According to Evelyn Duvall’s family stage, they belong to the family with preschool children. They have three children. The husband, the head of the family works as a messenger at BPI while the wife is a full-time housewife. The family is slightly able to meet the needs for physical survival and security.
The reason that the group has chosen the Basco Family as the client for the case study is first,
they are very hospitable and accommodating. Their willingness was very astounding. They have exhibited enthusiasm when we were informing them about the things we are going to do for them. They have appreciated our purpose a lot. They were also able to understand our situation and presented themselves to help us. Second, through ocular observation, they are not well-off and that they are living in a non-conducive environment. Lastly, the group wants to help the family improve and enhance holistically their lifestyle and activities of daily living.
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IntroductionThrough the FNCP’s and implementations that we have designed, we
expect that our client’s overall health status will improve and alleviate all the problems they had. And through this case study, we look forward to a more extensive understanding about the family with a pregnant mother, not only for our own benefit but also for the subject of this study.
Finally, we anticipate learning from the student nurses and the client. That learning may not end at this point; that this case study will mark the beginning of a new knowledge that will hopefully pass on through generations in the field of Community health Nursing.
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General Objective
This study aims to allow the student nurses to apply the different concepts, practices and principles of family health care process.
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Specific ObjectivesSpecifically, this study aims to:• Find a family in the area of exposure as our subject for the case study;• Establish rapport with the family members and their significant persons
to gain cooperation and trust;• Gather systematically the pertinent information in relation to their
health status and other significant matters; • Present the introduction related to the condition being studied;• Formulate specific, measurable, attainable, realistic and time-bounded
objectives;• Acquire the necessary information about the client and formulate the
family initial database;
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Specific Objectives• Identify the family’s developmental stage and compare the task attained by the
family and expected task to be achieved base on the theory of Evelyn Millis Duvall;• Present a comprehensive family genogram and trace the family web and to make a
corresponding legend that will show the status, hereditary diseases, present and past condition of the family;
• Rate the family’s coping index to provide a basis for estimating the nursing needs of the particular family;
• Prioritize the health problems observed upon assessment;• Formulate therapeutic family nursing care plans on the described problems;• Enumerate and give appropriate health teachings to the family involved;• Identify the implications of this case study to nursing research, education and
practice; and• List down the references used in the making of this case study.
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Initial Data Base
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Demographic Data
The Basco family is currently living in a rented house for nine months already since May of this year. It is located at Blk. 49 Barangay 21-C, Piapi Boulevard.
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Family Data
The Basco Family has been living here in Davao for 33 years already while in their current house, they only have 9 months length of residency. They are originally from Davao City. They are four of them in the family with a father, mother and two children. The family is Roman Catholic and they belong to the Bisayan tribe.
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Family Data• Name: Basco, Marlou• Age: 33 years old• Civil Status: Married• Position: Head of the Family• Educational Attainment:
High school Graduate
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Family Data• Name: Angelita Ablas-
Basco• Age: 33 years old• Civil Status: Married• Position: Wife• Educational Attainment:
High school Level
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Family Data• Name: Basco, Angelito• Age: Deceased• Civil Status: -• Position: Eldest• Educational Attainment: -
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X
Family Data• Name: Basco, John Marco• Age: 5 years old• Civil Status: Single• Position: Second Child• Educational Attainment:
Kinder 2
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Family Data• Name: Basco, Janna Mae• Age: 4 years old• Civil Status: Single• Position: Third Child
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Family Data
• Name: Basco, Jenna• Age: 2 months• Civil Status: Single• Position: Youngest Child
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Family DataThe Basco Family belongs to the Nuclear family structure. They are Roman Catholic.
Mr. Marlou Basco is the head of the family. He is 33 years old and he was born on March 07, 1976. He was able to finish high school. He is presently working as a messenger in Bank of the Philippine Islands or BPI. His wife is Mrs. Angelita Basco a 30 – year old and was born on March 15, 1979. She has 3 beautiful living children. The couple has been living together for 5 years. The eldest child unfortunately died few minutes after giving birth due to over dosage of the prescribed drug that was taken by Mrs. Angelita during her pregnancy because she was diagnosed of having weak lungs during her pregnancy then. John Marco Basco is the second child and 5 years of age. He was born at July 24, 2004. He is studying at the Day Care Center as kinder 1 student. The second child is Janna Mae Basco. She is 4 years old and was born on July 19, 2005. She is not yet in school but her parents are planning to send her the next school year. Their youngest child is Jenna Marie who is 2 month old. She was born on December 24, 2009.
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Family CharacteristicsCRITERIA STATUS ADDITIONAL INFORMATION
Observable conflicts between family members
We weren’t able to ask Mr. Basco about their usual conflicts since he needs to go to work. However, Mrs. Basco, his wife is the one who openly shared about their family issues. She told us that they are arguing mostly about money. Since the salary of Mr. Basco is sometimes not enough to sustain and provide the needs of the family. When this problem exists, both couples would talk about the matter and would come up a mutual decision to solve such conflict. Mr. Basco has the responsibility to hand the money to his wife for budgeting their daily expenses. She also reported that she will prepare baon for her husband’s lunch in order to save money.
Before, Mrs. Basco has part time job as a sales lady at Korean store in Uyanguren. Through this, she can help her husband to provide additional income to support their needs. But since she got pregnant she needs to stop the work in order to prevent complications during pregnancy. Last December 24, 2009 she gave birth to a lovely baby girl named Jenna. And still not able to go back to work to take care her children, especially baby Jenna.
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Family CharacteristicsCRITERIA STATUS ADDITIONAL INFORMATION
Characteristics of
communication
They have informal communication towards each other but not to the extent that they blurt out bad & foul words especially when they are having an argument. They don’t have cell phone for distance communication and emergency purposes.
As stated by Mrs. Basco, they will only borrow cell phone and ask favor to text from their close neighbor in case of emergency.
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Family CharacteristicsCRITERIA STATUS ADDITIONAL INFORMATION
Interaction patterns among
members
When it comes to family interactions, our group observed that they are so close and it seems they are contented with what they have. The parents discipline their children in a proper way. They want to be respected by their children. In terms of family bonding, the family spends their spare time only in their house watching t.v. shows. To tighten their family bonding, they sometimes go to People’s Park and Magsaysay Park. The mother is the one who spends most of the time with her children since her husband is working from Monday to Saturday. Only Sunday is his day-off.
If the children commit mistakes, the father will talk to his children and sometimes spank them. This is the way they discipline their children. The children call their parents mama & papa.
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Nutritional Status
Family Members Weight Height Results NORMAL RANGE
Basco, Marlou 65kg 1.70m N=22.49 kg/m2 20-25 kg/m2
Angelita 53kg 1.50m N=24.44 kg/m2 19.8-26 kg/m2
John Marco 19kg 1.07m N=16.60 kg/m2 14.4-20.2 kg/m2
Janna Mae 14.5kg 1.00m N=14.50 kg/m2 12.6-17.9 kg/m2
Jenna Marie 5kg 0.46m
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Activities Of Daily Living
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Sleeping PatternThe entire family has an average of 6-8 hours of sleep per day.
