Latest FCA Revsion (March 9'08)

8/14/2019 Latest FCA Revsion (March 9'08)

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community a standard of living adequate for the maintenance of health (p.30

Winslow, 1989).

The people that builds up the country and the world at large, and the same

persons who are potential of being ill or healthy makes up this publicthe

community. Therefore, promoting a healthy community is the main goal of CHN.

Employed CHN is a synthesis of nursing practice and public health

practice applied to promoting and preserving the health of the populations. The

practice is general and comprehensive. It is not limited to a particular age group

or diagnosis, and is continuing, not episodic. The dominant responsibility is to the

population as a whole; nursing directed to individuals, families, or groups

contributes to the health of the total population. Health promotion, healthmaintenance, health education, and management, coordination, and continuity of

care are utilized in a holistic approach to the management of health care of

individual, family, and group in a community. (ANA, 1980, p.2)

Throughout the course of this FCA, the adopted family had been assisted in

identifying their existing problems as they were taught to cope with it and

eradicate unnecessary conditions and factors to improve their health and quality

of life as a whole. As to maintain the privacy of the adopted family, they were

assigned with pseudonames that would be used for the whole activity. Namely:

Mr. Lorenzo for the father, Mother Mae for the mother, Anthony for the youngest

(son), and Ann for the eldest (daughter).

The student nurses involved in this study aim to help the said family as far

as they can to add another piece of experience to their student lives. Also, to give

back the love lavished upon them though they were not lawfully part of this

family. Most especially, it helped them nourish the love and compassion found in

being Christs servant as nurses while their future careers is fast approach.


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A. Objectives

a. Short Term

(Student-centered)

After one to two days of home visits, the student nurses will be

able to:

Introduce the purpose of their family case analysis.

Establish rapport with all or at least some of the family members

as evidenced by (AEB) light conversations.

Gain their trust and the necessary cooperativeness AEBanswering interview-questions honestly.

Assess the history and health status of all or at least some of

the members.

Perform physical assessment of the present members of the

family cephalo-caudally

Identify potential problems that might exist or actually existing

related to hygiene, sanitation, or health condition.

Initiate planning of the possible interventions.

(Family-centered)

After one to two days of home visits, the family will be able to:

Accept and understand the underlying purpose of the family

analysis AEB accepting the offer of making them the subjects

and showing cooperativeness.

Establish rapport with all the student nurses AEB light

conversations.

Trust to the student nurses AEB allowing them to join in their

side-line job.

Show enthusiasm in physical assessment done to them.


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Cooperatively respond to the questions asked such as

regarding history and health status of the members.

Honestly mention the reason behind some recognized

problems related to hygiene, sanitation, and health condition.

b. Long Term

(Student-centered)

After four to five days of home visits, the student nurses will be

able to:

Gather the necessary information to formulate the appropriate

nursing intervention.

Identify all the existing problems and properly provide

immediate interventions and plan for long term interventions

such as maintenance of good sanitation.

Establish stability with regards to the familys health status AEB

normal vital signs and decreased risk factors.

Supply or advice the family to supply lacking materials in the

house that cause problems to arise. Achieve the goals they have set like gaining the familys trust.

(Family centered)

After four to five days of home visits, the family will be able to:

Manifest enthusiasm in resolving the existing problems AEB

inquiry and initiative in management of the problem

Participate in care provided to them by student nurses likephysical examination and interventions in sanitation.

Initiate lifestyle changes necessary to obtain improvement in

health status.

Comply with the habit modifications carefully provided to them

by the student nurses.


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Switch to the proper treatment or utilize community health

center before consultation to herbolarios

Seek health care from authorized providers of care and utilize

community resources.

A. Early Climate and Acceptance, First few words, Number of visits

Immersion is the best way to describe the bustle of home visit. The group

felt very excited before they are immersed in the community and meet the

chosen family. On the 21st day of February, 2009 was the start of the group to be

in the community. They are assigned in zone 2 of Macapagal Village, Clark Field,

Pampanga. The student nurses have criteria in choosing a family in which the

family should be classified as poor where in the allowance of the each of the

family members are less than P2, 768.00, family member of five and above, a

living children less than 7 years old, and the most Important of all is that they are

willing to cooperate. The family is very supportive and very warm, very

cooperative and they are very friendly, they are also very accommodating to the

point that whenever they do something, they stop it or do it while entertaining us,

multi-tasking it is. They also always see to it that nobody stands and giveseveryone a very comfortable chair to seat to. They even thought us the barbecue

stick making, the mothers sideline. They have a very cheerful aura.

1st Home Visit January 21, 2009

It was a very hot day when the student nurses met the chosen family at

around 10:30 in the morning. On the same day the student nurses stated their

purpose of visiting the family. The group was overwhelmed with the hospitality

shown by the family. Good morning pu ate! Pwede da kayu pu ainterview? said

by the student nurses. Uwa sige, gawan yu kaming family yu! said by the

mother. The group explained the purpose saying taga AUF kami pu, ikayu pu ing

apili mi para keng Family Case Analysis mi. Bali mga two to three weeks kami pu

kanyan mumunta keni. uwa ok mu pu itamupin pu mamako kung 11 am ne?


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we were struck because of the response of the mother saying uwa gawan yu

kaming family yu! and gave as the thought of them being a subject of a previous

FCA subject, and true, they were used as the subject with a preceding FCA.

Never the less, that did not gave the group a negative notion and continued the

purpose. At that moment the student nurses established rapport and had light

conversations with the family and able to take their 1st vital signs and did

physical assessment to the few members present.

2nd Home Visit January 22, 2009

It was a hot Monday morning when the student nurses conducted their

second home visit. They went to the chosen family at around 10:00 p.m. in the

morning. The groups were very much welcomed by the family with hospitality

while the mother is doing her sideline, making barbeque sticks. On the second

day of interview, the student nurses interviewed the family regarding their

demographic data. They were able to take the history of past and present illness

of the family as well. Mentioning the death of Mother Mae to be caused by

cancer, they wee able to explain that the heredity factor can predispose her to

the said disease. They also assessed the problem is experienced by the family

experiencing and classified them. They were also thought of the barbeque stick

making and had a wonderful experience, not mentioning the sticks we have

broken.

3rd Home Visit January 23, 2009

A sunny morning around 10am when the member of the group went to the

chosen family and the mother is not at home; her sister whos living in the left

side of their family subjects house entertained them. She told them that mother

is on the PTA meeting with her children at school. On that day, the student nurses

made an ocular inspection of the house, of course with the consent and

supervision of the sister of mother Mae. On that said day, they have also

identified problems that the family is experiencing like the inside of the house

having improper disposal of garbage and some exposed wires. While some of


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the group outside noticed the poor drainage system. Also the practice of the

burning garbage where ashes where ashes are found scattered outside.

4th Home Visit January 27, 2008

For a change, it was a very cloudy morning when the student nurses went

to the family and welcomed them again with hospitality and it was the very first

time for the group to see the youngest and the big sister who were preparing for

school. With a limited time, they took their physical assessment for not to soil the

oppurtunity. It was around 10:30 a.m. when the group arrived in the family with a

rushing behavior because they are avoiding the mother to be disturbed, as to her

kindness, she asked them to stay for a while and wait for her as she took her

children to school. Patiently waiting, mother Mae arrived and she urgently

entertained the group with her apologies of waiting for her. As usual, they made

an interview and conducted a physical assessment to mother, and this time, they

made is as comprehensive as they can. They also pointed out the problems they

identified during the previous home visit. Mother Mae interestingly showed

enthusiasm in resolving the problems. They cleaned the house and threw the

garbage. They also advised her to refrain from burning the garbage outside.


It is a Wednesday morning as they arrived in their family and mother gave

them a big HELLOOOOOOOO and a smile on her face showing her

enthusiasm as they arrive. Immediately they conducted the interview completing

the requirements and asking the left questions unasked. As they come deeper

with their rapport to the mother, they have come to the point of asking their

favorite foods, past time etc, there then the mother asked the group if they are

eating the famous native adobo and that craved the appetite of the group. They

also begun giving health teachings to Mother Mae such as visiting the health

center. They also evaluated the coping of the family with regards to the changes

being applied like the garbage disposal and such. As time pass by, the

conversation went. When the group were about to go, mother Mae said, Sandali


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lang may papabaon ako sainyo, ulamin nyo masarap ito. The group reluctantly

took the plastic bag not knowing what is inside. As they arrived at the heath

center, they checked the plastic bag seeing a hot freshly cooked native adobo.

