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Page
2012
I. INTRODUCTION
A. OVERVIEW
Community refers to a group of people who interact with each other; it is a
social group determined by geographic boundaries, common values and interest. It
functions within a social structure, exhibits and creates norms, values, and social
institution. (Microsoft ® Encarta, 2009)
In Community health nursing, one of the two major fields of nursing in the
Philippines, nursing practice in the community means different things to different
nurses. Its primary goal is the promotion and preservation of health of its client that
could be in the individual, family, population, group and community. In community
health nursing practice includes nursing directed to individuals, families, groups; the
dominant responsibility is the population as a whole. With these, the health of the
people is a reflection of the communities of which they live, play, work and learn.
Communities shape the lifestyle that people adopt and their livelihood of living safe,
fulfilling and productive lives.
Family, basic social group united through bonds of kinship or marriage,
present in all communities. Ideally, the family provides its members with protection,
companionship, security, and socialization. The structure of the family, and the
needs that the family fulfills vary from society to society. The nuclear family—two
adults and their children—is the main unit in some societies. In others, it is a
subordinate part of an extended family, which also consists of grandparents and
other relatives. In a community, the family is considered to be its basic unit.
(Microsoft ® Encarta, 2009)
Our community experience has been founded on the above principle. This
exposure did not only provide an avenue to apply what we have acquired in the
classroom but also provided an opportunity to serve our fellowmen. Because being
in the community is more than meeting the requirements in the Related Learning
Experience (RLE), it is being experience the real world, making real memories and
rendering service with competence, conscience, commitment and care.
This paper presents a case of a nuclear family of five (5) members at The
Tent City, Calaanan, Cagayan de Oro City. As a community health student nurse
assigned in the area, I was given a chance to care for a certain family. After initial
survey of the place, I came across to the XX family.
The objective of the study is to smooth the progress of putting into practice
the concept of family-oriented nursing care and make certain an organized
approach in the delivery of the nursing services to the families in the community,
purposely in the application of the nursing process. It aims to identify the health
problem of a family within the community. As student nurse, I could give and apply
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2012
some nursing interventions that are applicable and attainable within the community
health services.
At the end of two (4) weeks of Community Health Exposure, I will be able to
provide to the XX family nursing interventions to the identified health problems
affecting the family. The health programs of the Department of Health (DOH) for the
promotion of health and prevention of illnesses and the improvement of the
conditions in the social and physical environment will also be imparted to the
family, and also to participate with the family in the over-all health plan affecting
the family, in its implementation and evaluation.
B. SCOPE AND LIMITATION OF THE STUDY
This Family Health Care Study provides information and additional knowledge
about health to the family concerned. The student is focusing only on the XX family,
on their health promotion, prevention of illness and possible ways of alleviating
health problems.
The student also rendered health teachings according to our knowledge of
health care concepts as well as through the culminating and microteaching last
March 01, 2012. The student also emphasized DOH programs offered by the
Department of Health and the services they offered at Barangay Health Centers.
Family care study covers only four (4) weeks of Community Health Nursing. This is
also limited to the family's capabilities and willingness to participate and cooperate
with the nursing interventions.
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2012
II. SPOT MAP
A. NARRATIVE DESCRIPTION
Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City, Misamis
Oriental is located Southwest and 7.5 kilometers away from Cagayan de Oro City
proper. Our reference point is from Liceo de Cagayan University-main campus to
Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City. From here the
students have to charter a jeepney to transport the group to and from with the fare
of 43 pesos. From the school, the jeepney should turn right on the intersection
going to Patag, passing through the SSS building, GSIS building, Highschool
Department, National Grid of the Philippines. The jeepney will then turn left with the
House of Bulalo as the landmark then going to the Villarin street passing through
the establishments of Department of Telecommunication and National Irrigational
Administration, straight passing the St. Mary’s Academy and Mt. Carmel Church.
Then turn left from the intersection between Macanhan and Upper Carmen passing
Immanuel Mission School and Landfill Zayas, Upper Carmen going downward
passing the Silver Creek Subdivision and St. Therese Chapel. Upon arriving on the
Canitoan Road, the jeepney must turn left to P.N Roa area, going straight passing to
the P.N Roa Elementary school then finally to the Tent City. The Tent were
numbered and arranged by five, the tent of our family is # 273.
B. ALTERNATIVE ROUTE
One may ride a jeepney going to Cogon Market where you will stop near
Petron Gasoline Station facing south you will go then to the street leading to
National Bookstore. At the back of the National Bookstore is where you will the find
the jeepney going to the P.N Roa including Calaanan. Upon riding on that jeepney,
you can pass by the Rotonda circle and Upper Carmen passing Immanuel Mission
School and Landfill Zayas, Upper Carmen going downward passing the Silver Creek
Subdivision and St. Therese Chapel. Upon arriving on the Canitoan Road, turn left to
P.N Roa area, going straight passing to the P.N Roa Elementary school then finally
the Tent City.The Tent were numbered and arranged by five, the tent of our family
is # 273.
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2012
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C. ILLUSTRATION/DIAGRAM OF THE MAP
Spot Map of The Tent City, Calaanan Relocation Site, Canitoan, Cagayan de Oro City, Misamis Oriental
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III. FAMILY PROFILE
Client’s Name: Mr. XX
Position in the Family: Head
Gender: Male
Age: 27 years old
Civil Status: Married
Birth date: April 08, 1984
Birth place: Punong, Gingoog City
Citizenship: Filipino
Religion: Roman Catholic
Occupation: Motor- rela driver
Monthly income: P 1,500.00
Client’s Name: Mrs. XX
Position in the Family: Wife
Gender: Female
Age: 22 years old
Civil Status: Married
Birth date: May 14, 1989
Birth place: Punong, Gingoog City
Citizenship: Filipino
Religion: Roman Catholic
Occupation: Housewife
Monthly income: None
NO PICTURE TAKEN
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Client’s Name: XX1
Position in the Family: 1st Child
Gender: Female
Age: 4 years old
Civil Status: Child
Birth date: January 23, 2008
Birth place: Northern Mindanao
Medical Center, CDOC
Citizenship: Filipino
Religion: Roman Catholic
Client’s Name: XX2
Position in the Family: 2nd Child
Gender: Female
Age: 2 years old
Civil Status: Child
Birth date: May 07, 2009
Birth place: Northern Mindanao
Medical Center, CDOC
Citizenship: Filipino
Religion: Roman Catholic
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Client’s Name: XX3
Position in the Family: 3rd Child
Gender: Male
Age: 1 year old
Civil Status: Child
Birth date: October 26, 2010
Birth place: Northern Mindanao
Medical Center, CDOC
Citizenship: Filipino
Religion: Roman Catholic
IV. FAMILY HEALTH HISTORY
1. Client Mr. XX
Mr. XX is 27 years of age, and is presently residing with his whole family now
at the Tent City, Calaanan Relocation Site, CDO; Tent No. 273. He had common
colds and cough last month and doesn’t have any chronic illness as claimed. He was
fully immunized during his childhood days since his mother was a BHW in their
place. Last 2005, he suffered from Urinary Tract Infection thus consulted and
admitted at NMMC which lasted for 5 days. He had heredofamilial diseases of
asthma, diabetes mellitus II and hypertension. No known food and drug allergy.
