Family Nursing Care Plan & Community Dx

A Family Case Study of the A. Family

IN PARTIAL FULFILLMENT OF THE COURSE

REQUIRMENT IN NCM 102 – RLE IN

COMMUNITY HEALTH NURSING

BACHELOR OF SCIENCE IN NURSING

Presented to the Faculty

Of Manila Doctors College, College of Nursing

Buzon, Myra Katrina R.

Caberte, Iris D.

Jinno, Chieri D.

Group 31

March 2010

Acknowledgement

The students would like to extend their profound gratitude to the following people who

have generously shared their help in the completion of this study:

First and foremost, God Almighty for giving us unending intelligence and strength to finish

every task to facilitate and is dedicated for us to finish. Our parents for providing us their never

ending support in this study. And last but not the least, to our clinical instructor, Mr. Nyl Rafols

Patangan, RN, who is never weary of providing us encouragement and guidance all throughout the

making of this study. He has always been accessible and approachable every time when we are in

need of help.

Dedication

This family nursing care plan is intended for the improvement and betterment in terms of

health of our host family, the Atienza’s. We dedicate this presentation to their family who gave us

their cooperation and whole-heartedly accepted our favour of giving us an ample amount of time

for us to conduct our interviews and for responding to us with complete honesty. We give our full

efforts to make this care plan the best and most appropriate one to improve their health. Lastly we

ask God, the Father Almighty to always guide the Atienza’s in their future endeavours more

practically in the terms of their health.

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Abstract

A family nursing care plan is the blue print of the care that the nurse designs to

systematically minimize or eliminate the identified health and family nursing problems through

explicitly formulated outcomes of care (goals and objectives) nd deliberately chosen set of

interventions, resources and evaluation criteria standards, methods and tools.

Features of Family Nursing Care Plan:

1. The nursing care plan focuses on actions which are designed to solve or minimize

existing problem. The plan is a blueprint for action. The core of the plan are the

approaches, strategies, activities, methods and materials which the nurse hopes will

improve the problem situation.

2. The nursing care plan is a product of a deliberate systematic process. the planning

process is characterized by logical analyses of data that are put together to arrive at

rational decisions. The interventions the nurse decides to implement are chosen from

among alternatives after careful analysis and weighing of available options.

3. The nursing care plan, as with all plans, relates to the future. It utilizes events in the

past and what is happening in the present to determine patterns. It also projects the

future scenario if the current situation is not corrected.

4. The nursing care plan is based upon identified health and nursing problems. The

problems are the starting points for the plan, and the foci of the objectives of care and

intervention measures.

5. The nursing care plan is a means to an end, not an end in itself. The goal in planning is

to deliver the most appropriate care to the client by eliminating barriers to family

health development.

6. Nursing care planning is a continuous process, not a one-shot-deal. The results of the

evaluation of the plan’s effectiveness trigger another cycle of the planning process until

the health and nursing problems are eliminated.

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Table of Contents

Acknowledgement 1

Dedication 1

Abstract 2

Table of Contents 3

I. Introduction 4

II. Background of Study 4-6

A. Study Locale B. Spot Map

III. Family Background 7

IV. Socio-Economic Data 7

V. Home and Environment 8

VI. Family Functional Assessment by Gordons 9 - 15

A. Health Perception-Health Management PatternB. Nutritional Metabolic PatternC. Elimination PatternD. Activity and ExerciseE. Cognitive PerceptionF. Sleep and RestG. Self-Perception/Self ConceptH. Role-Relationship PatternI. Sexuality-ReproductiveJ. Coping Stress Tolerance PatternK. Values Beliefs Pattern

VII. Physical Examination 15 - 25

VIII. Typology of Nursing Problems 26

A. 1st Level AssessmentB. 2nd Level Assessment

IX. Problem Scoring 27 -28

X. Priority Setting 29

XI. Family Nursing Care Plan 30 - 32

XII. Action Plans 33 - 35

XIII. Evaluation 36

XIV. Recommendation 37

Appendices 38 - 53Appendix A Appendix B Appendix C

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I. Introduction

A family nursing care plan is the blue print of the care that the nurse designs to

systematically minimize or eliminate the identified the identified health and family nursing

problems through explicitly formulated outcomes of care (goals and objectives) nd

deliberately chosen set of interventions, resources and evaluation criteria standards,

methods and tools.

The use of the family nursing process will result in a care plan describing the needs

and care for each client. An organized sequence of problem solving steps used to identify

and to manage the health problems of clients.

II. Background of the Study

A. Study Locale

About Barangay Talon Dos

Barangay Talon Dos in the City of Las Piñas was created on April 3, 1978 by

virtue of Presidentiable Decree No. 1335 signed by then President Ferdinand

Marcos.

Predominantly Residential Components

The decree ordered that the subdivisions of BF resort, Sta. Cecilia,

Sarino, Mother Earth and Camella be detached from the mother Barangay

Talon to form Barangay Talon Dos. Today this Barangay is composed of 26

residential villages and sectors.

Demography

Talon Dos is one of the twenty barangays of Las Piñas City with a

population of 47, 479 (2007 PopGen) and land area of 391.61 hectares. It is

situated on the southern side of the mid-section of Las Piñas. It is bounded

on the north by Zapote-Alabang Road and Barangay Pamplona Dos; on the

west by the Zapote River, Bacoor, and Cavite; on the east by Barangay Talon

Cuatro and on the south by Barangay Talon Cinco.

Health and Sanitation

Barangay Talon Dos provides health and nutrition and social welfare

services such as the Barangay Health Centers and Days Care Centers.

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Barangay Health Centers

Two health centers are found in BF Resort Village and Barangay Hall

compound provide primary health care for minor medical and dental

problems, immunizations and pre-natal care.

Day Care Centers

A Day Care Center is a community work place facility providing a full

range of health, nutrition, early education, psychosocial and other services

to children below 6 years old. Day care centers in Talon Dos are found in

Carnival Park A and B, Manggahan, Satima and Vatican Dulo River Side.

Feeding and Multivitamin Enhancement

A barangay nutrition scholar and barangay health workers provide

primary delivery of nutrition information and services in the community

together with the regular feeding and multivitamin supplementation

programs of the committee on health and sanitation.

Anti-Rabies Vaccination

To protect dogs and humans from the ill-effects of rabies, the

barangay, in the cooperation with the Department of Agriculture conducts

annual anti-rabies vaccination of dogs.

Waste Management

The proper management of solids and wastes protects public health and the

environment; thus; Barangay Talon Dos does its part by composting and bio-

digesting “wet garbage.”

Talon Dos Waste Management Facility

“Wet wastes” collected from homes by the barangay biomen are

processed into compost as soil conditioners into biogas for cooking at the

Waste Management Facility in BF Resort Village. The facility is a project of

Sen. Manny Villar and Con. Cynthia Villar, in cooperation with Barangay

Talon Dos and BF Resort Village Homeowners Association.

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B. Spot Map

BARANGAY TALON DOS LAS PIÑAS CITY

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Figure 1

Talon Dos is one of the twenty barangays of Las Piñas City with a population of 47, 479

(2007 PopGen) and land area of 391.61 hectares. It is situated on the southern side of the mid-

section of Las Piñas. It is bounded on the north by Zapote-Alabang Road and Barangay Pamplona

Dos; on the west by the Zapote River, Bacoor, and Cavite; on the east by Barangay Talon Cuatro and

on the south by Barangay Talon Cinco.

III. Family Background

The head of the family is Herminia D. Green. She was born on June 7, 1942 at

Bulacan and is 67 years old. She is a Bachelor of Science in Education and was a former

Filipino teacher. She currently earns income through a tricycle business. She owns three

tricycles and earns money through boundaries paid to her and usually owns P3, 000.00 a

month. She owns a bungalow type house at #24 Alice Crisostomo St., BR Resort Village,

Talon II, Las Piñas City. They have been living there for 15 years already. The primary

dialect that they use is tagalong. They also use other dialects such as, English, Ilonggo, Bicol,

and Kapampangan.

Dante D. Atienza Jr. (Herminia’s son) is a 38 year old father of three children. He was

born on May 19, 1971 and is 38 years old. He worked as an FX driver, but is currently not

working. He is helping his wife managing the food store where his wife is working. His wife,

Lucila S. Atienza, 47 years old, is a high school graduate who was born on October 30, 1963.

She earns about P1500.00 a day (5 days a week).

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They have three children who are currently studying. Hannah Grace S. Atienza is

their eldest daughter. She was born on August 7, 1994 and is 15 years old. She is a third

year high school student at Saint Francis of Assisi College. Jay Marvin S. Atienza is the

second among the siblings. He was born on December 12, 1995 and is 14 years old. He is a

freshmen student at St. Mark’s Academy. The youngest of the sibling is John Oliver S.