How thoughtful their family was.


It is the last day of home visits and the group and stayed for a while, they

helped the mother make barbecue sticks and had a meaningful conversation

while doing the chores. This was also the time for them to evaluate the changes

in behavior that took place on the part of the subjected family. They also

performed final physical assessment to compare the progress with the initial

data. This served as an over-all evaluation of the familys health status. As the

clock waved goodbye, the group gave tokens to the family as a sign of their

gratitude for the kindness the family gave to them. The families were so happy

for the things that the group gave them that the mother said a million of thanks. It

was a happy satisfying overwhelming experience that the group will possibly

remember forever.

II. Family Constellation

NAME AGE SEX POSITIONIN THEFAMILY

EDUCATIONALATTAINMENT

GENERAL APPEARANCE

Mr.Lorenzo

37y/o male father Elementarygraduate

(Referring from pictures) He isapproximately the same orslightly taller than Mother Maeand not too fat and not tooskinny. He has thinning hair onthe front part of his head. Hehas light brown-colored skin.

According to Mrs. Mae, Mr.Lorenzo works in a company(junkshop). He goes to hiswork by means of a bicycle.Mrs. Mae told the group that hishusband is a smoker heconsumes 1 pack of cigaretteevery day. He seldomexperience cough and colds.


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Mrs. Mae

Ann

30y/o

9y/o

Female

female

Mother

Eldestchild

High school

graduate

Still in

Elementary

On the groups initial visit Mrs.Mae was wearing a yellow t-shirt and blue pajamas and herhair was pony tailed. Mrs. Maeis 30 years old who weight 49kg

and has a height of 152 cm. hervital signs were taken andrecorded as follow;

T = 36.1C/axilla

PR = 55cpm

RR =20bpm

BP = 110/70mHg

Height: 152cm

Weight: 49kg

BMI: 21.21

Nutritional status: normal

Upon initial visit Annwearing

a clean school uniform, and

black shoes. She is alert and

awake. Ann 9year old. Her

vital sign are as follow:

T = 36.5C/axilla

PR = 83bpm

RR =17 cpm

Height: 125cm

Weight:31 kg

BMI: 19.84

Nutritional status: normal


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Anthony 5 y/o Male Youngest

Still in

Kindergarten

During the initial visit Anthony

was seen clean white sando

and blue short. He has black

complexion with short nails.Anthony is a 5 year old who

weight 15 kg and has height 111

cm. temperature: 36 *C: Pulse

Rate: 120 bpm: Respiratory

Rate: 23 cpm..

T = 36C/axilla

PR =120bpm

RR =23cpm

Height: 111 cm

Weight: 15 kg

FNRI= normal weight shouldbe 14.4 to 23.5

III. Health Assessment (IPPA-CEPHALOCAUDAL)

Mother: Mae MacapagalPhysical Examination

First Home Visit (January 23, 2009)A. General appearance and BehaviorOn the groups visit Mother Mae Macapagal was wearing a yellow t-shirt and bluepajamas and her hair was tied up. Mother Mae Macapagal is 30 years old whoweighs 49kg and has a height of 152 cm. Her vital signs were taken andrecorded as follow; temperature: 36.1C: Pulse Rate:55 pm: RespiratoryRate:20cpm: blood pressure 110/70 mmHg

Physical Assessment

Mental Status

Client is alert and awake with eyes open and looking at the student nurse. She established eye contact when asked questions.

She also smiles and frowns appropriately without difficulty.

The client is cooperative, when asked, can answer properly.

The client was able to express free-flowing thoughts and expresses realistic

perceptions.

She is aware of self, other, time, home address and current location.


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She listens and can follow directions without difficulty.

She was able to recall recent event without difficulty.

She recalls her birthday and answer information correctly.

Motor Function -Walking gait has slouched posture with opposing arm

swing upon walking; maintaining balance

Integumentary System:

Skin is brown in complexion, no odor, and uniform in color. Her skin turgor is

normal because when her skin was pinched, it go back to previous stateimmediately. The skin is not edematous and is in normal temperature. Withsensation to touch, pain & temperature.

Skull & Face (Head)

She has a round skull, no contusions, bruises noted nodules and masses,

and no tenderness palpated. She has symmetrical facial movements asevidenced by clients ability to smile, frown, raise his forehead & eyebrows

& shows his teeth. Facial features and facial movements are symmetrical.Hair

Hair is long, dry, straight, thick, black and evenly distributed hair. There is

no dandruff, no area of loss of hair and no infection/infestation.

Nails

Her nails are untrimmed and dirty as well. She has light brown, smooth,

epidermis is intact, has convex curve nails, no discoloration of the nail beds,no clubbing of nails, normal capillary refill (


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The client can see objects at the periphery by letting her cover her right eye

and look directly to the student nurses nose.

Holding the penlight in the periphery, the client was able to spot the moving

object.

Holding a penlight, the student nurse asked the client to follow the movement

of the penlight with the eyes only to test for extraocular muscle test. Thenurse then moved the penlight using the 6 cardinal movements. The clientseyes have coordinated movements.

Ears and Hearing

Her ears (auricles) are symmetrical in size and auricles aligned with the outer

canthus of the eye. No lesions or masses noted.

Pinnas are elastic recoils after folded, firm and without tenderness upon

palpation.

Internal ear has no lesions and with a presence of dy cerumen,

Nose and Facial Sinuses

Her nose is symmetrical and uniform in color; there is no discharge or flaring,

no lesions or tenderness.

Air moves freely as the client breathes through nares by asking client to exert

pressure on the nares, and breathe through the opposite.

Her facial sinuses are not tender.

Mouth and Throat

Her teeth are incomplete; she has 33 set and all have dental carries. Her

teeth are yellowish in color.

Her tongue is pinkish in color, moves without restraint, no tenderness and nolesions.

Soft palate is light pink in color and it is smooth. Her hard palate is lighter pink

in color compared to the soft palate.

Uvula is positioned in the middle of the soft palate.

Oropharynx and tonsils are pink and smooth, no discharge and are not

inflamed.

Chest and Back

Skin at the back is intact with uniform in temperature.

Chest is symmetric in volume, no tenderness and masses, full and symmetriclung expansion, and resonant sound upon percussion over the lungs and noadventitious breath sounds.

Breathing pattern is normal with symmetrical chest movement noted on

anterior thorax. She has a regular heart beat pattern.

Spinal cord is vertically aligned. She has a slouched posture, with right and

left shoulders at the same height.


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Abdomen

Uniform in color, not distended, rounded symmetric contour and movements

upon by respiration and with audible bowel sounds every 5 to 20 seconds, Nolesions noted, no tenderness, relaxed abdomen with smooth and consistenttension.

Thorax and Lungs

Posterior thorax is chest symmetric. Regarding her spinal alignment, her

spine is vertically aligned; slouched postures, left and right shoulders andhips is at the same height.

Jugular veins are not visible.

Upper Extremities

There are firm with coordinated movements; Her bones and joints have no deformities, tenderness nor swelling noted.

Shecan sense touch, pain and temperature.

The client is able to repeatedly and rhythmically touch the nose during the

finger to nose test.

Lower Extremities

The muscles in the lower extremities are symmetrical.

The client can resist against the pressure given by the student nurse and

elicited fine coordinated movements.

The bones and joints in the lower extremities have no deformities andpain, temperature and touch is felt.

The clients gait and balance is stable. She can walk in straight line and

can maintain balance.

B. CRANIAL NERVES

CN 1: OLFACTORYType: SensoryFunction: SmellTests perform: The student nurse asked the client to close her yes and identifydifferent aromas such as perfume and coffee.Expected result: She is expected to identify the different aromas such as perfumeand coffee presented with hers closed.Actual Result: Mother Mae was able to identify the aromas of perfumes andcoffee.