The Family usually retires to bed at between 8:00-10:00 p.m. after they watch TV shows. Their wake up time depends upon the members of the family. For Mr. Marlou and Mrs. Angelita, they usually wake up at 4:00 a.m – 4:30 a.m. as Mr. Marlou will go to work at 6:00 am and Mrs. Angelita will prepare food for the family. Their children will wake up at 6:00 am in preparation for school. The whims of retiring and getting up of the family members are dependent on each individual.
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Eating Pattern• The family is able to eat three times a day. As we ask
them of their 24 hour dietary recall, their usual breakfast is dried fish or fried fish.
• Mr. Basco has enough income fitted only for their basic needs like food. Mrs. Basco reported that even though they cannot provide for house resources like appliances, they try to make sure that they will prioritize the nutritional status of their family as evidence on the Body Mass Index which all results were normal.
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Diatary Habbits
February 18(Thursday)
February 19(Friday)
February 20(Saturday)
Breakfast Bread, milk, milo or coffee.
champorado, milo and coffee.
Rice and dried fish, milk, milo or coffee.
Lunch Fried fish, rice and juice.
Dried fish and rice. Fried fish and rice.
Dinner Tinolang isda and rice.
Dried fish, rice and legume soup.
Fried fish and rice.
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Leisure Time ActivitiesWatching TV shows and the children play jolen outside
the house after their school. They also spend time listening to music and also taking time in chatting with neighbors. The kids are free to play outside the house but they are always reminded not to play with harmful objects such as sticks, wires etc. Sometimes if there is extra money, they also go to amusement parks and malls. These are the activities that promote relaxation to the entire family.
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Monthly Family IncomeMembers
of the family w/ income
Educational Attainment
Occupation Nature of Work Place of work Monthly income
1) Marlou Basco (father)
High school graduate
Messenger of BPI
An employee who delivers bills of BPI clients directly to their offices or homes
P4,800
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Monthly Family Income
The family’s breadwinner is the father who is Mr. Marlou Basco. He is a high school graduate who works as a messenger of BPI. He is an employee who delivers bills of BPI clients directly to their offices or homes here in Davao City. He earns approximately P4,800 monthly.
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Family Health Status
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Mr. Marlou BascoWhen we interviewed Mr. Marlou, he said that he didn’t
experience any serious illness when he was young. He also verbalized that he had a complete immunization during his childhood. He experienced common illnesses such as colds, cough and fever. He can consume at least 3-5 sticks per day of ‘Fortune’ cigarettes. These results served as evidences for presence of a health threat. He mentioned that their family on his mother’s side has a past health history of hypertension. He is also hypertensive.
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Mrs. Angelita Basco
Mrs. Angelita just recently gave birth a live baby girl via Normal Spontaneous Vaginal Delivery last December 24, 2009 namely Jenna Marie. She also verbalized that she had complete immunization during her childhood and she didn’t experience any serious illness when she was young. She experienced common illnesses such as colds, cough and fever.
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John Marco Basco
As verbalized by the mother and through observation, John Marco experienced cough, colds and fever. Also he is presently experiencing colds and cough that’s why her mother verbalized that there is a need for medical consultation.
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Janna Mae Basco
Presently, Janna Mae experiences cough and colds. That’s why her mother verbalized that there is a need for medical consultation.
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Jenna Marie Basco
She is 2 months old and she was just recently immunized with BCG, DPT, OPV and Hepatitis B. Fortunately Jenna has not yet experience any illness.
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Immunization Status
Child’s name BCG DPT OPV HEP. B MEASLES1.) John Marco Basco
C C C C C
2.) Janna Mae Basco
C C C C C
3.) Jenna Marie Basco
C 2doses 2doses C X
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Legend:C- Complete X- Not immunized √- Done
Immunization Status• There are three children in the Basco family. Each child has taken
such immunization for the goodness of their health.• John Marco, the eldest child has 1 BCG, 3 DPT, 3 OPV, 3
HEPA B and 1 MEASLES immunization and is considered a fully immunized child.
• Janna Mae has 1 BCG, 3 DPT, 3 OPV, 3 HEPA B and 1 MEASLES immunization and is considered a fully immunized child.
• Jenna Marie the youngest child has 1 BCG, 2 DPT, 2 OPV, 3 HEPA B and no MEASLES immunization and she is not considered a fully immunized child.
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Home and Environment
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Flooring• Brown- Kitchen• Gray- Sleeping/Eating
Area• Violet-Door• Sky Blue- Windows
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Total Floor Area• TFA = (length of the
house’s floor) x (width of the house’s floor)
= (2.31m) x (3.15m)= 7.28sqm
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3.15
m2.31m
Total Window Opening• TWO = (length in
meters) x (width in meters)
= (0.66m) x (0.76m)= 0.50sqm x 2windows= 1.00sqm
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0.66
m
0.72m
Door Opening• Door Opening = (length
of the door) x (width of the door)
= (1.07m) x (0.68m)= 0.73sqm
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1.07
m
0.68m
Ventilation• Ventilation = (TWO/TFA)
x 100= (1.0032sqm +
0.73sqm) / (7.28sqm) x 100
= 13.07%= Poor Ventilation
• Scale: 20% - satisfactory / good
ventilation18-19% - fair17% below – poor
ventilation
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Comparison of TFA and TSRNumber of family members
currently living in the house: 4
Category of members: adults (2) children (2)
Room Category: Multi-Purpose room
Client Multi- Purpose room Single-Purpose room
Adult 3sq.m 2.50sq.mChildren 1.5sq.m 1.26sq.mInfant 0 0
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Comparison of TFA and TSRComputation:Adult: 3sq.m x 2 adults = 6sq.mChild: 1.5sq.m x 2 children = 3sq.mInfant: 0 x 1 = 0sqmTSR = 6sqm + 3sqm = 9sqmTFA = 7.28sqm7.78sqm<9sqm = overcrowdedCondition: TFA > TSR = not overcrowded
TFA < TSR = overcrowdedVoughn
Comparison of TFA and TSRThe Family rents a house where they are currently residing. The house
is a mixed type; it’s made up of the combination of wood and cement. Their house is a multipurpose room with two windows and one door. The length of their house measures 2.31m and the width is 3.15m resulting to a TFA of 7.28sqm. They have two windows measuring 0.50sqm each resulting to a TWO of 1sqm. The door’s length is 1.07m and has a width of 0.68m resulting to a Door Opening of 0.73sqm. Their TSR is 9sqm and their TFA is 7.28sqm. Because of this, they are overcrowded. We divided the TWO by the TFA and multiplied to 100 resulting to 13.07% ventilation. Normal vent is 17%. So, they have poor ventilation in their current house.
