chn part 2

PINES CITY COLLEGESMagsaysay Avenue, Baguio City

College of Nursing

FAMILY CASE STUDY IN COMMUNITY HEALTH NURSING

Submitted by:LAGMAY, Jaclyn G.

BSN IV – 1

Submitted to:, BSN, RN

Clinical Instructor

December, 2009

ACKNOWLEDGEMENT

This study will not be possible without the help, motivation and encouragement of these people who are very close to my heart.

First, I would like to thanks my parents, my brothers and sisters for their love and care they have given me, their sacrifices and constant guidance especially in my financial needs.

To my friends, who are always there to share their ideas.

To the Barangay Health Nurse, Mrs. Dionisia Andres, Barangay Health Midwife, Mrs. Marlene Garcia, to the Barangay Health Workers and especially to the Barangay Captain, Mr. Robert Cruz for their full support and warmest welcome in accommodating us in their Barangay and providing us the materials we could use in making this study possible.

Special thanks to my Clinical Instructor, Mrs. Geronima Patalinghug for imparting her knowledge, patience and considerations in guiding and checking my work.

Above all, our Heavenly Father, for His countless blessings and infinite love.

Jaclyn G. Lagmay

I. Introduction A. Source of Referral

B. Reason of choice of studyI would like to inform the body why I choosed this study because of the

following reasons:

1. The family belongs to a low income

2. The disease is hereditary and find out how it is also a lifestyle disease.

3. How is the disease being cured.

4. How the family accepts the presence of illness/disease.

C. Expected benefits to be derived from study (Student and Family)

The benefits that I will acquire from this study, is that I will gain knowledge about the disease they have, the proper interventions, medications and care that I will render to my future patients with the same disease or illness. This study will enlighten my mind, on how to deal with my future patients. It will also serve as my guide and source in my nursing practice, nursing education and nursing profession. In doing this study, it serves as a practice for me on how to deal with the individual, group, family or in the community. It also serves as a practice for me on how to assess different family in the community, this study really gives or provides me so many benefits that would help and enhance my capability as a nursing student and as a nurse in the future. And the benefit that I will gain from this study is that I will also impart it to the different family in the community. And I learned from this study on how the family appreciate little things and this could make them happy, and I also learned that do not take for granted anything that you have, because not all people are lucky.

The benefits that the family will acquire in this study, is that they will also gain knowledge about the disease they have, the proper medication, interventions and care that they will render to the member of the family having an illness. And they will become more aware or conscious on their health, they will be actively participating to the different activities of the barangay like health education about the different illness or disease. They will also learn what is the importance of having healthy body and a healthy lifestyle. And they will also learn the importance of going to the health centers for regular check-up, proper immunization of their children and proper hygiene, the importance of eating nutritious food. The family will also learn on how to utilize available resources in their community and proper use of herbal medicines.

Having community health services to the different community and conducting family case study would not only benefit the student and the family but also the community. This case study would serve as a guide for us in our daily living and a healthy life.

II. Family ProfileA. Family structure and characteristics

Members of the household of Pilila family are Mr. Bagano he is the head of the family, 49 years old and he is happily married with Mrs. Semiona Pilila, 50 years old. They have three (5) children namely, Myra, she is 23 years old, female, single and she is the eldest, second child is Bernabe, he is 21 years old, third child is Jomari he is 16 years old, fourth

child is Rachelle she is 9 years old and the youngest child, female, she is 5 years old namely Mabeline. The place of their residence is at KM8 ,Tuba Benguet. The type of their family structure is nuclear and patriarchal. In terms of decision making the dominant family member is the head of the family Mr. Bagano Pilila. The family relationship is they talk or communicate to each other respectfully, no observable conflict between members. They respect and love each other especially their children.

B. Socio – Economic and Cultural FactorsThe source of monthly income of the family is Mr. Bagano Pilila

the head of the family, he is working as a driver. His income is exact for their basic necessities like foods and clothing, sometimes they cannot even buy some extra clothing because of insufficient income for his family, not intended for hospitalization or for regular check-up. The income of the family ranges from P200 – 300.00 per day. He is the one who make decisions on how the money is spent. The educational attainment of Mr. Juan Dela Cruz is a high school level, and his wife Josefina Dele Cruz is also a high school graduate and she is a housewife. Their child, Juan Jr., is a Grade 1 student at Alonzo Elementary School, Joana is a nursery student she is also studying at Alonzo Elementary School and Janine is not yet studying. The place of origin of Mr. Juan is in Cebu and Mrs. Josefina is from Manila, they both migrated at Tuba, Benguet and they met each other and now they have a happy family. The families are not aware of any activities or projects in their community. They are not involved in its activities, and not a member of any organizations. But the family is aware that there are existing organizations in the community.