2. Client Mrs. XX
Mrs. XX is 22 years of age, a housewife. She had her first menstruation at the
age of 12 years old and had a regular monthly period. She was immunized
completely during childhood. She claimed that she was positive for Hepatitis B when
she was carrying her 2nd child on her womb (4 years ago) after a blood test was
performed. She was in denial at that time, she did request another test but the
result was still the same. She had no idea where she got the dreadful disease. She
knows how the disease was transmitted. Now she’s in a stage of acceptance as she
claimed.
She has no known food and drug allergy and don’t have any history of
diseases in their family line. She delivered her children through normal spontaneous
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vaginal delivery at Northern Mindanao Medical Center. She had her prenatal check-
up at same institution. So far she had no complications experienced for her past
pregnancy.
Gynecology History
Menarche at 12 y.o. regular subsequent menses, 5 days (-) dysmenorrhea
Obstetric History
G1- (January 23, 2008) XX1- NSVD, NMMC
G2- (May 07, 2009) XX2- NSVD, NMMC
G3- (October 26, 2010) XX3- NSVD, NMMC
Hospital Confinement
UTI admitted at NMMC for 4 days (2008)
3. Client XX1
Client XX1, a 4 year old female child, was delivered through normal
spontaneous vaginal delivery at Northern Mindanao Medical Center. She was fully
immunized. The child was hospitalized when she was about 6 months old at NMMC
for a week due to Acute Gastroenteritis with Moderate Dehydration.
4. Client XX2
Client XX2, a 2 year old female child, was delivered through normal
spontaneous vaginal delivery at Northern Mindanao Medical Center. She was fully
immunized. Like her older sister, she was hospitalized when she was about 6
months old at NMMC for 4 days due to Acute Gastroenteritis with Moderate
Dehydration.
5. Client XX3
Client XX3, a 1 year old male child, was delivered through normal
spontaneous vaginal delivery at Northern Mindanao Medical Center. He was fully
immunized now. Like his older sisters, again he was hospitalized when he was about
6 months old at NMMC for just 4 hours for hydration purposes due to severe
dehydration. Their mother did say that her children experienced the same disease
when they were about 6 months old. Coincidence?
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V. PRESENT HEALTH STATUS
A.
1. Client Mr. XX
Mr. XX claimed that he doesn’t have any illnesses at the moment. His cough
and colds subsided a month ago. He works as a motor-rela driver. No history of
drinking alcoholic beverages and non-smoker. Vital signs was taken last February
02, 2012 with a Pulse: 88 bpm RR: 21cpm BP: 130/80 mmHg Temp: 36.2 o C.
2. Client Mrs. XX
Mrs. XX claimed that he doesn’t have any illnesses but do have troubled
sleeping at night when they transferred at their tent. She’s a housewife and always
taking care of their young ones, making sure that they’re safe and sound. No history
of drinking alcoholic beverages and non-smoker as claimed. Vital signs was taken
last January 20, 2012 with a Pulse: 78 bpm RR: 23cpm BP: 110/80 mmHg
Temp: 36.5
3. Client XX1
During assessment, cough and colds with whitish sputum was noted with
client XX1. Her mother said that her cough and colds was intermittent for the past 4
weeks. The child does take Vitamin C and Multivitamins given by the clinic for free
after consultation. Vital signs: Pulse: 97 bpm RR: 25cpm BP: no pedia cuff avail,
Temp: 36.3 0 C
4. Client XX2
No illness was noted with client XX2. She’s playful, energetic and cheerful
during the course of assessment. The child also takes Vitamin C and Multivitamins.