Atienza. He was born on November 3, 1996 and is 13 years old. All of them are Roman

Catholics.

IV. Socio Economic Data

According to the priorities for expenditure, the family prioritizes food first. The next

is health, followed by education, house bills and then clothing. Their primary source of

income is the food business that Lucila is currently in. She earns about P13, 000.00 a month

(minus the rental fee and other expenditures in the food store). Other sources of income

include the tricycle business Herminia is in, where she earns P3, 000.00 monthly. When

Dante works as a FX driver he earns P20, 000.00 monthly, making their average monthly

income P36, 000.00. Now that Dante is currently jobless, the average monthly income they

earn as of now is P16, 000.00. The family’s monthly expenses reaches as much as P15,

000.00 – P20,000.00 monthly; making their earnings short for paying expenses.

The family recognizes the Barangay Captain as one of the first persons they know to

be leader of the community. Some of the projects that the community has are Clean and

Green Project, Proper Segregation Program and Lighting System. The family is aware of

these projects and are utilizing it.

V. Home and Environment

Herminia owns the land and house they are living at. The house is made of light

materials and concrete. The house is well-ventilated and use electricity as a source of light.

The family’s source of drinking water is commercially prepared. They have their drinking

water delivered from a nearby water station. They store their drinking water in clean

bottles and pitchers which are usually covered. Their water supply is supplied by Nawasa,

and if water is not available, they have it delivered.

The type of toilet the family owns is a flush type toilet. The sewerage system is a

blind drainage and its condition is free flowing. The family practices waste segregation.

They used a covered trashcan as a container used for garbage collection. Garbage is

collected once a week, during Thursdays.

Herminia owns three love birds. She keeps them in a cage and feed them every day.

Roaches an flies are present in their household. They control these pests by using pesticide

to kill them. The health programs that are present in the community are free consultation

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and weighing , EPI, Ligtas Tigdas, Well-baby clinic , pre-natal checkups, Anti-rabies vaccine.

The family is aware of the health programs present in the community but does not utilize it

at once. The first person that the family consults in times of illness is the neighbourhood

albularyo and they only consult the doctor whenever the illness becomes severe.

Formula for Ventilation:

Total window area (cm.sq)

X 100

Total floor area (cm.sq)

Total window area (TWA) = window length x window width

Total floor area (TFA) = floor length x floor width

Results:

Well ventilated: >20%

Fair: 18 – 19%

Poor: <17%

VI. Family Functional Assessment by Gordon’s

A. Health Perception-Health Management Pattern

1. History

The family’s general heath has been good in the last few years. The children

in the family experience cough and colds, but not very often. Hannah Grace and John

Oliver have also had fever 2 months ago, once at the same time during the Christmas

break. Luckily these illnesses didn’t affect the children’s school attendance. In cases

like these, Herminia and Lucila call their neighbourhood albularyo for help. They

only consult the doctor in cases where in sickness becomes severe. Lucila, started

having hypertension, September last year. She was given prescription by her

physician and has been taking her Diovan (Valsartan) medications for hypertension

80mg once a day, every day, since then as maintenance. The family takes vitamins to

keep themselves healthy.

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Herminia and Lucila also tidy the house daily to keep the house clean and

keep themselves away from an environment that may cause sickness to them. None

of the family members drink alcohol, take prohibit drugs or smoke. The children

have complete immunizations since they were 8 years old. The client states that it

has been easy to find ways to follow suggestions of doctors, nurses, social workers.

2. Examination

The general appearance of the family’s home environment is conducive to

their health. It is clean and tidy, has well-ventilation and lighting, and the family can

control the presence of pests and vectors such as flies and cockroaches. Lucila stores

the available medications at home in a safe place which is unreachable by her

children. She and Herminia make sure that hazards are eliminated such as knives on

the counters, are put back to their appropriate places so that they are out of reach to

the children.

B. Nutritional Metabolic Pattern

1. History

Breakfast Lunch Merienda Dinner

Bread, fried egg

with tomatoes,

fried rice, with

water or coffee

Rice and pork

with water or

juice

+ fruits

Bread, Pancit

canton with soft

drinks, juice, coffee

or water

Rice and beef with

water

Bread, beef

noodles/mami with

added rice, with

water or coffee

Rice and fish with

water or juice

+ fruits

BananaQue with

soft drinks, coffee

or water

Rice and chicken

with water or juice

Bread,

Champorado with

added milk and

Rice and chicken

with water or

juice

Lugaw added with

tofu/Macaroni

soup added with

Rice and beef with

water or juice

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dried fish, with

water or coffee

+ fruits milk, with coffee or

water

Bread, left over

foods from last

night (may be beef,

pork or chicken),

with water or

coffee

Rice and beef with

water or juice

+ fruits

Pancakes with

milk, coffee or

water

Rice and fish with

water or juice

(May have any of these meal patterns. Meal patterns change every day.)

The family makes it sure that each member drinks 6 – 8 glasses of water

daily. The client says that usually, the elders never fail to have a cup of coffee daily.

The children are given juice and milk. They also drink soft drinks. The family usually

eats meaty foods such as beef, pork and chicken. They do not cook vegetables that

much because the children dislike eating it. All the family members have a good

appetite, except for Herminia who eats only small quantities of food per meal.

The children have regular dental check-ups, twice a year. The family doesn’t

have any problems with regards to the skin, and wound healing.

2. Examination

The refrigerator mostly contains food stocks of beef, pork, and chicken.

Bottles of drinking water and dairy products are also present. Fruits such as apples,

bananas, oranges and avocado are placed on top of the refrigerator. Vegetables such

as tomatoes, string beans, cauliflower, carrots, cabbages, and eggplants are also

found. The family usually eats adobo, nilaga, champorado, pancit, chicken curry,

kare-kare, pork/beef sinigang, afritada, fried pork/chicken, beef steak.

C. Elimination Pattern

1. History

All members of the family sighted no abnormalities observed in their stool.

The family members regularly have normal defecation patterns:

Herminia: Every other day at around 5 in the morning

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Dante: Every day at night time

Lucila: Every other day in the afternoon

Hannah: Every other day in the afternoon

Jay: Every other day in the afternoon

Oliver: Everyday in the morning

The family practices waste segregation. They used a covered trashcan as a

container used for garbage collection. Garbage is collected once a week, during

Thursdays. Herminia owns three love birds. Their wastes are disposed every other

day, outdoors. Roaches and flies are present but are controlled through the use of

pesticides (baygon).

2. Examination

The family has 3 functional toilets at home. The toilet bowls are all flush type

and kept clean. Garbage disposal doesn’t seem to be a problem and the pet cages are

also kept clean. Flies and roaches are not considered as a problem.

D. Activity and Exercise

1. History

Lucila and Herminia consider doing everyday household chores as their

form of exercise. Oliver and Jay are members of their school basketball team, and

have drills and training every Monday, Wednesday, Friday and Saturday. Hannah

Grace on the other hand is a member of her schools volleyball team and is a team A

player. Her drills and training schedule take place during Monday, Wednesday and

Friday afternoon and Tuesday, Thursday and Saturday in the morning. Dante does

no form of exercise at all.

The family doesn’t experience problems in housekeeping, budgeting for food

education and clothes.

2. Examination

The home is well organized and clean. Personal belongings of each member

are appropriately arranged and maintained by Lucila and Herminia.

E. Sleep and Rest

1. History

Generally, each family member is well-rested and ready for school or work

at the start of the day. Herminia has her own room where she sleeps in. She sleeps

using a “banig” topped by a comforter. Lucila and Dante share their room with

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Oliver and Jay, with Lucila and Dante using a floor mattress topped by a comforter

for sleep and Oliver and Jay sharing the King sized bed. Hannah sleeps on a separate

room. She sleeps on a wooden bed topped by a soft mattress.

Usually the children wake up at around 5:00 AM to get ready for school.

Lucila also wakes up at 5:00 AM to assist the needs of her children such as preparing

breakfast for the whole family, boiling water for a warm bath, and checking if her

children’s school needs are all prepared. Dante wakes up at around 6:00 AM. He gets

himself prepared to give his children a ride to school. Herminia also wakes up at

6:00 AM and starts doing the household chores. The family usually sleeps at around

9:00 PM.

2. Examination

The sleeping space is adequate for each family member and is also

appropriately arranged.

F. Cognitive Perception

1. History

No family member has hearing problems however; Lucila and Herminia

have visual problems. Herminia has a vision of 275(Left)/250(Right), while Lucila

has 120(Left)/120(Left). They both have personal reading glasses.