C. Environmental Factors As what I have observed and gathered information, there are different environmental factors that could affect the health of the family.

According to the information given by the family, it is their owned house but it is their owned lot. Their house is made up wood. They said that the living space is adequate for them. They have their owned appliances like radio as a source of news and also their diversional activities, television and iron. There are presence of breeding or resting site of vectors of disease like mosquitoes and flies, and there is a presence of accident hazards wherein they are risk for falls and vehicular accidents. The type of their garbage disposal is burning. Their waste disposal is flush, but their drainage system is open. The source of their water supply is from spring, they cover their drinking water storage wherein it is placed in the plastic bottles. For their food storage they just cover it. As I observed there are common household pests found on their house like dogs and cats. They are far from their neighborhood, it is poor rural. But there are many resources that they can utilize as a health resource like herbal medicines which is available to their environment. They also have health centers in their Barangay but it is far from their house.

D. Health and Medical HistoryPast and Present:a. Immunization and Nutritional Status of 0-6 childrenb. Family Planning

In a high populated community, knowing family planning method is important. Most of the adults or those families in the community do not know about the family planning method and how it will help to minimize the population in their family. There are lots of methods to prevent

pregnancy like for example condom which is very popular, pills, injection, IUD (intrauterine device) and there are also what we call natural method like withdrawal, calendar method or abstinence.

Pilila family used pills as a family planning method, they are buying at the health center. The mother said that she is using family planning method because she doesn’t want to have a child for now, because she wanted to minimize the number of their family. And she also said, that it’s good that there are family planning method that every family can use.

c. Health Practices For the health practice of the family is that they consult their health

related problems to “manghihilot” or to the Barangay Health Center. Sometimes they do not go to the hospital for check-up due to insufficient financial resources. Their lifestyle is, sometimes due to insufficient financial status they can’t eat nutritious food, their source of exercise is walking. They have an adequacy of rest and sleep and they also have activities for relaxation or any stress management activities. In preventing diseases, they used some protective measures like bed nets or protective clothing in dengue. They use promotive-preventive health services like utilizing resources and herbal medicines available to their community for their health related problems. They also go to the health center if they have time and if their children got sick.

E. Word portrait of case/casesThe perception of the family about the case (UTI) is that it needs a

long term medication. And they also said that if they do not take care of their selves this may cause further complications on their health problem. They also want to know some preventive measures to avoid having the disease though the family are not familiar with the disease you will see to them that they are really interested to learn about the disease because of their fear that the disease might become worst.

III. Problem Identified

The Assessment Process

The available data gathered during the first-level assessment reflected the following possible health condition or problems.

1. Congestive Heart FailureSupporting Cues: 26 years old, father of three with a BP of 150/80 and he feels difficulty of breathing and dizzy, he was diagnosed having CHF.

2. Cough and ColdsSupporting Cues: Joana, 4 years old, nursery student has a cough and colds started two weeks ago.

3. ScabiesSupporting Cues: Juan Jr. and Janine brought to the health center for scabies, 2 weeks ago.

4. Lack of ImmunizationSupporting Cues: Janine doesn’t receive any immunization.

5. Inadequate Living SpaceSupporting Cues: A family with three children sleeping in a single room.

The results of the in-depth second level of assessment on the identified health condition or problems are presented in the following tables.

Cues/Data Family Nursing Problems

Mr. Juan Dela Cruz, 26 years old, father of three with a BP of 150/80 and he feels dizzy and had difficulty of breathing (dyspnea)

Mr. Juan Dela Cruz verbalized “I feel alright with the previous months and when I fell difficulty of breathing and dizzy I passed by at the hospital for check-up and it was diagnosed that I have Congestive Heart Failure (CHF)

I am a driver and I am too busy with my work that’s why I don’t have enough time to go to the clinic for regular check-up

The clinic or health center is 3km away from their house.

Family income is ranged from P200.00-300.00 a day

A. Hypertension1. . Inability to manage the condition due to

the lack of knowledge regarding its management.