Vital signs: Pulse: 89 bpm RR: 23cpm BP: no pedia cuff avail. Temp:
36.3 o C
5. Client XX3
Cough and colds with whitish sputum was noted with client XX3 with no
respiratory distress, just like her eldest sister. The mother said that his cough and
colds was intermittent for the past 2 weeks and was given Vitamin C and
Multivitamins after consulting the clinic. Vital signs: Pulse: 94 bpm RR: 24cpm
BP: no pedia cuff avail. Temp: 36.2 o C
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B. NURSING ASSESSMENT (SYSTEM REWIEW CHART)
LEGEND:
EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality √ no problemRESP.𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales 𓀿 cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort √ no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort √ no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problemGENITO-URINARY and GYNE
𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding 𓀿 hematuria 𓀿 discharge 𓀿 nocturia
Assess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge √ no problemNEURO
𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures 𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors 𓀿 confused 𓀿 vision 𓀿 grip
Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ no problemMUSCULOSKELETAL and SKIN
𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae 𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling 𓀿 lesion 𓀿 poor turgor 𓀿 cool 𓀿 deformity 𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed 𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic 𓀿 moist
Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity √ no problem
-slightly elevated blood pressure of 130/80 mmHg-dirty fingernails
-dirty toenails
Name: XX, Mr. XX Date: February 02, 2012Vital Signs:Pulse: 88 bpm BP: 130/80 mmHg Temp: 36.2 o C Height: 5’5’’ Weight: 77 kg
Place an (√) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (√)
1ST WEEK
2ND WEEK
3RD WEEK
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LEGEND:
EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality √ no problemRESP.𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales 𓀿 cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort √ no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort √ no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problemGENITO-URINARY and GYNE
𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding 𓀿 hematuria 𓀿 discharge 𓀿 nocturia
Assess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge √ no problemNEURO
𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures 𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors 𓀿 confused 𓀿 vision 𓀿 grip
Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ no problemMUSCULOSKELETAL and SKIN
𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae 𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling 𓀿 lesion 𓀿 poor turgor 𓀿 cool 𓀿 deformity 𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed 𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic 𓀿 moist
Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity √ no problem
-pale in appearance
-difficulty sleeping-(+) Hep. B
Name: XX, Mrs. XX Date: January 20, 2012Vital Signs:Pulse: 78 bpm BP: 110/80 mmHg Temp: 36.5 o C Height: 5’2’’ Weight: 58 kg
Place an (√) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (√)
4TH WEEK
1ST WEEK
2ND WEEK 4TH WEEK
3RD WEEK
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LEGEND:
EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality √ no problemRESP.𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales 𓀿 cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort √ no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort √ no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problemGENITO-URINARY and GYNE
𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding 𓀿 hematuria 𓀿 discharge 𓀿 nocturia
Assess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge √ no problemNEURO
𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures 𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors 𓀿 confused 𓀿 vision 𓀿 grip
Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ no problemMUSCULOSKELETAL and SKIN
𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae 𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling 𓀿 lesion 𓀿 poor turgor 𓀿 cool 𓀿 deformity 𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed 𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic 𓀿 moist
Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity √ no problem
- tooth decay all throughout the assessment
-cough and colds with whitish sputum in minimal amount
- Moderate personal hygiene
- Dirty nails
Name: XX, XX1 Date: January 26, 2012Vital Signs:Pulse: 97 bpm BP: no pedia cuff avail, Temp: 36.3 o C Height: 103 cm Weight: 13.2 kg
Place an (√) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (√)
1ST WEEK
2ND WEEK 4TH WEEK
3RD WEEK
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LEGEND:
EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality √ no problemRESP.𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales 𓀿 cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort √ no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort √ no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problemGENITO-URINARY and GYNE
𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding 𓀿 hematuria 𓀿 discharge 𓀿 nocturia
Assess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge √ no problemNEURO
𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures 𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors 𓀿 confused 𓀿 vision 𓀿 grip
Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ no problemMUSCULOSKELETAL and SKIN
𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae 𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling 𓀿 lesion 𓀿 poor turgor 𓀿 cool 𓀿 deformity 𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed 𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic 𓀿 moist
Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity √ no problem
-tooth decay all throughout the assessment
-moderate personal hygiene -dirty fingernails
Name: XX, XX2 Date: January 26, 2012Vital Signs:Pulse: 89 bpm BP: no pedia cuff avail. Temp: 36.3 o C Height: 97cm Weight: 14 kg
Place an (√) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (√)
1ST WEEK
2ND WEEK 4TH WEEK
3RD WEEK
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LEGEND:
EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality √ no problemRESP.𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales 𓀿 cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort √ no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort √ no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problemGENITO-URINARY and GYNE
𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding 𓀿 hematuria 𓀿 discharge 𓀿 nocturia
Assess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge √ no problemNEURO
𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures 𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors 𓀿 confused 𓀿 vision 𓀿 grip
Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ no problemMUSCULOSKELETAL and SKIN
𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae 𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling 𓀿 lesion 𓀿 poor turgor 𓀿 cool 𓀿 deformity 𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed 𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic 𓀿 moist
Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity √ no problem
-cough and colds with whitish sputum in minimal amount
-moderate personal hygiene-dirty fingernails
Name: XX, XX3 Date: January 26, 2012Vital Signs:Pulse: 94 bpm BP: no pedia cuff avail. Temp: 36.2 o C Height: 79cm Weight: 49 kg
Place an (√) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (√)
1ST WEEK
2ND WEEK 4TH WEEK
3RD WEEK
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VI. INTERGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Date: January 26, 2012
Child’s name: XX3 Age: 1 year old Sex: Male Weight: 9.5 kg Temp:
36.2˚C
ASK: What are the child’s problem? Cough and colds all throughout the
assessment (WEEK 2-WEEK4)
Initial visit and Follow-up Visit
ASSESS CLASSIFY
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING
CONVULSIONS
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
YES___
NO_√_
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes_√_ No___
For how long?
Count the breaths for one minute. _26_breaths per minute. Fast breathing?
Look for chest indrawing? Look and listen for stridor.
No Pneumonia: Cough and Cold
DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_
For how long? ___days
Is there blood in the stools?
Look at the child’s general condition. Abnormally sleepy or difficult to awaken?
Restless or irritable?
Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink poorly?
Drinking eagerly, thirsty?
Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)?
Slowly?
No Dehydrati
on
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes__ No_√__
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Decide Malaria Risk
Does the child live in malaria area? No Has the child visited a malaria area in the past 4 weeks? NoIf malaria risk, obtain a blood smear.
Look or feel for stiff neck. Look for runny nose. + Pf Pv - Not done
For how long has the child had fever? __days If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months?Look for signs of MEASLES
Generalized rash and One of these: cough, runny nose. Or red eyes.
………………………………………………………………………………………………………………………….
If the child has measles now or within the last 3 months:
Look for mouth ulcers If yes, are they deep and extensive?
Look for pus draining from the eye Look for clouding of the cornea.
………………………………………………………………………………………………………………………….
Decide Dengue Risk:
Yes__ N o__√_
If dengue risk, then ask:
Has the child had any bleeding form the nose or gums or in the vomitus or stools? No
Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other
signs and has fever for more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM?
Yes___ No__√_
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Is there ear pain? No Is there ear discharge? No
If yes, for how long? ___days
Look for pus draining from the ear. None Feel for tender swelling behind the ear. None
No Ear Infection
THEN CHECK FOR MALNUTRITION AND ANEMIA
Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? None
Determine weight for age Very Low? Low.
No Anemia and low weight
CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today
_√__ _√__ __√_ __√__
BCG DPT1 OPV1 HEPB1
__√__ _√__ __√_ ____√___
DPT2 OPV2 HEPB2 MEASLES
_√___ __√__ __√___
DPT3 OPV3 HEPB3
Return for next
immunization on:
(date)
CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older
Is the child six months of age or older? Yes_√_ NO___
Has the child received Vitamin A in the past six months? Yes_√___ No___
Vitamin A needed today
Yes___ No_√__
ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old.