2. Examination

The primary dialect that they use is tagalong. They also use other dialects

such as, English, Ilonggo, Bicol, and Kapampangan.

G. Self Perception-Self Concept

1. History

Herminia states that the family feels good most of the time. They normally

have their own family problems like every other family and tend to help each other

at times of family crisis. The show the children that they feel happy most of the time,

to lessen the stress that the children have in studying for school. Herminia, Dante

and Lucila feel anxious sometimes because of Dante being jobless at the moment.

With Dante jobless, they are worrying about the monthly expenses that they have to

pay for. Examples of things that may affect their mood are quarrels or

misunderstandings between their members, when the children become stubborn at

times and problems regarding finances.

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2. Examination

General mood state: rate is 3 because Herminia presents herself to be fine at

the moment of interview when their family is under a state of crisis. She is

cooperative but gets serious at times. Her mood changes whenever she talks about

the current financial problems in the family.

Members are generally assertive. Rate given is 5 because during interview,

interviewee is cooperative and honest in answering questions.

H. Role-Relationship Pattern

1. History

NameRelationship to the head of the family

Age Sex Educational Attainment

Herminia D. Green Head of the Family 68 F College BSE Graduate

Dante D. Atienza Jr. Son 38 M College Undergrad

Lucila S. Atienza Daughter-in-law 47 M High School Graduate

Hannah Grace S. Atienza Granddaughter 15 F Still Studying

Jay Marvin S. Atienza Grandson 14 M Still Studying

John Oliver S. Atienza Grandson 13 M Still Studying

The Atienza’s are an extended type of family. Regarding the family’s role-

relationship pattern, Herminia states that they sometimes get rough with the kids

and sometimes experience a hard time in disciplining them; most usually with

Hannah and Oliver. They may sometimes answer back at any of their elders. They

also find it hard to make Hannah and Oliver cooperate with helping in the household

during their free time. Herminia states that all they do sometimes is laze around all

day after doing their school activities. Jay is however a responsible child, sharing his

part in doing the household chores at home. However like Oliver, they may stay in

computer shop late up until midnight. Herminia also states that even though they

have a hard time in disciplining the kids, their relationship as brother and sister

remain equal.

The family also considers themselves as a part of their community and keep

contact/socialize with their neighbours.

2. Examination

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The family communicates during meals. The elders and Jay help each other

out in doing household chores. The siblings help each other out in times of need,

such a help in school assignments. The family is an extended type and it

I. Sexuality-Reproductive

1. History

Lucila and Dante are still sexually active. They say that their sexual

relationship is satisfying. The parents are using the BBT method for family planning

since Lucila is still not menopausal. They still don’t educate their children about

topics regarding sex and reproduction. They feel that it is inappropriate for them to

discuss that topic to their children.

J. Coping Stress Tolerance Pattern

1. History

The family is adjusting to the financial problem that they are currently facing. The family tries to help each other as possible. When family problems arise, the elders first discuss regarding what steps they will have to take in solving the problems, and then they will discuss these to the family members. They take things slowly and think of resolutions they may do to solve the problem. Lucila experiences hypertension once tension in situations rises. She resolves this by taking her Diovan medications, deep breathing and drinking plenty of water. The other family members only cool off for a moment and just try to relax to decrease the tension. When all members have cooled down, the family then goes back to discussion of how to solve the conflict. Herminia states that her methods are successful most of the time.

K. Values-Beliefs Pattern

1. History

The family members do not get everything they want because of current

financial problems. One of the parent’s goals is to let their children be able to get a

college degree, stay healthy and live a harmonious life. Only Herminia participates in

religious activities of the community, such as attending afternoon sessions of

praying the rosary at the community grotto. She and Lucila try their best to get

Dante and the kids attached to religion. They usually go to Church every Sunday

afternoon. Religion is very important to them once problems arise since they call

God and ask for guidance to help them during crisis in the family arises.

VII. Physical Examination

Herminia D. Green

Age: 68 y/o Weight: 125 lbs Height: 5’2

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1. SkinI: The clients’ skin is fair in color evenly, decrease elasticity, wrinkled and moles scattered on facial skin and on upper and lower extremities and only small healed scars are present. Skin is intact, and no reddened areas. P: There are no masses palpated. Skin temperature is warm and clammy and skin is dry.

2. NailsI: Nails are clean, thick, and slightly pink in color, convex curvature, nails are evenly cut; tissue surrounding the nails is intact with beau’s line.P: Nails are hard and immobile. Capillary refill is present at 2 sec, smooth texture.

3. Head, Face and NeckI: Head and neck is symmetrically aligned, head is normocephalic, held still and upright. Neck has slight cervical curvature, decrease flexes without bulging mass. Symmetric facial movements, Hair is short and a mixture of brown, gray and white in color, thin but evenly distributed, no presence of flakes.Facial wrinkles are prominent, mouth is drawn inward.P: No lumps or masses, no inflammation of lymph node in the face, there is presence of pulsations on temporal artery.

4. EyesI: Eyebrows are brown in color and symmetrically aligned, no discharges, pupils are equally round and reactive to light and accommodation. There is no discoloration of the eye, sclera appears white, and eyes are at the level of the ears, can follow the six ocular movements. Yellowish nodules on bulbar conjunctiva on medial side of iris are present. The vision of client is 275/270 she is near sighted. P: Absence of masses and tenderness and discharges on inner and outer cantus upon palpation

5. EarsI: Color same as facial skin, both are symmetric and evenly aligned to the head and auricle of the ear aligns with aligned to the corner of the eye. Can react to sounds or noises, normal voice tone audible, able to hear snapping fingers on both ears.P: No tenderness, no lesions and masses

6. Nose and SinusesI: upon assessment the nose is symmetrical and able to sniff through each nostril, no discharges or nasal flaring, same color of the face, no lesions and deformitiesP: No tenderness and masses felt over bony prominence above each eye and maxillary sinuses.

7. Mouth and PharynxI: Lips are pinkish in color, all are false teeth slightly yellow stained. Gums are pink and tight. No bulging masses. Tongue is pinkish in appearance and is in midline, moves freely up, down and sideward. Uvula hangs freely in the midline. Hard palate is pale with transverse rugae.P: The client elicits gag reflex. And tongue offers strong resistance on up, down, and side to side tongue pressure.

8. Spine

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I: The patient has a slight curvature of the thoracic spine. The spine is vertically aligned right and left clavicles and hips are at the same height and moves symmetrically.P: No masses or tenderness noted.

9. Thorax/ChestI: the posterior and anterior thorax is uniform in color. No lesions or bulging mass noted. No respiratory distress noted. Ratio of AP diameter is 1:2.Pa: No masses or tenderness are present. Has uniform body temperature. Has symmetric chest expansion.Pe: normal resonance sounds is elicited upon percussion of the thorax/chest.A: Lung sounds are clear to auscultation bilaterally. No abnormal breath sounds was heard.

10. Cardiovascular and Peripheral Vascular/HeartI: There are no heaves noted on the chest of the patient. No pulsations noted.A: No bruit was noted. No extra heart sounds noted.P: No masses or tenderness palpated.

11. Breast and Axilla - refused

12. AbdomenI: Presence of striae and small healed on the skin of the abdominal area. Inverted umbilicus, color is symmetric to the upper extremities and face. A: Bowel sounds heardPe:Pa: abdomen is soft and with doughy texture, warm to touch, no masses present. No pain is elicited.

13. ExtremitiesI: Varicosities are present in both legs and feet and back of the hands; scars are present on arms and legs.P: Has equal pulsations in both sides of lower and upper extremities

14. Genitals – refused

15. Rectum and Anus - refused.

16. Neurologic ExamPatient was conscious, oriented, and coherent. She was aware on what is happening around her. She was actively voluntarily cooperative. She was able to identify objects with open and closed eyes. She can also answer questions appropriately and she was oriented.

Dante D. Atienza Jr.

Age: 38 y/o Weight: 170lbs Height:5’6

1. SkinI: Skin is dark in color evenly, skin is elastic, and moles scattered on skin on upper and lower extremities and only small healed scars are present. Skin is intact, and no reddened areas. P: There are no masses palpated. Skin temperature is warm and clammy and skin is moist.

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2. NailsI: Nails are clean, slightly pink in color, convex curvature, nails are evenly cut; tissue surrounding the nails is intact. Some nails on feet have darkened in color (light brown) and with beau’s line.P: Nails are hard and immobile. Capillary refill at 2 sec, smooth texture.

