Family Case Analysis

Angeles University Foundation
Angeles City
College of Nursing
In partial fulfillment
of the requirements in
Related Learning Experience
“Family Case Analysis”

Submitted to:
Ms. Kristine Joy Villarosa R.N.
Submitted by:
Ano, Carl Elexer C
Group Leader
BSN III-7
I. Introduction
“The family is the nucleus of civilization.”

-Ariel and Will Durant: Wisdomquotes.com
The family is smallest unit of the society and the natural fundamental core
of the community and consequently, it is considered as the primordial recipient of
the nursing effort, which is contributory to the development, and progress of the
community through active involvement and self – responsibilities of each
constituent. It is composed of Father, Mother and children and it is being molded
to be as one, working hand in hand to maintain a good atmosphere among the
family members. On the other hand, a nucleus controls the functions of the entire
cell and can be thought as the “command center” of the cell. The nucleus as well
has different components which are all needed in order for it and the cell to
function well. The impression or status of each family will always affect the status
of the community as a whole.
Community health nursing is a response to the health needs of the

people. It does not focus on a particular class or family. It is comprehensive
and general in approach. Community health service is not episodic as it
requires continuous observation and monitoring of the community as a whole.
Promotion and preservation of the health of its different clients (individual,
family, group or community) is the primary goal of community health nursing.
It is just to say that community health nursing has a big role in nursing
education. It is in the community where the student nurse learns nursing apart
from the hospital setting as she was exposed to different level of orientation. It
is in the community where the saying “nursing is an art” can be applied as
student nurse tries to give quality service using the available resources in the
health center.
The community is a group of people sharing geographic boundaries
and/or values and interests. (Maglaya, 2004) No two communities are alike. A
nurse exposed in the community learns how to interact and adapt to different
kinds of people. The family is considered as the basic unit of care in the
community health nursing. It is in the family where a member develops his
health values, beliefs and practices. The family is a major influence in the
health behaviors of an individual. With this, it is important that families in a
community are aware of the things and practices pertaining to their health.
`
Family Case Analysis (FCA) is a means by which student nurse

reaches and feel the community through its basic structure – the family. It is a
tool in determining the health status of a family through assessment and critical
inspection. Through this, health related problems are identified, thus giving the
student nurse a hint on where to act and how to intervene. It is also a means
towards improving the health of the community people, making them more
productive. To come up with a FCA gives a sense of fulfillment to student nurse
as she was given the opportunity to share their skills, knowledge and time to
alleviate and uplift the living condition of a family.
The family that was assigned to the nurses is a picture of the majority of
the family here in our country. Imagine you living in a poor environmental
condition without enough resources and experiencing lack of knowledge
including health information and other socio-economic related problems. In
behalf of the students accomplishing this, though it is tiring, this makes them feel
the sense of fulfillment as they share their knowledge, skill and time to take
action to uplift the condition of the family.
A. Objective
a. Short Term
 Student Nurse Centered

After 2 days of home visits, the student nurses will be able to:
• Familiarize ourselves with the community and its people.
• Established rapport and be familiar with the family members.
• Introduce the students to the adopted family.
• Explain the purpose of conducting home visits.
• Assess the house and the sanitary condition of their environment.
• Understand the means of living of the chosen family.
• Assess the health condition of each member of the family.
• To give advice concerning the health of the family.
 Client Centered
After 2 days of home visits, the adopted family shall be able to:
• Have trust and confidence to the student nurse.
• Cooperate with the student nurse.
• Tell the student nurse whether he or she understands the
instruction given.
• Acquire knowledge from the health teaching given and know the
importance on having a good health.
b. Long Term
 Student Centered
After 4 days home visits, the Student nurses shall be able to:
• Impart knowledge to the family to make them self reliant.
• Educated the family regarding the importance of proper hygiene.
• Guide the family in identifying actual and potential problems which
may be a hindrance in attaining optimum health.
• Generate interventions considering the nurses, community and the
family’s resources.
• Enhance their ability to interact and communicate with people as
learning from the exposure to the community.
• Evaluate changes in condition after giving interventions.
 Client Centered
After 4 days of home visits, the family shall be able to:
• Apply some of the health teaching that the student nurse had
imparted.
• Become self reliant especially when it comes to health matters.
• Attain a level of proper hygiene.
• Maximize the use of resources as needed.
• Identify health problems that can be a threat in attaining optimum
health.
B. Entry, Climate of acceptance, First few words, Number of home visit
The student nurses were assigned at San Jose, Angeles City. On the first day
of the community exposure, July 14, 2008 Monday, the student nurses had a tour
and familiarize their selves around the community and went to the Barangay
Health Center later on under the supervision of their clinical instructor.
July 15, 2008, a rainy Tuesday morning, the student nurses were tasked
to look for the appropriate family that will qualify under their study. They must be
near poverty level, with existing health problems or threats, and families who are
in need of assistance and health teachings.
Fortunately, they were able to find a family that is accommodating,
responsive, and of course accepted to be the subject of their study, the
Chocolate Family.
First Home Visit (July 15, 2008, Tuesday)
On their first home visit, it was a rainy afternoon then; Mrs. Kisses was
sleeping with ChocoBaby while Snickers and Kitkat were found playing outside
their house in front of their Lola Tootsie Roll’s store. Mrs. Kisses was awakened
by Kitkat because of the arrival of the student nurses. They warmly welcomed the
student nurses inside their house. After settling down at Chocolate’s Residence,
the student nurses briefly introduced their selves and explained to the family their
purpose and said, “Ate pwede dakayu po bang ainterview? Para ya keng Family
Case Analysis mi kailangan ya keng skwela ita.” Mrs. Kisses then replied, “Wa
sige ok muh, para nokarin ya wari yan?”
The student nurses further introduced themselves to the family. They

explained thoroughly the purpose of their study. Unfortunately, they only met Mrs.
Kisses, Kitkat, the eldest child, and Snickers, the second eldest. ChocoBaby
Ruth, the youngest was still sleeping that time while the other members of the
family are not around. Lola Tootsie Roll stays in her sari-sari store outside most
of the time, as well as Mr. Ferrero who works as a tricycle driver the whole day.
Brother Crunch, sibling of Mrs. Kisses, and Uncle Butterfinger, sibling of Lola
Tootsie Roll were not present that time. They left the house before the arrival of
Student Nurses said Mrs. Kisses because they shy to be interviewed.
Anyway, the student nurses were able to establish rapport with the present
family members and were able to interview the mother regarding their socio-
economic status, environmental sanitation and the like. They were able to
acquire some information and even exchanged light-hearted conversations with
Mrs. Kisses. The vital signs of the present members were also assessed and
recorded. After an hour or two, the student nurses bid the Chocolate Family
goodbye and told them that they will be back the next day.
Second Home Visit (July 16, 2008, Wednesday)
The groups arrived on their respective families on a rainy afternoon, at

around 2:00 pm. Mrs. Kisses gladly welcomed the student nurses and offered
them chairs to sit on. The group assessed the kids, Kisses and Snickers followed
by their mother, Mrs. Kisses. ChocoBaby that time was asleep but still the
student nurses were able to assess her vital signs. On that day, the group had
only completely assessed the mother and the two kids. Unfortunately, the other
members of the family were not around again due to the same reason. Mr.
Ferrero and Lola Tootsie Roll are both busy with their job while Uncle Butterfinger
and Brother Crunch left the house before the arrival of the student nurses. The
group was able to explain thoroughly how they can help the family regarding their
present condition, in terms of proper hygiene, their home sanitation, and the
presence of health problems like malnutrition that may hinder them from attaining
optimum level of wellness. The group was also able to gain the mother’s trust
and her children’s. After assessing, the group bid the family farewell.
Third Home Visit (July 21, 2008, Monday)
The following visit was a sunny morning. The group decided to go to their
assigned family during morning for them to assess ChocoBaby, the youngest
child of Mr. and Mrs. Chocolate, because she usually sleeps every afternoon said
Mrs. Kisses. That day, the only members that the student nurses met were Mrs.
Kisses and ChocoBaby. Kitkat and Snickers at that time were at school. The
group finished assessing ChocoBaby and further interviewed Mrs. Kisses
regarding their health, like the children’s immunization and nutrition status, her
obstetrical history and their history of past and present illness. It is on this day too
that they discussed about the potential and actual problems of the family. Some
of these problems are the presence of accident hazards in their house,
malnutrition, faulty eating habits, etc. After the assessment, the group bid
goodbye to Mrs. Kisses and ChocoBaby.
Fourth Home Visit (July 22, 2008, Tuesday)
The group visited the Chocolate Family about 11:00 am. It was a hot
morning then. When they arrived at the Chocolate’s Residence, it was brownout
so Mrs. Kisses requested the group to be back after lunch.
The student nurses returned around 2:30 pm as requested by Mrs. Kisses.

Kitkat was seen playing outside while Snickers and ChocoBaby were sleeping.
They were awakened after few minutes by their sister Kitkat. Mrs. Kisses bid the
group and the kids goodbye because she needs to deliver the “merienda”
ordered by their customers and promised to be back after few minutes. The
group started to assess the kids at the same time the group started some of their
implementations regarding the problems noted. The group trimmed the children’s
long fingernails and asks them to wash their hands properly to remove the dirt.
They also told the children to wear slippers every time the go out of the house.
We told Mrs. Kisses to assure the cleanliness of Choco Baby’s pacifier before
giving it to her and not to allow her to use it after it fell on the floor. The family’s
and the group’s relationship by now is very much established. They are both
comfortable with each other now and the student nurses are at ease in doing
their assessment and interview.
.
Fifth Home Visit (July 29, 2008, Tuesday)
This time, the student nurses arrived at the house of the Chocolate Family
around 1:45 pm. The weather that time is unpredictable because there are
episodes of rainy and hot weather that day. Upon the arrival of the group, all of
the family members present are sleeping. They were just awakened by their
neighboring relatives.
That day, the student nurses continued the final assessment. They also
continued their nursing interventions and implementations. The implementations
done were focused on the sanitation of the house and regarding the hygiene of
the kids. Health teachings were given also for the family to understand the
group’s interventions. The group told the family again about how essential
hygiene is in attaining an optimum level of health, the advantages of having a
good environmental sanitation and how rodents and insects can affect their
health.
Sixth Home Visit (July 30, 2008, Wednesday)
This home visit is the last and final one that was conducted. The student
nurses are just finalizing every data that they have obtained starting from their
initial home visit until the very last. They are making sure that they have the
complete data and information needed. The group also reminded the family
about the health teachings that they told them during the recent home visits. The
group also told the family about the potential and actual problems that had been
identified by the student nurses and how to control and avoid them. The family’s
response upon the student nurses is very good and they show much appreciation
towards the student nurses which made the group feel good.
Until the last day of home visit, the group did not have the chance to meet
and assess Mr. Ferrero, Lola Tootsie Roll, Uncle Butterfinger and Brother
Crunch.
The group thanked the Chocolate Family for allowing them to conduct
their study.
II. Family Constellation
Name Age Ordinal Sex Educational Present Health

position Status Status
Mr. Ferrero 34 Father M Not going to Mr. Ferrero was not
Chocolate y/o school: assessed by the
College group because he is
working the whole
day.
Mrs. Kisses 30 Mother F Not going to Mrs. Kisses has a

Chocolate y/o school: thick, long, black hair
Grade which is tied up.
school She was wearing
white sleeveless top
and floral shorts with
no sleepers on.
She was conscious
then but a bit sleepy.
Her fingernails were
untrimmed and dirty.
A palpable mass on
her right cheek was
noted. She also has
pallor paplebral
conjunctiva. Her
teeth are yellowish in
color with presence
of tartar and plaque.
2 teeth are extracted
on lower teeth and
minimal dental caries
on molars and pre
molars. 2 extracted
teeth, 1 excess tooth,
and dental caries on
molars on the upper
teeth. Stretch marks
were noted on left
and right lower
quadrant on her
abdomen. Her
toenails were
untrimmed and dirty.
There are also scars
present on her both
lower extremities.
Stretch marks were
noted both on her
hips.
Her vital signs are as

follows:
T- 36.6 °C
PR- 76 bpm
RR- 24 cpm
BP- 90/70
BMI = 20.97
(Normal)
Kitkat 9 Eldest F Going to Kitkat was wearing
Chocolate y/o daughter school: green shirt and
Grade 4 shorts with slippers
on. She was
conscious, coherent
and awake. Her shirt
is dirty as well as her
hands and feet.
She was sweaty also
because she was
playing outside. She
has a short, thick and
frizzy hair with
pediculosis noted.
She has untrimmed
and dirty fingernails
and with presence of
scars on both her
upper extremities.
Her palpebral
conjunctiva on her
right eye is reddish in
color. She complains
that she is
experiencing pricking
pain on her right eye
and it was red. It was
noted during the third
home visit of the
student nurses and it
started during
weekends.
With yellowish color
of teeth and with
presence of plaque,
tartar and cavities.
With untrimmed and
dirty toenails and
noted scars on lower
extremities and dry
skin.