Do you breastfeed your child? Yes__ No__√__If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a __
Does the child take any other food or fluids? Yes_√__ No___If Yes, what food or fluids? _Bear brand milk, fruits, noodles, canned goods, rice
How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_
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If very low weight for age: How large are servings?___child is within normal weight___
Does the child receive his/her own serving? yes __ Who feeds the child and how?_mother, spoonfeeding; child feeds on his own most of the time
During the illness, has the child’s feeding changed? Yes _√__ No___If yes, how? Fair appetite
ASSESS OTHER PROBLEMS: Moderate personal hygiene
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Date: January 26, 2012
Child’s name: XX2 Age: 2yrs Sex: Female Weight: 14 kg Temp: 36.3˚C
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ASK: What are the child’s problem? None all though out the assessment
(WEEK 2- WEEK 4)
Initial visit and Follow-up visit
ASSESS CLASSIFY
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING
CONVULSIONS
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
YES___
NO_√_
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No_√__
For how long?
Count the breaths for one minute. _24_breaths per minute. Fast breathing?
Look for chest indrawing? Look and listen for stridor.
No Pneumoni
a
DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_
For how long? ___days
Is there blood in the stools?
Look at the child’s general condition. Abnormally sleepy or difficult to awaken?
Restless or irritable?
Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink poorly?
Drinking eagerly, thirsty?
Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)?
Slowly?
No Dehydrati
on
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes__ No_√__
Decide Malaria Risk
Does the child live in malaria area? No Has the child visited a malaria area in the past 4 weeks? NoIf malaria risk, obtain a blood smear.
Look or feel for stiff neck. Look for runny nose. + Pf Pv - Not done
For how long has the child had fever? __days
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If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months?Look for signs of MEASLES
Generalized rash and One of these: cough, runny nose. Or red eyes.
………………………………………………………………………………………………………………………….
If the child has measles now or within the last 3 months:
Look for mouth ulcers If yes, are they deep and extensive?
Look for pus draining from the eye Look for clouding of the cornea.
………………………………………………………………………………………………………………………….
Decide Dengue Risk: Yes__ N o__√_
If dengue risk, then ask:
Has the child had any bleeding form the nose or gums or in the vomitus or stools? No
Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other
signs and has fever for more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM?
Yes___ No__√_
Is there ear pain? No Is there ear discharge? No
If yes, for how long? ___days
Look for pus draining from the ear. None Feel for tender swelling behind the ear. None
No Ear Infection
THEN CHECK FOR MALNUTRITION AND ANEMIA
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Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? None
Determine weight for age Very Low? Low.
No Anemia and low weight
CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today
_√__ _√__ __√_ __√__
BCG DPT1 OPV1 HEPB1
__√__ _√__ __√_ ____√___
DPT2 OPV2 HEPB2 MEASLES
_√___ __√__ __√___
DPT3 OPV3 HEPB3
Return for next
immunization on:
(date)
CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older
Is the child six months of age or older? Yes_√_ NO___
Has the child received Vitamin A in the past six months? Yes_√___ No___
Vitamin A needed today
Yes___ No_√__
ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old.
Do you breastfeed your child? Yes_ _ No__√__If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a
Does the child take any other food or fluids? Yes_√__ No___If Yes, what food or fluids? _noodles, milk, fruits, rice and canned goods
How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_
If very low weight for age: How large are servings?_ n/a _____
Does the child receive his/her own serving? yes __ Who feeds the child and how?_child herself, spoonfeeding
During the illness, has the child’s feeding changed? Yes _√__ No___If yes, how? Fair appetite
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ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Date: January 26, 2012
Child’s name: XX1 Age: 4yrs Sex: Female Weight: 13.2 kg Temp:
36.7˚C
ASK: What are the child’s problem? Cough and colds all throughout the
assessment (WEEK 2-WEEK4)
Initial visit and Follow-up visit
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ASSESS CLASSIFY
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING
CONVULSIONS
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
YES___
NO_√_
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No_√__
For how long?
Count the breaths for one minute. _25_breaths per minute. Fast breathing?
Look for chest indrawing? Look and listen for stridor.
No Pneumonia: Cough and Cold
DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_
For how long? ___days
Is there blood in the stools?
Look at the child’s general condition. Abnormally sleepy or difficult to awaken?
Restless or irritable?
Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink poorly?
Drinking eagerly, thirsty?
Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)?
Slowly?
No Dehydrati
on
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes__ No_√__
Decide Malaria Risk
Does the child live in malaria area? No Has the child visited a malaria area in the past 4 weeks? NoIf malaria risk, obtain a blood smear.
Look or feel for stiff neck. Look for runny nose. + Pf Pv - Not done
For how long has the child had fever? __days If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months?Look for signs of MEASLES
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Generalized rash and One of these: cough, runny nose. Or red eyes.
………………………………………………………………………………………………………………………….
If the child has measles now or within the last 3 months:
Look for mouth ulcers If yes, are they deep and extensive?
Look for pus draining from the eye Look for clouding of the cornea.
………………………………………………………………………………………………………………………….
Decide Dengue Risk: Yes__ N o__√_
If dengue risk, then ask:
Has the child had any bleeding form the nose or gums or in the vomitus or stools? No
Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other
signs and has fever for more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM?
Yes___ No__√_
Is there ear pain? No Is there ear discharge? No
If yes, for how long? ___days
Look for pus draining from the ear. None Feel for tender swelling behind the ear. None
No Ear Infection
THEN CHECK FOR MALNUTRITION AND ANEMIA
Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor.
No Anemia and low
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Severe palmar pallor? Some palmar pallor? None
Determine weight for age Very Low? Low.
weight
CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today
_√__ _√__ __√_ __√__
BCG DPT1 OPV1 HEPB1
__√__ _√__ __√_ ____√___
DPT2 OPV2 HEPB2 MEASLES
_√___ __√__ __√___
DPT3 OPV3 HEPB3
Return for next
immunization on:
(date)
CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older
Is the child six months of age or older? Yes_√_ NO___
Has the child received Vitamin A in the past six months? Yes_√___ No___
Vitamin A needed today
Yes___ No_√__
ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old.