CN ||: OPTICS


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Types; sensoryFunction: vision and visual fieldsTests perform: the student nurse asked her to read on the newspapersExpected result: the client will be able to read the newspapersActual result: Mother. Mae was able to read at a distance of 14

CN |||: OCULOMOTORTypes: motorFunction: Extra ocular movements of the eyes, movement of the sphincter of thepupils.Tests performed: the student nurse made use of a penlight at a distance of 1 footin front of the clients eyes and asked the client to hold the head in a fixedposition facing the student and followed the movement of the penlight with eyesonly. The student nurses assess the 6 ocular movement and pupil reaction.Expected result: client is expected to move her eyes though the cranial fields ofgaze that is from the center to the upper right, upper left lower right, lower left

and medially. Actual result: Mother Mae wasable to move her eyes though the cranial fields of gaze that is from the center tothe upper right, upper left lower right, lower left and medially.

CN|V: TOCHLEARTypes: motorFunction: extra ocular eye movements specifically nerve eyeball downward andlaterallyTests perform: the student nurse asked to asses the 6 ocular movements usingthe penlight at distance or 1 foot and followed the penlight with the eyes onlyExpected result: Mother Mae will be able to move her eyes downward obliquelyActual result: Mother Mae was able to move her eyes downward obliquelywithout moving hid head.CN V: TRIGEMINALType: motorFunction: jaw movement and mastication, Sensation of cornea, skin of face, andnasal mucosaTests perform: The student asked the client to look upward, lightly touch lateralsclera at eye to elicit blink reflex.To test light sensation, the student ask the client to close eyes then wipe a wispof cotton over the clients foreheadTo test deep sensation, use alternating blunt and sharp ends of the cap of a penover the same area.Allow the client to chew, open, and clench her jaw, while palpating the jawmuscles.Actual result: The client was able to blink after the sclera is touchedThe client was able to identify the light and deep sensations through the objectspresented.The client was able to open and clench her jaw without extra effort.


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CN V|: ABDUCENType: motorFunction: lateral movement of the eyes

Tests perform: the student nurse stand directly in front of the lint and holdpenlight at a distance of 1 foot and asked client to hold head follow themovement of the penlight with her yes only.Expected result: She will be able to follow the lateral movement of the penlight.Actual result: She was able to follow the lateral movement of the penlight.

CN V||: FACIALType: motorFunction: facial expression, taste (anterior or 2/3 of tongue)Tests perform: she was asked to raise her eyebrows, smile, show teeth and puffout cheeks.

Expected result: she is expected to raise her eyebrows, smile, show teeth andpuff out cheeks.Actual result: she was able to raise her eyebrows, smile, show teeth and puff outcheeksThe client was able to identify the different tastes placed on the anterior two-thirds of the tongue.

CN V|||: VESTIBULOCOCHLEARType: sensoryFunction: sense of hearing and balancedTests perform: whispered few words at the client back and allow repeating clientback.Expected result: Mother Mae will be able to hear the words that the student nursewhispered to the client.Actual result: Mother Mae was able to hear the words that the student nursewhispered to the client.

CNIX: GLOSSOPHARYGEALType: motor and sensoryFunction: pharyngeal movement and swallowing abilityTests perform: whispered few words at the client back and allow repeating clientback.Expected result: When asked to say ah, she will be able to say it and she willbe able to elicit the gag reflex. And she will be able to move the tongue from sideto side and up and down.Actual result: Mother Mae was able to move the tongue foam side to side and upand down and was able to say ah when asked. She also elicited gag reflex.

CN X: VAGUSType: motor and sensory


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Function: swallowing and speakingTests perform: assess with cranial nerve IX, assess client speech for hoarsenessand ask the client to swallow and speechExpected result: she will be able to state her name without hoarseness voice andwas able to swallowing.

Actual result: she was able to state her name without hoarseness voice and wasable to perform swallowing.

CN XI: ACCESORYType: motorFunction: head movement and movement of shoulders muscleTests perform: the student nurse asked the client to shrug her shoulder againstresistance of the student nurses hand and turn head side against resistance.Repeat both sides.Expected result: she must be able to shrug her shoulder against resistance of thestudent nurses hand and turn head side against resistance.

Actual result: She was able to shrug her shoulder against resistance of thestudent nurses hand and turn head side against resistance.

CN XII: HYPOGLOSSALType: motorFunction: movement of the tongue and stretch of the tongueTests perform: She was asked to protrude her tongue at midline, and then moveit side to side.Expected Result: She should be able to protrude her tongue at midline, and thenmove it side to sideActual result: She was able to protrude her tongue at midline, and then move itside to side.

B. Obstetrical History:

Mrs.Mae obstetric record is G5P2T2P0A3L2M0.She had her firstmenstrual period when she was 12 years old. She has a regular menstrual cycle.Mrs. Mae and Mr.Lorenzo were married for ten years now.. She consulted themidwife after her delivery to her youngest child. Mrs. Mae usually takes note ofher last menstrual period for her to be aware of it.

All of the deliveries of Mrs. Mae were done in the hospital via NormalSpontaneous Delivery with the aid of the midwife. After being confirmed thatMrs. Mae is positive for pregnancy test she has her frequent prenatal checkupsthat started for her two months of pregnancy.. She had her frequent check-ups;her check up for the 2nd to 6th month is every month, for 7th and 8th month, twice amonth, and for the 9th month every week. Mrs. Mae had her Tetanus Toxoidvaccine in her early pregnancy and after giving birth.


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During her pregnancies she experienced morning sickness that usually lastfor a weeks According to her, she craved for mangoes,oranges, and Tamarind.According to her, she believes in some superstitions regarding pregnancy like noteating twin bananas because it may bring about twin babies and not wearingnecklace because it might choke the baby. She also avoid taking a bath after

delivering a baby, she only takes a bath after three days.C.Nutritional Status

Nutritional StatusBMI= Weight in Kilograms

(Height in meters)2

= 49 kg = 49kg(1.52 m2) 2.31

= 21.21 (normal)Age: 30 y/oHeight: 152cm

Weight: 49 Kg

BMI Range Classification

Below 15 Emaciated

15-18.9 Underweight

19-24.9 Normal

25-29.9 Overweight

30-39.9 Obese

40-more Morbidly Obese

E. History of past and present illness

Mother Mae mentioned that she did not experience any major illnesses orhospitalizations before. She only had occasional fever, cough and colds. . Butwhen further asked, she made mention of her mother who died of brain cancer.

At present, she is complaining of frequent headaches. The group providedhealth teachings such as increasing fluid intake and eating nutritious foods as aform of protection for her to increase her resistance to pathogenic

microorganisms and to consult the midwife regarding her condition.

F. Activities of daily livingMother Mae wakes up between 5 to 6 am and prepares breakfast for her

family especially the meal for her children who are about to go to school. Shecooks for about 30 minutes between 6 to 6:30 am. She joins them in eating from6:30 up to 7 am. Then she sends them to school. While waiting, she performs herdaily activities like watching television or cleaning the house. Then she cooks


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their lunch at around 11am to 12noon. Then she prepares it as her children arriveat around 12noon. Then they eat lunch for about an hour or so from 12noon to1pm. After lunch, she does her sideline, sharpening BBQ sticks. All her familychores including her side-line she spends from 1pm to 6pm. She prepares foodat 6pm and they eat at 7pm. Then she sleeps at 8pm.

Health Assessment (IPPA-CEPHALOCAUDAL)Ann (daughter)Physical ExaminationFirst Home Visit (January 23,2009)

A. General Appearance and BehaviorUpon initial visit Ann is wearing school uniform and black shoes. She is alert andawake. Ann is 9 year old. Her vital sign are as follow: temperature: 36.5C: PulseRate: 83 BPM: Respiratory Rate: 17 CPM. Her weight is 46 lbs. and her height is

125cm.

Physical Assessment

Mental Status

Client is alert and awake with eyes open and looking at the student nurse.


She established eye contact when asked questions.

The client is cooperative, when asked, can answer properly.


perceptions.