follows:
T- 36.9 °C
PR- 80 bpm
RR- 23 cpm
BMI=17.59
(Underweight)
Snickers 7 Eldest son M Going to Snickers was seen

Chocolate y/o (2nd child) school: playing outside the
Grade 1 house with his elder
sister, cousin and
some playmates
before the initial
assessment and was
catching dragon fly.
He was wearing gray
shirt and red shorts
with no slippers on.
His shirt, shorts, as
well as his arms and
feet are dirty. He also
has dirty and
untrimmed finger
nails. He was
conscious, coherent
and awake during
the first visit. His hair
was short, frizzy and
there were some lice
noted. He has a
pallor palpebral
conjunctiva and with
presence of tartar,
plaque cavities on
molars on upper
teeth and 1 tooth is
extracted on both
upper and lower
teeth due to cavities.
He has dirty and
untrimmed toenails.
He also has scars on
both lower
extremities.
His vital signs are as

follows:
T- 36.9 °C
PR- 72 bpm
RR- 21 cpm
ChocoBaby 27 Youngest F Never been During the initial visit,
Chocolate mos daughter to school icy was in the room,
sleeping. She was
wearing white sando
and yellow shorts.
She has dirty and
untrimmed
fingernails, with
lesion noted above
her left eyebrow. She
has dry skin and
allergies on the left
fore arm and above
the left knee which
appears to be fresh,
palpable and reddish
in color. It was noted
during the initial
assessment and
started during
weekends, Saturday
prior to the home
visits of the student
nurses according to
Mrs. Kisses and
managed it with
Calamine lotion. Her
toenails are
untrimmed and dirty
and with dirty soles
of feet. She also has
scars on both lower
extremities.

follows:
T- 36.7°C
PR- 72 bpm
RR- 23 cpm
FNRI= 12 kg normal
(9.9-15.6 kg)
Lola Tootsie 50 Grandmother F Not going to Lola Tootsie Roll

Roll school: wasn’t able to be
Highschool assessed by the
group because she is
working the whole
day.
Uncle 31 Uncle M Not going to Uncle Butterfinger
Butterfinger school: wasn’t able to be
Highschool assessed because
he wasn’t around
during the home
visits.
Brother 34 Brother M Not going to Brother Crunch

Crunch school: wasn’t able to be
Highschool assessed because
he wasn’t around
during the home
visits.
III. HEALTH ASSESSMENT (IPPA-CEPHALOCAUDAL)
MR. FERRERO CHOCOLATE

The student nurses were not able to assess Mr. Ferrero because he is
working the whole day starting from 6:00 am to 10:00 pm. The group didn’t even
saw him throughout their home visit.
MRS. KISSES CHOCOLATE
INITIAL ASSESSMENT
General Appearance
Mrs. Kisses is 30 y/o. She has a thick, long, black hair which is neatly tied up.
She was wearing white sleeveless top and floral shorts with no sleepers on. She
was conscious during the assessment. Her fingernails and toenails were
untrimmed and a dirty. She stands 163 cm and weighs 56 kg. Mrs. Kisses has
dark complexion and normal gait.
Mrs. Kisses’ vital signs were taken and recorder as follow:

Temp: 36.6° C
RR: 24 cycles/min.
PR: 76 breaths/min.
BP : 90/70 mmHg
Physical Assessment
 HEAD
⇒ Hair and Scalp: evenly distributed, long, thick, black hair, no presence
of pediculosis
⇒ Skull and Face: symmetrical, smooth uniform consistency, symmetrical
facial features, palpebral fissures equal in size, symmetrical facial
movements, palpable mass noted on her right cheek
⇒ Eyes and Vision
⇒ External Eye Structures
• Eyebrows: hair evenly distributed, thin eyebrows and are
symmetrically aligned, equal movement
• Eyelashes: equally distributed and slightly curled outward
• Eyelids: skin intact with no discharge noted, lids close
symmetrically, bilaterally blinking
• Bulbar Conjunctiva: transparent, sclera appears white and
pinkish bulbar conjunctiva
• Palpebral Conjunctiva: shiny, smooth. Pallor noted.
• Lacrimal Sac and Nasolacrimal Duct: no edema or tearing
• Cornea: transparent, shiny and smooth, details of iris are visible
• Corneal Sensitivity: client blinks when the cornea is touched on
its side by a wisp of cotton which indicates that cranial nerve no.
5 (trigeminal nerve) is intact
• Pupils: black in color, PERRLA (pupils equally round respond to
light accommodation) when a penlight pass through at about 6
inches far the pupils constrict upon illumination, smooth border,
iris flat and round, pupils converge when near object is move
towards the nose
• Visual Fields: the client has a normal visual field as evidence by
the ability to see object in the periphery even when looking
straight ahead which was done by asking the person to close
one eye then a pen or the index finger in the periphery and ask
if the person can see it without moving his head on the side
direction.
• Visual Acuity: able to read a newspaper 14 inches away with an
unaided eye
⇒ Ears and Hearing
• Auricles: the color of the auricle skin which is dark brown is
same as the facial skin, they are symmetrical, aligned with the
outer canthus of the eye, it is firm not tender, pinna recoils after
it is folded
• External Ear Canal and Tympanic Membrane: with dry cerumen
• Gross Hearing Acuity: normal voice tones audible
• Watch Tick Test: able to hear on the tick of the watch in both
ears with a distance of 3 cm.
⇒ Nose and Sinuses
• Nose: symmetric, straight, no discharge or flaring noted; uniform
in color; not tender and without lesions, air moves freely when
she breaths through the nares, which was done by asking the
person to occlude one of the nares then check for airway
patency on the unoccluded nares (done alternately), the
mucosa is pink, nasal septum intact in midline
• Facial Sinuses: not tender
⇒ Mouth and Oropharynx
• Mouth:
• Lip and Buccal Mucosa: uniform pink color soft, moist, smooth
texture, ability to purse lips
• Teeth and Gums: yellowish color of teeth, with presence of
tartar and plaque noted, cavities are also present; 12 lower
teeth, where in 2 are extracted, minimal dental carries on pre
molars and molars; 14 upper teeth, where in there is 2
extracted teeth, 1 excess tooth, and dental carries on
molars
• Tongue and Floor of Mouth: in central position, pink in color,
moist with thin whitish coating, smooth lateral margins, no
lesions upon observation, raised papillae, tongue moves freely
with no tenderness by asking the person to move her tongue in
different direction, smooth floor of the mouth
• Salivary Glands: same as the color of the buccal mucosa and
the floor of the mouth
• Palates and Uvula: light pink smooth soft palate, lighter pink
hard palate with irregular texture, the uvula is on the midline of
the soft palate
• Oropharynx and Tonsils: pink and smooth posterior wall of
oropharynx , pink tonsils without discharge
 NECK
⇒ Neck Muscles: muscles equal in size, head movement are coordinated
and smooth with no discomfort able to flex 45 degrees hyper extend at
60 degrees; head laterally flexes at 40 degrees and laterally rotates at
70 degrees, muscles strength are equal by turning the head to one
side and shrugging the shoulder against the resistance of hands of
the student nurse which was done by asking the person to resist the
pressure of the hands of the student nurse by shrugging her shoulders
⇒ Lymph Nodes ( posterior and below the jaw): not palpable
⇒ Trachea: central placement of the midline of neck by palpation or by
asking the person to swallow
⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence
of bruit
⇒ Neck Veins: not distended (ask the person to turn his head side to side
then check for the neck veins if distended or bloated)
 UPPER EXTREMITIES
⇒ Skin and Nails: skin warm to touch, good skin turgor, nails are smooth,
colorless, untrimmed and dirty, and in capillary refill result is normal
because it returns to its usual color less than 4 seconds.
⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures,
no presence of tremor and it is normally firm smooth coordinated
movements.
⇒ Brachial and Radial Pulse: palpable
⇒ Fine Motor Test: repeated and rhythmical touches the nose, can
altenately supinate and pronate hands at rapid phase performs with
coordination and rapidity to the finger nose and to the nurse finger
 CHEST and BACK
⇒ Skin: evenly distributed skin color skin intact with uniform temperature
⇒ Chest Shape and Size: anterior-posterior to transverse diameter in
ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall
intact
⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and
effortless respiration, full symmetric excursion with bronchial & tubular
breathe sounds
⇒ Heart: no pulsation, symmetric pulse volume
⇒ Spinal Column: straight, right and left shoulders and hips are at the
same height
 ABDOMEN
⇒ Skin: unblemished skin, symmetric movements caused by respiration,
stretch marks were noted on left and right lower quadrant
⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach
and gas filled bowels
⇒ Specific Organs: not palpable
 LOWER EXTREMITIES
⇒ Skin and Toenails: uniform skin temperature, convex curve and
colorless nail plates, presence of smooth nail texture, highly vascular
nail bed, stretch marks on left and right hips, untrimmed toenails and
intact epidermis
⇒ Gait and Balance: was able to perform all the gait and balance without
any discomfort
Cranial Nerves Assessment
Cranial Nerve Assessment Technique Normal Response Client’s

Response
I. Olfactory Ask the client to smell Client is able to Mrs. Kisses was
and identify the smell of identify different able to identify
cologne with each nostril smell with each the different
separately and with the nostril separately scents (coffee
eyes closed. and with eyes and alcohol) that
closed unless such she had smelled.
condition like colds
is present.
II. Optic Provide adequate lighting The client should She was able to
and ask client to read be able to read with read with each
from a reading material each eye and both eye and both
held at a distance of 36 eyes. eyes.
cm. (14 in.).
III. Oculomotor Reaction to light:
Using a penlight and Illuminated and The illuminated
approaching from the non-illuminated and non-
side, shine a light on the pupil should illuminated pupil
pupil. Observe the constrict. of Mrs. Kisses
response of the constricted.
illuminated pupil. Shine
the light on the pupil
again, and observe the
response of the other
pupil.
Reaction to Pupils constrict Her pupils