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Comparison of TFA and TSR• As soon as we entered the house of our client, we observed that the family has
the following appliances: 1 TV and 1 small electric fan. We also noticed that there is a small multi-purposed room with only 1 small bulb light as their light. They don’t pay their electric and water bills since its part of the money that they’re paying for their rent.
• Their garbage is being dumped in a place in their barangay where garbage men collect the trash daily.
• Their toilet system is water sealed latrine, a toilet similar to flush type but without the flushing system. Their source of water is Davao City Water District.
• They do not have a gas stove; they only use charcoal for cooking. Finally, we noticed that they have a hazardous environment because of the sharp objects such as knives, nails and other dangerous object lying anywhere inside their house.
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Health and Health Practices
The family has no specific principle or practice with regards to infirmity. They don’t believe in the healing powers of quack doctors. If they experience colds, cough or fever, they seek medical advice from the barangay health worker or go to the health center.
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Environment
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Kind of NeighborhoodSince the family is living in a community where houses
are built close to each other, it’s expected that almost everyone knows each other and are close to each other. The neighborhood’s environment is quite dirty because trash, spit and left over food are seen everywhere. Almost all houses are at risk for fire hazards since most of the houses in barangay 21-C are made of wood. The presence of rats and other rodents are also noticeable.
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Social and Health Facilities Available
The community has a Health Center where they could have their immunizations done, pre-natal check up, dental and health check up. The Health Center is so accessible to them since it’s strategically located in a place near to everyone.
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Communication and Transportation Facilities
Almost everyone in barangay 21-C have cell phones. So, it is the basic means of communication in the community aside from personally speaking to the person. For their transportation, tricycles are the basic means of transportation in barangay 21-C because it’s cheap, easily accessible and travels faster than walking. Jeepneys could also be used when trying to go to other places outside the community.
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Awareness to Comunity Organization
The family is aware of some organization in the community such as the GKK and the Barangay Officials, but they aren’t members of any of these organizations. In fact, the family isn’t even aware and involved in any activities in their community.
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Family Developmental Task
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Level Ideal Actual
Family with Preschool Children
°Adjusting to the costs of family life
°Adapting to needs of preschool children to stimulate growth and development
- The family are budgeting their money for the different expenses every month. - The eldest child is Kinder 1 and goes to school at the Piapi Day Care Center.
Level Ideal Actual
°Coping with parental loss of energy and privacy
- The parents are adjusting to the high energies of the children. They constantly play without ceasing. They also want to cling always to their parents leaving them with less privacy.
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Based on their classification, the Basco family belongs to the family with preschool children. The developmental tasks at this stage are adapting to the critical needs and interest of preschool children in stimulating, growth-promoting ways and coping with energy depletion and lack of privacy as parents.
Through our observation, all of these developmental tasks were evident in the Basco Family. This is a good sign that the family is responding really well to family life. They have been adjusting and coping to the different tasks under the criteria. Thus, each new development crisis necessitates new adaptations and imposes new responsibilities. At the same time, it opens up new opportunities and poses new challenges for the family.
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GenogramVoughn
Legend: Hypertension MaleX deceased Female
Tiborcio Basco, 60
XRosalita, 58
Rita Basco, 25
Nicolas Ablas, 59
X
Angelita,30Jhong Basco, 28 Marlou Basco, 33
Janna Mae Basco, 4
Angelito Basco,
X(still birth)
John Marco Basco, 5Jenna Basco,
2mo
Carmelita Basco, 60
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Genogram
The genogram shows the three generation of hereditary disease from the grandfathers and grandmothers of our client Janna Mae Basco. Janna’s grandmother, Carmelita Basco has hypertension and so does her father.
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Eco-mapVoughn
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Legend:Rarely MarlouOften Angelita Janna Mae
John Marco Jenna
MARKET
SCHOOL
Eco-map• As shown above, the family specifically Mrs. Basco usually goes
to the market where their basic needs are being brought. Since the family do not have refrigerator to store their perishable, thus explain the frequent trip to the market.
• Furthermore, Mr. and Mrs. Basco submits their selves along with their children for any services offered in the health center such as free vaccinations and medicines, they utilize the services being offered at the health center. However, Mr. Carlos and Mrs. Rosalita tend to drop by at the health center when certain medical conditions are being address.
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EcoMap• The family is considered to be a member of the Roman
Catholic Church, however, they does not involve themselves in any activities related to their religion such as attending the so called “kasaulugan” during Saturdays. Nonetheless, Mr Mr. and Mrs. Basco are trying to find time to attend the activities structured by their religion.
• The family sometimes goes to Gaisano Mall or People’s Park to relax and enjoy when there is extra money.
• Mr. Basco always go to work every weekdays, his son John Marco is attending daycare every morning.
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Family Coping Index
Admission: February 20, 2010
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9 CATEGORIES
ADMISSION DISCHARGERATING JUSTIFICATIO
NRATING JUSTIFICATION
1. Physical Independence
2. Therapeutic Competence
3
3
- Some family members are able to move in and out of bed and some weren’t able to take care of grooming- Can carry out some treatments such as managing fever by taking “BIOGESIC” and can only do exercise sometimes
3
3
-Still, some family members are able to move independently. But, Jenna is still too young to take care of herself.
-Manage common illnesses fairly. The mother encourages the children to drink lots of water when having cough and give them “BIOGESIC” when they have fever.
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9 CATEGO
RIES
ADMISSION DISCHARGERATING JUSTIFICATION RATING JUSTIFICATION
3. Knowledge and Health Condition
4. Application of Principles of General Hygiene
3
3
- Has some general knowledge about their health and sanitation and is only partially informed. Has not understand fully because of low educational attainment
- Takes a bath only once a day. Does not wash hands regularly
5
5
-Has fully understood the concept of cleanliness & sanitation. They have been well-informed. They were able to keep their house clean.
-Family members already are taking a bath twice a day & they wash hands regularly.
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9 CATEGORIES
ADMISSION DISCHARGERATING JUSTIFICATION RATING JUSTIFICATION
5. Health Attitudes
6. Emotional Competence
5
3
-Understands and recognizes the need for medical care during illnesses. When the mother was still pregnant, she goes to the health center for prenatal visit. -Family is doing fairly well. The mother sometimes acts immature because she giggles a lot when being asked about serious questions.
5
3
-The family still understands and recognizes the need for medical care during illnesses. Ma’am Angelita ensures that Jenna Marie has complete immunization to prevent diseases.
-The family is still somewhat immature. Only the parents are capable of making decisions and handling problems within family.
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9 CATEGORIES
ADMISSION DISCHARGERATING JUSTIFICATIO
NRATING JUSTIFICATION
7. Family Living 3 - Family gets along but has problem adjusting to maintenance of open communication. Husband is only available at Sundays and rarely gets day offs. No cell phones for constant and easy Communication
3 -Though the family is trying to adjust living together, there is still a problem in maintaining open communication.