Do you breastfeed your child? Yes_ _ No__√__If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a
Does the child take any other food or fluids? Yes_√__ No___If Yes, what food or fluids? _noodles, fruits, rice and canned goods_
How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_
If very low weight for age: How large are servings?_ n/a
Does the child receive his/her own serving? yes __ Who feeds the child and how?_the child herself, spoonfeeding
During the illness, has the child’s feeding changed? Yes _√__ No___If yes, how? Fair appetite
ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene
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VII. HOME AND ENVIRONMENT
1. Housing
All families who were victims of the typhoon Sendong, including family XX
were sent at Calaan Relocation Site, Canitoan, Cagayan de Oro City
(known as the Tent City) and were also given a tent (known as the
Shelter box) by the
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government where they will temporarily reside. The family was on Tent
No. 273.
The whole covering (doors, flooring, and small windows) of the Tent is
made up of polyester cloth which is a specialized kind of cloth that can
stand heat and rain, and can’t be easily tear or damage. They were given
a special mat additional for their flooring inside the tent. Two doors, the
back and front have a pair of zippers used to lock their houses when
they’re not around. Windows are widely open at night time. The family
said that when its day to noontime (around 9am-3pm) it’s totally hot
inside the tent, and very cold at nighttime to dawn (around 10pm-5am).
Inside the tent, at the center of it is where their little sala is seen, and the
left and right compartments serve as the rooms where they usually sleep,
change clothes and for the privacy of the couple.
Clothes hanging inside are noticeable also (resting sites of vectors of
diseases such as mosquitoes).
Uses no electricity for their lighting facilities and other electrical devices (
cell phone charger, electric flashlight, electric fan, radio)
Has proper ventilation when the doors and windows are widely open
2. Water supply
Water comes from the
common source where they
usually have to walk and fetch
from the water station (25
meters away from their tent-
washing clothes and dishes,
taking baths)
They use pail and plastic
containers as storage of water
for washing the dishes.
Uses plastic gallons as storage
for purified drinking water
where it’s usually free and
delivered by DUAL NARRA. If
their supply is already consume, they then usually buy purified drinking
water at the nearest drinking water system.
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3. Toilet facility
The LGU’s, NGO’s and
other private sectors
donated these portalette, a
portable toilet where the
people urinates and expel
their wastes. Every day it
is cleaned by a “poso
negro” personnels.
The walls are made up of
special concrete plastic
thing.
Antipolo type
After three weeks of visit, the toilet facility was changed from a portalet into a
water sealed type for a better and more sanitized toilet for all.
4.
Kitchen
Doesn’t have sink, they usually wash dishes at the water station 25 meters
away from their tent
Uses firewood/charcoal for cooking
Washes their dishes using pail as storage of water
Foods are placed on the table outside the tent; leftovers are covered with plates
only and a special covering device was noted
5. Garbage/waste disposal
The family does not segregate their
wastes.
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Uses plastic cellophane container then throws it when its already full at the big
barrel for garbage collection
6. Domestic Animals
They don’t have any domesticated animals and pets in their tent.
7. Neighborhood
Their neighbors are
composed mostly of low-
income families and all of
them were victims of the
typhoon Sendong. Most of
these families are friendly
and show concern for one
another especially when
there is a problem among
them.
The health center is near
and no need to spend money for fare
No fresh air and trees that give shade to the surrounding
VIII. FAMILY COPING INDEX
The objective of this indicator is to present a benchmark for approximating
the nursing needs of the particular family, thus Family Coping Index. It is the
coping capacity and not the underlying problem that is being rated, and it is
designed to record family rather than individual coping capacity. The family cannot
be seen only as a factor that affects health; rather, the family is the patient.
Legend:
1 – No competence
3 – Moderate competence
5 – Complete competence
CATEGORY SCALE JUSTIFICATION1. Physical Independence
5 All family members are physically fit and
physically capable of performing independently.
The family provides needs to its members. The
father works as a motor-rela driver to provide the
needs of his family. The mother takes care of the
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children and is responsible for bathing, grooming
and making their children clean and safe.
2. Therapeutic Competence
3 The family’s initial treatment was the use of
herbal medication to treat existing diseases. They
consult to the physician only if referred from the
barangay health center and if immediate medical
attention is required due to financial problems.
3. Knowledge of Health Condition
3 Has some general knowledge of the disease or
condition, but has not grasped the underlying
principles, or is only partially informed and does
not know how to lessen & prevent the disease.
4. Application of Principles of General Hygiene
5In terms of hygiene, the family was consciously
practicing and applying hygiene principle as part
of their lifestyle. Based on the objective
observation, as well as assessment gathered.
They usually attends seminars about health and
hygiene as stated by the mother when there is
time.
5. Health Attitudes 3 Accepts health care in some degree but with
reservations. Most of the time, the family does
not seek the help of medical professionals only if
symptoms persists and intensifies.
6. Emotional Competence
3 The family was able to maintain a fair degree of
emotional calm, face up to illness realistically and
hopefully; their problem was only lack of financial
support that was not able to sustain what are
those family needs.
7. Family Living 3 Family’s does things together and act for the
good of the family as a whole and they have good
interpersonal relationship. The children do
respect their parents as what I’ve observed.
8. Physical Environment
3 The house is generally in good condition and
safe. But they don’t have a proper drainage. The
environment possibly has vectors that can cause
diseases such as dengue or filariasis.
9. Use of Community Facilities
3 Family is aware of and uses of the health services
offered in their place. Their children had received
already full immunization.
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IX. SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM
SOCIO-CULTURAL FACTORS
Economic Political
FATHER MOTHER
High school undergraduate
High School undergraduate
Cultural
NONE NONE
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Motor- rela driver
Housewife
Financially unstable with a monthly income of
Php 1, 500
HEALTH THREAT:
- Family size beyond what family resources can adequately provide (financially unstable)
No other additional expense for the Family
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BIOLOGICAL FACTORS
Psychosocial
Physical
Genetic
- Typhoon Sendong took away so many things from them, but they were able to adjust in the new environment they have. They’re in the stage of acceptance
-Express anxiety over budget compensation for additional budgets
Father Mother Children
- Long dirty fingernails and toenails
- Slightly elevated BP of 130/80mmhg
- Difficulty sleeping
- Lack of sleep- (+) Hep. B
- Moderate personal hygiene
- Dirty nails- Tooth decay- Cough and colds
Hypertension. DM II and asthma on
paternal side
HEALTH THREAT
- Moderate personal hygiene
- Heredito-familial diseases: hypertension, asthma and DM II
- Dirty nails- Tooth decay
HEALTH DEFICIT
- Lack of sleep- Hepatitis B
disease- Elevated blood
pressure- cough and
colds
FORESEEABLE CRISIS
- infection- hospitalization- death
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ENVIRONMENTAL
Home and Sanitation
TENTS:
-No proper division.- No privacy.-Fire Hazard (made up polyester cloth)
Water Supply
Water Source is 25 meters away from the tent.