accommodation: when looking at a constricted when
Ask client to look at a near object, dilate asked to looked
near object and then at a when looking at a at a near object,
distant object. Alternate distant object, dilated at a far
the gaze from the near to converge when object, and when
the far object. Next, move near object is an object is
an object towards the moved towards the moved towards
client’s nose. nose. the nose, the iris
converged.
IV. Trochlear Hold a penlight 1 ft. in Client’s eyes should Both eyes are
front of the client’s eyes. be able to follow the able to move as
Ask the client to follow the penlight as it necessary.
movements of the moves.
penlight with the eyes
only. Move the penlight
upward, downward,
sideward and diagonally.
V. Trigeminal While client looks upward, Client should have Mrs. Kisses was
lightly touch lateral sclera a positive corneal able to elicit
of eye to elicit blink reflex. reflex, able to corneal reflex,
To test light sensation, respond to light and sensitive to pain
have client close eyes, deep sensation and stimuli and
wipe a wisp of cotton over able to differentiate distinguish hot
client’s forehead. hot from cold. from cold.
To test deep sensation,
use alternating blunt and
sharp ends of an object.
Determine sensation to
warm and cold object by
asking client to identify
warmth and coldness.
VI. Abducens Hold a penlight 1 ft. in Both eyes Both eyes move
front of the client’s eyes. coordinated, move in coordination.
Ask the client to follow the in unison with
movements of the parallel alignment.
penlight with the eyes
only. Move the penlight
through the six cardinal
fields of gaze.
VII. Facial Ask client to smile, raise Client should be She performed
the eyebrows, frown, puff able to smile, raise various facial
out cheeks, close eyes eyebrows, puff out expressions
tightly. Ask client to cheeks and close without any
identify various tastes eyes without any difficulty and able
placed on tip and sides of difficulty. The client to distinguish
tongue. should also be able varied tastes
to distinguish (coffee, sugar,
different tastes. salt).
VIII. Have the client occlude Client should be Mrs. Kisses was
Vestibulocochlear one ear. Out of the able to hear the able to hear
client’s sight, place a tickling of the watch tickling in both
tickling watch 2 to 3 cm. in both ears. ears.
ask what the client can
hear and repeat with the
other ear.
The client should She was able to
Ask the client to walk have upright stand and walk in
across the room and back posture and steady an upright
and assess the client’s gait and able to position and able
gait. maintain balance. to maintain
balance.
IX.
Glossopharyngeal Ask the client to say “ah” Client should be She was able to
and have the patient able to elicit gag elicit gag reflex
yawn to observe upward reflex and swallow and able to
movement of the soft without any swallow without
palate. difficulty. difficulty.
Elicit gag response.
Note ability to swallow.
X. Vagus Ask the patient to swallow The client should She was able to
and speak (note be able to swallow swallow without
hoarseness) without difficulty difficulty and
and speak audibly. speak audibly.
XI. Accessory Ask client to shrug Client should be She was able to
shoulders against able to shrug shrug her
resistance from your shoulders and turn shoulders and
hands and turn head to head from side to turn her head
side against resistance side. from one side to
from your hand (repeat the other.
for other side).
XII. Hypoglossal Ask client to protrude The client should She was able to
tongue at midline and be able to move move tongue in
then move it side to side. tongue without any different
difficulty. directions.
FINAL ASSESSMENT
General Appearance
Mrs. Kisses has a thick, long, black untied hair. She was wearing blue tank top
and blue denim shorts with no sleepers on. She was conscious during the
assessment. Her fingernails and toenails were trimmed and a bit dirty. She
stands 163 cm and weighs 56 kg. Mrs. Kisses has dark complexion and normal
gait.
Physical Assessment
Mrs. Kisses’ vital signs were taken and recorded as follow:
Temp: 36.9° C
RR: 21 cycles/min.
PR: 72 breaths/min.
BP : 100/60 mmHg
 HEAD
⇒ Hair and Scalp: evenly distributed, slightly thin, black hair, with no
presence of lice
movements, palpable mass noted on her right cheek
⇒ Eyes and Vision
towards the nose
direction.
• Auricles: the color of the auricle skin is same as the facial skin,
they are symmetrical, aligned with the outer canthus of the eye,
it is firm not tender, pinna recoils after it is folded
• Nose: symmetric, straight, no discharge; uniform in color; not
tender and without lesions, air moves freely when he breaths
through the nares, which was done by asking the person to
occlude one of the nares then check for airway patency on the
unoccluded nares (done alternately), the mucosa is pink, nasal
septum intact in midline
• Mouth:
tartar and plaque noted, cavities are also present; 12 lower
teeth, where in 2 are extracted, minimal dental carries on pre
molars and molars; 14 upper teeth, where in there is 2
extracted teeth, 1 excess tooth, and dental carries on
molars
the soft palate
 NECK
of bruit
⇒ Skin and Nails: skin warm to touch, dry to moist, with good skin turgor,
nails are smooth, colorless, trimmed and a bit dirty, and in capillary
refill result is normal because it returns to its usual color less than 4
seconds.
movements.
 CHEST and BACK
intact
breathe sounds
same height
 ABDOMEN
⇒ Skin: unblemished skin, symmetric movements caused by respiration,
slightly distended abdomen, stretch marks were noted on the left and
right lower quadrant
nail bed,stretch marks on both hips untrimmed and dirty toenails and
intact epidermis, with presence of scars on both extremities
any discomfort
⇒ With presence of stretch marks on both extremities
⇒ Fine Motor Test: able to perform normally the fine motor test
Obstetrical Record
Mrs. Kisses got married by the age of 20 and was able to bear three
children in the years 1998, 2001 and 2006. She had her menarche when she
was 11. Currently, her menstrual cycle is a 28-day cycle due to the pills she is
taking. She delivered all her children via normal spontaneous delivery (NSD),
vertex presentation at home. A “madrona” was the one who delivered the baby.
According to her obstetrical record, she has G3P3T3P0A0L3.
She stated that she had all the necessary prenatal check-ups with all her
pregnancies at the health center and no complications were noted. She
continued her usual activities even though she is pregnant and told the group
that she experienced nausea and vomiting during the first trimester of pregnancy.
When she was pregnant, she does not have any unusual belief. She was able to
obtain 2 shots of Tetanus Toxoid vaccine.
She is still in her reproductive age however; she resorted to artificial family
planning with the use of oral contraceptives (Pills) as a form family planning
method to prevent further pregnancies. She started to take pills in the year 1999.
The main reason for this is for proper spacing of her children.
Nutritional Status
Body Mass Index

Emaciated Below 15
Underweight 15 – 18.9
Normal 19 – 24.9
Overweight 25 – 29
Obese 30 – 39.9
Morbidly Obese 40 and above
Age: 30 yrs. old

Height: 163 cm
Weight: 56 kg
BMI = Wt. in kg
Ht in m2
= 56 kg .
2.67m2
= 20.97 (Normal)
History of Past and Present Illness
Mrs. Kisses is presently in a good health condition and does not have any
health problems. During the interview, she stated that she had not been
hospitalized because of severe illness. However, she had fever, coughs and
colds but had not experienced any serious illness. She told the group that her
management on fever is by means of over the counter medications usually
paracetamol. Whenever her skin is warm to touch and she is feeling dizzy, she
assumes that she has a fever and usually takes a paracetamol tablet. She also
told the group that she does not have any management for cough and colds.
Activities of Daily Living
3:00 am Wake up
3:30- 5:00 Cook foods for the store
5:00- 6:00 Prepare foods for breakfast
(Wake up kids during school days)
6:00- 8:00 Chores
8:00- 12:30 Wash clothes; Take care of ChocoBaby
12:30- 1:00 LUNCH
1:00- 4:00 Sleeping
4:00- 7:00 Stays at the sari-sari store
6:00/7:00- 8:00 DINNER
8:00- 10:00 Watch TV
10:00 pm Sleeping
KITKAT
General Appearance
Kitkat is 9y/o, born on September 30, 1998. She has a thick, black and oily untied
hair. She was wearing green shirt and shorts with no sleepers on. She was
conscious during the assessment. Her fingernails and toenails were
untrimmed and dirty. She stands 141 cm and weighs 35 kg. Kitkat has dark
complexion and normal gait.
INITIAL ASSESSMENT
Temp: 36.9 ° C
RR: 23 cycles/min.
PR: 80 breaths/min.
 HEAD
⇒ Hair and Scalp: evenly distributed, thick, black hair, shoulder length,
with presence of lice and hair is frizzy.
movements
⇒ Eyes and Vision
• Palpebral Conjunctiva: shiny, smooth, reddish.
towards the nose
direction.
he breaths through the nares, which was done by asking the
• Mouth:
tartar and plaque noted, with cavities present
the soft palate
 NECK
of bruit
movements.
 CHEST and BACK
intact
breathe sounds
⇒ With presence of productive cough, rales upon auscultation
same height
 ABDOMEN
⇒ Skin: unblemished skin, symmetric movements caused by respiration
nail bed, trimmed and dirty toenails and intact epidermis, with
presence of scars on both extremities
any discomfort
⇒ Presence of Tendon of Achilles reflex
⇒ Presence of Patellar reflex
FINAL ASSESSMENT
General Appearance
Kitkat has a thick, black, frizzy, and untied hair. She was wearing green shirt and
shorts with no sleepers on. She was conscious during the assessment. Her
fingernails and toenails were trimmed but a bit dirty. She stands 141 cm and
weighs 35 kg. Mrs. Kisses has dark complexion and normal gait.
Physical Assessment
Temp: 37 ° C
RR: 22 cycles/min.
PR: 98 breaths/min.
 HEAD
⇒ Hair and Scalp: evenly distributed, thick, black hair, shoulder length,
with presence of lice and hair is frizzy
movements
⇒ Eyes and Vision
• Palpebral Conjunctiva: shiny, smooth.
towards the nose
direction.

• Mouth:
the soft palate
oropharynx , inflamed tonsils without discharge
 NECK
of bruit
colorless, trimmed and a bit dirty, and in capillary refill result is normal
movements.
 CHEST and BACK
intact
⇒ Lungs: full and symmetric chest expansion, presence of rales on
both lung fields upon auscultation.
⇒ With presence of productive cough
same height
 ABDOMEN
nail bed, trimmed and slightly dirty toenails and intact epidermis,
with presence of scars on both extremities
any discomfort
Nutritional Status
Body Mass Index

Emaciated Below 15
Normal 19 – 24.9
Obese 30 – 39.9
Age: 9 yrs. old

Height: 141 cm
Weight: 35 kg
BMI = Wt. in kg
Ht in m2
= 35 kg .
1.99 m2
= 17.59 (Underweight)
Kitkat stands 141 cm and weighs 35 kg. Her BMI is 17.59 which is
considered as underweight,
Kitkat experienced fever, cough and colds, and diarrhea that can be
managed by means of “over the counter” medications. Mrs. Kisses usually gives
her Tempra Syrup for fever and packet oresol for diarrhea. She does not have
any management for cough and colds. Kitkat also had chicken pox, rubella and
mumps. Mrs. Kisses mentioned that she already forgot the date when Kitkat
experienced them because she told the group that it was already a long time
ago.
Two years ago, last September; Kitkat had a minor surgery at ONA
(Ospital ning Angeles). She complained for pain in her right ear while her mom
fixes her hair. Her mother assessed the affected ear and observed some swelling
present on the inner canal. With Kitkat’s complaint, they brought her at ONA
where she had the operation and was only confined there overnight. Both Mrs.
Kisses and Kitkat forgot what the diagnosis is. For home management, she was
prescribed with an ear dropper which they cannot remember what exact
medication it is and was ask to comply for antibiotic therapy.
Recently, during the home visits of the student nurses, Kitkat complained
that she is having sore eyes on her right eye followed by sore throat. The group
assessed Kitkat and noted that the palpebral conjunctiva is reddish in color. This
was noted during the 3rd home visit and she told the group the student nurses
that it started during the weekends. She did not have any management for this.
They also Kitkat’s tonsils and noted that they are inflamed and Kitkat verbalized
that it is painful everytime she swallows. She took Strepsils as management for
the sore throat.
Activities of daily living
5:00 am Waking up
5:00- 5:30 Breakfast
5:30- 6:00 Bathing
6:00- 7:00 Grooming
7:00- 7:10 Arrival to school
7:10- 10:00 First half of school
10:00- 10:45 Recess
10:45- 12:00 noon Second half of school
12:00-12:30 Arrival at home
12:30- 1:00 Lunch
1:00- 1:30 Stays at Lola Tootsie Roll's sari-sari store
1:30- 3:00 Watching t.v/ playing
3:00- 4:00 Taking a nap
4:00- 6:00 Stays at Lola Tootsie Roll's sari-sari store
6:00- 7:00 Dinner
7:00 Sleeping time
SNICKERS
INITIAL ASSESSMENT
General Appearance
Snickers a seven- year old boy, wearing a gray shirt and red shorts with
no slippers on. He was seen playing outside the house with his elder sister,
cousin and some playmates before the initial assessment. His shirt, shorts, as
well as his arms and feet, are dirty. His fingernails and toenails are also
long and untrimmed. He was conscious, coherent and awake during the first
visit. His hair was short and there are some lice noted.
Physical Assessment
T- 36.9 °C
PR- 72 bpm
RR- 21 cpm
 HEAD
⇒ Hair and Scalp: evenly distributed, slightly thin, short, black hair, with
presence of lice, hair is frizzy
⇒ Skull and Face: smooth uniform consistency, symmetrical facial
features, palpebral fissures equal in size, symmetrical facial
movements
⇒ Eyes and Vision
towards the nose
direction.