3. Head, Face and NeckI: Head and neck is symmetrically aligned, head is normocephalic, held still and upright. Neck is without bulging mass. Symmetric facial movements, Hair is short and black in color some strands of hair are white, thick and evenly distributed, no presence of flakes.P: No lumps or masses, no inflammation of lymph node in the face, there is presence of pulsations on temporal artery.

4. EyesI: Eyebrows are black in color and symmetrically aligned, no discharges, pupils are equally round and reactive to light and accommodation. There is no discoloration of the eye, sclera appears white, and eyes are at the level of the ears, can follow the six ocular movementsP: Absence of masses and tenderness and discharges on inner and outer cantus upon palpation



7. Mouth and PharynxI: Lips are pinkish brown in color, teeth are intact and 2 false teeth on the upper front have 32 slight yellow stained teeth. Gums are pink and tight margins to the tooth. No bulging masses. Tongue is pinkish in appearance and is in midline, moves freely up, down and sideward. Uvula hangs freely in the midline. P: The client elicits gag reflex. And tongue offers strong resistance on up, down, and side to side pressure.

8. SpineI: The patient has no bone deformities. The spine is vertically aligned Right and left clavicles and hips are at the same height.P: No masses or tenderness noted.

9. Thorax/ChestI: the posterior and anterior thorax is uniform in color. No lesions or bulging mass noted. No respiratory distress noted. Ratio of AP diameter is 1:2Pa: No masses or tenderness are present. Has uniform body temperature. Has symmetric chest expansion.Pe: normal resonance sounds is elicited upon percussion of the thorax/chest.A: Lung sounds are clear to auscultation bilaterally. No abnormal breath sounds was heard.

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11. Breast and Axilla – refused

12. AbdomenI: Presence of striae and small healed on the skin of the abdominal area. Inverted umbilicus, color is symmetric to the upper extremitites and face. A: Bowel sounds heard

13. ExtremitiesI: Varicosities are present in both legs, scars are present on arms and legs.P: Has equal pulsations in both sides of lower and upper extremities



16. Neurologic ExamPatient was conscious, oriented, coherent and cooperative. He was able to identify objects with open and closed eyes. He can also answer questions appropriately and he was oriented.

Lucila S. Atienza


1. SkinI: The client has an evenly fair skin tone, wrinkles around the eyes and moles scattered on facial skin and on upper and lower extremities and only small scars are present on extremities. Skin is intact, and no reddened areas. Calluses are present on the sole. Has 3 large scars from 3 cesarean delivery.P: There are no masses palpated. Skin is smooth, temperature is warm and clammy and skin is dry but has good mobility and turgor.

2. NailsI: Nails are clean, thick, and slightly pink in color, convex curvature, nails are filed; tissue surrounding the nails is intact with beau’s line.P: Nails are hard and immobile. Capillary refill is present at 2 sec, smooth texture.

3. Head, Face and NeckI: Head and neck is symmetrically aligned, head is normocephalic, held still and upright. Neck has slight cervical curvature, good flexion without bulging mass.

19

Symmetric facial movements, Hair is short and black in color, thick and evenly distributed, no presence of flakes.Facial wrinkles are prominent.P: No lumps or masses, no inflammation of lymph node in the face, there is presence of pulsations on temporal artery.

4. EyesI: Eyebrows are black in color and symmetrically aligned, no discharges, pupils are equally round and reactive to light and accommodation. There is no discoloration of the eye, sclera appears white, and eyes are at the level of the ears, can follow the six ocular movements. The vision of client is 120/120 she. P: Absence of masses and tenderness and discharges on inner and outer cantus upon palpation



7. Mouth and PharynxI: Lips are pinkish brown in color, all teeth are intact slightly yellow stained with pasta at left lower molar. Gums are pink and tight. No bulging masses. Tongue is pinkish in appearance and is in midline, moves freely up, down and sideward. Uvula hangs freely in the midline. Hard palate is pale with transverse rugae.P: The client elicits gag reflex. And tongue offers strong resistance on up, down, and side to side tongue pressure.

8. SpineI: The patient has a straight spinal cord, without any deformities. The spine is vertically aligned right and left clavicles and hips are at the same height and moves symmetrically.P: No masses or tenderness noted.

9. Thorax/ChestI: the posterior and anterior thorax is uniform in color. No lesions or bulging mass noted. No respiratory distress noted. Ratio of AP diameter is 1:2.Pa: No masses or tenderness are present. Has uniform body temperature. Has symmetric chest expansion.Pe: normal resonance sounds is elicited upon percussion of the thorax/chest.A: Lung sounds are clear to auscultation bilaterally. No abnormal breath sounds was heard.


20

11. Breast and Axilla -refused

12. AbdomenI: Presence of striae and large scars due to past CS deliveries on the skin of the abdominal area. Inverted umbilicus, color is symmetric to the upper extremities and face. A: present bowel soundsPe:Pa: abdomen is soft and with doughy texture, warm to touch, no masses present. Fundus is firm, at the midline and tenderness is present when palpated. No pain is elicited.

13. ExtremitiesI: Varicosities are present in both legs and feet and back of the hands; scars are present on arms and legs.P: Has equal pulsations in both sides of lower and upper extremities

14. Genitals –refused

15. Rectum and Anus – refused

16. Neurologic ExamPatient was conscious, oriented, and coherent. She was aware on what is happening around her. She was actively voluntarily cooperative. She was able to identify objects with open and closed eyes. She can also answer questions appropriately and she was oriented.

Hannah Grace S. Atienza

Age: 15y/o Weight: 110 lbs Height: 5’6

1. SkinI: Colors is light brown and uniform.P: The texture is smooth, even and smooth. Normal skin turgor. Warm to touch.

2. NailsI: Nailbeds are pink in color.Convex and curvature

P: Normal capillary refill.

3. Head, Face and NeckI: The patients head is symmetrical to the body. The size, shape and symmetry of skull is normal. The color of the skin is the same with the rest of the body. There’s no distention of jugular vein. P: The carotid artery is easily palpable and there’s no enlarged lymph nodes and any tenderness. There’s no bruit sounds heard while auscultation .

4. Eyes

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I: Pupils are equally round, reactive to light and accommodation.It has full ocular visions and peripheral visions. The eyebrows have equal hair distribution and eyelashes are cured outward. The eyelids are color light brown.

P: No abnormal findings

5. Ears

I: The ears are symmetric and proportional to the head, even in color and consisitent with the rest of the skin. It is aligned with the eyebrows.P: Normal pinna recoil and no abnormal findings

6. Nose and SinusesI: Color is consistent with the rest of the skin. The client can tell the smell od=f an object being presented.P: No abnormal findings

7. Mouth and Pharynx

I: She has dry and pinkish brown colored lips. The tongue is moist. Gums are pink and smooth. Tonsils are small, pink and symmetric in shapeP: No abnormal findings

8. SpineI: The spine is centrally placed no curvature.P: No masses or tenderness noted.

9. Thorax/ChestI: Chest is symmetric and color is consistent with the rest of the skin.It has equal anterior and posterior excursion Pa: It has equal anterior and posterior excursion Pe:.A: No abnormal breath sounds

10. Cardiovascular and Peripheral Vascular/HeartI:A: No bruit was noted. No extra heart sounds noted.P: The pulmonic and aortic pulsations is easily palpable.. Peripheral pulses are equal (radial, brachia, carotid, popliteal).

11. Breast and Axilla -refused

12. AbdomenI: The patient’s abdomen has the same skin color with the rest of the body.Pe:Pa: No masses and tenderness.

13. ExtremitiesI: The patient’s muscles, bones and joints are bilaterally symmetrical to left and right side of body, scar present on left index fingerP: There’s no presence of edema, swelling, pain and tenderness



16. Neurologic Exam

22

Patients is awake and alert. She is able to express self through speaking and gestures. Muscles and bones are bilaterally symmetrical to left and right side of the body. Movement of arms and legs are both in normal power and coordinated with all senses

Jay Marvin S. Atienza

Age: 14y/o Weight: 115lbs Height: 5’7

1. SkinI: Colors is fair and uniform.P: The texture is smooth, it is also even and soft. Skin turgor and mobility goes back after 2-3 seconds. The skin is also warm and dry.

2. NailsI: Nailbeds are pink in color.Convex and curvature

P: Normal capillary refill.

3. Head, Face and NeckI: The patients head is symmetrical to the body. The size, shape and symmetry of skull is normal. The color of the skin is the same with the rest of the body. There’s no distention of jugular vein. P: The carotid artery is easily palpable and there’s no enlarged lymph nodes and any tenderness. There’s no bruit sounds heard while auscultation .