Community faucets used for bathing and washing
dishes and clothes.
Uncovered water containers and
storage
Toilet
Communal toilet
Antipolo Portalet and Water
sealed type of toilet
Garbage Disposal
Waste segregation not practiced. The family hangs a plastic bag
adjacent to the tent for their garbage and
throws it when full at a big barrel of garbage
- presence of vectors for diseases such as mosquitoes and flies
Kitchen
Dirty kitchen adjacent to their
tent
Prone to fire accdients
HEALTH THREAT- presence of breeding or resting sites of vectors of
diseases- improper garbage disposal- making fire at children’s reach may cause burns and
injuries- inadequate living space
The family is given a galloon of purified drinking waterInadequate living
space, no proper sleeping grounds, room for
FORESEEABLE CRISIS
- infection- hospitalization- death
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X. FAMILY HEALTH PLANCUES HEALTH
PROBLEMFAMILY
NURSING PROBLEM
GOAL OF CARE
OBJECTIVES OF CARE
INTERVENTION PLAN EVALUATIONNursing
InterventionsMethod
of Nurse-Family Contact
Resources Required
Subjective:
“Kani lagi sila akong mga anak kay gipang ubo ug sip on,” as verbalized by the wife
Objective:
-productive cough with whitish sputum in minimal amount
- colds
- not in respiratory
Cough and colds as health deficit
1. Inability to make decisions about taking appropriate action due to:
a. failure to comprehend the nature and magnitude of the problem.
b. Fear of consequences of action, specifically economic consequences.
2. Inability to provide
At the end of nursing intervention,
The children in the family with cough and colds will be relieved.
At the end of nursing interventions, the family will:
a. gain knowledge on the management of cough and colds;
b. bring the child to the health center for consultation;
c. be able to carry out appropriate interventions to relieve the child’s cough
1. Taught the mother the ways to soothe the throat and relieve cough with a safe remedy such as tamarind, calamansi and ginger.
2. Instructed the mother not to use cough syrups and other decongestants if not prescribed by the doctor.
3. Instructed the mother to increase the
Home Visit
Material resources:
-tamarind, calamansi or ginger
Time and effort of the nurse and the family
Expenses for transportation of the student nurses
Goal partially met
At the end of nursing interventions, the family:
a. gained knowledge on the management of cough and colds;
;
b. was able to carry out appropriate interventions to relieve the child’s cough and colds.
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distress adequate nursing care to a member suffering from cough and colds due to:
a. inadequate knowledge regarding the health condition;
b. lack of knowledge on the nature and extent of nursing care needed;
and colds; child’s fluid intake.
4. Instructed the mother to keep the child’s back dry.
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CUES HEALTH PROBLEM
FAMILY NURSING
CARE
GOAL OF CARE
OBJECTIVES OF CARE
INTERVENTION MEASURES
MODE OF
NURSE-FAMILY CONTAC
T
RESOURCES NEEDED
EVALUATIONS
Subjective: “Gaibutang ra namo among mga pagkaon sa lamesa dayon takluban ug palto” as verbalized by the wife
Objective: -no other storage facilities to secure their uncooked and left over foods
Presence of health threat due to poor condition as evidenced by lack of food storage facilities
-Inability to provide a home environment conducive to health maintenance and personal development due to: a. inadequate family resources specially financial constraints or limited financial resources
At the end 30 minutes of nursing interventions, the family will be able to:a. Verbalize understanding about the importance of having better food storage.
b. Place their food in a safe place away from pests.
After the nursing intervention carried out, the family will at least have better containers or cover to secure their foods and from contamination.
1.Assess knowledge of the family towards the pending problem.2.Discuss possible threats to the family’s health due to these containers.3.Discuss the advantages which will bring about the partial solution to their problem.4.Plan appropriate action to the problem.
Home visit
Food storage
Time and effort of the nurse and actual participation and empowerment of the family
Financial Resources
After 30 minutes of nursing interventions, the family was able to:a.Verbalized understanding about the importance of having better food storage.
b. Placed their food in a safe place away from pests.
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CUES HEALTH PROBLEM
FAMILY NURSING
PROBLEMS
GOAL OF CARE
OBJECTIVES OF CARE
INTERVENTION MEASURES
METHODS OF
FAMILY-NURSE
CONTACT
RESOURCES REQUIRED
EVALUATION
Subjective:
“Wala lage me saktong butanganan sa mga plato ug uban pang materyles sa pagpreparar sa pagkaon” as verbalized by the wife
Objective:
Unwashed utensils
Unorganized placements of utensils
Exposed stencils to pest and rodents
Unsanitary food handling as a health threat
Inability to decide about taking appropriate actions due to failure to comprehend the identified problem as a health threat
After 4 weeks of rendering nursing interventions, the family will be able to practice the proper ways on handling food and recognize the importance of proper food handling
After 4 weeks of rendering nursing interventions, the family members will be able to:
1. Recognize the risk factors that will contribute to the identified problems;
2. identify the different measures to prevent the arousal of the risk factors of the
1. Assess the family concerning their practices on handling and preparing the food
2. Discuss with the family the health problems that will occur if improper food handling will persist and lead to undesirable illnesses such as diarrhea
3. Teach the family to do proper hand washing and encourage them to perform it before and after handling foods
arise
4. Discuss to the family on how to
Home visit Participation and empowerment of the family
Time and effort of the nurse and family member
At the end of 4 weeks, the family was able to practice proper ways about handling food and recognized the importance of proper food preparation and food handling
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Improper food storage and handling, foods exposed to flies
problem
3. determine the importance of preparing and handling the food properly;
4. practice and apply the techniques of food handling and preparation;
5. keep their kitchen clean and free from insects an rodents
handle the food properly:
5. Encourage the family to keep the house clean specially the kitchen area
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CUES HEALTH PROBLEM
FAMILY NURSING
PROBLEMS
GOAL OF CARE
OBJECTIVES OF CARE
INTERVENTION MEASURES
METHODS OF FAMILY-
NURSE CONTACT
RESOURCES REQUIRED
EVALUATION
Subjective:
“Hugaw jud ang amu palibot, cge man ko panlimpyo pero mahugaw ra jpon” as verbalized by the wife
Objective:
-unclean environment
-clothes
Poor home environmental condition as a health threat
Inability to provide a home environment conducive to health maintenance and personal development due to failure to comprehend the identified problem as a health threat
After 4 weeks of rendering nursing interventions, the family will be able to recognize the problem as a threat and will be able to recognize the importance keeping the home clean
After 4 weeks of rendering nursing interventions, the family members will be able to take action in cleaning their tent area and maintaining its cleanliness.