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9 CATEGORIES
ADMISSION DISCHARGERATING JUSTIFICATIO
NRATING JUSTIFICATION
8. Physical Environment
9. Use of Community Facilities
1
5
- House is in poor condition with inadequate living space and poor environmental sanitation. - When the mother was still pregnant, she goes to the Health Center regularly for Prenatal Check-up. The eldest child goes to school at the Day Care Center located just below the health center
3
5
-Even though the house has inadequate living space, the house now has good environmental sanitation. It is now clean. -Still, the mother regularly goes to the health center for the scheduled vaccinations of Jenna Marie. John Marco also goes to the Day Care Center in the barangay.
Physical Assessment
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Physical AssessmentGeneral Survey:
Our client is Jana Mae A. Basco a 4-year old female. On February 20,2010, we had conducted a thorough physical assessment on her. She had just finished taking a bath. She was well-groomed and neat. Has an mesomorphic body built with height of 100.33 cm and weight of 14kgs. Has an erect posture with coordinated movements. No signs of distress. Cooperative. Responds appropriately to the situation. Talks clearly and is understandable.
Vital Signs: T= 36.3 0CPR= 75 bpmRR= 18 cpmCR=78 bpm
Skin Assessment:General uniformity. No edema. Moderate moisture. Uniform temperature on both hands and feet. Good skin turgor.
Hair Assessment:Evenly distributed. Silky and resilient.No infection and infestations. Variable amount of body hair.
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Nails Assessment:Has a convex shape and with no clubbing. Smooth fingernail and toenail texture. Pinkish and has an intact epidermis. Capillary refill time of 2 seconds. Well trimmed finger and toe nails.
Skull and Face Assessment:Normocephalic with symmetr ical facial features. No edema and hollowness noted. Symmetrical facial movements. No presence of nodules or masses.
Eye Structure Assessment:E yebrows evenly distributed and skin intact. Equal and outward curl of eyelashes. Eyelids intact with 17 blinks per minute bilateral. Palpebral conjunctiva has pinkish-peach color with minimal blood vessels visible. Bulbar conjunctiva are clear with few underlying blood vessels. White sclera visible. Upon palpation of lacrimal duct, no edema or tenderness noted. Shiny and smooth cornea. Pupil is black in color, equal in size and 3mm in diameter. Illuminated pupil constricts(direct response). Non-illuminated pupil constricts(consensual response). Aligned and coordinated eyes.
Visual Acuity Assessment:Has good visual acuity.
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Ears Assessment:Color is same as facial color and auricles are symmetrically aligned with outer canthus. Elastic and firm auricles. Presence of cerumen in the external ear. No difficulty hearing.
Nose Assessment:Symmetrical external nosewith no flaring. No tenderness and no lesions. Pinkish with nasal catarrh. Nasal septum intact and maxillary and frontal sinuses non-tender.
Mouth and Oropharynx Assessment:Symmetric contour of outer lips. Has the ability to purse lips. Pinkish and moist inner lips and absence of skin lesions. No lumps and excoriations on tongue noted. Tongue in midline. No swelling and redness noted on salivary duct. Light pink and smooth soft palate. Lighter pink and more irregular texture of hard palate. Uvula in midline of soft palate. Pink and smooth posterior wall of oropharynx. Tonsils pink, smooth and with no discharge. Grade 1+ tonsils. Present gag reflex.
Assessment of the Neck:Muscles equal in size and head centered. Coordinated and smooth movements with no
discomfort. Equal strength of muscles. Lymph nodes not palpable. Trachea on central placement in midline of neck. Thyroid gland not visible upon inspection. Upon palpation, lobes are small, smooth, centrally located and rises freely with swallowing
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Lungs and Thorax: Transverse to anteroposterior diameter is 1:2 in ratio. Symmetrical chest expansion observed.
Spine aligned and no deformation noted. Not in respiratory distress. Skin is intact. Chest wall intact, no tenderness and no masses noted upon palpation. Bilateral and symmetrical vocal fremitus. Absence of adventitious sounds such as crackles wheezing. Breathing pattern is regular with a respirstory rate of 18 cycles per minute. With clear breath sounds on both lung fields noted upon auscultation.
Heart and central Vessels:Point of maximal impulse was heard on the left midclavicular line at the 5th intercostal space with
78 beats per minute. No abnormalities of the heart rate noted. No murmurs were heard during auscultation of the cardiac rhythm.
Carotid Artery:Symmetrical pulse volumes, full pulsations, thrusting quality noted. No sound heard during auscultation.
Jugular veins:Veins are not visible, its presence indicates advanced cardiopulmonary disease.
Peripheral Pulses:Symmetric pulse volumes and bilaterally full pulsations noted upon palpation except for carotid pulse.
Voughn
Peripheral Veins: No distended veins at lower limbs. limbs not tender and symmetrical in size.
Peripheral Perfusion:Skin color is pink, skin temperature not excessively warm or cold, no edema and has moist skin texture
during inspection. Using Buerger’s test in the limbs and lower limbs, original color returned after 15seconds and 10 seconds respectively.
Breast and axillae:Breasts are not yet mature. Not yet developed secondary sex characteristics. No hair in axilla. No foul
odor.
Abdomen:Skin uniform in color. Flat abdomen. No enlargement noted. Umbilicus is clean without any discharges,
foul smelling odor, and signs of inflammation. Has 20 bowel sounds per minute.
Musculoskeletal System:Muscles equal in size. No contractures or deformities. No tremors noted. Firm and tonic muscles with
smooth, coordinated movement. Active movement against full resistance.
Voughn
Bones:No skeletal deformities. No edema or tenderness noted upon palpation. Joints:No swelling. Joints move smoothly.
Neurologic Assessment:Oriented. RLS-GCS of 1/15.
Voughn
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
I-Olfactory Sensory Smelling We instructed the patient to close her eyes, smell, and identify the different mild
aroma we which we will be placing near her nose
Identification of mild aromas:
She was able to identify mild aromas like that of
the sweet candy and soap.
II-Optic Sensory Transmit visual information to the brain;
We checked the patient’s near vision through Rosenbaum test (asked the patient to read at a distance of about 14 cm) and
we checked for her visual fields as well.
Rosenbaum test:The patient was able to read at 14 cm distance
Visual Fields:The patient has a good
peripheral vision.
III-Oculomotor Motor Innervates levator palpebrae superioris, superior rectus, medial rectus, which collectively perform most eye movements, inferior rectus, and inferior oblique
We asked the patient to follow the penlight we are holding in
every direction we will be pointing and we also assessed
for the pupil reaction of the eyes of our patient.