• Mouth:
• 12 lower teeth, where in 1 is extracted (premolar) due to
caivities
12 upper teeth, where in there is also 1 tooth extracted
(premolar) due to cavities , and cavities on both upper and
lower molars, and dental caries on molars

the soft palate
 NECK
of bruit
movements.
 CHEST and BACK
intact
breathe sounds
same height
 ABDOMEN
nail bed, untrimmed and dirty toenails and intact epidermis, with
presence of scars on both lower extremities
FINAL ASSESSMENT
General Appearance
Snickers is a seven year-old boy white shirt and blue shorts with no
slippers on. His fingernails now are quite cleaner compared before. His feet are
clean as well. He was conscious, coherent and awake during the final
assessment. His hair was short and the presence of lice were still noted. He
has an abrasion on left face, below the outer canthus.
Physical Assessment
T- 37.1 °C
PR- 78 bpm
RR- 21 cpm
 HEAD
⇒ Hair and Scalp: evenly distributed, thin, short, brownish color of hair,
with presence of lice and hair is not clean because he was playing
with his chick in the soil outside their house prior to the assessment.
⇒ Skull and Face: smooth uniform consistency, absence of nodules,
symmetrical facial features, palpebral fissures equal in size,
symmetrical nasolabial folds, symmetrical facial movements
⇒ Eyes and Vision
⇒ With abrasion on left face, below the outer canthus
• Eyelids: skin intact with no discharge and discoloration, lids
close symmetrically, bilaterally blinking
• Palpebral Conjunctiva: shiny, smooth and pinkish in color
towards the nose
direction.
• External Ear Canal and Tympanic Membrane: with presence of
dry cerumen, in grayish in color
• Nose: symmetric, straight, no discharge or flaring uniform in
color not tender and without lesions, air moves freely when he
breaths through the nares, which was done by asking the
patency on the unoccluded nares (done alternately) ,the
• Mouth: with presence of dental caries like plaque and
tartar
tartar and plaque noted, with cavities present; 12 lower
teeth, where in 1 is extracted (premolar) due to cavities; 12
upper teeth, where in there is also 1 tooth extracted
(premolar)due to cavities as well, and cavities on both upper
and lower molars, and dental caries on molars
the soft palate
 NECK
of bruit
colorless, trimmed, and in capillary refill result is normal because it
returns to its usual color less than 4 seconds.
movements.
 CHEST and BACK
intact
breathe sounds
same height
 ABDOMEN
nail bed, trimmed and intact epidermis, with presence of scars on
both lower extremities
⇒ Presence of Achilles reflex
Growth and Development

Erik Erikson’s Psychosocial Stage – Industry vs. Inferiority
At the school-going stage, the child extends beyond the home to the
school and the emphasis is on academic performance. There is a movement
from play to work. If before the child could play at activities with little or almost no
attention given to the quality of results, now he needs to perform and produce
good results. The child learns that he can gain recognition from parents, teachers
and peers by being efficient in his school work. The attitudes and opinions of
others become important. If children are praised for doing their best and
encouraged to finish tasks then work enjoyment and industry may result.
Children's efforts to master school work help them to grow and form a positive
self-concept and find themselves, who they really are.
Source: psychology.about.com
Upon arriving from school, Snickers will do his assignments or homework

if there are and will play if there are none. If before, he plays the moment he
arrives home, now he does his school works first. During his play time with his
siblings, cousins or play mates, his learning increases by giving attention to the
results of his moves and gaining knowledge from it as well. He now aims for
good results as he strives to win in any game that he plays. Parents and teachers
are also the important persons in his life at this stage. He listens and
acknowledges his parents especially his mother. He follows what his mother tells
him, goes whenever he is called and eats and sleep whenever he is being told.
And in school, he listens attentively to his teacher and would not want to be
scolded. He gives these people importance in his life and the opinions of others
become important to him as well. What he does in school and at home and the
people around him most importantly his parents and teachers help him to grow
and develop and mold him to become a good person and find himself, him as a
person.
Sigmund Freud’s Psychosexual Stage- Latency Stage
During the latent period, the child begins around the time that children
enter into school and become more concerned with peer relationships, hobbies,
and other interests. The latent period is a time of exploration in which the sexual
energy is directed into other areas such as intellectual pursuits and social
interactions. This stage is important in the development of social and
communication skills and self-confidence.
Snicker’s attention is diverted to his school mates, play mated and other
activities and interests. He is focused and attentive on things that matters his
school and the people around him. This stage is important because through
these, his social skills, communication, and self-confidence are developed. The
people around him will determine who he will be in the future.
Nutritional Status
Body Mass Index

Emaciated Below 15
Normal 19 – 24.9
Obese 30 – 39.9
Age: 9 yrs. old

Height: 141 cm
Weight: 35 kg
BMI = Wt. in kg
Ht in m2
= 18 kg .
1.33 m2
= 13.53 (emaciated)
Snickers did not experience any major illness aside from fever, cough and
colds and diarrhea. The management that Mrs. Kisses usually do is just the
same with Kitkat. Tempra and Oresol are usual management given for fever and
diarrhea respectively. Mrs. Kitkat does not have any management when Snickers
is having cough and colds. He also had chicken pox, rubella and mumps before.
Right now, Snickers has an abrasion on left face, below the outer canthus but
does not have any complains of discomfort or pain because of it.

5:00 am Waking up
5:00- 5:30 am Breakfast
5:30- 6:00 Bathing
6:00- 7:00 Grooming
7:00- 7:10 Arrival to school
7:10- 10:00 First half of school
10:00- 10:45 Recess
10:45- 12:00 Second half of school
12:00-12:30 Arrival at home
12:30- 1:00 Lunch
1:00- 4:00 Playing time/ Studying time
4:00- 6:00 Taking a nap
6:00- 7:00 Dinner
7:00- 8:00 Playing time
8:00 pm Sleeping time
CHOCOBABY
INITIAL ASSESSMENT
General Appearance
Choco Baby, two years of age, was asleep during the initial visit. She was
wearing a white sando and yellow shorts. She has dirty and long fingernails
and toenails. The soles of her feet were dirty as well. She also has dry skin.
There are also presence of allergies on her left fore arm and above the left
knee. They appear red and palpable.
Physical Assessment
Temp: 36.7° C
RR: 23 cycles/min.
CR: 72 breaths/min.
 HEAD
presence of lice
⇒ Skull and Face: smooth uniform consistency, symmetrical facial
features, palpebral fissures equal in size, symmetrical facial
movements
⇒ Eyes and Vision
symmetrically aligned, equal movement, lesion seen above the
left eyebrow
towards the nose
• Mouth:
texture
• Teeth and Gums: yellowish color of teeth, no cavities present
• 8 teeth on the upper and 8 on the lower
moist, smooth lateral margins, no lesions upon observation,
raised papillae, tongue moves freely with no tenderness by
asking the person to move her tongue in different direction,
smooth floor of the mouth
the soft palate
 NECK
⇒ Neck Muscles: head movement are coordinated and smooth with no
discomfort
of bruit
⇒ Skin and Nails: skin warm and dry, good skin turgor, nails are smooth,
⇒ With allergies present on the left fore arm, fresh and reddish in
color
movements.
 CHEST and BACK
intact
breathe sounds
same height
 ABDOMEN
⇒ Skin and Toenails: uniform skin temperature, dry to touch, convex
curve and colorless nail plates, presence of smooth nail texture, highly
vascular nail bed, untrimmed and dirty toenails and intact epidermis,
with presence of scars on both lower extremities
⇒ With allergies above the left knee, fresh and reddish in color
Final Assessment
General Appearance
ChocoBaby was conscious, coherent and awake during the final assessment.
She wears a blue sando and a maong shorts. Her fingernails and toenails are
clean as well as his feet. The allergies noted on her left fore arm and above
the left knee are now dry and doesn’t appear red.
Physical Assessment
Temp: 36.9° C
RR: 22 cycles/min.
CR: 76 breaths/min.
 HEAD
presence of lice
movements
⇒ Eyes and Vision
symmetrically aligned, equal movement, lesion above the left
eyebrow
towards the nose

in color; not tender and without lesions
• Mouth:
• Teeth and Gums: yellowish color of teeth, no cavities present
• 8 teeth on the upper and 8 on the lower
lesions upon observation, raised papillae
the soft palate
 NECK
and smooth
of bruit
⇒ Skin and Nails: skin warm and dry, good skin turgor, nails are smooth,
colorless, trimmed and clean, and in capillary refill result is normal
⇒ With allergies present on the left fore arm, dry and grayish in
color
movements.
 CHEST and BACK
intact
breathe sounds
same height
 ABDOMEN
⇒ Skin and Toenails: uniform skin temperature, dry to touch, convex
curve and colorless nail plates, presence of smooth nail texture, highly
vascular nail bed, trimmed and clean toenails and intact epidermis,
with presence of scars on both lower extremities
⇒ With allergies above the left knee, dry and grayish in color
any discomfort
 Presence of Tendon of Achilles reflex
 Presence of Patellar reflex
Growth and Development
Erik Erikson’s Psychosocial Stage – Autonomy vs. Shame and Doubt

In this stage, the toddler wants to do things for himself without help or
hindrance from other people. The toddler's favorite word is "No". It is a
declaration of independence. It reflects his personality with the ability to make
choices. Autonomy is enhanced as toddlers try to use their developing muscles
to walk, climb, hop and jump and to explore their environment. Thus, toddlers
can get into dangerous situations. Therefore, parents have to balance their being
strict and too lenient. If a toddler is restricted to do things on his own by over-
protective parents then he may not have many opportunities to develop
autonomy. On the other hand, if a toddler was harshly criticized for accidents like
wetting, soiling, spilling or breaking things, then he may develop doubt about his
own abilities and might not able to have the chance to tackle new challenges and
explore the world and the things around him.
Chocobaby is fond of climbing up to high tables, chairs and drawers. She

likes to explore the things around her and is not afraid to try new things or even
get hurt. Mrs. Kisses on the other hand allows her to do things like climbing
tables and other high things at their home that she knows Chocobaby can climb.
She witnessed her child doing that and saw how her child would do as her
strategy in climbing up in elevated things and is aware that her child would know
what to do. Of course there is still supervision from Mrs. Kisses but she allows
her child to be able to grow and stand on her own.
Sigmund Freud’s Psychosexual Stage- Anal Stage

During the anal stage, the primary focus of the libido was on controlling
bladder and bowel movements and toilet training. The child has to learn to
control his or her bodily needs. And with this, the child leads to a sense of
accomplishment and independence. The success at this stage depends on how
parents would train their children. If parents would praise and give rewards to
their children for using the toilet properly, there would be a positive outcome and
it will help the children to feel capable and productive. If positive outcomes is
achieved in this stage, it will help the child to become a competent and
productive adults. However, if parents would punish or embarrass their child for
accidents, negative outcome will result. If parents would become too lenient to
their children, the child would become a messy and wasteful individual. And if
parents are too strict or began the toilet training too early, the individual will
become orderly and rigid.
psychology.about.com
In this stage, the role of the parents is of importance. Mrs. Kisses trained
Chocobaby in the toiletry at the right age. She is no longer wearing her diapers
and uses the toilet properly and whenever needed. Mrs. Kisses was neither too
strict nor too lenient that is why Chocobaby was trained properly that she knows
the right time for using the toilet.
Immunization Status
ChocoBaby is considered as a fully immunized child because she had 1
dose of BCG, 3 doses DPT, 3 doses of OPV, 3 doses Hepa B and 1 dose of
Measle Vaccine before her first birthday at the Barangay Health Center.
Nutritional Status
Age: 27 months
Weight: 12 kg
FNRI= normal (9.9-15.6)