1. Encourage the every family member to participate in cleaning
2. Discuss the importance of keeping the home/tent clean
3. Discuss the possible health condition that may arise
4. Encourage the family members to maintain the
Home visit Participation and empowerment of the family
Time and effort of the nurse and family member
At the end of 4 weeks, the family was able to:
a. Recognize the importance of home environmental sanitation
B. Family members participated in maintain the cleanliness of their place
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hanging inside the tent
-Presence of flies and mosquitoes flying the house
cleanliness in their home/tent
CUES HEALTH PROBLEM
FAMILY NURSING
PROBLEMS
GOAL OF CARE
OBJECTIVES OF CARE
INTERVENTION
MEASURES
METHODS OF
FAMILY-NURSE
CONTACT
RESOURCES REQUIRED
EVALUATION
Subjective cue:
”Sa cellopane nalang namu ginatambak tanan, then amu gnalabay sa barrel nga
Improper garbage disposal as a health threat
Inability to provide home environment conducive to health maintenance and personal development due lack of knowledge of
At the end of nursing interventions, the family will be able to realize the harmful effects of improper garbage disposal and
Short term objectives:
At the end of 15 minutes, the family will receive health teachings about importance of proper waste
Health teachings with emphasis on the importance of waste management.
Human waste and diseases. It is very important to keep human waste out of water supplies.
Home visitations of the student for six visits within 6 weeks
Family Interaction
Time and effort of the student and the family members
Fare for the students
At the end of 4 weeks ,the goal partially met. The family was not able to apply the proper waste
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basurahan, kwaon raman daun sa mangulekta ug basura ” as verbalized by the wife.
Objective cues:
Presence of flies and mosquitoes
Unsegregated way of garbage disposal and dumping in a cellophane bag
proper garbage disposal
benefits of clean and healthy environment
disposal
Long term objectives:
At the end of 4 weeks , the family will be able to adopt proper waste mangement
Human waste (faeces, poo, kuma, urine, wee) contains diseases that make people sick. Human waste can get into the local water supplies from leaking septic tanks, releasing contaminated water from sewerage treatment plants, dirty nappies, leaking sewerage pipes and people using local creeks as a toilet.
Injury and disease. People can get diseases like tetanus and leptospirosis if they cut or scratch themselves on pieces of metal, nails or glass. Children can be seriously hurt by playing with old car
disposal. But the family intermittently followed the waste management.
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batteries or household cleaners that they find lying around.
Litter can be a problem. Broken bottles and tins, for example, can cause injury. Mosquitoes and other vectors can breed in water trapped in old tyres and bottles.
CUES HEALTH PROBLEM
FAMILY NURSING
PROBLEMS
GOAL OF CARE
OBJECTIVES OF CARE
INTERVENTION
MEASURES
METHODS OF FAMILY-
NURSE CONTACT
RESOURCES REQUIRED
EVALUATION
Subjective cue:
“ Dili jud maigo ang sweldo sa akong bana, gamay kaayo. ” as
Low family income as a health threat
Inability to provide home environment conducive to health maintenance and personal development
At the end of nursing interventions, the family will be able to recognize or realize ways that will help
Short term objectives:
At the end of 20 minutes, the family will be able to recognize ways in saving money
Establish a family budget.
Spend Less.Try to never waste money and make every purchase a considered purchase.
Home visitations of the student for six visits within six weeks
Family
Time and effort of the student and the family members
Fare for the student
At the end of 4 weeks , the goal was partially met. The family recognized ways in saving their money but
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verbalized by the wife.
”Wala pod ko trabaho ” as verbalized by the wife
Objective cues:
Father – P1,500/month income
Poor family living
due to inadequate family resources specifically financial constraints/financial resources
in maximizing their money.
through giving adequate information.
Long term objectives:
At the end of 4 weeks , the family will be able to apply measures in saving money.
Use less. If could all use and consume less there would be less waste, less power consumption, and the benefits for you are SAVING MONEY.
Save Money.Each week or each month get into the habit of putting an amount, however small into your savings. Start by saving a very small fixed amount each time and then move to putting in larger amounts once you begin to save money from your other money saving strategies.
Shop Wisely. Consider markets, superstores, farmer's markets, local shops, marts and stores.
Buy used. There are huge money savings
Interaction needs to be applied in longer duration for sufficient results.
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to be made in buying used
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XI. ACTUAL IMPLEMENTATION
WEEK 1: January 19-21, 2012 (Orientation Phase)
The first encounter with my family was last
January 20, 2012 when we started our family
profiling and somehow after gathering data, this
family fitted the criteria for the family case study.
As always, I greeted Mrs. XX and introduced
myself. I stated the purpose of the visit and
eventually asked permission using a consent
letter if it is okay for them to be a part for the
family case study. Then, I explained to her the
whole course of the study, its purposes, benefits
and all: family profile, assessment for 4 weeks,
implementation of care and health teachings and
documentations.
I also assessed the family about their coping as for what had happen during
the typhoon Sendong. We talked a lot. She did express her feelings and verbalized
her thoughts.