Extraocular movements:All the extraocular muscles
were functioning well and she was able to follow the penlight
on 6 directionsPupilreaction:
The patient’s pupil was briskly reactive to light, constricts
when looking at near objects, and dilates to far objects
Voughn
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
IV-Trochlear Motor Innervates the superior oblique muscle, which depresses, rotates laterally (around the optic axis), and intorts the eyeball
We asked the patient to follow the penlight we are holding in every direction
we will be pointing
Extraocular movements:
All the extraocular muscles were
functioning well and she was able to
follow the penlight on 6 directions
V-Trigeminal Both Receives sensation from the face and innervates the muscles of mastication
We used a light object like cotton to check for the
blink reflex of the patient by touching the sclera of
the eye and also we assessed the patient’s ability to detect light
touch/sensation by wiping a wisp of cotton on the
patient’s forehead
Blink reflex:Our patient was able
to elicit active blinking reflexLight and deep
sensation:She was able to detect light
touch and differentiate it with a
deep touch
Voughn
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
VI-Abducens Motor Innervates the lateral rectus, which abducts the eye
We asked the patient to follow the penlight
we are holding in every direction we will be
pointing and we also observed the directions
of her gazes
Extraocular movements:
All the extraocular muscles were
functioning well and she was able to follow the penlight
on 6 directionsDirection of Gaze:The patient was
able to gaze laterally.
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
VII-Facial Both Provides motor innervations to the muscles of facial expression and stapedius, receives the special sense of taste from the anterior 2/3 of the tongue, and provides secretomotor innervations to the salivary glands (except parotid) and the lacrimal gland
We asked our patient to smile, raise her eyebrows,
frown, puff out her cheeks, close her eyes
tightly. And, we asked the client to identify various
tastes like little amount of sugar, salt and a sip of her calamansi juice with her
eyes closed
Facial Movements:Our patient was able
to smile, raise her eyebrows, frown, puff
out her cheeks and close her eyes tightly.
Identification of tastes:
Our patient was able to identify sweet &
salty tastes
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
VIII-Vestibulocochle
ar
Sensory Senses around, rotation and gravity (essential for balance and movement)
We checked for the ability of the patient to hear
spoken words
Hearing Acuity:The patient was able
to hear us and the words we had spoken like “Ma’am”, “Excuse Me”, and “Smile” as
evidenced by her appropriate responses
IX-Glossopharyngeal
Both Receives taste from the posterior 1/3 of the tongue, provides secretomotor innervations to the parotid gland
Motor innervations to the stylopharyngeus (essential for tactile, pain, and thermal sensation)
We asked the client to move tongue from side to
side and up and down
Tongue movements:Our patient was able to move tongue from side to side, up and
down
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
X-Vagus Both Supplies branchiomotor innervations to most laryngeal and pharyngeal muscles
Controls muscles for voice and resonance and the soft palate
We observed the patient’s speech for hoarseness
Speech:Our patient’s voice is not
hoarse
XI-Accessory Motor Controls muscles of the neck and overlaps with functions of the vagus
We asked the client to shrug her shoulders against the
resistance from our hands and to turn her head to side against our resistance
Shoulder resistance:Our patient was able to resist the force of the
hand on both shouldersFace resistance:
Our patient was able to resist force of the hand on every other side of
the face
Cranial Nerve Function PhysiologicFunction
Actual Test Done Result
XII-Hypoglossal Motor Provides motor innervations to the muscles of the tongue and other glossal muscles
Important for swallowing (bolus formation) and speech articulation.
We asked the client to protrude her tongue at
midline by saying “aahhh” then move it side to side
Tongue movements:The patient was able to protrude tongue at midline, then moved
it side to side
Voughn
Finger’s to Nose and to the nurse’s finger:
When instructed to touch her nose and to touch the nurse’s fingers alternately, she is able to perform it rapidly.
Finger to Fingers:
Can perform rapidly, able to touch fingers consistently.
Pain Sensation:
Can determine if the object used for testing is dull or sharp. (Tip of the ballpen for sharp and the cover of the ballpen for dull)
Kinesthetic Sensation:
Can determine her finger’s position if it is up or down.
Muscle strength: Sternocleidomastoid
- She was able to turn her head strongly when I tried to push it.
Trapezius- Able to shrugs her shoulder strongly against my resistance.
Deltoid- She can raised her both arms strongly against resistance.
Biceps- Able to flex her arms against my resistance.
Triceps- She can extend her arms strongly when I tried to push it.
Hip Abduction- Can abduct her leg to the side strongly against resistance.
Hip Adduction- Can adduct her legs back to the position against my resistance.
Voughn
IMCI Assessment
• No pneumonia, cough or cold
Prioritization Of Health Problems
Voughn
Top 10 Problems
Problem Score
Walking Barefooted 4 1/6
Pointed/Sharp Objects 4 1/6
Poor Personal Hygiene 4 1/6
Tobacco/Cigarette Smoking 4 1/6
Lack of Food Storage Facilities 2 5/6
Family Size beyond what Family Resources Can Adequately Provide 2 ½
Inadequate Living Space 2 ½
Poor Lighting and Ventilation 2 ½
Family History 2 1/3
Fire Hazard 1
K
10 Health Problems
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem 2/3 x 1 2/3 It is a threat against the
family’s safety and welfare.
2. Modifiability of the Problem
0/2 x 2 0 Not modifiable because it is impossible to change the
structure of the house because they are just
renting.
3. Preventive Potential 1/3 x 1 1/3 Future problems cannot be totally prevented. They can’t restructure the house. Only
renting
4. Salience 0/2 x 1 0 Not perceived as a problem or social concern of the family.
Total Score 1
•Fire Hazard
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem 2/3 x 1 2/3 It poses a threat to the
inadequacy of space for the family members.
2. Modifiability of the Problem 0/2 x 2 0 Not modifiable because of the lack of financial resources.
3. Preventive Potential 1/3 x 1 1/3 Problems cannot be totally alleviated be cause of financial
constraint to rent a bigger space.
4. Salience 1/2 x 1 ½ Not needing immediate attention as believed by the
family.
Total Score 1 1/2
b. Inadequate Living Space
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem 2/3 x 1 2/3 Hypertension imposes a threat
to the health of the family members especially the father.
2. Modifiability of the Problem 2/2 x 2 2 The problem can be potentially managed by avoiding
triggering factors of increase in HBP.
3. Preventive Potential 1/3 x 1 1/3 Low preventive potential because of passiveness of the
client. And hereditary illnesses can’t totally be eradicated.
4. Salience 0/2 x 1 0 The family most especially the husband does not see HPN as a
problem.
Total Score 21/3
c. Family History
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem 2/3 x 1 2/3 It would be harmful especially
to the children and be a cause of an accident.
2. Modifiability of the Problem 2/2 x 2 2 Can be modified easily because the thing to be done is to cover
or hammer protruding nails.
3. Preventive Potential 3/3 x 1 1 The problem is not that difficult to handle. Knives can b
e kept and nails can be hammered.