She was able to recall recent event without difficulty

Motor Function

Walking gait coordinated movement, sitting



normal because when her skin was pinched, it goes back to previous stateimmediately. The skin is not edematous and is in normal temperature. Withsensation to touch, pain & temperature.

Skull & Face (Head)


and no tenderness palpated. She has symmetrical facial movements as


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evidenced by clients ability to smile, frown, raise his forehead & eyebrows &shows his teeth. Facial features and facial movements are symmetrical.

Hair

Hair is long, dry, straight, thick, black and evenly distributed hair. No area of

loss of hair and no infection/infestation.

Nails




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In hearing acuity test by determining the function of 8th (acoustics) cranial

nerve, normal tone voice is audible. The client was able to hear on both earswhen the student nurse whispered.


Her nose is symmetrical and uniform in color; there is no discharge or flaring,no lesions or tenderness.




Mouth and Throat

Her teeth are incomplete; she has 30set and all have dental carries. Her teeth

are yellowish in color..

Her tongue is pinkish in color, moves without restraint, no tenderness and no

lesions.





inflamed.

Gag reflex is present by using a spoon and pressed in the posterior tongue

Chest and Back

Skin at the back is intact with uniform in temperature.

Chest is symmetric in volume, no tenderness and masses, full and symmetric

lung expansion, and resonant sound upon percussion over the lungs and noadventitious breath sounds.



Spinal cord is vertically aligned, with right and left shoulders at the same

height.

Abdomen

Uniform in color, not distended, rounded symmetric contour and movements

upon by respiration and with audible bowel sounds every 5 to 20 seconds, Nolesions noted, no tenderness, and relaxed abdomen with smooth andconsistent tension.

Thorax and Lungs


spine is vertically aligned; left and right shoulders and hips is at the sameheight.


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When chest was palpated for vocal fremitus there is bilateral symmetry of

vocal fremitus by placing nurses hands on the back of the client and lettingher say the word ninety-nine.

Jugular veins are not visible.

Motor Function

Walking gait

Opposing arm swing upon walking; maintaining balance

Upper Extremities

There are firm with coordinated movements;

Her bones and joints have no deformities, tenderness nor swelling noted.




Lower Extremities




The bones and joints in the lower extremities have no deformities and pain,

temperature and touch is felt.

The clients gait and balance is stable. She can walk in straight line and can

maintain balance.

CRANIAL NERVES

CN 1: OLFACTORYType: SensoryFunction: SmellTests perform: The student nurse asked the client to close her yes and identifydifferent aromas such as perfume and coffee.Expected result: She is expected to identify the different aromas such as perfumeand coffee presented with hers closed.Actual Result: Mother Mae was able to identify the aromas of perfumes andcoffee.

CN ||: OPTICSTypes; sensoryFunction: vision and visual fieldsTests perform: the student nurse asked her to read on the newspapersExpected result: the client will be able to read the newspapersActual result: Mother. Mae was able to read at a distance of 14


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CN |||: OCULOMOTORTypes: motorFunction: Extra ocular movements of the eyes, movement of the sphincter of thepupils.Tests performed: the student nurse made use of a penlight at a distance of 1 foot

in front of the clients eyes and asked the client to hold the head in a fixedposition facing the student and followed the movement of the penlight with eyesonly. The student nurses assess the 6 ocular movement and pupil reaction.Expected result: client is expected to move her eyes though the cranial fields ofgaze that is from the center to the upper right, upper left lower right, lower leftand medially.Actual result: Mother Mae was able to move her eyes though the cranial fields ofgaze that is from the center to the upper right, upper left lower right, lower leftand medially.

CN|V: TOCHLEAR

Types: motorFunction: extra ocular eye movements specifically nerve eyeball downward andlaterallyTests perform: the student nurse asked to asses the 6 ocular movements usingthe penlight at distance or 1 foot and followed the penlight with the eyes onlyExpected result: Mother Mae will be able to move her eyes downward obliquelyActual result: Mother Mae was able to move her eyes downward obliquelywithout moving hid head.CN V: TRIGEMINALType: motorFunction: jaw movement and mastication, Sensation of cornea, skin of face, andnasal mucosaTests perform: The student asked the client to look upward, lightly touch lateralsclera at eye to elicit blink reflex.To test light sensation, the student ask the client to close eyes then wipe a wispof cotton over the clients foreheadTo test deep sensation, use alternating blunt and sharp ends of the cap of a penover the same area.Allow the client to chew, open, and clench her jaw, while palpating the jawmuscles.Actual result: The client was able to blink after the sclera is touchedThe client was able to identify the light and deep sensations through the objectspresented.The client was able to open and clench her jaw without extra effort.

CN V|: ABDUCENType: motorFunction: lateral movement of the eyes


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Tests perform: the student nurse stand directly in front of the lint and holdpenlight at a distance of 1 foot and asked client to hold head follow themovement of the penlight with her yes only.Expected result: She will be able to follow the lateral movement of the penlight.Actual result: She was able to follow the lateral movement of the penlight.

CN V||: FACIALType: motorFunction: facial expression, taste (anterior or 2/3 of tongue)Tests perform: she was asked to raise her eyebrows, smile, show teeth and puffout cheeks.Expected result: she is expected to raise her eyebrows, smile, show teeth andpuff out cheeks.Actual result: she was able to raise her eyebrows, smile, show teeth and puff outcheeksThe client was able to identify the different tastes placed on the anterior two-

thirds of the tongue.

CN V|||: VESTIBULOCOCHLEARType: sensoryFunction: sense of hearing and balancedTests perform: whispered few words at the client back and allow repeating clientback.Expected result: Mother Mae will be able to hear the words that the student nursewhispered to the client.Actual result: Mother Mae was able to hear the words that the student nursewhispered to the client.


CN X: VAGUSType: motor and sensoryFunction: swallowing and speakingTests perform: assess with cranial nerve IX, assess client speech for hoarsenessand ask the client to swallow and speechExpected result: she will be able to state her name without hoarseness voice andwas able to swallowing.


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CN XI: ACCESORYType: motor

Function: head movement and movement of shoulders muscleTests perform: the student nurse asked the client to shrug her shoulder againstresistance of the student nurses hand and turn head side against resistance.Repeat both sides.Expected result: she must be able to shrug her shoulder against resistance of thestudent nurses hand and turn head side against resistance.Actual result: She was able to shrug her shoulder against resistance of thestudent nurses hand and turn head side against resistance.

CN XII: HYPOGLOSSALType: motor

Function: movement of the tongue and stretch of the tongueTests perform: She was asked to protrude her tongue at midline, and then moveit side to side.Expected Result: She should be able to protrude her tongue at midline, and thenmove it side to sideActual result: She was able to protrude her tongue at midline, and then move itside to side.

Nutritional Status

BMI= Weight in Kilograms(Height in meters)2

31kg = 31kg(1.25 m2) 1.5625

= 19.84 (normal)

BMI Range Classification

Below 15 Emaciated

15-18.9 Underweight

19-24.9 Normal

25-29.9 Overweight

30-39.9 Obese

40-more Morbidly Obese

F. History of past and present illness


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Ann, as mentioned by her mother, was hospitalized last 2005 due toconvulsion at a private hospital.Her present health status shows that she has coughs.

G. Activities of daily living

Anne wakes up at 7am and prepares for school. Shes at school from 7-11am. She walks home at 11 and arrives at 12. She eats at 12noon and goesback to school at 12:45. Her afternoon class starts at 1pm and ends at 4. Shewalks home at 4pm and arrives at 4:15. She plays for about an hour up to 5:15.She does her homework until 6pm and eats at 6:30. She sleeps at 8pm.

Health Assessment (IPPA-CEPHALOCAUDAL)Anthony (Son)Physical ExaminationFirst Home Visit (January 23,2009

A. General Appearance and BehaviorDuring the initial visit Anthony was seen clean white sando and blue short. Hehas black complexion with short nails. Anthony is a 5 year old who weight 15 kgand has height 111 cm. temperature: 36C: Pulse Rate: 120 BPM. RespiratoryRate: 23 CPM.