WEEK 2: January 26-28, 2012 (Working
Phase)
During this week I continued my
assessment and put my attention to their 3
children. I assessed them individually using my
nursing skills and with the used of the IMCI
booklet. Problems were identified and made me
plan for the succeeding days to come. Same with
Mrs. XX, problems were raised and explanations of
such diseases were discussed. The whole week,
implementations done and health teachings were
imparted to the family. The importance of hygiene
to achieve a healthy well being was emphasized;
bathing, grooming and cutting long and dirty
fingernails were performed with the family members.
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WEEK 3: February 02-04, 2012 (Working Phase)
The third week of the
exposure here at the Tent City, I
finally assessed the head of the
family Mr. XX. He’s not always at
their tent since he’s the only one
working as a motor- rela driver for
the needs and provision of his
family. After the assessment and
interview, health teachings were
again imparted to him since he
has an elevated blood pressure.
He also claimed that they do have
a family history of hypertension,
asthma and DM II which makes
him more at risk.
Cleanliness not only to their bodies but also to their environment was
stressed out. The disease conditions that one can get from improper handling of
food, improper garbage disposal, and uncleanliness made the family more
conscious about their health and hygiene. The family did raise many questions and I
did answer them based on the books I read.
WEEK 4: February 17-18, 2012 (Termination Phase)
The fourth week and termination phase has already come. Together with the family, we
evaluated the course of home visits and asked the family what they’ve learned for the past
weeks. Same with them, I thanked the family for the hospitality and time they had given to me.
Finally, I invited them to come and join the income generating activity and microteaching this
coming March 01, 2012.
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XII. EVALUATION AND RECOMMENDATION
Community Health Nursing has been a part of every student nurse’s life. It is
a nurse’s duty to bring to the people the health programs of the government. To
provide immediate health care to the community people’s health problems before
going to the higher health care facilities. Prevention is our primary task so it is our
duty to do every means in order to educate the people.
After four weeks of visitation, I had identified several family health problems
and environmental problems as well. As included in the whole process of assessing,
imparting health teachings and rendering care to the family members, I recommend
that the family should give first priority to their health and avail the services offered
by the local government at the Tent City for proper referrals and further
intervention of their disease conditions in which they are not familiar with. I am
hoping and looking forward that the XX family will apply the things that the student
nurse imparted to promote health and well being.
Overall, the intervention that was implemented to family made a difference
on their perception towards promoting health, and preventing illness. As a
practicing health care giver, the experience that I have gain during the rotation had
improved my understanding about community health nursing, not only that I have
implemented interventions but the feeling of being accepted as a health care
provider and helped in the improvement of others’ lives is very heartwarming and
gave me a sense of accomplishment. For me, the concept of Community Health
Nursing is not all about fulfilling the requirements to pass or just intervening the
problems identified, it’s how the health care giver touches others lives and be one
of them in attaining the solution of the problem, it’s about empathy and motivation
towards one self and the community to perform such task pertaining to promoting
health and preventing disease. This exposure inculcates to us lots of learning and
values which would eventually help us to become competent health care providers
as future nurses.
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XIII. BIBLIOGRAPHY
Maglaya, A., & Earnshaw , R., Nursing Practice in the Community.
Community Health Nursing by DOH
Kozier, et al. Fundamentals of Nursing. Singapore: Pearson Education Asia
Ltd., 2004
Smeltzer, S. Medical-Surgical Nursing. Manila, 1996.
Reyala, A. et al. Community Health Services in the Philippines. Manila: Na-
tional
League of the Philippine Government Nurses, Inc., 2000
Maglaya, A. Nursing Practice in the Community. Philippines: Argonauta Corp.
Microsoft® Encarta® 2009 . © 1993-2008 Microsoft Corporation.
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XIV. APPENDICES
A. LETTER OF CONSENT FOR CARE STUDY AND TAKING OF PICTURES
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B. PRIORITIZING HEALTH CONDITION AND PROBLEMS (ACTUAL COMPUTATION)
RANK 1
Problem: Cold and Cough as health deficit
Criteria Computation Actual Score JustificationNature of the condition or problem presented
3/ 3 x 1 = 1 1 Health deficit problem
Modifiability of the condition or problem
2/ 2 x 2 = 2 2 Easily modifiable
Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 2/ 2 x 1 = 1 1 Needing immediate
attentionTotal Score and Rank 5 Highest weight
RANK 2
Problem: Presence of health threats due to poor food sanitation as evidenced by lack of food storage facilities
Criteria Computation Actual Score JustificationNature of the condition or problem presented
2/ 3 x 1 = 0.66 0.66 Health threat problem
Modifiability of the condition or problem
2/ 2 x 2 = 2 2 Easily modifiable
Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 2/ 2 x 1 = 1 1 Needing immediate
attentionTotal Score and Rank 4.66 Highest weight
RANK 3
Problem: Unsanitary food handling as health threat
Criteria Computation Actual Score JustificationNature of the condition or problem presented
2/ 3 x 1 = .66 0.66 Health threat problem
Modifiability of the condition or problem
2/ 2 x 2 = 2 2 Easily modifiable
Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 2/ 2 x 1 = 1 1 Needing immediate
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attentionTotal Score and Rank 4.66 Highest weight
RANK 4
Problem: Poor home and environmental condition as health threat
Criteria Computation Actual Score JustificationNature of the condition or problem presented
2/ 3 x 1 = 0.66 0.66 Health threat problem
Modifiability of the condition or problem
2/ 2 x 2 = 2 2 Easily modifiable
Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 1/ 2 x 1 = 0.5 0.5 Problem not really
perceived needing change
Total Score and Rank 4.16
RANK 5
Problem: Improper garbage disposal as a health threat
Criteria Computation Actual Score JustificationNature of the condition or problem presented
2/ 3 x 1 = 0.66 0.66 Health threat problem
Modifiability of the condition or problem
2/ 2 x 2 = 2 2 Easily modifiable
Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 1/ 2 x 1 = 0.5 .5 Not needing immediate
attentionTotal Score and Rank 4.16 Highest weight
RANK 6
Problem: Low family income as a health threat
Criteria Computation Actual Score JustificationNature of the condition or problem presented
2/ 3 x 1 = 0.66 0.66 Health threat problem
Modifiability of the condition or problem
1/ 2 x 2 = 2 1 Partially modifiable
Preventive potential 1/ 3 x 1 = 0.33 0.33 Low preventableSalience 2/ 2 x 1 = 1 1 Needing immediate
attentionTotal Score and Rank 2.99 Highest weight
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