4. EyesI: The client’s eye lashes is curled outward while the eyebrows have equal hair distribution. His conjunctiva is pink in color and the sclera is white and clear. Pupils are equally round, reactive to light and accommodation. The pupil response properly. P: Absence of masses and tenderness and discharges on inner and outer cantus upon palpation

5. Ears I: The patient’s ears are symmetric to each other just above the level of the eye. The color of the skin is the same as the color of the face P: Normal pinna recoil and no abnormal findings

6. Nose and SinusesI: The patient’s nose has the same color with the rest of the face. No discharges seen, and has no pain and edema in maxillary and frontal sinuses Color is consistent with the rest of the skin. The client can tell the smell of an object being presented.P: No tenderness and masses felt over bony prominence above each eye and maxillary sinuses.

7. Mouth and PharynxI: Lips are pinkish in color. Gums are pink and tight. No bulging masses. Tongue is moist, moves freely up, down and sideward. Tonsils are small, pink and symmetric in shapeP: No abnormal findings


23

9. Thorax/ChestI: Chest is symmetric and color is consistent with the rest of the skin.It has equal anterior and posterior excursionPa: It has equal anterior and posterior excursion Pe:.A: No abnormal breath sounds

10. Cardiovascular and Peripheral Vascular/HeartI:A: No bruit was noted. No extra heart sounds noted.P: The pulmonic and aortic pulsations is easily palpable.. Peripheral pulses are equal (radial, brachia, carotid, popliteal).

11. Breast and Axilla

12. AbdomenI: The patient’s abdomen has the same skin color with the rest of the body.Pe:Pa: No masses and tenderness.

13. ExtremitiesI: The patient’s muscles, bones and joints are bilaterally symmetrical to left and right side of bodyP: There’s no presence of edema, swelling, pain and tenderness



16. Neurologic Exam

The patient is conscious and able to answer questions immediately. Movements are

well coordinated with the rest of the body parts.

John Oliver S. Atienza


1. SkinI : Color is light brown. Its texture is even, smooth, and intact.P : Skin temperature is warm. Good skin turgor.

2. Nails

I :The nails are colored pink in nail beds & convex. Upon assessment, it is 160° between the nail and base. P : It has a smooth texture and capillary refill is 1-2 seconds.

3. Head, Face and Neck

I :Head is normocephalic while the color is consistent with rest of the skin. It is symmetrical to the body. Eyes, nose, ears and mouth are symmetrical to each other.

24

P : No other abnormal observations

4. EyesI : The eyes are parallel to each other.Pupils are equally round, reactive to light and accommodation. It has good ocular visions and peripheral visions while the eyebrows have equal hair distribution and eyelashes are curled outward. The eyelashes are color black. The conjunctiva is pinkish in color.

P : No other abnormal observations

5. Ears I: The ears are symmetric and proportional to the head, smooth, even in color and consistent with the rest of the skin. Auricles are normally level to each other and smooth in texture. Good hearing acuity.P : Has good pinna recoil and it can hear whispered voice from 1-2 feet away from the patient.

6. Nose and SinusesI - Nose is symmetrical to the face and has neither underlying deviations nor nasal discharge or flaring. Color is consistent with the rest of the skin; the client can also identify the smell of an object being presented such as perfume and alcohol.

P – No other abnormal observations

7. Mouth and Pharynx I- Lips are soft, moist, and pink. The tongue is located in the midline and it moves freely from side to side and up and down. Gums are pink and smooth. The tonsils are bilateral, small, pink and symmetric in shape. Uvula is at the center.

P – No other abnormal observations


9. Thorax/Chest

I :Chest is symmetric and color is consistent with the rest of the skin. Pa : It has equal anterior and posterior thorax excursion. A :Normal Breath Sounds

10. Cardiovascular and Peripheral Vascular/Heart

I : No visible palpitationsA :No S3 or S4 sounds. Pa : There is palpable pulsation on aortic and pulmonic and at Point of Maximal impulse. Peripheral pulses are bilaterally equal (radial, brachia, carotid, popliteal).

11. Breast and Axilla

12. Abdomen

I : Abdomen color is consistent with the rest of the skin Umbilicus is centrally located. A :No abnormal sounds

25

Pe : Pa : No masses and tenderness

13. Extremities

I :Muscles and bones are bilaterally symmetrical to left and right side of body. The patient can perform active range of motion. P : No other abnormal observations



16. Neurologic ExamPatient is awake and able to cooperate with us during the interview. Coordinated body movements.

VIII. Typology of Nursing Problems

Second Level Assessment

Cues/Data Family Nursing Plan

“Hindi kami kumakain ng gulay. Ayaw kasi ng mga bata.” as stated Herminia.

A. Faulty eating habits – Health Threat1. Inability to recognize the presence of the

condition due to attitude in life which hinders acceptance of a problem

2. Inability to make decisions with respect to taking appropriate action due to:a. Conflicting opinions among family

members regarding action to takeb. Negative attitude towards the health

condition.3. Inability to provide adequate nursing care

26

Mrs. Green verbalized “Hindi kami nag-papatingin agad sa doctor. Sa albularyo kami nagpapatingin.”

When Hannah Grace and John Oliver had fever 2 months ago, they call their neighborhood albularyo for help.

They only consult the doctor in cases where in sickness becomes severe.

Lucila, started having hypertension, September last year.

She was given prescription by her physician and has been taking her Diovan (Valsartan) medications for hypertension 80mg once a day, every day for lifetime, since then as maintenance.

“Nakakadagdag sa gastos yung gamot ni Lucila.” As stated by the client.

to the sick, disabled, dependent or at-risk member of the family due to inadequate knowledge about child development and care.

B. Inappropriate Health Care – Health Deficit

1. Inability to recognize the presence of the condition or problem due to philosophy in life which hinders acceptance of a problem.

2. Inability to make decisions with respect to taking appropriate action due to:a. Failure to comprehend the nature of

the problem.b. Negative attitude towards the health

condition.c. Misconceptions about proposed

course of action.3. Inability to provide adequate nursing care

to the sick, disabled, dependent or at-risk member of the family due to philosophy in life which hinders caring for the sick, disabled, dependent, at-risk member.

4. Failure to utilize community resources for health care due to negative philosophy in life which hinders effective or maximum utilization of community resources for health care.

C. Hypertension – Health Deficit 1. Inability to recognize the presence of the

problem due to denial about its existence as a result of fear of consequences of diagnosis of problem, specifically cost implications.

2. Inability to make decisions with respect to taking appropriate health actions due to:a. Failure to comprehend the

nature of the problem.b. Inaccessibility of appropriate

resources for care, specifically cost constraints.

3. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk family member due to:a. Inadequate knowledge and

skill in carrying out the necessary care.

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b. Inadequate family resources for care, specifically absence of responsible member and financial constraints.

IX. Problem Scoring

A. Faulty eating habitsCriteria Computation Actual Score Justification

1.Nature of the problem

2/3 x 1 0.67 The problem is a health threat since it may affect the family’s health.

2.Modifiability of the Problem

2/2 x 2 2 The problem is easily modifiable and the resources are available.

3.Preventive Potential 3/3 x 1 1 The problem can be prevented temporarily but it affects the whole community.

4.Salience of the Problem

2/2 x 1 1 The family recognizes as a problem but does need immediate action.

Total Score 4.67

B. Inappropriate Health Care

Criteria Computation Actual Score Justification

1. Nature of the problem

3/3 x 1 1 The problem is a health deficit because they call the albularyo instead of seeing the doctor.

1. Modifiability of the problem

2/2 x 2 2 The problem is easily modifiable and the resources are available.

2. Preventive Potential

3/3 x 1 1 The problem is high prevention because the health center is available and accessible to them.

3. Salience of the 1/2 x 1 0.5 It is perceived as a

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Problem condition needing change since it makes them well without doctor’s diagnosis.

TOTAL SCORE: 4.5

C. HypertensionCriteria Computation Actual Score Justification

1.Nature of the problem

3/3 x 1 1 The problem is a health deficit since it is a lifetime illness and can be hereditary or due to lifestyle.

2.Modifiability of the Problem

2/2 x 2 2 The problem is easily modifiable and the resources are available in the health center.

3.Preventive Potential 3/3 X 1 1 The problem is high prevention because the health center is available and accessible to them.

4.Salience of the Problem

2/2 x 1 1 The family recognized as a problem. It consulted to the health personnel and needs immediate action.

Total Score 5

X. Priority Setting

RANK 1 Hypertension 5

RANK 2 Faulty Eating Habits 4.67

RANK 3 Inappropriate Health Care 4.5

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30

XI. Family Nursing Care Plan

Health Problem Family Nursing Problems Goal of Care Objectives of care

Intervention Plan

Nursing Interventions Method of Nurse-family contact

Resources Required

Hypertension4. Inability to recognize the

presence of the problem due to denial about its existence as a result of fear of consequences of diagnosis of problem, specifically cost implications.