ChocoBaby only experienced fever, cough and colds and diarrhea. Mrs
Kisses gives her some Tempra when she has fever and Oresol for diarrhea and
does not have any management for cough and colds. She also had rubella and
mumps. Right now, she had allergies on her left fore arm and above her left
knee. During the initial assessment they were fresh, itchy and reddish in color.
Mrs. Kisses managed it with Calamine lotion and during the final assessment
they already appeared dry and grayish in color and were no longer itchy as
verbalized by Mrs. Kisses.
8:00 am Waking up
8:00- 8:10 Breakfast
10-10:15 Bathing
10:15- 12:30 Watching tv
12:30- 1:00 Lunch
1:00- 5:00 Sleeping time
5:00- 6:00 Eating snacks
8:00- 8:30 Dinner
10:00 pm Sleeping time
LOLA TOOTSIE ROLL
The student nurses were not able to assess Lola Tootsie Roll because she
stays in her sari-sari store the whole day starting from 5:00 am to 8:00 pm.
UNCLE BUTTERFINGER
The student nurses was not able to assess uncle butterfinger because he
is not around during the house visits
BROTHER CRUNCH
The student nurses was not able to assess brother crunch because he is
not around during the house visits
IV. SOCIO ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT
A. Type of Family
The Chocolate Family is considered as an extended type of family. An

extended type is a family having another kin outside the nuclear family. In their
case, aside from the Chocolate Family in one house lives with them Lola Tootsie
Roll, Uncle Butterfinger, and Brother Crunch.
B. Dominant family member/s in terms of decision-making especially to

health care
Mr. Ferrero and Mrs. Kisses Chocolate goes hand in hand in terms of
decision-making, they consult each other in terms of planning and budgeting for
their family, they also discuss matters concerning their children’s schooling
financially and emotionally. When problem arises, they make sure that both of
them will handle and solve the problem. But then, in terms of matter concerning
health Mrs. Kisses is more dominant. She makes sure that she will comply with
the appropriate regimen regarding the condition that arises and she has greater
awareness regarding health matters compared to Mr. Ferrero. An example of
health matters wherein Mrs. Kisses is more responsible for is immunization. This
is so because Mr. Ferrero is also busy at his work giving Mrs. Kisses to decide on
matters that needs an urgent decision.
C. Source of income and expenditures
The Chocolate family’s main source of income is coming from Mr. Ferrero.
Lola Tootsie Roll does have contributions as well in the house expenses.
Sometimes, Uncle Butterfinger shares some in the budget only when he has
work.
On a daily basis, Mr. Ferrero gives Mrs. Kisses Php 200.00. This amount
is for the utilization of their daily needs like foods and allowances of the children.
It is used in buying over the counter medications when necessary. Lola Tootsie
Roll’s contribution was not specified but as stated by Mrs. Kisses, she told the
student nurses that Lola Tootsie Roll is the one who pays the Electric bills and
sometimes buys for the food they eat. Their monthly electric bill is about Php 600
to Php 700, and water bill costing about Php 300. Mrs Kisses also told the group
that Mr. Ferrero is still paying for his tricycle every month but she does not know
how much is the exact amount.
But with Mr. Ferrero’s daily income, the group can say that this is not
enough to shoulder every expense they have in the household. According to
NEDA, each individual should at least have Php 2768.60 when the total monthly
income of the family is divided among the total family members. The total
monthly income of Mr. Ferrero is about Php 5,200 and when divided among the 8
members, it is only Php 650. With these, they were considered poor. Mrs. Kisses
also told the student nurses that they do not have any financial assets at hand in
case of emergency; they just usually borrow money from their relatives,
neighbors or sometimes “five, six”.
D. Working Hours
Mr. Ferrero works as a tricycle driver, he works from 5 am until 10 pm from

Mondays to Saturdays. He seldom works every Sunday. Lola Tootsie Roll stays
on her sari-sari store from 5 am until around 7 and 8 pm. Mrs. Kisses doesn’t
usually work rather she stays at home as housewife and usually helps her
mother at the sari-sari store. Uncle Butterfinger has an unstable job schedule.
Usually, he works from 7 am until 5 pm as a painter and he usually do not work
during rainy days.
E. Ethnic background and religious affiliation
The Chocolate family resides and all grew up in Barangay San Jose,
Angeles City. All of them are affiliates of Roman Catholic. Mrs. Kisses even
mention that they do not attend the Holy Mass every Sunday but she told the
student nurses too that Kitkat usually attends mass with her cousin and go to
mall afterwards.
F. Significant other’s roles in the family life
The most significant persons involved in their lives are the aunt of Mrs.
Kisses living just beside their house, some close family friends which resides
within the vicinity area, and in some cases where in there is no one they can turn
to, they borrow money from the “five, six”.
G. Health habits/beliefs
The family still believes in the power of tawas or hilot. They first consult
in a mananawas or manghihilot whenever a family member gets sick. If the
situation gets worse, they go to their barangay health center and in severe cases,
they go to Ospital Ning Angeles and seek for help.
H. Family’s involvement in community activities
The family participates in the community activities such as celebrating

fiesta and watching different affairs such as amateur singing contest and Ms.
Teen San Jose. They also find time to go to carnivals accessible.
I. Family’s utilization of community resources
The Chocolate Family enjoys the facilities available in the community like
the basketball court; the barangay health center, where in the children had their
immunization and where Mrs. Kisses avails her contraceptive pills. Kitkat and
Snickers also studied in the Day Care Center in their Barangay. They also
consult the Barangay Captain or any official in the Barangay Hall in times of
problems.
J. Housing condition
The house is made of concrete wood. It has a floor area of 5.76m x

4.70m. Its total floor area is 23.62 m2. In order for the house to be considered as
adequate, the total floor area should be divided among the total members of the
family and each should at least have 3.5 m2. In the case of the Chocolate Family,
each of them would only have at least 2.95 m2. With this, the house is considered
inadequate for them.
The house only has 2 windows which basically does not sustain the
adequate ventilation needed by the family. The reason why the group considered
the ventilation of the family as inadequate is because the windows are obstructed
and air is not free flowing inside the house. Some clothes are also hanged in
front of the windows blocking the passage of air.
The house has 2 rooms with bed. Mr. Ferrero and Mrs. Kisses together with
Choco Baby sleeps on the room at the left side while Uncle Butterfinger sleeps
on the right room. Lola Tootsie Roll, Brother Crunch, Kisses and Snickers sleeps
at the sala. They use mattress and “banig.”
The Chocolate Family have different appliances such as television, radio,

and 2 electric fans which they use in their daily living. There are present accident
hazards too. Some faulty wiring was noted as well as the presence of rodents
and insects. In terms of garbage disposal, they just use plastic bags or sack
which is hanged at the back of their house near the comfort room. The sack or
plastic used is usually left untied.
K. Food sources, storage and cooking facilities
Lola Tootsie Roll goes to the market for their food every day. Though they
have a stove, they prefer to use charcoal because they cannot avail the Liquid
Petroleum Gas. Mrs. Kisses and Lola Tootsie Roll were the ones who usually
prepares the food. They cook at the back of their house beside the comfort room.
It is where their “dirty kitchen” is located. The food that they usually eat is
sardines and other canned goods. They also eat the leftovers from the merienda
that they cooked. When it comes to storing their food, they just cover their left
over with plate. But in some cases, they ask their relatives to let their leftovers
store in their refrigerator. In terms of cooking facilities the family is equip with
casserole, “sandok”, frying pan and knives.
L. Water Supply
NAWASA is the family’s source of water. They use a jar, which is covered
to store their drinking water. According to them the water is very much potable.
M. Toilet Facility
Chocolate Family owns their Comfort room. It is located outside their

house. Its toilet does not have any water carriage. It has a fair sanitation and it is
newly painted. The toilet bowl itself is clean, there are no fecal materials noted
but the smell of the comfort room is stinky that is why the group considered it as
having a fair sanitation.
N. Drainage System
The drainage system of the family is open type. It is dirty and has a stinky
smell. There are some rice grains noted on the drainage. Molds are also noted.
There is no obstruction present at the drainage system, which makes the flow
continuous.
O. Social and health facilities available

The family benefits from the services offered by the Barangay Health
Center; this is where their children, Kitkat, Snickers and Choco Baby received
their full immunizations. Mrs. Kisses also avails her free contraceptive pills at the
center. The other facilities within the community are the recreational facilities like
basketball court.
P. Communication and transportation facilities
The family does not own any cell phones or telephone. They usually
borrow their neighbor’s or relatives’ cell phone if they need to text someone. Mr.
Ferrero has a tricycle which until now is not fully paid. He pays for it at installment
basis. Mrs. Kisses did not specify the amount regarding how much Mr. Ferrero
pays for the tricycle because she too does not know. It is their main mode of
transportation other than the public utility jeepneys.
V. PROBLEM IDENTIFICATION
A. List of Problem Identified
No. Problems Identified Score Rank

Presence of vector of diseases e.g. rodents,
1 4.34 1
mosquitoes, flies, roaches
2 Presence of Pediculosis 4.17 2.5
3 Presence of Dental Caries 4.17 2.5
4 Poor Lighting Condition 3.84 4.5
5 Poor Ventilation Condition 3.84 4.5

Family size beyond what family resources can
6 3.34 6
adequately provide
7 Presence of Health Deficit: Malnutrition 2.67 7
8 Poor Home Sanitation: Inadequate Living Space 2.5 8

Inadequate Immunization Status: Mrs. Kisses and
9 2 11
Snickers
10 Poor Personal Hygiene 2 11
11 Faulty eating habits 2 11

Poor Environmental Sanitation: Lack of Food Storage
12 2 11
Facilities
13 Improper Garbage Disposal 2 11
14 Accident Hazard: Fire hazard due to faulty wirings 1 14

B. Priority Setting
Problem# 1: Presence of vector of diseases e.g. rodents, mosquitoes, flies,

roaches
Actual
Criteria Computation Justification
score
The problem is considered to be a
health threat since it predisposes
1. Nature of the
2/3 x 1 .67 the family to acquire vector borne
problem
diseases such as Dengue,
leptospirosis, and the like.
2/2 x 2 2 The problem is highly modifiable
2.Modifiability of the AEB the following criteria
problem observed:
Current > The family has a current

knowledge knowledge of the problem as
 during the interview the Mrs.
Kisses was able to verbalize the
Family presence of the problem
Resources "wa ating dagis keni
 daramadaman mila kening
bubungan, egana gana atang
SN insekto atin keni"(yes there are
Resources rats her in the house we can here
 them from the roof, I think most of
the insect are present on this
Community house)
Resources
 > The family's manpower and
physical resources are available
AEB the family's willingness to
cooperate and comply with the
Student Nurses health teachings
and as verbalized by Mrs. Kisses
they have insecticides such as
Baygon which they use to
eradicate those insects.
> The Student Nurses are well

informed and knowledgeable
about vector borne diseases and
the management to be done to
prevent the occurrence of these
diseases and on how to eradicate
those rodents and insects, thus
making them enable to impart
these knowledge to the family,
another thing is the Student
Nurses willingness to help the
family to minimize if not to
eradicate this problem.
> The Barangay Health Center

offers Mother's Class and
conducts information
dissemination on how to prevent
the multiplication of these vectors
and insecticides are also available
in the community.
3. Preventive 2/3 x 1 .67 Prevention of these vectors has a
Potential moderate potentiality as reflected
by the criteria the Student Nurses
Severity have observed:
▲
> The problem is not yet severe
Duration since no one on the family was
▼ affected by the problem, the
rodents bit no one, no one has
Current acquired any of the vector borne
Management diseases.
▲
>The problem has existed for a
High -risk long time ago, this has already
Group existed approximately for almost
▲ 30 years as verbalized by Mrs.
Kisses that there were already
rodents and insects on their house
even when she was a child.
>The family has a current

management on the problem,
"Manispray kami mu ning kayi
minsan keng parumingu" (we used
to spray insecticides every week)
as verbalized by Mrs. Kisses upon
interview.
> The children and even Mr. Mrs.