4. Salience ½ x 1 1/2 Not needing immediate attention as believed by the
family.
Total Score 4 1/6
d. Pointed/sharp objects
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem 2/3 x 1 2/3 Contribute to difficulty of
breathing and blurring of visions.
2. Modifiability of the Problem 0/2 x 2 0 Not modifiable because it is impossible to aid about poor
ventilation because it involves renovation of the house.
3. Preventive Potential 1/3 x 1 1/3 Low preventive potential because they are just renting. They can’t do renovation on
the ventilation.
4. Salience ½ x 1 1/2 Is not the major concern of the family because of financial
aspects and they are a lot of problems to solved.
Total Score 1 1/2
e. Poor lighting & ventilation
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem 2/3 x 1 2/3 It could be the cause of death
due to poisoning which is a big threat.
2. Modifiability of the Problem ½ x 2 1 Partially modifiable because of lack of financial resource like buying a refrigerator or other
containers. But,it can be modifiable.
3. Preventive Potential 2/3 x 1 2/3 Moderate preventive potential because base on their financial
status.
4. Salience ½ x 1 1/2 They usually buy ready made foods and it is usually consumed.
Total Score 2 5/6
f. Lack of food storage facilities
Voughn
Criteria Rating Actual Score Justification1. Nature of the Problem
2/3 x 1 2/3 Tobacco smoking would lead to lung complications so it’s a big threat to the
bread winner of the family.
2. Modifiability of the Problem
2/2 x 2 2 Easily modifiable because it can be eradicate through simple counseling and therapeutic
approach.
3. Preventive Potential
3/3 x 1 1 High preventive potential especially with a person which is not really involved in
smoking and it can easily be prevented. The father is the only one smoking.
4. Salience ½ x 1 ½ The family are not aware about the consequences of secondary smoking but the family knows the disadvantages of smoking
alone.
Total Score 4 1/6
g. Cigarette/ tobacco smoking
Voughn
Criteria Rating Actual Score Justification
1. Nature of the Problem
2/3 x1 2/3 It promotes threat to health due to high risk for contamination and injury.
2. Modifiability of the Problem
2/2 x 2 2 Easily modifiable problem and it can be solved easily suck purchasing sleepers.
3. Preventive Potential
3/3 x 1 1 High preventive potential and to superficial problem and problems are easily prevented.
4. Salience ½ x 1 1/2 Rated 1 for social concern because this problem for the family would not make
them dying.
Total Score 4 1/6
h. Walking barefooted
Criteria Rating Actual Score Justification
1. Nature of the Problem
2/3 x 1 2/3 When there is untidiness, dieases can be easily acquired.
2. Modifiability of the Problem
2/2 x 2 2 Easy modifiable and interventions can be render easily such medical hand washing.
3. Preventive Potential
3/3 x 1 1 High preventive potential problem because the root of the problem are easily identified.
4. Salience ½ x 1 1/2 Not needing immediate attention as believed by the family and too dependent
on government program.
Total Score 4 1/6
i. Poor personal hygiene
Criteria Rating Actual Score Justification1. Nature of the Problem
2/3 x 1 2/3 It is a health threat because it poses a risk in providing for the needs of the members. Financial
problems arise.
2. Modifiability of the Problem
½ x 2 1 Partially modifiable because the family could still apply family planning or the couple could plan the number of children they really want to have without compromising their financial stability.
3. Preventive Potential
1/3 x 1 1/3 Low preventive potential because base on the monthly salary which is P4, 800, it is impossible to provide all their needs especially now, commodities are expensive.
4. Salience ½ x 1 1/2 Their social concern is one because they are still being passive about it, though they already knew that indeed it is one of their problems.
Total Score 2 1/2
j. Family Size beyond what family resources can adequately provide.
Top 5 prioritized health problems
1. Walking barefooted
2. Pointed/sharp objects
3. Poor personal hygiene
4. Cigarette/ tobacco smoking
5. Lack of food storage facilities
Nursing Care Plans Vaug
hn
Walking BarefootedRoselle E. Anino, St. N
FEBRUARY 20, 2010 @ 9:00 AM
Vaughn
CuesSubjective:• “Ana jud na sila gang, magtiniil” , as verbalized by the
patient Objective:• walking without slippers• with long nails which is not properly trimmed• dirty sole
Vaughn
Family Nursing Problem
• Unhealthful lifestyle and personal habits/practices specifically : Walking barefooted or inadequate foot wear as health threat
Vaughn
Family Health Problem
• Inability to make decisions with respect to taking appropriate health action due to: failure to comprehend the nature/magnitude of the problem
Vaughn
Goal of Care
• At the end of nursing interventions, the family will be able to practice proper foot care and foot hygiene.
Vaughn
ObjectivesAt the end of nursing interventions, the family would be able
to:• identify the importance of proper foot care, foot hygiene
and foot wear for sustaining healthy foot;• follows hygienic and other interventions such as proper
foot wear to maintain skin integrity and prevent infection;• demonstrate optimal foot hygiene as evidenced by intact,
pink, smooth, hydrated and warm skin, intact cuticles and skin surrounding nails.
Vaughn
Nursing Interventions1. Establish rapport with our client and apply therapeutic communication.® To facilitate trust and cooperation2. Provide client information on how to manage foot care and foot hygiene ® To prevent potential foot problems.3.Discuss the risk for infection and impaired skin integrity related to walking
barefoot® For the client to be able to gained knowledge4. Explain thoroughly nursing interventions that will help the client to maintain
healthy foot care practices5. Instruct the patient to wear slippers every time they go outside the house ® To avoid contracting athlete’s foot and other infections
Vaughn
Nursing Interventions6. Render health teachings such as wearing correctly fitting size of shoes
neither restrict the foot nor rub on any area®To prevent corn and calluses.7. Encourage client wash the feet daily and dry them well especially
between the toes, trim nails and make use of creams or lotions® To moisten the skin that reduces dryness.8.Give positive remarks or compliments®To enhance self-esteem9. Ensure that responsible individual are wearing slippers especially the
parents® They serve as role models for children to follow
Vaughn
Methods of Family Contact
• Home visit
Vaughn
Resources
• Human Resources, time and effort of the nurse and family
• Teaching aid
Vaughn
Evaluation“GOAL MET”
March 05, 2010
@9:00am
At the end of nursing interventions, the family was able to:• identify the importance of proper foot care, foot hygiene and foot wear;• follows hygienic and other interventions such as proper foot wear to maintain skin integrity and
prevent infection;• demonstrated optimal foot hygiene as evidenced by intact, pink, smooth, hydrated and warm
skin, intact cuticles and skin surrounding nails.