5. Inability to make decisions with respect to taking appropriate health actions due to:a. Failure to comprehend the

nature of the problem.b. Inaccessibility of appropriate

resources for care, specifically cost constraints.

6. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk family member due to:a. Inadequate knowledge and skill

in carrying out the necessary care.

b. Inadequate family resources for care, specifically absence of responsible member and financial constraints.

After nursing intervention, the family will be able to have adequate knowledge in hypertension treatments, nature, causes, effects, and management.

After nursing intervention, the family will be able to:

a. Relieve symptomsb. Comply with the

medications prescribed by the doctor.

1. Discuss:a. Nature and causes

of hypertension.b. Signs and

symptoms of hypertension.

c. Possible effects of hypertension.

d. Benefits of the treatment.

e. Side and Adverse effect of the medications.

f. It will take 3-6 weeks for the full therapeutic effect of the drug.

2. Ask the client to:a. Check blood

pressure and cardiac rate regularly.

b. Decrease potassium intake.

c. Continue medication even if feeling well.

d. Take the medication same time each day.

Home Visit and

Clinic Visit

Material Resources:

Visual Aids on teaching principles of after-death call.

Human Resources:

Time and effort of the nurse and the family.

Financial Resources:

Expenses for teaching aids, food, and transportation of the nurse.

31


Intervention Plan


Resources Required

Faulty Eating Habits 1. Inability to recognize the presence of the condition due to attitude in life which hinders acceptance of a problem.

2. Inability to make decisions with respect to taking appropriate action due to:

a. Conflicting opinions among family members regarding action to take

b. Negative attitude towards the health condition.

3. Inability to provide adequate nursing care to the sick, disabled, dependent or at-risk member of the family due to inadequate knowledge about child development and care.

After nursing intervention, the family will be able to understand the importance of balanced diet.


a. Understand the importance of vegetables in the body.

b. Eat vegetables regularly.

1. Discuss:

a. Food pyramidb. Importance of

balance diet

2. Ask the family to:

a. Increase vegetables intake

b. Exercise regularly

3. Devise a food plan that specifies total daily calories (³1600 kcal/day) and includes all food groups, with three meals plus a light evening snack.

Home Visit and

Clinic Visit

Material Resources:


Human Resources:




Intervention Plan

32



Resources Required

Inappropriate

Health Care

1. Inability to recognize the presence of the condition or problem due to philosophy in life which hinders acceptance of a problem.

2. Inability to make decisions with respect to taking appropriate action due to:

a. Failure to comprehend the nature of the problem.

b. Negative attitude towards the health condition.

c. Misconceptions about proposed course of action.

3. Inability to provide adequate nursing care to the sick, disabled, dependent or at-risk member of the family due to philosophy in life which hinders caring for the sick, disabled, dependent, at-risk member.

4. Failure to utilize community resources for health care due to negative philosophy in life which hinders effective or maximum utilization of community resources for health care.

After nursing intervention, the family will be able to acknowledge the importance of regular check up with health care providers.


a. Visit the health care providers for regular check up.

b. Appreciate the health center within their community.

Discuss:

a. Importance of regular check up.

b. Benefits and programs offered by the health facilities within the community.

Home Visit and

Clinic Visit

Material Resources:


Human Resources:




33

XII. Action Plans

HYPERTENSION

Time frame Problem Goals/Objectives Implementation Focus of Responsibility

Resources Evaluation

2 weeks Risk to develop severe hypertension

To maintain normal blood pressure

To monitor blood pressure and cardiac rate regularly

To educate family members about hypertension

Conduct health teaching about hypertension treatments, nature, causes, effects, and management.

Affected family member

BP Apparatus and stethoscope

After two weeks of health education and implementation, the client will be able to be compliant to the medications

34

FAULTY EATING HABITS



2 weeks Readiness for enhanced nutrition

To follow appropriate standard for intake according to the food pyramid

To be free from malnutrition or obesity

Conduct health teaching about importance of balance diet, and food pyramid.

Conduct cooking sessions with the mother to implement the intake of vegetables within the dishes that children will like.

Children Visual aids or pictures of food pyramid, malnutrition, and obesity.

Real vegetables

After two weeks of health education and implementation, the family eats balance diet meals.

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INAPPROPRIATE HEALTH CARE



2 weeks Health seeking behavior To express desire to change specific lifestyle patterns to maintain optimal health

To seek community resources with desired change

Conduct health teaching about importance of regular check up and benefits given by the health center.

Have the family to tour to the health facilities within the community.

The whole family Time and money for transportation

After two weeks of health education and implementation, the family visits the health center for regular check ups.

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XIII. Evaluation

Criteria Mark if observed Remarks

YES NO

1. The family was able to be compliant with their medications.

2. The family was able to take balance diet meals.

3. The family was able to recognize the health center and its offered programs.

4. The family practices regular check-ups.

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XIV. Recommendation

Our group came up with the following recommendations to help the family cope up

with the existing health problems, promoting proper nutrition, and maximizing the benefits

of health facilities within the community:

1. Assess their preparedness and capabilities to learn additional knowledge about health

promotion and health lifestyle of the family.

2. Educate the family about the benefits and programs offered by the health facilities

within the community.

3. Regular consultation and monitoring of the family members health status promotes

wellness.

4. Compliance with the medications and proper treatment helps the family maintain

healthy lifestyle.

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List of Appendices

Appendix A

I. Family Functional Health Patterns Assessment

A. Health Perception-Health Management Pattern 1. History

a. How has family’s general health been (in the last few years)?______________________________________________________________________________________________________________________________________________________________________________________

b. Colds in the past year? Absence from work/school due to health reasons?______________________________________________________________________________________________________________________________________________________________________________________

c. Most important thing you do to keep healthy? Do you think these make a difference to health?______________________________________________________________________________________________________________________________________________________________________________________Members’ use of cigarettes, alcohol, drugs? ______________________________________________________________________________________________________________________________________________________________________________________

d. Immunizations? Health care provider? Frequency of checkups? Accidents (home, work, school, driving)? ______________________________________________________________________________________________________________________________________________________________________________________

e. In the past, has it been easy to fins ways to follow suggestions of doctors, nurses, social workers?______________________________________________________________________________________________________________________________________________________________________________________

f. Are there things important in the family’s health that I could help with?______________________________________________________________________________________________________________________________________________________________________________________

2. Examination

a. General appearance of family members and home.______________________________________________________________________________________________________________________________________________________________________________________

b. If appropriate: Storage of medicines, location of cribs, playpens, stove, scattered rugs, presence of hazards etc. ______________________________________________________________________________________________________________________________________________________________________________________

B. Nutritional-Metabolic Health Pattern 1. History

a. Typical family meal pattern/food intake? Make a 24 hours meal pattern table.

b. Typical family fluid intake. (Describe). Supplements: types available (fruit juices, carbonated beverages, coffee, etc.)? ______________________________________________________________________________________________________________________________________________________________________________________

c. Does family have good appetite? ______________________________________________________________________________________________________________________________________________________________________________________

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d. Anyone on the family with dental problems? How often does the family visit the dentist? ______________________________________________________________________________________________________________________________________________________________________________________

e. Any skin problems/ healing problems in the family? ______________________________________________________________________________________________________________________________________________________________________________________

2. ExaminationIf opportunity available: Describe refrigerator contents, meal contents and preparation, etc. ________________________________________________________________________________________________________________________________________________________________________________

C. Elimination Pattern1. History

a. Family members’ use of laxatives or any other aids in elimination? ____________________________________________________________________________________________________________________________________________________________________________________

b. Problems in waste / garbage disposal? ____________________________________________________________________________________________________________________________________________________________________________________

c. Any pet animals at home? How are wastes disposed? (indoor/ outdoor) ____________________________________________________________________________________________________________________________________________________________________________________

d. If indicated: Any problems with flies, roaches, rodents in your house? ____________________________________________________________________________________________________________________________________________________________________________________

2. Examination If opportunity available: examine toilet facilities, garbage and pet waste disposal; Indicators of risk for flies, roaches, rodents

D. Activity-Exercise Pattern1. History

a. In general, do family get a lot/ little exercise? Type? Frequency? ____________________________________________________________________________________________________________________________________________________________________________________

b. Are there any family leisure activities? Active/ Passive? ____________________________________________________________________________________________________________________________________________________________________________________

c. Are there problems in shopping (transportation), cooking, keeping up the house, budgeting for food. Clothes, housekeeping, house cross? ____________________________________________________________________________________________________________________________________________________________________________________