Chocolate and the other family
members are all at risk to be
affected of the problem, since they
all live on the house.
Prior to the interventions and
4. Salience of the health teachings, the family has
2/2 x 1 1
problem already viewed this as a problem,
which needs an immediate action.
Total Score 4.34
Problem# 2 Presence of Pediculosis

Actual
score
Pediculosis is considered to be a
health deficit brought about by the
infestations of these parasites
1. Nature of the wherein they feed themselves by
3/3 x 1 1
problem getting the nutrients from the host.
In the Chocolate family’s case,
Kitkat and Snickers are affected by
the said infestation.
2/2 x 2 2 The Chocolate Family’s problem
2.Modifiability of regarding Pediculosis has a high
the problem modifiability status as reflected by
the following criteria below.
Current
knowledge
> The family has a current
 knowledge about the problem as
Family Mrs. Kisses was able to verbalized
Resources the existence of this problem as
 evidenced by the statement below:
“ay makutu ya i Hershey[Kitkat]”
SN Resources
(Hershey [Kitkat} really ahs a lot of
 lice)
Community
Resources > The family has manpower
 resources that the family can use to
minimize Kitkat’s lice by removing
them; the family also has a comb
that they use to remove Kitkat and
Snickers lice.
>The students nurses knowledge

and initiative will enable the student
nurses to provide health education
for the family on how to minimize if
not to eradicate their problem
regarding pediculosis such as the
use of shampoos that kills the lice.
>The Barangay Health Center is

open for consultations every
Tuesday in which Mrs. Kisses can
come to the Health Center and
asked for necessary actions she
can do to manage Kitkat and
Snickers problem regarding
pediculosis.
3. Preventive 2/3 x 1 .67 After the student nurses have
Potential considered the criteria on
determining the Preventive
Severity Potential of the Chocolate Family’s
▼ problem on Pediculosis, it shows
Duration
that the problem has a moderate
▼ preventive potential as evidenced
by the following criteria.
Current
Management > The problem is considered to be
▲ severe since two of the family
High -risk Group
(Kitkat and Snickers) is infected by
▲ lice infestation wherein there are
some cases where Choco Baby
was also infected by the said
infestation.
> The problem is approximately

existing for almost 5 years, as
reported by Mrs. Kisses:
“anyang anak ya pa i Hershey
[Kitkat] atin neng kutu, I Ivan
[Snickers] mehawa yamu
kaya.”(Hershey [Kitkat] have those
lice even when she was a child,
Ivan [Snickers] just his lice from
her.)
> The family has current

management on the problem as
Mrs. Kisses remove Kitkat’s lice
whenever she has free time.
> Mrs. Kisses, Choco baby and the
rest of the family are the high- risk
group, as these parasites are easily
transferred from one person to
another.
> Prior to the student nurses’
4. Salience of the interventions Mrs. Kisses was
1/2 x 1 .5
problem aware of the problem but does not
need immediate action.
Total Score 4.17
Problem# 3 Presence of Dental Caries

Actual
score
Dental Caries are health deficits
brought about by poor personal
1. Nature of the hygiene wherein the structure of
3/3 x 1 1
problem the teeth are being damaged, thus,
leading to toothache, tooth loss,
and infection.
2/2 x 2 2 As reflected by the criteria below, it
2.Modifiability of shows that the problem on dental
the problem caries has a high modifiability
status.
Current
knowledge
> The family is fully aware that the
 problem exist on their family as
Family Mrs. Kisses and Kitkat was able to
Resources verbalize the problem as evidenced
 by the statement below:
Mrs. Kisses- “ay sira sira la reng
SN Resources
ipan ku”(I have dental caries)
 Kitkat- “sira la rin pu deng ipan ng
Community Ivan [Snickers]” (Ivan [Snickers]
Resources also have dental caries)

> The family has physical
resources specifically tooth
cleaning articles such as
toothbrushes and toothpaste.
> With the student nurses

knowledge and anatomical
background about dental caries,
the student nurses can provide the
family health teachings about the
importance of maintaining the
integrity of their teeth such as the
teeth are vital part of the
Gastrointestinal System especially
on food grinding.
> The Angeles City Municipal Hall

houses public dentists wherein the
Chocolate Family could avail the
dental services offered by the
municipality.
3. Preventive The problem of the Chocolate
Potential family regarding Dental Caries has
a moderate preventive potential
Severity after the student nurses has
▼ considered the following criteria
Duration
presented below.
▼
> The problem is severe as Mrs.
Current Kisses and her three children all
Management have dental caries.
▲
High -risk Group
> The problem approximately exists
▲ for almost 10 years, as Mrs. Kisses
2/3 x 1 .67 was only a teenager when she had
her dental caries, and Kitkat, Choco
Baby, and Snickers had their dental
caries when they were still young.
> As a management to the problem,

they brush their teeth as verbalize
by Mrs. Kisses:
“…magtoothbrush na kami man”
(We do brush our teeth)
> Mrs. Kisses and her children are

exposed to the problem.
Prior to the student nurses
verbalizing the problem to the
4. Salience of the
1/2 x 1 .5 family, the family is already aware
problem
of this but for them it does not need
an immediate action.
Total Score 4.17
Problem# 4 Poor Lighting Condition
Actual
score
The family’s problem on poor
lighting is considered to be a
health threat to the family, since
with poor lighting condition, it may
bring strain on the eyes which may
lead to eye problem such as
1. Nature of the blurring of the vision, another thing
2/3 x 1 .67
problem is this may lead to accidents since
without the use of enhancement
for lighting condition such as
lamps the family member cannot
see their home environment
clearly thus may lead to accidents
such as sliding and the like.
2/2 x 2 2 After considering the criteria
2.Modifiability of the below, the Student Nurses have
problem arrived to a result that shows that
the problem of the Chocolate
Current Family is highly modifiable.
knowledge
 > The family has a current
knowledge on the problem as
Family shown with the behavior of Mrs.
Resources Kisses wherein the student nurses
 have observed Mrs. Kisses turn on
the light whenever the student
SN nurses arrived for their home visits
Resources and as evidenced by her
 statement
“sindyan ke mu ing sulu
Community madalumdum eh”(I will just turn on
Resources the lights, it is so dark)

> The family has their physical
resources such as light bulbs and
fluorescent lamps.
> The student nurses are well

equipped of the knowledge about
having a good lighting condition
thus, the student nurses can
provide the family some health
teachings to the family regarding
the importance of having a good
lighting condition such as it
prevent straining the eye and
making their environment more
visible, they can also pinpoint
some articles that contribute to the
problem such as the clothes they
hang at the window.
> The community has hardware

stores wherein the family could
buy fluorescent lamps and light
bulbs.
3. Preventive The Chocolate Family’s problem
Potential on poor lighting condition has a
moderate preventive potential as
Severity reflected by the criteria shown
▼ below:
Duration > The problem is severe as

▼ evidenced by upon entering the
house the student nurse have
Current observed that it is impossible to
Management see without the aid of electricity,
▲ the house is so dark.
High -risk >The problem has exist for

Group approximately about almost 30
2/3 x 1 .67
▲ years, as stated by Mrs. Kisses:
“dati neng madalumdum ing bale,
anyang anak ku pa makanini ne”
(this situation was the same even
when I was a child, it is really dim
inside the house)
>The family uses light bulbs and

fluorescent lamps to manage the
problem.
> All of the family members of the

chocolate family are exposed to
this problem as they were all living
on that house.
4. Salience of the 1/2 x 1 .5 Mrs. Kisses was able to verbalize
their problem about poor lighting
problem condition and it does not need any
immediate intervention.
Total Score 3.84
Problem# 5 Poor Ventilation Condition

Actual
score
The problem is basically a health
threat to the Chocolate family as
poor ventilation condition
predisposes cross contamination
since there is an inadequate air
1. Nature of the circulating on their home
2/3 x 1 .67
problem environment, another thing is that
with poor ventilation condition, the
family members may suffer to
respiratory problems since there is
minimal amount of air circulating on
their house.
2/2 x 2 2 After the student nurses have
2.Modifiability of the considered the following criteria
problem below, it reflected that the problem
is highly modifiable.
Current
knowledge
 > The family has a current
knowledge of the problem as Mrs.
Family Kisses was able to verbalize the
Resources
problem during the interview

conducted by the student nurses:
SN Resources “ay malisangan keni alang hangin
 lulub” (it is so hot in here, probably
there are no air coming inside the
Community
Resources
house)

resources such as electric fan; they
also have manpower resources
that will enable the family to make
prior actions in clearing their
windows.
> With the skills, initiative and

knowledge of the student nurses,
the student nurses can provide the
family with health teachings
regarding the importance of having
a good ventilation condition such
as it will promote relaxation and
prevent cross contamination of
diseases; the student nurses could
also demonstrate with the family
some necessary actions that the
family can apply such as clearing
their window by removing the
hanged clothes on their window.
> The community has City
Engineers whom the family can
consult on what they can do to
improve their ventilation condition.
3. Preventive 2/3 x 1 .67 After the student nurses have
Potential considered the following criteria
below, it reflected that the problem
Severity
has a moderate preventive
▼ potential.
Duration
▼ > The measurement of the
windows of the house of the
Current
Management
chocolate family have passed the
▲ standard of the National Building
code of the Philippines R.A 6541
High -risk Group as evidenced by the total
▲ measurement of the windows of
the house yield _______ which is
more than 1/10th of the total floor
area of the house, but majority of
the windows of the house is being
covered by the adjacent house
located at their vicinity making their
ventilation condition poor.
> The problem on poor ventilation

condition of the Chocolate Family
existed for approximately almost 30
years ago, as verbalized by Mrs.
Kisses on her statement:
“malwat ne yan, anyang anak ku
pa makanyan ne yan matatakpan
ne keng harap mi” (oh that existed
a long time ago, because when I
was still a child that house on our
front covers our window)
> The family uses electric fan to
minimize the problem.
> All of the family members are all

affected of the problem since all of
them are living together on that
house.
Mrs. Kisses views it as a problem
but does not need an immediate
4. Salience of the
1/2 x 1 .5 action; this is as evidenced by Mrs.
problem
problem.
Total Score 3.84
Problem# 6 Family size beyond what family resources can adequately

provide
Actual
score
The problem is a health threat,
inadequacy of the family resources
to suffice their daily needs may
1. Nature of the result to serious health problems if
2/3 x 1 .67
problem not corrected e.g. malnutrition
which is now actually evident in the
family since Snickers is considered
to be Malnourished.
1/2 x 2 1 The problem is partially modifiable
2.Modifiability of the as reflected by the criteria being
problem considered:

knowledge of the problem, as Mrs.
Kisses was able to verbalize this
problem during the interview when
the Student Nurses asked her of
what are their problems in their
house
"…ay pera apin yan ing
pinakproblema mi...” (Financial
problem is our worst problem) as
verbalized by Mrs. Kisses.
> Family's physical and manpower

Current resources are not enough to correct
knowledge
the problem. Mr. Ferrero's income

is not enough to suffice their needs.
Family
Resources >The Student Nurses can pinpoint
some tips on how they are going to
minimize their water and electric
SN Resources
consumption and enumerate some
 foods that are nutritious yet cheap
Community which may help in lowering their
Resources expenses. Examples of this are:
  Use fluorescent lamp instead of
light bulbs.
 Close the faucet when not in
use
 Remove barriers on the
windows to let the sunlight
enter the house so that they
may minimize the use of
electricity for lighting.
 Foods such as vegetables, tofu
and the like.
> Community Resources are
available, as these vegetables,
tofu's and cheap and nutritious
foods are available on the market,
and fluorescent lamps are also
available in the community.
3. Preventive 2/3 x 1 .67 The problem has a moderate
Potential preventive potential as reflected by
the following criteria:
> The family's monthly income is

really small and would not suffice
their needs and if to compare with
the NEDA prescribed share amount
of money that each of the family
members must have it is really far
behind.
NEDA- P2, 768.60
Chocolate family- P600 (P1200 x 4
= P4800, P4800/8 = P600)
>The problem existed when they

transferred to Mrs. Kisses' mother
that was approximately a year
Severity already.
▼
Duration
▼ management on the problem since
Mrs. Kisses helps Lola Tootsie
Current Roll's store which help them to
Management suffice their daily needs on food.
▲
High -risk Group

> All of the family members are
▲ exposed to this problem.
The family sees this as a problem,

which is for them, needs an
4. Salience of the immediate action AEB when the
2/2 x 1 1
problem Student Nurses did their interview
Mrs. Kisses was able to verbalize
their problem financially.
Total Score 3.34
Problem# 7: Presence of Health Deficit: Malnutrition

Actual
score
The problem is a health deficit;
malnutrition is an alteration on the
client's health due to inadequacy of
the nutrients needed by the body.
1. Nature of the
3/3 x 1 1 This can be verified by using the
problem
FNRI chart or through BMI
calculation. Malnutrition if not
managed may lead to much
serious health problems.
2.Modifiability of the as reflected by the following
criteria:
problem
> The family does not have any
current knowledge on the problem,
AEB the Mrs. Kisses is not aware
that Snickers is malnourished.
Current > Family's financial resources are
knowledge
not adequate to correct the
problem.
Family Resources
> Student Nurses skills and
knowledge will enable them to
SN Resources provide health teachings regarding
 proper nutrition and can enumerate
foods that are nutritious and cheap
Community
Resources that could replace/ substitute those
 expensive one, like instead of
meat, the family can buy
"tokwa"(tofu) as a substitute.
> Community resources are

available; AEB the Health Center
conducts Mother's Class, which
Mrs. Kisses may attend.
The problem is moderately
3. Preventive preventable as reflected by the
Potential following criteria:
Severity
>The problem is not severe, due to
▲
the following reasons:
Duration  Only one member of the
▼ family is affected of the
problem. (Snickers)
Current
Management
▼
 The problem can be
High -risk Group corrected by proper
▲ 2/3 x 1 .67 motivation and
compliance.
> The problem exists for about 3

months already.

