Group 5 Grand Family Case Presentation

Abela Caro Cosalan

DatorDe Castro

J. HernandezL. Hernandez

IshimuraPascuaA.Que

Index Case: A.E.

• 3 year-old male

• Chief complaint:– Multiple pustular skin lesions on scalp and both

upper and lower extremities of 1 week duration

History of Present Illness

1 week PTC • Development of multiple erythematous pruritic pustules on scalp and lower extremities

• Lesions were noted to be gradually increasing in size and number

• No associated symptoms of fever, cough and colds, diarrhea, loss of appetite, and weakness

• No medications taken

CONSULT

• Past Medical History– Recurrent viral URTIs since birth

• Family History– Unremarkable

• Birth History– Born full-term via NSD – 29-yr old G4P4 (4004)– Birth attended to by a midwife at a lying-in clinic– Unrecalled birth weight; No perinatal/neonatal complications– Completed EPI vaccinations from health center

• Nutritional History– Breastfed exclusively until 6 months– Formula: Bear Brand– No food allergies and specific food preferences

• Developmental History– Milestones are at par with developmental age

group

Physical Examination

• General survey– Active and cooperative– Stable vital signs

• Unremarkable systemic PE

• Skin– Multiple furuncles with sizes ranging from 1x1 cm to 2x2 cm– Lesions in different stages of healing concentrated on the

scalp and lower extremities

• Assessment– Furunculosis

• Plan– Cloxacillin suspension 0.6 ml 3x a day for 7 days– Mupirocin ointment to be applied 2x daily on

lesions– Daily bathing with antibacterial soap with a

change of clean clothes

Case Summary

28

7 4 mo811 312

3232

ACUTE MI

Family Map

Home Situation

• Currently live in a 1-room unit in an apartment-type complex– Unit on 2nd floor; Accessed by a single narrow wooden

staircase– Rent: P700 monthly– Single room acts as a living room, dining area, bedroom,

and storage space– “Dirty kitchen”-like space with a charcoal stove and

makeshift sink– Dimly lit by a single light source– Windows provide moderate ventilation

Home Situation

• Appliances owned: Single light bulb and radio• Communal toilet and poso– Located outside the unit– Shared by other tenants of the complex– Also doubles as a bathing area and laundry area

• Water supply from communal faucet• Stray animals wander freely around the area

Family Profile

• Parents are both high school undergraduates– Primary breadwinner: Stepfather• Part-time mason/welder• Occasional parking attendant at a mall• Earns ~P200 per day

– Primary caregiver: Mother• Maintenance of the house• Oversees children’s school activities and health

concerns

Family Profile

• 5 children (ages ranging 4 mos-12 years old)– Eldest child (12 y/o male) lives separately with

maternal grandmother in the province

– 2nd eldest (11 y/o female) is out of school and helps mother with household chores

– Only 1 child in school (7 y/o male)

Family Profile

• Few resources for basic amenities (food and clothing

• Recreational activities– Visiting the plaza– Going to mass

• Minor health concerns directed to health center– Children have all completed vaccinations– No major illnesses necessitating hospitalization

Family APGAR ScoreFather Mother Eldest Daughter

Adaptation 2 2 2

Partnership 2 2 2

Growth 2 2 2

Affection 2 2 2

Resolve 2 2 2

Overall Assessment Highly Functional

SCREEMParameter Resource Pathology

Social Good relationship with neighbors and in-laws

None

Cultural Urbanized and Filipino (modern and nuclear)

None

Religious Roman Catholic (non-practicing) Only attend mass together when they have extra funds for

commuting expensesEconomic Father’s unstable employment

status as part-time mason/welder/parking attendant

provides for financial needs

Basically jobless when no contractual mason/welder jobs are

available

Current income as a parking attendant is insufficient to meet

basic needs

SCREEMParameter Resource Pathology

Educational Only 1 child is currently in school

Other kids had to stop schooling after getting sick and were unable to resume

studying due to lack of funds

Family does not seem to place much importance on education (added expense)

Medical Mother oversees health concerns

Free health consultations c/o Ilugin community

center and barangay health center

Poor environmental sanitation and hygiene

mainly contribute to the family’s common health problems like viral URTI’s and Staphylococcal skin

infections

Family Promotive Care PlanFamily

MemberScreening Tests Chemoprop

hylaxisLifestyle Modification Counseling Needs

L.E. (Father)

None None Consider using contraception

Get a stable job to provide properly for

family

Do not engage in vices

Clear up misconceptions about

family planning

A.E. (Mother)

Self Breast Exam

Annual Pap Smear

HPV vaccine Consider using contraception

Consider undergoing bilateral tubal ligation

Clear up misconceptions about

family planning

Importance of proper hygiene & sanitation

practices

A.E. (11 y/o female)

Routine wellness consultation for

adolescents

HPV vaccine Maintain good hygiene practices

Should start sex education

Counseling regarding proper

sanitation and hygienic practices

Regular adolescent interview

A.E. (8 y/o female)

A.E. (7 y/o male)

A.E. (3 y/o male)

Well child check-ups

EPI vaccines with complete boosters

Maintain good hygiene practices

Should eat a more nutritious

diet

None

A.E. (4 mos female)

Well baby check-ups

Newborn screening and newborn care

package

Developmental screening

EPI vaccines with complete boosters

Continue exclusive

breastfeeding until 6 mos old

None

Overall Promotive Health Care Plan

• Educate family about importance of good hygiene and sanitation practices– Prevent spread of communicable diseases– Boost immunity– Improvement of overall health and well-being in

the community

Recommendations

• Cultural limitations within a community may hinder adaptation to hygiene education– Change is brought about by experience and

experimentation– A community’s inherent knowledge, beliefs, &

values are integral to developing proper health education and hygiene programs

– Family meeting dialogues allow people to discuss problems freely and make sense of them and their proposed solutions

Biological & Psychosocial Assessment

• Index patient’s main health issue is related to improper hygiene and sanitation practices

• Primary caregiver should be educated regarding basic aspects of good hygiene:– Handwashing with soap & water– Daily baths– Use of slippers/proper footwear

Insights

• Proper hygiene and sanitation play a big role in preventive health measures.

• A disease’s biomedical aspect is only the tip of the iceberg when dealing with a patient’s problems.

• Family meeting is both a diagnostic and curative tool in assessing the family’s overall state of health