2. ExaminationDescribe pattern of general home maintenance, Personal maintenance.________________________________________________________________________________________________________________________________________________________________________________

E. Sleep-Rest Pattern1. History

a. Generally family members seem to be well rested and ready for school /work? ____________________________________________________________________________________________________________________________________________________________________________________

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b. Is there sufficient space? Is it quiet or noisy? ____________________________________________________________________________________________________________________________________________________________________________________

c. Does the family find time to relax? ____________________________________________________________________________________________________________________________________________________________________________________

2. ExaminationIf appropriate: Observe sleeping space and arrangements. ________________________________________________________________________________________________________________________________________________________________________________

F. Cognitive-Perception Pattern1. History

a. Is there any member of the family with visual or hearing problem? How was it managed? ____________________________________________________________________________________________________________________________________________________________________________________

b. Any big decisions family has to make? How was it made? ____________________________________________________________________________________________________________________________________________________________________________________

2. Examinationa. If indicated: Language/ Dialect spoken at home?

____________________________________________________________________________________________________________________________________________________________________________________

b. Grasp of ideas and questions (abstract/concrete)? ____________________________________________________________________________________________________________________________________________________________________________________

c. Vocabulary Level ____________________________________________________________________________________________________________________________________________________________________________________

G. Self Perception-Self Concept Pattern1. History

a. Most of the time , do the family members feel food/ not so good about themselves as a family ____________________________________________________________________________________________________________________________________________________________________________________

b. General mood of family? Happy? Anxious? Depressed?What affects family mood? ____________________________________________________________________________________________________________________________________________________________________________________

H. Roles-Relationship Pattern1. History

a. Name of family (or household) members? Indicate age and family structure (nuclear/extended). Draw a family tree or diagram

Name Relationship to the head of the family

Age Sex Educational Attainment

41

b. Any family problems that is difficult to handle? Child rearing? If appropriate: Spouse/Parents (should be included if children are interviewed) or children ever get rough with you? ____________________________________________________________________________________________________________________________________________________________________________________

Family Assessmentc. Relationship good/not so good among family members? Sibling? Support each

other? ____________________________________________________________________________________________________________________________________________________________________________________

d. If appropriate: Is family income sufficient for needs? ____________________________________________________________________________________________________________________________________________________________________________________

e. Does the family feel apart of (or isolated from) neighbors or community? ____________________________________________________________________________________________________________________________________________________________________________________

2. Examinationa. Describe interaction among family members (if present).

____________________________________________________________________________________________________________________________________________________________________________________

b. Observe family leadership roles. ____________________________________________________________________________________________________________________________________________________________________________________

I. Sexuality-Reproductive Pattern1. History

a. If appropriate (sexual partner within household or situation): Sexual relationships satisfying? Any problem or changes? ____________________________________________________________________________________________________________________________________________________________________________________

b. Use of family planning methods? Problems? ____________________________________________________________________________________________________________________________________________________________________________________

2. Examination: None

J. Coping-Stress Tolerance Pattern1. History

a. Any big changes within the family in the last few years? ____________________________________________________________________________________________________________________________________________________________________________________

b. Family tensed or relaxed most of the time? When tense, what helps? Use of medicines, drugs, alcohol to decrease tension? ____________________________________________________________________________________________________________________________________________________________________________________

c. When family problems arise, how is it being handled? ____________________________________________________________________________________________________________________________________________________________________________________

d. Most of the time, is this way successful? ____________________________________________________________________________________________________________________________________________________________________________________


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K. Values-Beliefs Pattern1. History

a. Generally, does the family get what it wants from life? ____________________________________________________________________________________________________________________________________________________________________________________

b. Important goals for the future? ____________________________________________________________________________________________________________________________________________________________________________________

c. Any rules in the family that everyone believes important? ____________________________________________________________________________________________________________________________________________________________________________________

d. Is religion important in the family? Does this help when difficulties aries? ____________________________________________________________________________________________________________________________________________________________________________________


II. FAMILY STRENGTH AND WEAKNESSESA. Identify two family strengths and why do you say so? How can this be

mobilized to solve other family concerns/problems? ____________________________________________________________________________________________________________________________________________________________________________________

B. Identify two family weaknesses and why do you say so How can this be strengthened to help develop the family? ____________________________________________________________________________________________________________________________________________________________________________________

III. PERCEPTION ON MY FAMILY’S LEVEL OF FUNCTIONING: Instruction: For each statement listed below, indicate your answer by placing a check ( / ) on the corresponding columns marked “Almost always”, “Some of the Time” or “Hardly ever”. Then total your score for each of the five statements.

STATEMENTSALMOST ALWAYS

2PTS

SOME OF THE

TIME 1PT

HARDLY EVER 0PT

1. I am satisfied with the help that I receive from my family when something is troubling me

2. I am satisfied with the way my family discusses topics of common interest and shares problems solving with me.

3. I find that my family accepts my wishes to take on new activities or make changes in my lifestyle.

4. I am satisfied with the way my family expresses affection and responds to my feelings of anger, sorrow and love.

5. I am satisfied with the amount of time my family and I spend together.

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TOTAL SCORE: 10 points

Appendix B

Scale for Ranking Health Conditions and

Problems According to Priorities

Criteria Weight

1. Nature of the condition or problem presented

1

Scal

e

Wellness State 3

Health Deficit 3

Health Threat 2

Foreseeable Crisis 1

2. Modifiability of the condition of problem

2

Scal

e

Easily Modifiable 2

Partially Modifiable 1

Not Modifiable 0

3. Preventive Potential

1

Scal

e

High 3

Low 2

Moderate 1

4. Salience

1

Scal

e

A condition or problem needing immediate attention 2

A condition or problem not needing immediate attention 1

Not perceived as a problem or condition needing change 0

44

45

Appendix C

Manila Doctors CollegeCollege of Nursing

COMMUNITY HEALTH SURVEY TOOLControl No:

Head of the Family (HF) (Kinikilalang puno ng pamilya): Date:

I. DEMOGRAPHIC INDICESA. Family Information

Complete Address (tirahan): Type of Family (uri ng pamilya): ( ) Nuclear ( ) ExtendedLength of Residency (tagal ng paninirahan sa lugar): No. of Families in the House (bilang ng pamilya sa nasabing bahay):Ethnic Background (etnikong grupo na kinabibilangan): Type of Family according to authority: ( ) Patriarchal ( ) MatriarchalPrimary Dialect Spoken (pangunahing salitang ginagamit): ( ) EgalitarianPlace of Origin (rehiyong pinanggalingan):

No. Name of Family Members(pangalan ng miyembro ng

pamilya)

Sex(kasarian)

Age(Edad)

Birth Date(araw ng

kapanganakan)Month/Day/Year

Birth Place(lugar ng

kapanganakan)

Civil Status(Estadong

Sibil)

Religion(relihiyon)

Relationship to HF (relasyon sa puno

ng pamilya)

Ethnic Background: Igorot, Negrito, Kalinga, Mangyan, Maranaw, Manobo, Badjao, Matigsalug, Tasaday, Tausug, etc.Civil Status: S (single) M (married) W (widowed) Sep (separated) CL (common law)Relationship to HF: Wife (W) Husband (H) Son (S) Daughter (D) Mother (M) Father (F) Grandfather (GF)

Grandmother (GM) Sister (Sis) Brother (Bro) Uncle (Un) Auntie (Au) Others (specify)

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B. OCCUPATION (15y/o and above but may include working individual below 15)

Name of Family Members (pangalan ng miyembro ng pamilya)

Age (edad)

Occupation Estimated Monthly Income

Unemployed Employed Self- Employed

Nature of Occupation Place of Work

Private Government

C. EDUCATION (7 y/o and above)

Name Age No Formal Education

Elementary Level High School Level College Level Others (Please Specify)Out of

SchoolStill

StudyingUnder-

graduateGraduate Out of

SchoolStill

StudyingUnder-

graduateGraduate Out of

SchoolStill

StudyingUnder-

graduateGraduate

Out of school: if a person whose age is proper for an educational level, but nit currently enrolled in the same level.Undergraduate: a person who did not finish an educational level and his/her age is no longer appropriate to the same level.Age Brackets Per Level Elementary – 7-12 y/o, High School – 13-17 y/o, College – 18-23y/o.