current management on the
problem AEB the family is not even
aware that the problem exists.
> High-risk group are present, AEB

other family could also be
susceptible to this problem if
proper nutrition will be ignored.
The family does not view
malnutrition as a problem at all
4. Salience of the
0/2 x 1 0 until the Student Nurses has
problem
informed them of the existence of
this problem on their family.
Total Score 2.67
Problem# 8 Poor Home Sanitation: Inadequate Living Space

Actual
score
The problem is considered to be a
health threat to the family,
inadequacy on the living space
1. Nature of the
2/3 x 1 .67 denotes a crowd home
problem
environment, which is a very
favorable environment for easy
transfer of infections.
1/2 x 2 1 The family’s problem regarding
2.Modifiability of the inadequacy of living space has a
problem partial modifiability status as
reflected by the criteria that the
Current
knowledge
Student Nurses have observed:

Family knowledge of the problem as Mrs.
Resources Kisses was able to verbalize the
problem during the interview and
stated:
SN Resources
“maskup na kami keni, ning kayi

reng anak keni lang sala matudtud
Community magfoam la mu” (we are really
Resources crowded here, that is why my
children used to sleep here at the
living room)
> The family’s resources are not

available especially their financial
resources, as shown on their
problem regarding “Family size
beyond what family resources can
adequately provide” it reflects that
their monthly income is really not
enough to suffice their daily needs
therefore they cannot also suffice
the expenses they need for
increasing their living space to
make it adequate for them.
> The Student Nurses skills and

knowledge can help the Chocolate
family by planning on how to
arrange their furniture so that they
may increase somehow their living
space, at least to minimize the
problem if not to fix it totally.
> The community’s resources are

not available since the community
must implement any actions they
will do to the family to the other
family who has the same problem.
3. Preventive 1/3 x 1 .33 Upon consideration of the following
Potential factors below, it shows that the
problem has a low preventive
Severity
potential.
▼
Duration
>The problem is considered to be
▼ severe AEB after computing the
share of each family member on
Current their living space it shows that upon
Management
dividing the whole floor area of the
▼
Chocolate Family’s house, each of
High -risk Group the family member yields only
▲ _________ showing that the total
floor area of the house is
inadequate as to compare with the
prescribed by the National Building
code of the Philippines R.A 6541
that each of the family must have at
least a share of 3 m2, therefore if it
will be further divided considering
the space occupied by their
furniture it will yield a more lower
results.
> The problem was already

occurring for almost a year now; it
started when Mrs. Kisses family
has transferred to the house.
current management on their
problem regarding Inadequate
living space as evidenced by Mrs.
Kisses statement when the student
nurses asked her about their
management to the problem:
“ala, ala na sane na kami”(nothing,
we are used to it)
> All of the family members of the

Chocolate Family are exposed to
the problem as they all live on that
house.
Inadequacy of Living space is
viewed by the family as a problem
4. Salience of the
1/2 x 1 .5 and does not need immediate
problem
action prior to the student nurses
conduct their health teachings.
Total Score 2.5
Problem# 9: Inadequate Immunization Status: Mrs. Kisses and Snickers

Actual
score
The problem is a health threat;
inadequacy of immunization status
denotes inadequacy of antibodies
against those specific diseases,
thus it imposes possibility of
acquiring those diseases when the
client came into contact with these
1. Nature of the
2/3 x 1 .67 microorganism, on the Chocolate
problem
family's case, Mrs. Kisses has
inadequate immunization on her
Tetanus Toxoid which brings her to
a risk of acquiring tetanus, while
Snickers lacks immunization on
Hepa B, which brings him at risk to
acquire Hepatitis B.
2.Modifiability of the upon the consideration of the
problem following criteria:
Current >The family does not have any
knowledge
current knowledge on the problem
AEB Mrs. Kisses was not aware
Family that she lacks 3 doses of her
Resources Tetanus Toxoid vaccine and at the
 same time she is not aware that
Snickers does not have any shots
SN Resources
of Hepa B vaccine.

Community > Family manpower resources are

Resources available; the family can go to the
 Barangay Health Center to avail
those vaccines.
> Student Nurses are well equipped

with knowledge and skills enabling
them to impart information about
the importance of having a fully
immunized status and the
importance of each vaccine the
Barangay Health Center offers.
> Community resources are

available; the Barangay Health
Center offers the EPI program of
the Department of Health (DOH).
3. Preventive 1/3 x 1 .33 The problem has a low preventive
Potential potential as reflected on the
following criteria the Student
Severity
Nurses considered:
▼
Duration
> The problem is considered to be
▼ severe due to the following
reasons:
Current  The awareness of the family
Management
to this problem is not evident.
▼
 2 of the family member are
High -risk Group affected by the problem.
▲
>The problem exists years before
since the Snickers is now 7 years
old wherein ideally he must
completed the vaccine for Hepa B
when he was only 1 year old. With
Mrs. Kisses years have already
passed and she did not got her
third dose of Tetanus Toxoid
vaccine.
>They family do not have any

management on this problem since
their awareness to this problem is
not evident.
>Snickers is at risk to acquire Hepa

B, AEB the disease is prevalent in
the country, another thing is
Snickers nutritional status is below
the normal range and considered to
be malnourished.
The family does not view
inadequacy of the immunization
status of Mrs. Kisses and Snickers
4. Salience of the
0/2 x 1 0 as a problem since they are not
problem
aware of the existence of this
problem prior to the Student Nurses
informing them about this problem.
Total Score 2
Problem# 10 Poor Personal Hygiene

Actual
score
Poor Personal hygiene is a health
threat to the family as this problem
1. Nature of the
2/3 x 1 .67 predisposes to health deficits such
problem
as dental caries, pediculosis, and
skin diseases.
1/2 x 2 1 After the Student nurses have
2.Modifiability of observed the criteria on
the problem determining the modifiability status
of the problem, it suggests that the
problem is partially modifiable.

knowledge that they have a poor
personal hygiene as evidenced by
the observations of the student
nurses wherein they have observed
that Mrs. Kisses does not care
even her children has a dirty
Current fingernails and clothing because
knowledge
even her has a dirty clothing too.
Family > The family has physical

Resources resources specifically cleaning
 articles such as soap, shampoo
and the like.
SN Resources
 > The student nurses knowledge
Community will enable them to provide the
Resources family with health teachings
 regarding personal hygiene such
as cutting their finger and toenails,
washing their hands and the like.
>The community offers Mother’s

Class where the family could learn
about good personal hygiene.
3. Preventive 1/3 x 1 .33 After the Student nurses have
Potential observed the criteria on
determining the Preventive
Severity Potential of the problem, it
▼ suggests that the problem has a
Duration
low preventive potential.
▼
> The problem is already severe as
Current the almost of the family members
Management are observed to have a poor
▼ personal hygiene.
High -risk Group
▲ > The problem on poor personal
hygiene approximately exists for
about a year already as Mrs.
Kisses have been so busy on
helping Lola Tootsie Roll on the
store and often neglected her
hygiene including her children.

current management on the
problem as observed by the
student nurses that Mrs. Kisses just
let her children be dirty.
>Mrs. Kisses, Kitkat, Snickers, and

Choco Baby are all exposed to this
problem.
Prior to the student nurses do their
4. Salience of the interventions; the family does not
0/2 x 1 0
problem see their poor personal hygiene as
a problem at all.
Total Score 2
Problem# 11 Faulty Eating Habits

Actual
score
Faulty eating habits is considered
to be a health threat as it
predisposes health problems
1. Nature of the
2/3 x 1 .67 related to Gastrointestinal system
problem
such as Acute Gastroenteritis
which is very common among
children.
1/2 x 2 1 The problem of the Chocolate
2.Modifiability of the family regarding faulty eating
problem habits is said to be partially
modifiable after the student nurses
Current has considered the following
knowledge criteria presented below.
> The family is not aware of the

Family problem, as evidenced by the
Resources observations of the student nurses
 during their home visits wherein
Mrs. Kisses was not able to guide
SN her children regarding their eating
Resources pattern as she just let her children
 eat too much junk foods and foods
that were left alone on the table.
Community
Resources > Family’s manpower resources
 are available as evidenced by;
Mrs. Kisses is very capable
enough to educate her child about
correct eating habits such as
limiting the children’s consumption
of junk foods. Only, Mrs. Kisses
still needs motivation by the
student nurses to do this.
> The student nurses with their

knowledge and skills can motivate
Mrs. Kisses to limit her children’s
consumption of junk foods, the
student nurses can also provide
the family on health teaching
regarding good eating habits such
as instead of junk foods the
children can be offered of foods
that are rich in minerals and
vitamins such as fruits and
vegetables.
> The Barangay Health Center

offers Mother’s Class that
disseminates information
regarding good eating habits and
proper nutrition.
3. Preventive 1/3 x 1 .33 The problem of the Chocolate
Potential family regarding faulty eating
habits has a low preventive
potential after the student nurses
Severity has considered the following
▼ criteria presented below.
Duration > The problem is considered to be

▼ severe as the behavior on faulty
eating habits is present among the
Current three children; Kitkat, Snickers,
Management and Choco Baby.
▼
> The problem approximately
High -risk exists for almost 9 years as
Group evidenced by from Kitkat until
▲ Choco Baby behaviors regarding
faulty eating habits is evident.

management on the problem as
evidenced by the family is not
aware that the problem exists on
their family.
> The three children, Kitkat,

Snickers and Choco Baby are all
exposed and affected of the
problem.
Mrs. Kisses was not able to
4. Salience of the verbalize the existence of the
0/2 x 1 0
problem problem prior to the student nurses
interventions.
Total Score 2
Problem# 12 Poor Environmental Sanitation: Lack of Food Storage Facilities

Actual
score
The Chocolate Family’s problem on
lack of food storage facilities is
considered to be a health threat as
it predisposes the family to
Gastrointestinal problems such as
1. Nature of the
2/3 x 1 .67 diarrhea, Acute Gastroenteritis and
problem
other food borne diseases, since
improper storage of food
predisposes contamination of the
food thus leading to the said
Gastrointestinal problems.
2.Modifiability of upon the consideration of the
the problem following criteria:

current knowledge of the problem
prior to the student nurses
interventions as evidenced by the
behavior of the family as observed
by the student nurses it shows that
the family are used into that
situation wherein their food are
confined on a single container and
mixed together.

physical resources such as articles
like Tupperware that they can use
to store their foods, and also the
family does not have enough
financial resources to suffice the
Current expenses they need for them to b
knowledge
able to buy those storage facilities
mentioned.
Family
Resources > With the equipped knowledge
that the student nurses have, the
student nurses are capable enough
SN Resources
to provide health teachings to the
 family such as the consequences
Community that may arise due to lack of food
Resources storage facilities such as
 contamination of the food they eat
ant the ingredients they use in
cooking.
> Within the community vicinity,

there are a lot of stores that
bargains storage facilities such as
Tupperware that the family can
avail.
3. Preventive 1/3 x 1 .33 Upon the assessment of the
Potential following criteria mentioned below,
the problem on lack of storage
Severity facilities yields a low preventive
▼ potential.
Duration
▼ > The problem of the family on lack
of food storage facilities is
Current considered to be severe as
Management evidenced by the observations of
▼ the student nurses upon the
High -risk Group
assessment of the housing and
▲ environmental sanitation of the
house the student nurses was able
to observe that the storage facility
that the family uses is very dirty as
evidenced by soil particles and flies
present on the storage facility.
> Upon the interview with Mrs.