2. Inability to provide home care or in-tervention that will help in maintain-ning the health maintenance and per-

sonal development due to:

a. Inadequate family resources like financial resources

b. Lack of information/knowledge regarding preventive

measures/interventions

c. Lack of knowledge in the nature of the health condition

3. Failure to utilize community resources for health care due to:

a. Lack of appropriate information


Joana, 4 years old, weighs 25 kgs., she has cough and colds

Mother verbalized “Joana is having cough and colds a week ago”

Joana is a nursery student, her eldest brother Juan Jr., is also studying and her youngest sister Janine is not yet studying and she is left in their house with her mother.

Mother is very busy working in their house and she cannot properly take care and give proper attention to her children.


Juan Jr. and Janine have scabies

Mother verbalized “I have such a lot of things to attend when Im working in our house, and I couldn’t even see or attend to the health needs of my children due to lack or insufficient financial needs. My husband was able to buy a medicine for them, but due to insufficient financial resources he cannot buy another one when it is already consumed. This scabies must be due to the children they are playing with”.


Water supply is from a public deep well or “nakiki-igib” .

Family sleep in only one room.

b. Busy on work

c. Physical inaccessibility of health services due to far from the health centers

B. Cough and Colds as a Health Deficit1. Inability to recognize the existence of the

problem due to lack of knowledge regarding the illness.

2. Inability to make decisions in taking appropriate interventions/management to

health problem due to:

a. Failure to utilize different available resources in the community like

herbal medicines.

b. Lack of knowledge regarding health condition

c. Lack of knowledge as to alternative courses of action open to them.

3. Inability to provide appropriate conducive environment for the

development of the health problem.

C. Urinary Tract Infection 1. Inability to provide home remedies or

interventions to the scabies of Juan Jr. and Janine due to:

a. Lack of knowledge regarding the condition

b. Inadequate family resources

c. Lack of information regarding preventive measures.


a. Financial resources

b. Physical resources like water supply facilities


Janine the youngest child did not yet received any immunization.

Mother verbalized “I didn’t bring my child to the health center for immunization because it is too far from our house. My husband is always busy that he cannot accompany me to go to the health center”.

D. Lack of Immunization as a health threat1. Inability to recognize the existence of the

problem due to ignorance of facts.

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

a. Lack of knowledge regarding proper immunization

b. Responsible family member


a. Inadequate family resources

b. Inadequate physical resources


5 members of the family stay in one room.

Mother verbalized “we are all sleeping together in one room”

F. Inadequate living space as a health threat

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES

CRITERIA WEIGHT

1. Nature of the condition or problem presented Scale **: wellness state health deficit health threat foreseeable crisis

2. Modifiability of the condition or problem

Scale **: easily modifiable partially modifiable not modifiable

3. Preventive potential

Scale **: high moderate low

4. Salience

Scale **: a condition or problem needing immediate attention

a condition or problem not needing immediate attention

not perceived as a problem or condition needing change

3321

210

321

2

1

0

1

2

1

1

Scoring:1. Decide on a score for each of the criteria.2. Divide the score by the highest possible score and multiply by the weight:

(Score / Highest Score) x weight3. Sum up the scores for all the criteria. The highest score is 5, equivalent to

the total weight.

Problem: Congestive Heart Failure (CHF)

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the problem

2. Modifiability of the problem

3. Preventive Potential

4. Salience of the problem

3/3 x 1

2/2 x 2

3/3 x 1

2/2 x 1

1

2

1

1

The problem is health deficit and it requires more immediate interventions and medications for maintenance of the health problem.

The resources and interventions for the maintenance of the health of the father and healthy lifestyle is available to the family like help them or encourage them to do some exercise, eat nutritious food and a healthy lifestyle.

The possibility of any complication of congestive heart failure in the father will be decreased or may be eliminated if he does exercise, has a healthy lifestyle and a maintenance of medication. The chance of acquiring the children of the disease or illness of the father will be reduced by eating nutritious food and healthy lifestyle.

The family recognize the existence of the problem. This condition needs a close attention or immediate proper care.

TOTAL SCORE 5

Problem: Cough and Colds






3/3 x 1

2/2 x 2

2/3 x 1

2/2 x 1

1

2

2/3

1

The nature of the problem is health deficit. It is a failure to maintain a healthy body. There is the presence of the disease or illness due to unable to take care of our health.

It is easily modifiable, wherein the family can utilize and know how to use available resources and interventions to their community, like utilizing or using herbal medicines like for example drinking lagundi juice or fruits like kalamansi juice.