Physical Assessment

Mental Status

Client is alert and awake with eyes open and looking at the student nurse.


She established eye contact when asked questions. The client is cooperative, when asked, can answer properly.


perceptions.




She was able to recall recent event without difficulty

Motor Function

Walking gait coordinated movement, sitting



normal because when her skin was pinched, it go back to previous stateimmediately. The skin is not edematous and is in normal temperature. Withsensation to touch, pain & temperature.


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Skull & Face (Head)


and no tenderness palpated. She has symmetrical facial movements asevidenced by clients ability to smile, frown, raise his forehead & eyebrows &shows his teeth. Facial features and facial movements are symmetrical.

Hair

Hair is long, dry, straight, thick, black and evenly distributed hair. No area of

loss of hair and no infection/infestation.

Nails




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Pinnas are elastic recoils after folded, firm and without tenderness upon

palpation.

Internal ear has no lesions and with a presence of cerumen.

In hearing acuity test by determining the function of 8th (acoustics) cranial

nerve, normal tone voice is audible. The client was able to hear on both ears

when the student nurse whispered.


Her nose is symmetrical and uniform in color; there is no discharge or flaring,

no lesions or tenderness.




Mouth and Throat

Her teeth are incomplete; she has 30set and all have dental carries. Her teeth

are yellowish in color..

Her tongue is pinkish in color, moves without restraint, no tenderness and no

lesions.





inflamed.

Gag reflex is present by using a spoon and pressed in the posterior tongue

Chest and Back Skin is intact with uniform in temperature.

Chest is symmetric in volume, no tenderness and masses, full and symmetric

lung expansion, and resonant sound upon percussion over the lungs and noadventitious breath sounds.



Spinal cord is vertically aligned, with right and left shoulders at the same

height.

Abdomen Uniform in color, not distended, rounded symmetric contour and movements

upon by respiration and with audible bowel sounds every 5 to 20 seconds, Nolesions noted, no tenderness, relaxed abdomen with smooth and consistenttension.

Thorax and Lungs


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spine is vertically aligned; left and right shoulders and hips is at the sameheight.

When chest was palpated for vocal fremitus there is bilateral symmetry of

vocal fremitus by placing nurses hands on the back of the client and letting

her say the word ninety-nine. Jugular veins are not visible.

Motor Function

Walking gait

Opposing arm swing upon walking; maintaining balance

Upper Extremities

There are firm with coordinated movements;

Her bones and joints have no deformities, tenderness nor swelling noted.




Lower Extremities




The bones and joints in the lower extremities have no deformities and

pain, temperature and touch is felt.

The clients gait and balance is stable. She can walk in straight line andcan maintain balance.

CRANIAL NERVES

CN 1: OLFACTORYType: SensoryFunction: SmellTests perform: The student nurse asked the client to close her yes and identifydifferent aromas such as perfume and coffee.Expected result: She is expected to identify the different aromas such as perfume

and coffee presented with hers closed.Actual Result: Mother Mae was able to identify the aromas of perfumes andcoffee.

CN ||: OPTICSTypes; sensoryFunction: vision and visual fieldsTests perform: the student nurse asked her to read on the newspapers


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Expected result: the client will be able to read the newspapersActual result: Mother. Mae was able to read at a distance of 14

CN |||: OCULOMOTORTypes: motor

Function: Extra ocular movements of the eyes, movement of the sphincter of thepupils.Tests performed: the student nurse made use of a penlight at a distance of 1 footin front of the clients eyes and asked the client to hold the head in a fixedposition facing the student and followed the movement of the penlight with eyesonly. The student nurses assess the 6 ocular movement and pupil reaction.Expected result: client is expected to move her eyes though the cranial fields ofgaze that is from the center to the upper right, upper left lower right, lower leftand medially. Actual result: Mother Mae wasable to move her eyes though the cranial fields of gaze that is from the center tothe upper right, upper left lower right, lower left and medially.

CN|V: TOCHLEARTypes: motorFunction: extra ocular eye movements specifically nerve eyeball downward andlaterallyTests perform: the student nurse asked to asses the 6 ocular movements usingthe penlight at distance or 1 foot and followed the penlight with the eyes onlyExpected result: Mother Mae will be able to move her eyes downward obliquelyActual result: Mother Mae was able to move her eyes downward obliquelywithout moving hid head.CN V:

TRIGEMINAL

Type: motorFunction: jaw movement and mastication, Sensation of cornea, skin of face, andnasal mucosaTests perform: The student asked the client to look upward, lightly touch lateralsclera at eye to elicit blink reflex.To test light sensation, the student ask the client to close eyes then wipe a wispof cotton over the clients foreheadTo test deep sensation, use alternating blunt and sharp ends of the cap of a penover the same area.Allow the client to chew, open, and clench her jaw, while palpating the jawmuscles.Actual result: The client was able to blink after the sclera is touchedThe client was able to identify the light and deep sensations through the objectspresented.The client was able to open and clench her jaw without extra effort.

CN V|: ABDUCENType: motor


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Function: lateral movement of the eyesTests perform: the student nurse stand directly in front of the lint and holdpenlight at a distance of 1 foot and asked client to hold head follow themovement of the penlight with her yes only.Expected result: She will be able to follow the lateral movement of the penlight.

Actual result: She was able to follow the lateral movement of the penlight.

CN V||: FACIALType: motorFunction: facial expression, taste (anterior or 2/3 of tongue)Tests perform: she was asked to raise her eyebrows, smile, show teeth and puffout cheeks.Expected result: she is expected to raise her eyebrows, smile, show teeth andpuff out cheeks.Actual result: she was able to raise her eyebrows, smile, show teeth and puff outcheeks

The client was able to identify the different tastes placed on the anterior two-thirds of the tongue.CN V|||: VESTIBULOCOCHLEARType: sensoryFunction: sense of hearing and balancedTests perform: whispered few words at the client back and allow repeating clientback.Expected result: Mother Mae will be able to hear the words that the student nursewhispered to the client.Actual result: Mother Mae was able to hear the words that the student nursewhispered to the client.


CN X: VAGUSType: motor and sensoryFunction: swallowing and speakingTests perform: assess with cranial nerve IX, assess client speech for hoarsenessand ask the client to swallow and speechExpected result: she will be able to state her name without hoarseness voice andwas able to swallowing.


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CN XI: ACCESORYType: motor

Function: head movement and movement of shoulders muscleTests perform: the student nurse asked the client to shrug her shoulder againstresistance of the student nurses hand and turn head side against resistance.Repeat both sides.Expected result: she must be able to shrug her shoulder against resistance of thestudent nurses hand and turn head side against resistance.Actual result: She was able to shrug her shoulder against resistance of thestudent nurses hand and turn head side against resistance.

CN XII: HYPOGLOSSALType: motor

Function: movement of the tongue and stretch of the tongueTests perform: She was asked to protrude her tongue at midline, and then moveit side to side.Expected Result: She should be able to protrude her tongue at midline, and thenmove it side to sideActual result: She was able to protrude her tongue at midline, and then move itside to side.

B. Immunization Status

1st dose 2nd dose 3rd dose

BCG

Error! Bookmark

not defined. _______ _______

DPT

OPV

HEPA B

MEASLES _______ _______

Anthony is fully immunized before he turns 1 y/o in their health center.

C. Growth and DevelopmentErik Ericksons Psychological Stages

Initiative vs. GuiltDuring this stage, a child should learn to do socially acceptable behavior

and this is the time when a child learns to set his own goals. As for Anthony he


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actively socializes with other people especially those who are within his agegroup but hes very shy with older people like the student nurses. He doesntcooperate well in the first two days of student nurses and family interactionInitiative in doing even basic things such as wearing of shoes. Her mother isconsistent in disciplining him. He does what satisfies him because in this stage a

child becomes more eager in adventures. There are no distinct limitations thatare set for him by her mother.Sigmund Freuds Psychosexual Stages

Phallic StageIn this period the child focuses feelings chiefly on the parent of the opposite sex.

And during the groups home visit, they had observed that he is close to hismother. The group did not observe any sexual diversion on his part.