Roselle E. Anino, St. N
Vaughn
Pointed/Sharp ObjectsYvanne Ronald A. Agno St.N
FEBRUARY 20, 2010 @ 9:00 AM
Vaughn
CuesSubjective:• “Ah kanang mga lansang daan naman na diri,katong
bago pami nagrent” , as verbalized the wife Objectives:• presence of nails in the floor• protruded nails on the wall• protruded sharp parts of the wall (made up of wood)
Vaughn
Family Nursing Problem
• Accident hazard: pointed/sharp objects as a health threat
Vaughn
Family Health Problem
• Inability to make decisions with respect to taking appropriate health action due to low salience of the problem
Vaughn
Goal of Care
• At the end of nursing interventions the family would be able to enhanced social concern towards safety precautionary measures
Vaughn
ObjectivesAt the end of nursing interventions, the family would be able
to:• Identify pointed and sharp objects as a health threat • Verbalizes3-5 steps to eradicate pointed and sharp objects • Demonstrate accurately preventive steps or actions to
eliminate pointed/ sharps object such as:• wearing foot ware like slippers;• Daily general cleaning;• Vaccination of Tetanus toxoid.
Vaughn
Nursing Interventions1. Assess the level of understanding of the client.*to know anticipatory measures on how to interact with the client 2.Discuss the nature and magnitude of the problem*knowing the nature and magnitude of the problem would open the client for any
nursing interventions3.Explain the significance of having a hazard free environment *to encourage the family to participate in nursing interventions4. Discuss the dangers of improper storage of sharps and pointed objects.*to emphasize said problem 5. Encourage the family to remove protruded nails and pointed objects if possible.*sharps and pointed objects would cause injury to the family
Vaughn
Nursing Interventions6.Advice the parents to cover the protruded nails which are not removable.*to protect family from injury Advice parents to instruct children to keep away from object*children are hyperactive in playing, this is o prevent them from harm and injuries7. Advice parents to instruct children to keep away from object*children are hyperactive in playing, this is o prevent them from harm and injuries8.advice the family to have daily general cleaning*to avoid presence of pointed/sharps object9. Advice the parents to wear always slippers especially their children.*Slippers would lessen the incidents of stepping sharp objects which causes injury10. Encourage to have Tetanus toxoid vaccination.*For preventive measures incase a member of the family will be punctured.
Vaughn
Methods of Family Contact
• Home visit• Group Aproach
Vaughn
Resources
1. Human Resources: - Time and effort of the student and the
family2. Financial Resources:
-Money for transportation
Vaughn
Evaluation“GOAL MET”
March 05, 2010 @ 9:30am
At the end of nursing interventions the family was able to:Identified pointed and sharp objects as a health threat; “ Maka-tetanus diay ng mga lansang noh. Cge
lang himuon naku to tanan.” As verbalization by the wife.Verbalized 3 steps to eradicate pointed and sharp objects;
1.“Bukbukon nako ni ug martilyo kung madala ning naglabaw na mga lansang” as verbalized of the wife.
2. “ Ang dili madala tabunan nalang naku ni ug kahoy napud or fly wood” as verbalized by the wife.
3. “Lagi, kumpleto maning mga bata ug ako basta bakuna ug ako” as verbalized by the wife.
c. Demonstrated accurately preventive steps to eliminate pointed/sharps object such as; wearing foot ware like slippers, daily general cleaning, vaccination of Tetanus toxoid.
Yvanne Ronald A. Agno St.NVaug
hn
Poor Personal HygieneHannah Berry Alegado, St.N
FEBRUARY 20, 2010 @ 9:00 AM
Vaughn
CuesSubjective:• “ Pasensya namo ha….baho pa baya mi. Wla pa man gud mi kaligo.” As verbalized
by Ma’am Angelita
Objectives:• Excessive sweating of the family members• Faint odor from the mother’s axilla • Unpleasant odor from father’s mouth• Nails untrimmed• unclean clothes• hair is unkept• Fingers & feet are dirty
Vaughn
Family Nursing Problem
• Unhealthful lifestyle and personal habits/practices; Poor personal hygiene as a health threat
Vaughn
Family Health Problem
• Inability to make decisions with respect to taking appropriate health action due to: Low salience of the problem and condition
Vaughn
Goal of Care
• At the end of nursing interventions the family will be able to realize and explain the importance of good personal hygiene
Vaughn
Objectives
At the end of nursing interventions, the family would be able to:
• Identify the importance of personal hygiene.• Appreciate the benefits of practicing good
personal hygiene• Return demonstrate the general practices of
proper personal hygiene.Vaughn
Nursing Interventions1.Recognize with the family factors that contribute to poor personal hygiene®To identify causes of poor hygiene.2. Encourage joint decision making between the nurse and the family to handle the problem.®To encourage the family’s participation.3.Explain the importance of practicing good personal hygiene®To promote awareness of its significance4. Discuss with the client the effects of poor hygiene®To inform about the consequences of not caring for personal hygiene.5. Encourage to take a bath regularly at least twice a day.®To facilitate cleanliness6. Encourage to rush teeth at least three times a day ®To facilitate fresh breath and clean teeth
Vaughn
Nursing Interventions7. Encourage to clean and wash perineal area regularly.®To prevent infection8. Wash hands regularly especially before and after eating®To prevent the spread of microorganisms9. Encourage to cut nails at least once a week.®To prevent accumulation of dirt underneath which cause diseases. 10. Demonstrate the appropriate ways of good personal hygiene such as:a. taking a bathb. brushing teethc. washing hands11. Return demonstrate the different techniques taught.®To evaluate if the interventions are effective.
Vaughn
Methods of Family Contact
• Home visit• Group Approach
Vaughn
Resources
1. Human Resources: - Time and effort of the student and the
family2. Financial Resources:
-Money for transportation
Vaughn
Evaluation“GOAL MET”
March 05, 2010 @ 9:30am
At the end of nursing interventions the family was able to:-verbalized the importance of having good personal hygiene. “Kailangan dyud manlimpyo sa lawas
para makaiwas sa sakit.:-verbalized appreciation.“Mas mayo dyud diay kung mag-alaga dyud sa atong lawas kada isa.” -family member were able to take a bath twice a day, brush teeth thrice & wash hands regularly.-family has clean & trimmed nails.-family members have a presentable appearance.
Hannah Berry Alegado, St.N
Vaughn
Tobacco/ Cigarrete SmokingKevin Van Eric O. Saballo, St. N
FEBRUARY 20, 2010 @ 10:00 AM
Vaughn
CuesSubjective:• “Dili man jud naku malikayan gang uy. Dili magbaba tulo ka sticks nga
fortune akoang mahurot usaka adlaw..”as verbalized by Mr. Basco.• “Sige gud siya naga sigarilyo, makaubos gud na siya ug tulo usahay
makaabot ug lima nga stick sa isa ka adlaw” as verbalize by Mrs. Basco
Objective:• consumed not less than 3-5 sticks of fortune cigarettes per day• yellowish teeth noted• bluish discoloration of lips• smoking during the conversation
Vaughn
Family Nursing Problem
• Unhealthful lifestyle and personal habits/practices due to cigarette smoking as a health threat
Vaughn
Family Health Problem
• Inability to recognize the presence of condition or problem due to lack of or inadequate knowledge about cigarette smoking.