The preventive potential is moderate, wherein the family doesn’t have enough resources for the health problem and the lack knowledge about the different resources. The family recognize it as a problem and it also needs immediate attention to decrease the chance of spreading the virus or infection to other family member.

TOTAL SCORE 4 2/3

Problem: Scabies






3/3 x 1

1/2 x 1

3/3 x 1

2/2 x 1

1

1

1

1

It is a health deficit that requires immediate care and proper treatment and to reduce the chance of spreading the disease to other family member.

The problem is partially modifiable because the family does not have adequate resources for the health problem and they have inadequate living space. Their water supply is from public deep well or “nakiki-igib”. Which sometimes its hard for them to get water .

The preventive potential is high if they treat immediately and manage the health problem appropriately the chance of transferring and spreading the disease to the other family member will be reduced.

The family does recognize the existence of the problem and it needs immediate treatment/attention. To prevent the chance of spreading the disease to other family members

TOTAL SCORE 4

Problem: Lack of Immunization






2/3 x 1

2/2 x 2

3/3 x 1

2/2 x 1

2/3

1

1

1

It is a health threat because the child has a high susceptibility to infection due to lack of immunization which will lead to some diseases that may affect their health.

It is easily modifiable because immunizations are available at the Barangay Health Centers, which they can get it for free.

The preventive potential for immunization is high wherein they can immunize their children at Barangay Health Centers for free.

The family does not recognize it as a serious problem or they does not recognize the existence of the problem due to lack of knowledge. But this needs immediate attention to prevent the child acquiring diseases.

TOTAL SCORE 3 2/3

Problem: Inadequate Living Space






2/3 x 1

1/2 x 2

3/3 x 1

0/2 x 1

2/3

1

1

0

The nature of the problem is health threat because inadequate living space may lead to conditions that are conducive to accidents or illness.

The problem is partially modifiable because they need financial expenditure for increasing the adequacy of living space considering that they do not have sufficient income to increase the living space. However they can allow more space if they will arrange their furniture or removed things that they do not use.

If the living space is adequate for the family there will be, privacy for each family member, adequate living space will allow them to do their work appropriately and reduce the chance of transferring diseases.

The family does not recognize it as a serious problem.

TOTAL SCORE 2 2/3

The prioritized health problems

The list of health condition or problem ranked according to priorities is presented

Congestive Heart Failure (CHF) ----------------------------------- 5

Cough and Colds------------------------------------------------------ 4 2/3

Scabies ----------------------------------------------------------------- 4

Lack of immunization ------------------------------------------------ 3 2/3

Inadequate Living Space --------------------------------------------- 2 2/3

The priority health condition or problems are going to be addressed in the Family Nursing Care Plan (FNCP) which will be developed and illustrated.

1. Congestive Heart Failure (CHF)

V. PATHOPHYSIOLOGY

VII. Recommendations for further family careThe family needs further care and follow up check-up for the maintenance

of the health of the family. Especially the health problem of the father which is Congestive Heart Failure which needs close attention and proper care and treatment and also a regular check-up. Also their children needs further care due to their illness which is scabies and cough and colds. They need closed attention so that it will not lead to any further complications.

VIII. References

Nursing Practice in the Community, 4th Edition by Araceli S. Maglaya

Community Health Management Manual For Nursing Students by Lydia C. Viet RN, MAN

www.google.com

LAGMAY, Jaclyn G. July 20, 2009BSN IV-I

Journal Reaction

SUMMARY:A 14-year old Marian Jose (not her real name) was brought to hospital with a

complained of headache, stabbing pain in her left leg and unusually thirty. And the doctor find out that she has a high fever, he placed her for under careful observation. The following morning, Marian’s manifested shuddering gasps, saliva filled her mouth and when she tried to swallow, violent spasms tore at her throat muscles. And when the doctor ask question it was find out that Marian was bitten by a dog two months ago. The doctor cleaned the wound and gives an anti-tetanus shot. Until they find out that the dog died few days after Marian had bitten by that dog. They done an autopsy and the result confirmed the doctor’s worst fear: no hope for Marian now, for rabies once it was permitted to take hold cannot be checked.