D. Nutritional StatusHt: 111cmWt: 15 kg (normal) Age: 60months

FNRI= Normal weight 14.4-23.5 Therefore, Anthony is Normal

E. History of past and present illnessAnthony, as mentioned by her mother was hospitalized due to BPN

(bronchopneumonia) last 2005 at a public hospital.His present health status reveals that he has no presence of illness.

G. Activities of daily livingAnthony wakes up at 7am and prepares for school. Hes at school from 7-

10am. He walks home at 10 and arrives at 10:15. He eats at 110:30am up to11am. He plays at 12noon up to 5pm. He does his homework until 6pm and eats

at 6:30. He sleeps at 8pm.

TYPE OF FAMILY STRUCTURE

The chosen family, the Macapagal family is of a nuclear type. The nuclear

family consists of a father, mother and child living together. This type of family

structure is found in almost societies, although the length of time in which the


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family remains in this form varies even within the same society. The family

consists of Mr. Lorenzo, Mrs. Mae & their 2 children namely: Ann and Anthony.

Mr. Lorenzo is a junkshop worker in a company in Clark field, Pampanga while

Mother Mae, is a full time house wife and she is responsible in taking care of the

families needs and health. The type of residence is bilocal since they live

separately from their parents. Two of their children are going to school. In spite of

the problems that they are facing, their relationship with each other is good

because they have a positive outlook in life and really loves each other.

ETHNIC BACKGROUND AND RELIGIOUS AFFILIATIONS

Originally, Mr. Lorenzo is from Surigao while Mrs. Mae is originally from

Macapagal village. The religion of the family is Catholic Mrs. Mae honestly told

us that they seldom go to church because they have no time to go and also the

church is far from their village.

DOMINANT FAMILY MEMBERS IN DECISION MAKING

The family can be classified under the Matriarchal type of family when it

comes to the authority exercised w/in the household since Mr. Lorenzo is always

out for work the mother is considered the head of the family and has power in

decision-making. She told us that also because Mr. Lorenzo is poor in decision

making and just follows Mrs. Maes orders. She is the one who decide for the

family especially when its money matters. As well as, in terms of discipline and

with the health of the children Mrs. Mae is the one who dominates.

SOURCES OF INCOME, EXPENSES AND OCCUPATION

The familys main source of income is Mr. Lorenzos work at the junkshop.

According to Mrs. Mae, Mr. Lorenzo earns 7,500 a month. While Mr. Lorenzo is

at work Mrs. Mae is sharpening BBQ sticks as a form of sideline for their monthly

expenses. She earns 8 pesos for every 1,000 pcs of BBQ sticks. According to

them, their funds are enough to meet their basic needs such as food, clothing

and shelter although there are times when they are not able to pay their monthly


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expenses like the electric & water bills in due to the time given & so they are left

with no choice but to borrow from their relatives or even from their neighbors. As

soon as they save enough money, they would pay the people they have

borrowed money from. They do not have excess money for medical-related

needs, activities and leisure.

The family has no financial assets available in case of emergency. If there

is an emergency, however, they are able to borrow money from their neighbors

and relatives.

Source of income

1Junkshop worker

Usual profit P7,500 a month

The following is the family expenditures:

(Monthly)

Rice P1120.00

Fish, meats, Vegetables P1, 050.00

Electric bill P550.00

Water bill P400.00

Kids allowance (P20/day) P1,240.00

Extra Expenses (soap, toothpaste, shampoo,etc) P300.00

Total: P4,660/month

NATURE OF WORK, WORKING HOURS

Mr. Lorenzo is a regular junkshop worker he regularly goes to work at

7:00am and comes back at 5-6pm. His schedule of work is from Monday to

Saturday. The reason the student nurses were not able to meet him.

SIGNIFICANT OTHERS/RELATIVES ROLE IN FAMILYS LIFE

They live in the vicinity close to other relatives on the side of his wifes

family. Although there are some relatives in that area, their relatives do not

interfere with the affairs and businesses of the Macapagal family.


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FAMILY HEALTH HABITS, BELIEFS, PRACTICES AND SUPERSTITIONS

The Macapagal family believes in albularyos(herbolarios). They also make

use of herbal medicines (like oregano, lagundi,kalamansi, bayabas, & ampalaya)

when they have minor illnesses like cough, colds & fever. However, Mrs. Mae

cleared that they have nothing against the credibility of the medical doctors. In

fact, they seek for medical advice when their diseases can no longer be cured by

the albularyos & the herbal medicines they use.

On the other hand, cleanliness is quite practiced in their home but,

sometimes the children, after going to school usually play with their friends and

go home dirty.The family believes that some diseases like cough and colds are

brought about by the sudden change of temperature and climate. They make use

ofkalamansias a remedy such diseases.

COMMUNITY, SOCIAL AND HEALTH RESOURCES AND FAMILYS

UTILIZATION OF THESE RESOURCES

The community has a Barangay Health Center located near their house

wherein they barely utilize any of the services given by the Barangay Health

Center; where in the BHC is only giving free medical missions and feeding

programs only when student nurses are around to facilitate the said activity. The

BHC (barangay health center) is also giving such services (Vaccines, medical

mission, Family Planning Programs, Pregnant Care, feeding programs etc.) but

this services are only given when the midwife is around (every Tuesday).

LIVING CONDITION

The house structure is made of hollow blocks, concrete cement and

cut wood. There is a gap between the walls and roofing, allowing entrance of

cold and hot air and insects. During the day, they are lighted by artificial

lighting because sunlight cannot light the house due to some environmental

factors such, as their house is covered by big trees; Also the location of their

windows do not provide entry for the light to come in. The house is not stable


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and has many threats. The wires are exposed since they do not have a

ceiling and during rainy season water flows to their house making them at risk

for some diseases like Leptospirosis. It has a bedroom, kitchen, toilet, and a

living room. There are 6 windows throughout the house which measures

93.98cmX60.96cm (living room), 75.2cmX86.36cm (bedroom),

60.96cmX71.12cm (kitchen). Their windows do not have screens w/c allows

the entry of mosquitoes and flies. Also they have an incandescent light bulb

which is located in the bathroom (60watts) 1 fluorescent(40watts) in the living

room, 1 fluorescent in the bedroom(18watts), 1 fluorescent outside near the

door(18watts). The household was also positive from mice & cockroaches

due to the garbage exposed in front of their house. According to the mother

their house has approximately 11m2

TFA [total floor area]: 11m2

Total surface requirement per individual is as follows:

-Adult: 13 y/o above = 3m

-Child: 1 y/o (0-12 y/o) = 1.5 m

Member Age TSR

Father 37 y/o 3m

Mother 30 y/o 3m

Child 1 5 y/o 1.5m

Child 2 9 y/o 1.5m

= 9m2

Therefore the living space is adequate.

The computation of ventilation is as follows:

Living room: 93.98 X 60.96cm total window size=living bed

=0.94m X 0.61m room + room + kitchen

=0.5734m X 2 windows =1.15m2 +1.31+0.87m2

= 1.15m2 =3.33m2


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Bedroom: 76.2 X 86.36 cm

=0.76m X 0.86m

=0.6536 X 2 windows

=1.31m2

Kitchen: =60.96 X 71.12

=0.61 X 0.71

=0.4331 X 2 windows

=0.87m2

Adequate= required window size is 10% of TFA

TFA =11m2 X 10%

=1.1m2

3.33m2 (total window size) > 1.1m2

Therefore, there is adequate ventilation

The computation for lighting is as follows:

Adequacy of lighting= 50watts incandescent bulb or 20-40watts fluorescent bulb

=60watts incandescent bulb + 40watts fluorescent light + 18watts

+18watts

=136watts

Therefore, there is adequate lighting both daytime and nighttime.

FOOD STORAGE, SOURCE & COOKING

The kitchen consists of a small table sink and cooking (charcoal) facility

where the 4 family members eat altogether.

The size of the house appears adequate for the size of the family. Their

appliances consist of radio, electric fan, television, VCD player and stove (but not

used).