Vaughn
Goal of Care
• After the nursing intervention the family specifically, Mr. Basco will be able to lessen the consumption of cigarette from 3 to 2.
Vaughn
Objectives
At the end of nursing interventions, the family will be able to:
• identify at least 2 of harmful effects cigarette smoking such as cancer and ;
• appreciate the benefits of preventing the use of cigarette;
• identify at least 3 substitute for cigarette such as candies, lollipop and gums.
Vaughn
Nursing Interventions• Discuss with the family the:
– The nature of the problem*to promote awareness and know how the patient view the situation or the identified problem
– The effects and possible complication of cigarette smoking– The effect and possible complication that may appear on
passive smokers• Identify situations that trigger the urge to smoke.
*avoiding the certain situation may or will reduce the urge to smoke
Vaughn
Nursing Interventions• Encourage the family specially Mr. Basco to:
– Have a support person or group *someone you can call for those times when you feel like you are having a weak moment and might smoke a cigarette
– Keep candies, Toothpicks, sunflower seed or Lollipops handy *it can be used as a substitute for cigarette
– Use diversionary activities such as eating candies, gums or food*– Brush his teeth regularly *reduce the presence of tartar – To buy food instead of buying cigar *– Client to remind their children not to smoke and what are the effects of
smoking*to encourage their children not to smoke• To smoke away from other person if smoking cannot be avoided*to avoid second
hand smoking
Vaughn
Methods of Family Contact
• Home visit
Vaughn
Resources
• Human resources: time, and effort of the nurse and the family
• Financial resources: Fare for transportation• Teaching aids
Vaughn
Evaluation“GOAL MET”
March 05, 2010
@9:30am
At the end of nursing interventions, the family was able to verblize:• “duha nalang na sticks ang nahurot nako gahapon…plano na gani nako magundang na ko
pagsigarilyo” as verbalized by Mr. Basco.• “kanser,ubo na dugay mayo”• “mas maayo jud ang dili na mag sigarilyo para makalikay sa sakit ”• “pwede kendi, lollipop ug bubble gum ang pwede ipuli sa pagsigarilyo”
Kevin Van Eric O. Saballo, St. NVaughn
Lack of Food Storage FacilityPhoebe Lyn S. Brusas, St. N
FEBRUARY 20, 2010 @ 10:00 AM
Vaughn
CuesSubjective:• “Lage, wala mi butanganan para sa among pagkaon kay wala man
pud gud mi ref gang’’, as verbalized by Mrs. Angelita Basco.
Objectives:• -no water container;• -observable leftover food with presence of ants;• -grocery items such as milk, noodles and condiments are unkept at
one side near the sink;• -no refrigerator or cabinet for food storage purposes.
Vaughn
Family Nursing Problem
• Poor home condition specifically lack of food storage facilities as a health threat.
Vaughn
Family Health Problem
• . Inability to provide home environment conducive to health maintenance due to: limited physical resources such as lack of food storage facilities.
Vaughn
Goal of Care
• At the end of nursing interventions, the family would be able to recognize the importance of proper storage of food for health maintenance. Thus, take appropriate actions to solve the existing problem.
Vaughn
ObjectivesAt the end of nursing interventions, the family would be able to:
1. enumerate at least two effects of unprotected and non-stored food such as:a. possible contamination of other substances or microorganisms; b. easy spoilage of food.2. appreciate the benefits of having proper food storage facilities.3. demonstrate proper ways of storing food such as:a. placing in properly sealed containers;b. labeling the containers;c. providing containers for leftovers.
Vaughn
Nursing Interventions 1. Assess the salience of the family regarding the presence of the problem. ®to know whether the family think it as a problem or not2. Inform them about the existing problem.® to promote awareness about the problem3. Explain to the family the good effects of proper storing of food such as:a. prevention of rapid spoilage;b. possible contamination may be avoided.® to provide information about the benefits of proper food storage.4. Enumerate ways and means on how to improve food storage such as :a. placing food in clean and properly sealed containers:b. labeling the containers according to use.® to prevent contamination
Vaughn
Nursing Interventions5. Instruct the family to cover drinking containers with caps or clean plastic or cellophane
which can be sealed by rubber bands.® to ensure it is clean and is safe to drink6. Encourage the family to wash and clean the containers from time to time. ® this promotes health maintenance and wellness7. Persuade the family to find other ways in storing food. ® resourcefulness and creativity are also solutions on the existing problem.8. Encourage the client to buy food enough only for the meals.® to prevent food wasting and spoilage since they don’t have refrigerator9. Instruct parents to put food containers away from children’s reach.® to avoid accidental spilling and food wasting10. Instruct the family to set a place for food storage that is free from moist and insects.® to prevent microorganisms from setting-in Vaug
hn
Methods of Family Contact
• Home visit
Vaughn
Resources
1. Human resources: Time and effort of the nurse and the family.
2. Financial resources: fare for transportation and money for the grocery items
3. Teaching aids
Vaughn
Evaluation“GOAL MET”
March 05, 2010@ 9:30am
1. enumerated two effects of unprotected and non-stored food such as:a. possible contamination if not properly sealed and kept;b. easy spoilage of food.
2. “ Bitaw no..dapat jud diay nato ibutang sa limpyo na butang anan ug kanang nay taklob ang pagkaon para dili madapuan ug mga ok-ok ug langaw . Para makaiwas pud ta sa sakit”, as verbalized by Mrs. Angelita Basco.
3. demonstrated proper way of storing food such as:a. the condiments, milk and noodles are placed inside a container with cover;b. labeled the containers as for the salt, vinegar and sugar.c. provided container for the leftovers.
Phoebe Lyn S. Brusas, St. NVaug
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Implications Of The Study
Acknowledgement
“Ongoing research is essential for the growth of the profession”. Thus, this family case study would not be a success if it were not for our dear Clinical Instructor, Mr. Quirino Untua Jr.. He has painstakingly guided us in every step of the way. He is a great mentor and teacher. Big thanks to our Practicing Clinical Instructor, Ms Ruffa Therese Mae Enriquez for her continuing support, guidance and encouragement. We would like to thank our great parents who continually showed their love and support. They have been very considerate and understanding through all those stressful nights.
Acknowledgement...
Acknowledgement...We would like also to thank our sponsors: STAR kids Tutorial Center, Anino and Brusas residence and the San Pedro College Library for making this case study possible. And most of all, we would like to thank the Almighty Father for guiding us, enlightening us and protecting us from all harm. He has been with us from the very beginning. We owe this remarkable blessing to Him. To all those who were not mentioned but contributed a lot to this success, our deepest gratitude and thanks to all of you. Thank you very much!