Six out of every million Filipinos get afflicted with rabies, a fatal and incurable virus. According to the Rabies Control of the Department of Health, rabies are caused by stray dogs and cats. In 1984, World Health Organization that Philippines had the 4 th

highest human death rate for rabies. The rabies is an old problem of mankind. The term “rabies” came from the Sanskrit word “rabhas” which means “to do violence”. Back to 20th century there was an ordinance form in the Eshnunna Code of Mesopotamia, until it is translated as Rabies in dog was described by Democritus (500 B.C) and Aristotle (322 B.C) they said that once a person is bitten by a dog became mad. Galen (A.D 200) recommended excising wounds to prevent development of the disease. Rabies was proven infectious by Zinke in 1804, he done a test wherein he transmitted rabies from a normal dog by inoculating it with saliva from the infected animal. Medical experts said that rabies is caused by an ultra-microscopic organism that attacks through any break in the skin, multiplies in salivary glands of infected animals and it is usually spread in biting. The virus pauses for a while to gather force, then creeps into nearby nerves to make a fatal, shattering rendezvous with the brain. It can strike for six days, and it can also takes a month or more. The first sign of the disease in man is a hot pain in the area of exposure, headache, nausea, accompanied by irrational irritability and strange forebodings of doom. Although thirst may be agonizing, they will experience hydrophobia (“fear of water”), eventually sounds, lights and even gentle puffs of air can cause convulsions. After a week of torture, the body becomes paralyzed and death follows, usually caused by stoppage of breathing and blood circulation. They said that rabies is the beast that unexpectedly bites a person should be confined and watched closely by a veterinarian for ten days to see if it has a disease. The best prevention according to medical expert is avoid strange animals and those known to be rabid. The main carriers of the rabies are the vampire bats, the primary affected by the rabies are dogs and cats. According to Dr. Fatima N. Macavinta, there are three principal methods available in our country for laboratory diagnosis of rabies. The first is fluorescent antibody test, sensitive test, it is almost 100% accuracy and highly specific but requires sophisticated equipment and expensive reagents. Second, mouse inoculation, highly sensitive but requires several days for positive diagnosis and the last, direct microscopic examination, a rapid and cheap test but less sensitive. For many years, treatment of rabies was a fearful disease itself. In 1885, a nine-year-old boy bitten by a rabid dog was

inoculated with a vaccine made by Pasteur from a powdered spinal cord tissue of rabies infected rabbits, it was a success for the boy and did not develop rabies.

The DOH issued first aid measures should be done when a person bitten by a dog or animal assumed to be rabid:

Scrub the wound or bitten area with soap under running water for at least five minutes.

Remove foreign material from the site Rinse with plain water Irrigate with a viricidal agent such as alcohol or povidone iodine and

consult a physician immediately for appropriate preventive measures.

Bad news for dog eater, medical expert said that cooking does not kill a virus, rabies is a nerve lover and is concentrated in the brain so don’t eat the dogs brain.

REACTION:This journal talks about rabies, which is one of the common problem in the

community due to many stray animals like dogs and cats which are not immunize for anti-rabies. When you hear the word rabies, the first thing that comes into your mind is that, it is fatal and incurable virus. Yes it’s true, but we can prevent thru getting away from stray animals and having enough knowledge and information about rabies and proper immunization for our pets like dogs and cats. The one way also is to control stray dogs and quarantine other domestic dogs would eliminate the disease. There is a certain topic in the journal that I have read that talks about an individual namely Marian Jose (not her real name) who had bitten by a dog, the lesson there is they should not wait that the child would manifest some signs and symptoms of having a rabies, they should bring her immediately to the hospital for proper immunization and treatment. Once a person is bitten by a dog they should also observe for the dog for ten days, if the dog died with ten days this means that the dog has rabies. It is also discuss in this journal the different studies they conducted about rabies. It’s nice to know that there are many people who worked about rabies that helps us today how to manage rabies. Medical expert said that rabies is caused by ultramicroscopic organism that attacks through any break skin, multiplies the salivary glands of infected animals and it is usually spread in biting. They also said that cooking does not kill the virus, because rabies is a nerve lover and is concentrated in the brain so don’t eat the dogs brain. There are some basic first aid measures to do if bitten by a dog like wash the wound with soap in running water, remove foreign materials and rinse with plain water.

This journal I have read gives me more knowledge and idea about rabies and proper measures to do when you are bitten by a dog. I will also be able to deal without any confusion to the procedures and treatment to be done. I can also avoid errors in case of future management of similar case. This study will be a supplemental for me as a student nurse for any related research and will be utilized as my basic reference or source. And it will be a helpful guide for me in dealing with my future patients.

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