Their food resources are bought on daily basis. Mrs. Mae buys and brings

home the food to be prepared for the day. They cook the food with charcoal. The

family also, do not have a refrigerator where they could store their food & so

when there are left over food, they have no choice but to place it on the dining


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table & cover it w/ another plate to be eaten for the next meal or hang it in a

casserole just above the cooking facility.

TOILET FACILITY

They have a small bathroom near the kitchen. They use plastic container

as a dipper in flushing the toilet. The toilet is fairly clean because there is some

urine smell but there is no fecal stains observed in the toilet bowl. The roof also

has small holes on it.

WATER SUPPLY

They obtain their water supply from jetmatic, which is owned by their neighbor.

According to them, they pay 2 pesos per pale. They drink the water from the

jetmatic and store it in a pitcher. The family regularly boils the water before

drinking it. This provides them to have a potable drinking water.

DRAINAGE SYSTEM

They have an open type of drainage system. It is man-made type of

drainage system in which they dug pits where water can flow and will not bedirected towards their house in case of heavy rains or typhoons; since their

house is located at a slope of the village. This is a man-made drainage facility

where they dug pits to make flood-water and the like to be in free flowing when it

is raining while the water usually dries up and absorbed by the soil when the rain

stops.

GARBAGE DISPOSAL

They do no have proper ways of throwing their garbage. Their garbage is

placed outside of the house and is burned. All the waste materials including

bamboo waste, plastic, leftover foods etc. are burned all together. Sometimes

they just place it in an area and leave it there where it is exposed to chickens,


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ducks, and, flies, cockroaches and other insects w/c is a threat to the health of

the family. The collection of garbage in their community is irregular.

COMMUNICATION AND TRANSPORTATION

The family has 2 cellular phones, which belong to Mr. Lorenzo and Mrs.

Mae. According to them, these were bought for them to be able to contact their

relatives in case of emergency.

On the other hand, the family doesnt own any vehicle Mr. Lorenzo uses

his bike to go to work. While the children walks to school every morning since the

school is just near their house. The family commutes if they go to other place

such as malls or visiting their relatives and other sorts of things.


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A. PROBLEM IDENTIFICATION

Problem # Problem Score

Problem #1: Presence of Coughs (Ann) as a Health Deficit 4.67

Problem #2: Unhealthful Lifestyle and Personal Habitsor Practices: CIGARETTE SMOKING as aHealth Threat 4.34

Problem #3: Inappropriate role Assumption (Mrs. Maehas the power to decide) as a Health Threat 3.84

Problem #4: Presence of Rodents andCockroach as a Health Threat 3.84

Problem #5: Inadequate/Insufficient Family Resourcesas Health Threat 3.34

Problem #6.5: Lack of food storage facilities as a HealthThreat 2.84

Problem #6.5: Poor Environment Sanitation: ImproperDrainage System as a health threat 2.84

Problem #8: Improper Garbage Disposal as a Health threat 2.50

Problem #9: Risk for Cross-infection as a health threat 2.5

Problem #11: Presence of Accident Hazards (ExposedElectrical wires) as a Health Threat 2

Problem #11: Poor environmental Sanitation: Air Pollution asa Health Threat 2

Problem #11: Risk for injury as a Health threat 2


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B. Priority Setting

Problem #1: Presence of Coughs (Ann) as a Health Deficit

CRITERIA COMPUTATION SCORE JUSTIFICATION

A. Nature of theproblem 3 / 3 x 1 1 The problem is a health deficitbecause one of the membersneeds immediate care to preventthe pass of infection from onemember to another. It alters thenormal health status of one ofthe members that may alter theproper functioning of the familyas a whole.

B. Modifiability of theproblem

CurrentKnowledge

Resourcesof theFamily

Resourcesof theNurses

Resourcesof theCommunity

2 / 2 x 2 2 The problem is easily modifiablebecause:

Current KnowledgeThe family recognizes

the presence of coughs ofAnn and the need for her tobe properly taken care ofAEB the verbalization of theproblem by mother Mae

Resources of the FamilyThe family has adequateresources to make aparticular intervention to theproblem since they have andare knowledgeable of theuse of some herbalmedicines useful for treatingthe cough like Lagundi.

Resources of the Nurses

Knowledge and time ofthe student nurses areavailable to establishawareness and recognitionof the problem. Also, theyhave proper know-how toperform independent nursingintervention to help treat or


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soothe the cough.

Resources of theCommunity

The community resources

are also available to assist thefamily in terms of consultingabout the disease condition.

C. PreventivePotential (PP)

SeverityorGravity

=PP

Duration

=PP

CurrentManage

ment

=PP

Exposure to anyhigh risk

group

=PP

2/ 3 x 1 0.67The problem is moderatelypreventable.

Severity or gravity of theproblem.

The problem has highgravity because it can affectthe health status of the other

members. Also it can alterthe functioning of Ann in thefamily making the roleassumptions within thefamily altered too.

Duration of the ProblemThe problem has

existed approximately twodays before the studentnurses arrived.

Current Management

Since the supposedprovider of care Mother Maeknows some herbalmedicines that can be aremedy to the cough, it iscurrently managed.

Exposure to any high riskgroup

Since the brother ofAnn is younger and spendsmost of the time with Ann, he

is at risk to be infected incase the cough is caused byinfection.

D. Salience 2 / 2 x 1 1 The family recognizes the needto intervene with the problem themoment they knew it is existingAEB Mother Mae being worried


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of the condition of her daughter.TOTAL SCORE 4.67

Problem #2: Unhealthful Lifestyle and Personal Habits or Practices:CIGARETTE SMOKING as a Health Threat


A. Nature of theproblem

2 / 3 x 1 0.67 The problem is a health threatbecause the presence of asmoker within the family canaffect both the smoker and theother family members notsmoking. They can be active andpassive smokers who will haveboth affectations in their healthstatus and state of equilibrium.


CurrentKnowledge


Resources

of theNurses




the problem existing AEBmother Mae verbalizing thather husband smokes evenwhen he is still single till now

that hes married even withthe advices of mother Mae tostop it.

Resources of the FamilyThe family has basic

know-how as to what are thepossible effects of smokingspecifically the ill effectssuch as possibledevelopment of respiratory

diseases.

Resources of the NursesKnowledge and time of

the student nurses areavailable to establishawareness and recognitionof the problem. They are


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also knowledgeable for theteachings to help the familyexpand their knowledge ofthe ill effects of smoking.

Resources of theCommunityThe community resources

are also available where theycould provide teachings andearly diagnosis of possiblyoccurring disease.


SeverityorGravity

=PP

Duration

=PP

CurrentManage

ment

=PP

Exposure to any

high riskgroup

=PP

2 / 3 x 1 0.67 The problem has lowpreventability because:


The problem has highgravity because it can affectthe whole family once asactive and passive smokers.


existed even before thestudent nurses arrived longbefore the couple was

married.

Current ManagementMother Mae

constantly advices Mr.Lorenzo to stop smoking yetit is not effective since Mr.Lorenzo still engages into it.


Since the whole

family is residing in thehouse, they are all belongingto the high risk groupbecause all of them caninhale the smoke eitherpassively or actively.

D. Salience 2 / 2 x 1 1 The mother recognizes the


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existence of the problem thatrequires prompt interventionbecause it might cause herhusband or her and her childrenrespiratory diseases.

TOTAL SCORE 4.34

Problem #3: Inappropriate role Assumption (Mrs. Mae has the power todecide) as a Health Threat



2 / 3 x 1 0.67 The problem is a health threatbecause if the mother takes allthe responsibility in decision-making, she can make unlikelydecisions that may affect the

family as a whole. But if theparents share in theresponsibilities of makingdecisions, they are more able tomake wise choices.


CurrentKnowledge





Current KnowledgeThe mother

recognizes the problemexisting AEB mother Maeverbalizing that her husbandis a calm person, the reasonshe assumes to be themaker of decisions. Also,that Mr. Lorenzo is alwaysnot at home.

Resources of the FamilyThe couple can have

talks to share the problems

with each other that eachmay contribute to itssolution.


the student nurses areavailable to establishawareness and recognition


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of the problem. They arealso knowledgeable for theteachings to help the familymake wise choices.