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1.) Source of income Primary Source: Other sources of income or livelihood (iba pang pinagkukuhaan ng kabuhayan)You can check more than one.( ) Sari-sari store ( ) Livestock ( ) Farming( ) Craft making ( )Public utility ( )Fishing( ) Others, pls. specify:

2.) Average family income (buwanang kita ng pamilya)

IncomeP 1,000 and belowP 1,001 – 5,000P 5,001 – 10,000P 10,001 – 15,000P 15,001 – 20,000P 20,001 – 25,000P 25,001 – 30,000P 30,001 – 35,000P 35,001 and Above

3.) Monthly family expenditure (buwanang gastusin ng pamilya)

ExpenditureP 1,000 and belowP 1,001 – 5,000P 5,001 – 10,000P 10,001 – 15,000P 15,001 – 20,000P 20,001 – 25,000P 25,001 – 30,000P 30,001 – 35,000

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4.) First 5 priorities for expenditure. Rank 1 to 5, 1 as the highest and 5 as the least priority.

Food (pagkain) House rental (upa sa bahay)

Health (kalusugan) Education (edukasyon)

Clothing (damit) Housebills (bayad sa kuryente, tubig, etc)

Others, pls. specify:

5.) Land and House ownership

a.) Land ownership (pagmamay-ari ng lupang tinitirahan)( ) Owned ( ) Rented ( ) Rent to own ( ) Rent

Free( ) Others, pls. specify:

b.) House ownership (pagmamay-ari ng bahay na tinitirahan)( ) Owned ( ) Rented ( ) Rent to own ( ) Rent

Free( ) Others, pls. specify:

6.) Type of materials used for building the house (yari ng bahay)( ) Light ( ) Concrete ( ) Mixed

7.) House Ventilation( ) Well ventilated ( ) Fair ( ) Poorly ventilated

8.) Source of Light( ) Electricity ( ) Kerosene ( ) Candle( ) Others, pls. specify:

P 35,001 and AboveII. ENVIRONMENTAL INDICES

A. WATER SUPPLY1. Source of drinking water (pinagmumulan ng inuming tubig)

( ) Level I- Point source (without distribution system- protected well, developed spring)

( ) Level II- Faucet system (piped and communal faucet)( ) Level III- Individual household connection( ) Commercially prepared( ) Others, pls. specify:

2. Storage of drinking water (paraan ng pag-iimbak)( ) Covered ( ) Uncovered

3. Method used in water treatment (paraang ginagamit upang mapanatiling malinis ang inuming tubig)( ) None ( ) Boiling ( ) Sedimentation ( ) Chlorination( ) Filtration ( ) Processed (multi- stages)( ) others, pls. specify:

B. WASTE DIPOSAL1.) Excreta

a. Type of toilet (uri ng palikuran)( ) No toilet ( ) Open pit privy ( ) Closed/

Covered pit privy( ) Water-sealed ( ) Flush ( ) others, pls. specify:

b. Ownership of toilet (pagmamay-ari ng palikuran)( ) Private (sariling palikuran) ( ) Public (gamit pambayan( ) Shared (may ibang pamilyang gumagamit) ( ) N/A(no toilet)

2.) Seweragea. Sewerage system

( ) Blind drainage ( ) Open drainage ( ) none

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3. Garbagea. Waste Segregation ( ) Yes ( ) No ( ) Sometimesb. Container used for garbage collection (pinaglalagyan ng iniipong basura)( ) none ( ) Garbage bag ( ) Sack ( ) Trash can/pail)( ) others, pls. specify: c. Condition of garbage container? (kalagayan ng lalagyan ng basura)( ) Covered ( ) Uncoveredd. Types of disposal ( ) collected ( ) open dumping ( ) burning

( ) composting ( ) throw in river/canals( ) others, pls. specify:

C. ANIMALS AND PESTSa. Domestic animals

Kind (uri ng alagang hayop)

Number (bilang)

Vaccination Status

With (meron)

W/o(wala)

Chained/ Caged/ Penned

Astray Either

DogsCats

Others, pls. Specify:

b. Presence of vectors, rodents and other pests( ) mosquitoes ( ) roaches ( ) termites ( ) flies ( ) rodents( ) others, pls. specify: c. Ways to control

Breeding place of: Ways to control EffectiveYes No

MosquitoesRoachesTermites

FliesRodents

Others (specify):

b. Condition of sewerage (kalagayan ng tubig)( ) Free-flowing ( ) Stagnant ( ) N/A (blind drainage)

III. HEALTH INDICES

A. Morbidity (past 6mos.)Illness Age Sex Treatment

Acute lower RTI andPneumonia With WithoutAcute DiarrheaInfluenzaHypertensionTB RespiratoryParasitismChickenpoxDiseases of the HeartMalariaDengue FeverUTIScabiesDMOthers, pls. specify:

B. Mortality (past 5 years)1.) Infant Mortality (0-1 year)

Illness Age in months

Treatment

Neonatal sepsis With WithoutPneumoniaCongenital malformations of the heartDisorders related to short gestation and low birth weightIntrauterine hypoxia and birth asphyxiaDiarrhea

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2.) Maternal Mortality(Related to pregnancy, labor, delivery Puerperium)

Cause of Death Age InterventionWith Without

ComplicationsHypertensionHemorrhagePregnancy with abortive outcomeOthers, pls. specify:

3.) Other Mortality

Cause of Death Age Sex InterventionsWith Without

Heart DiseaseVascular System DiseasesMalignant Neoplasm(Ca)PneumoniaTuberculosis, all formsChronic lower respiratory diseasesDiabetes MellitusAcute Peptic UlcerOthers, pls. Specify:

Others, pls. specify:

C. For women of reproductive age (15-45 y/o)1.) Previous pregnancy (Last 3 pregnancies, if applicable)

No. With iron supplement

If no, why? TT immunization

If, no why? Prenatal check up of at least 3x

If no, why?

Yes No Yes No Yes No1st

2nd

3rd

2.) Previous deliveries (Last 3 deliveries, if applicable)

No. Doctor Nurse Midwife Traditional Birth Attendant

Others, specify Reason for choosing the person to handle

delivery

Post Partum visits Why?

P G P G P G Yes No1st

2nd

3rdLegend: P-Private G-Government

3.) Present Pregnancy

Name Obstetric Score

LMP AOG EDD/EDC

Prenatal Check-up Tetanus Toxoid Reason for absence or Incomplete TT

immunization

With iron suppleme

nt

If no, why?

G T 1st 2nd 3rd 1 2 3 4 5 Yes No

P P

A

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L

Legend: G-Gravida P-Parity (T-full term delivery; P-preterm delivery; A-abortion/miscarriage; L-living)

D. For Children

1) Immunizatio (0-8years)

NameBirth date BCG OPV DPT HEPA B MEASLES STATUS STATUS

1 2 3 1 2 3 1 2 3 (0-1) ↑1 YEAR

FICNOT FIC Complete Incomplete

2.) Feeding(0-2 years)

Name age Exclusives Complementary

Reasons for not BF until 6 mos. Age of Bottle Feeding Other food given aside from milk

BF until BF until 6 mos & weaning Formula Milk other

s 6 mos. 1 day-2yrs Yes No Yes No

3.)Nutritional Status (0-72 mos.)

Name Birthday Age in months Date of weighing weight in kilogram Nutritional Status( N,A, B)

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Nutritional Status: N: Normal A: Above Normal B:Below Normal

E. For Married Couples Of Reproductive Age

1) Practice Family Planning (FP) ( ) Yes ( ) No ( ) Sometimes

2) If yes, for how long?

3) If no, why?

4) If sometimes, reason for not consistently using FP

5) Family Planning Methods

Natural AwareNot

aware Utilized Artificial AwareNot

aware Utilized Permanent awareNot

aware Utilized Willingness What topic

to learn more about FP methodsBasal Body Condom Vasectomy Yes No

Temp IUD Tubal Ligation

Calendar Injectible hormonal Cervical contraceptives mucous Pills Lactational Amenorrhea Others, Others, Others,

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F. Other Practices Related to Health

1) Food

a) Food Frequently eaten ( Pagkaing madalas kinakain)( )Fish ( )Vegetable ( )Pork ( )Beef ( )junk food( )canned or processed food Others, pls. specify:

b) Usual food preparation (pinakamadals na paraan ng pagluto)( )Boiled ( )Fried ( )Broiled ( )Steamed( )Raw ( )Others, pls. specify:

2) Smoker/s Alcoholic drinker/Prohibited drug usera) Prohibited drug user (Kapamilya na gumagamit ng pinagbabawal na gamot)

( )Yes ( )Nob) Smoker/s(kapamilya na naninigarilyo) ( )Yes ( )Noc) Alcoholic Drinker (kapamilya na umiinum ng alak) ( )Yes ( )No

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Date post:	04-Mar-2015
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