Resources of the

CommunityThe community resources

are also available where theycould provide counseling.


SeverityorGravity

=PP

Duration

=PP

CurrentManage

ment

=PP


group

=PP

2 / 3 x 1 0.67 The problem is moderatelypreventable because:


The problem has lowgravity because it can only

affect the whole family oncethe primary decision-makerMrs. Maehas taken awrong choice.


existed even before thestudent nurses arrived.

Current ManagementMother Mae makes

the decision because her

husband is not present at alltimes. Therefore there is nomanagement undertaken toshare the decision-makingresponsibilities between bothparents.


Since the family istaken holistically, once Mrs.Mae took a wrong decision,

it can affect the whole family.

D. Salience 1 / 2 x 1 0.50 The family recognizes theexistence of the problem butdoes not require promptintervention since Mother Maestill manages to do decision-making while her husband is at


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work and they have been usedto this kind of role assumptions.

TOTAL SCORE 3.84

Problem #4: Presence of Rodents and Cockroach as a Health ThreatCRITERIA COMPUTATION SCORE JUSTIFICATION


2 / 3 x 1 0.67 The problem is a health threatbecause the presence ofbreeding sites of insects androdents are usual vectors ofmicroorganisms causing fataldiseases to the family such asleptospirosis.


CurrentKnowledge


Resourcesof the

Nurses




the problem existing AEBmother Mae verbalizing thateven Anthony recognized theoccurrence of the rodentsand insects esp. cockroach

in their house AEB theirmanual eradication of these.

Resources of the FamilyThe family has no

adequate resources to makethe best intervention to theproblem. But they havemanpower to manuallyeradicate the insects androdents.

Resources of the Nurses

Knowledge and time ofthe student nurses areavailable to establishawareness and recognitionof the problem. They arealso knowledgeable for theteachings to help the familythink of how to effective


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eradicate or totally preventtheir growth andmultiplication.


The community resourcesare also available where theycould provide teachings andmanpower. They can also havefumigations and programs likegeneral community cleaning.


Severity

orGravity

=PP

Duration

=PP

CurrentManage

ment

=PP


group

=PP

2 / 3 x 1 0.67 The problem is moderatelypreventable because:


The problem has highgravity because it can affectthe whole family once theserodents and insectscontaminate their food orbring about infection to them.



Current Management

Since a there iscareful prioritization ofincome, they are not usingthe most effective way ofkilling the insects or totallydestroying their breedingsite. However, they managethe problem by manualeradication of the insects.But this is still inefficient

Exposure to any high risk

groupSince the whole

family is residing in thehouse, they are all belongingto the high risk group.

D. Salience 1 / 2 x 1 0.50 The family recognizes theexistence of the problem but it


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does not require promptintervention for them becausethey already became used to itsoccurrence and it does notcause them harm at the

moment.TOTAL SCORE 3.5

Problem #5: Inadequate/Insufficient Family Resources as Health Threat



2 / 3 x 1 0.67 The problem is a health threatbecause if the family is not ableto suffice the needs of theindividual member, each canhave decreased ability to cope

with lifes processes. Food, forexample, is lacking, the childrenmay have decreased energylevel to cope with the pressuresin their studies.


Current

Knowledge

x


x



1 / 2 x 2 1 The problem is partiallymodifiable because:

Current Knowledge

The family does notrecognize the problemexisting because MotherMaethe provider of careis carefully prioritizing themost immediate needs.However, in doing this, sheneglects the other needswhich may also contribute tothe total necessities of theindividual members. They

also do not feel theinsufficiency because theyhave been deprived of beingprovided with the secondarynecessities in life such asown water supply, storagefacilities and the like.

Resources of the Family


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The family has noadequate resources to makethe best intervention to theproblem. The sideline of Mrs.Mae is still not sufficient.

They also do not have theknowledge to put up abusiness or plant avegetable garden, and thelike.


the student nurses areavailable to establishawareness and recognitionof the problem. They are

also knowledgeable for theteachings to help the familythink of other profitablelivelihood or handicraft.


The community resourcesare also available where theycould provide teachings andencourage vegetable planting orattend mothers classes that. At

times. Teach about livelihood.


SeverityorGravity

=PP

Duration

=PP

CurrentManage

ment

=PP


group

=PP

2 / 3 x 1 0.67The problem has moderatelypreventable because:


The problem has lowgravity because it cannotaffect the whole familyimmediately and effects will

only occur if the therehappened to be animmediate expenditurewhich is not as expected oris not included in the usualbudget.



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Current ManagementMr. Lorenzo is

currently working to earn a

living But since there is aninsufficient income, MotherMae tries to add up to theirincome by sharpening BBQsticks. However it is stillinsufficient to make theirincome above poverty line.


Since the wholefamily is residing in the

house and all of them haveindividual needs, they are allbelonging to the high riskgroup.

D. Salience 2 / 2 x 1 1 The family recognizes theexistence of the problem and itrequires prompt intervention.The reason Mrs. Mae is tryingher best to earn as well.

TOTAL SCORE 3.34

Problem #6.5: Lack of food storage facilities as a Health Threat



2 / 3 x 1 0.67 The problem is a health threatbecause improperly stored foodcan lead to food spoilage andeventually malnutrition (less thanbody requirements) because itwill be wasted rather than be

eaten to provide nourishment forthe children. It will also allow forthe growth of pathogenicmicroorganisms that wheneaten, will affect the health of thefamily members like the illeffects of molds and the like.


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Current

Knowledge

x


x




Current Knowledge

The family does notrecognize the existence ofthe problem and its badeffects since they had beenused to not having foodstorage (e.g. refrigerator)and they do not recognizethe need of such. They havebeen used to usingcasserole as food storage.

Resources of the Family

The family has noadequate resources to makethe best intervention to theproblem and alternatives arenot known to them like useof air-tight containers.


the student nurses areavailable to establishawareness and recognition

of the problem. They arealso knowledgeable for theteachings to help the familychoose alternative foodstorages that will aid inproper storing of food.


The community resourcesare also available where theycould provide health teachings

for the proper storing of food andthe possible risk of improperlystored food.


2 / 3 x 1 0.67The problem has moderatelypreventable because:

Severity or gravity of the


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SeverityorGravity

=PP

Duration

=PP

CurrentManage

ment

=PP


group

=PP

problem.The problem has low

gravity because it cannotaffect the whole familyimmediately and effects will

only occur if the food cookedwill not be all consumed.


existed even before thestudent nurses arrived and isunknown to the members.

Current ManagementSince a there is a lack

of proper food storage forthe family, the management

they do is to consume all thefood cooked and to disposethe left over so that it thepossible ingestion of spoiledfood and growth of pathogenic microorganismsmay be lessen.


Since the wholefamily is residing in the

house and eating the samefood prepared, all themembers are at risk ofingesting contaminated foodand spoiled food.

D. Salience 1 / 2 x 1 0.50 The family does recognize theexistence of the problem but itdoes not require promptintervention for them since theyare used to utilizing casseroles

as container for food leftovers.TOTAL SCORE 2.84

Problem #6.5: Poor Environment Sanitation: Improper Drainage System asa health threat


A. Nature of the 2 / 3 x 1 0.67 The problem is a health threat


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problem because if the drainage remainsinefficient, water may flow intothe house during rainy days andit may pose some flood-borne(like leptospirosis) disease to the

family or may serve as abreeding site for mosquitoes.


CurrentKnowledge

Resourcesof the

Family

x





the problem existingbecause they are worried of

the possible entry of waterinto their house especiallythat rainy season is fastapproaching. Mother Maethe provider of careiscarefully keeping the waterto be directed on to anotherway during rains.

Resources of the FamilyThe family has no

adequate resources to make

the best intervention to theproblem. It is costly in termsof money, time, andmanpower to construct aproper drainage in theirvicinity. Also, the father whocan think and do alternativeis not always present.


the student nurses are

available to establishawareness and recognitionof the problem. They arealso knowledgeable for theteachings to help the familythink of another alternativeor precautions during therainy season.

Latest FCA Revsion (March 9'08)

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