Kisses about their sanitation Mrs.
following:
“ah ken mi lang gulut kakabit deng

pemalengki mi, ken keng dukanan
a yan, dati pa ken mi nala talaga
kakabit, kasi maglutu yang lutung
ulam I ma ku” (we used to put the
foods that we have bought there at
the back on that Tupperware, we
are practicing that for a long time
already, since my mom used to sell
readily cooked dishes).
Approximately it exists for more
than a year already.
> The family doe not have any

management of the problem since
they are not aware of the existence
of the problem.
> High- risk group are all the family

members of the chocolate family
and their neighborhoods that tends
to buy on their readily cooked
dishes since the ingredients they
use for cooking are all the same.
The family does not see this as a
4. Salience of the
0/2 x 1 0 problem prior to the student nurses
problem
interventions.
Total Score 2
Problem# 13 Improper Garbage Disposal

Actual
score
Improper garbage disposal is a
health threat to the family as it
predisposes a good breeding
1. Nature of the
2/3 x 1 .67 ground for vectors of disease such
problem
as rodents and insects which could
bring about diseases such as
leptospirosis, dengue and the like.
2.Modifiability of upon the consideration of the
the problem following criteria:

current management of the
problem as evidenced by the trash
observed on their dirty kitchen.
Current
knowledge
resources such as brooms and
Family broomstick, Mrs. Kisses has also
Resources the capability to clean their house
 and environment.
SN Resources
>The Student nurses could give the
 family health teachings regarding
Community proper garbage disposal such as
Resources segregating their trash to
 biodegradable and non-
biodegradable.
> The barangay has a garbage

truck which collects the garbage of
the barangay.
3. Preventive Upon the assessment of the
Potential following criteria mentioned below,
the problem on lack of storage
Severity facilities yields a low preventive
▼ potential.
Duration
▼ > The problem is severe as
evidenced by the observations of
Current the student nurse on the family’s
Management dirty kitchen wherein their trash are
▼ scattered despite the fact that they
High -risk Group
are used to store their food articles
▲ at that place.
1/3 x 1 .33 > The problem approximately exists

for about more than a year, as Mrs.
Kisses have verbalized it during the
interview.
“disnan mi neng makanyan ing gulut nyang linipat kami
keni” (that place have that situation already when we have
transferred here)
> The family does not have any current

management on the problem as they
just let the trash scattered on their dirty
kitchen.
> All of the family members are

exposed to this problem since all of
them live on the same house.
Prior to the student nurses do their
4. Salience of the
0/2 x 1 0 interventions; the family does not
problem
see this a problem at all.
Total Score 2
Problem# 14 Accident hazard: Fire hazard due to faulty wirings

Actual
score
Accident hazards are health threat
to the family; on the chocolate
family’s case their faulty wirings are
1. Nature of the
2/3 x 1 .67 fire hazards wherein if fire happens
problem
on their house brought about by
this faulty wirings, fatality is mostly
to occur.
0/2 x 2 0 After the student nurses have
2.Modifiability of considered the following criteria
the problem below, it reflected that the problem
is not modifiable.
Current
knowledge
current knowledge of their problem
Family regarding faulty wirings as
Resources evidenced by ignoring the problem
as stated by Mrs. Kisses upon the
interview.
SN Resources “ah ok ya mu yan”(that is just ok)

Community > The family’s financial resources
Resources will not be able to suffice the
expenses needed to fix the
problem, since they are already
experiencing financial shortage for
their daily needs.
> The student nurses could inform

the family about the existence of
the problem and site some possible
consequences that may arise
brought about by faulty wirings
such as fire.
> There are no available

community resources since if the
community will do something about
the problem they also have to do
the same actions they have done to
the Chocolate family.
3. Preventive After the student nurses have
Potential considered the following criteria
below, it reflected that the problem
Severity has a low preventive potential.
▼
Duration
> The problem is severe as
▼ observed by the student nurses as
majority of the electrical wiring are
Current exposed.
Management
▼ > The problem approximately exists
High -risk Group
for about 30 years since the
▲ 1/3 x 1 .33 problem have existed when Mrs.
Kisses was still a child.
“malwat ne yan, anak ku pa kanta
makanyan ne” (that exists for a
long time ago, I was still a child
then...)
> The family does not have any current

management to the problem.
> All of the family members are all

exposed to the problem since all of
them reside on that house.
Prior to the student nurses conduct
4. Salience of the
0/2 x 1 0 their interventions; the family does
problem
not see it as a problem at all.
Total Score 1
VI. FAMILY NURSING CARE PLAN (in order of priority)
Problem# 1 Presence of vector of diseases e.g. rodents, mosquitoes, flies, roaches
INTERVENTION PLAN
ANALYSIS OF THE METHOD
CUES OBJECTIVES OF RESOURCES EXPECTED
PROBLEM NSG. INTERVENTIONS RATIONALE
FAMILY REQUIRED OUTCOME
CONTACT
S> "wa ating Inability to Short Term: >Explore the > To obtain a The family
dagis keni provide a family’s ideas baseline data H Family shall have
daramadama home After 2° of on rodents and for the health O Resources: recalled the
n mila kening environment, NI the family insect control teachings to be M other
bubungan, which is will be able through given to the E >Manpower methods of
egana gana conducive to to recall the interview. family. resources controlling the
atang insekto health other V such as time proliferation
atin keni" as maintenance methods of >Discuss with >To increase I and effort. of rodents
verbalized by due to controlling the family the the family’s S and insects
Mrs. Kisses inadequate the causes and awareness I >Physical presented to
knowledge of proliferation consequences about vector- T and chemical them via
O> The the other of rodents of different borne S resources health
student means of and insects vector- borne diseases. such as teaching, as
nurses have controlling presented to diseases. insecticides, evidenced by
observed the the them via cleaning the family will
following: proliferation health >Reinforce the > To increase/ articles such enumerate
of rodents teaching, as family’s suffice the as broom the methods
>Presence of and insects. evidenced knowledge on inadequacy of and presented.
breeding by the family rodent’s and the family’s broomsticks
ground of will insect control knowledge and dustpan. The family
cockroach. enumerate through health about rodents shall have
the methods teachings such and insect demonstrated
>Presence of presented. as maintaining control. Student the methods
mosquitoes a good Nurses of rodents
and flies. Long Term: sanitation Resources: and insect
condition of the control
After 4 days environment. >Knowledge, presented to
of NI the skills, time them.
family will be >Inform the > To avoid and effort of
able to family about accidents due the student
demonstrate proper handling to improper nurses.
the methods of insecticides. handling of
of rodents insecticides
and insect such as
control poisoning.
presented to
them. >Explore the > To measure
family’s the
reaction about understanding
the health of the health
teachings teachings
given. presented.
Problem# 2 Presence of Pediculosis
INTERVENTION PLAN

CUES OBJECTIVES NSG. OF RESOURCES EXPECTED
PROBLEM RATIONALE
INTERVENTIONS FAMILY REQUIRED OUTCOME
CONTACT
S> Mrs. Inability to Short Term >Explore the > To obtain a H The family
Kisses provide family’s idea baseline data for O Family shall have
have adequate After 2° of NI of how the health M Resources: demonstrated
verbalized nursing care the family will pediculosis teachings to be E understanding
the to the be able to occurs and given to the >Manpower of the health
following: infected demonstrate their family. V resources teachings
member of understanding management I such as time given about
“ay makutu the family of the health to control it. S and effort. Pediculosis
ya i due to teachings I such as
Hershey inadequacy given about > Provide the > to increase/ T >Physical methods to
[Kitkat]” of time r/t Pediculosis family with the suffice the S resources control
Mrs. Kisses such as information inadequacy of such as pediculosis as
“anyang ADL. methods to regarding knowledge of the cleaning and evidenced by
control Pediculosis family regarding grooming Mrs. Kisses
anak ya pa Inability to pediculosis as including the pediculosis. article e.g. will be able to
provide a evidenced by management shampoo, restate the
i Hershey home Mrs. Kisses that could be comb, soap health
environment will be able to done to and the like. teachings
[Kitkat] atin conducive to restate the control the given
personal health disease. according to
neng kutu, I development teachings Student her
due to given >Provide the > To promote Nurses understanding.
Ivan inadequate according to family with personal hygiene Resources:
[Snickers] knowledge her health to the family. The family
about understanding teachings >Knowledge, shall have
mehawa hygiene and . regarding skills, time practiced the
sanitation. personal and effort of methods of
yamu Long Term: hygiene the student controlling
especially hair nurses. pediculosis.
kaya.” After 2 days of care.
NI the family Community
will be able to > Instruct the > To have a resources:
practice the family to visit proper
O> The
methods of the health pharmacological Availability of
student
controlling center for management of the Barangay
nurse have
pediculosis. consultation. the problem. health center
observed
for
the
>Explore the > To measure consultation.
following:
family’s the
reaction about understanding of
> Presence
the health the health
of
teachings teachings
pediculosis
given. presented.
upon
inspection
of Kitkat
and
Snickers
hair.
Problem# 3 Presence of Dental Caries

INTERVENTION PLAN

CUES OBJECTIVES NSG. OF RESOURCES EXPECTED
PROBLEM RATIONALE
INTERVENTIONS FAMILY REQUIRED OUTCOME
CONTACT
S> “ay sira Inability to Short Term >Explore the > To obtain a H The family
sira la reng provide a family’s idea of baseline data O Family shall have
ipan ku” as home After 2° of NI how dental for the health M Resources: demonstrated
verbalized by environment the family will caries occurs, teachings to E understanding
Mrs. Kisses conducive to be able to their be given to >Manpower of the health
“sira la rin pu personal demonstrate knowledge of the family. V resources teachings
deng ipan ng development understanding the I such as time given about
Ivan[Snickers] due to of the health consequences S and effort. Dental Caries
” as verbalized inadequate teachings of having a I such as its
by Kitkat knowledge given about dental caries T >Physical cause;
about Dental Caries and their S resources methods to
O> The personal such as its management such as control and
student nurse hygiene. cause, to control it. tooth prevent dental
have observed methods to brushes and caries as
the following: control and > Provide the > To increase/ toothpaste. evidenced by
prevent dental family with the suffice the Mrs. Kisses
> Presence of caries as information inadequacy of will be able to
dental caries evidenced by regarding knowledge of Student restate the
upon the Mrs. Kisses Dental Caries the family Nurses health
inspection of will be able to including the regarding Resources: teachings
Mrs. Kisses restate the management Dental Caries. given
and her three health that could be >Knowledge, according to
children’s teachings done to skills, time her
mouth. given control the and effort of understanding.
according to disease, and the student
her the nurses. The family
understanding consequences shall have
. that may arise performed
such as tooth Community methods of
Long Term: loss and Resources: controlling and
infection. preventing
After 2 days of Availability of dental caries
NI the family >Provide the > To promote the such as proper
will be able to family with personal Barangay cleaning of
perform health hygiene to the Health teeth.
methods of teachings family. Center for
controlling and regarding consultation.
preventing personal
dental caries hygiene
such as proper especially
cleaning of mouth care,
teeth. the frequency
of cleaning the
teeth.
> Instruct the > To have a

family to visit proper
the health medical
center for management
consultation. of the dental
>Explore the caries.
family’s > To measure
reaction about the
the health understanding
teachings of the health
given. teachings
presented.
Problem# 4 Poor Lighting Condition
INTERVENTION PLAN
ANALYSIS OF METHOD
THE PROBLEM NSG. INTERVENTIONS RATIONALE
CONTACT
S> Mrs. Inability to Short Term: >Explore the > To obtain a Mrs. Kisses
Kisses have make family’s ideas baseline data Family shall have
verbalized decisions After 2° of NI about a good for the health Resources: restated
the following: with respect Mrs. Kisses lighting teachings to be H actions that
to taking will be able to condition given to the O >Manpower could be done
“dati neng appropriate restate actions family. M resources to improve
madalumdum action due that could be E such as time their lighting
ing bale, to negative done to >Discuss with >To increase and effort. condition as
anyang anak attitude improve their the family the the family’s evidenced by
ku pa towards the lighting importance of awareness >Physical Mrs. Kisses
makanini ne” problem. condition as having a good about good resources will be able to
evidenced by lighting lighting V such as repeat the
“sindyan ke Mrs. Kisses condition its condition and I fluorescent teachings
mu ing sulu will be able to benefits such promote a S lamps. given
madalumdum repeat the as it prevents good attitude I according to
eh” teachings straining of the towards the T Student her own
given eye, and also problem. S Nurses understanding.
O> The according to the Resources:
student her own consequences The family
nurses have understanding of having a >Knowledge, shall have
observed the . poor lighted skills, time showed an
following: house. and effort of improvement
Long Term: the student on their
> Dark lit >Reinforce the > To increase/ nurses. lighting
rooms (living After 6 days of family’s suffice the condition as
room, and NI the family knowledge on inadequacy of evidenced by
bedrooms) will be able to ways on how to the family’s removal of the
show an provide a well knowledge clothes that
> Obstructed improvement lighted house about other obstruct the
window on their ways of windows and
lighting improving their changing their
condition as lighting light bulbs with
evidenced by condition. fluorescent
removal of the lamps.
clothes that >Explore the > To measure
obstruct the family’s the
windows and reaction about understanding
changing their the health of the health
light bulbs with teachings teachings
fluorescent given. presented.
lamps.
Problem# 5 Poor Ventilation Condition
INTERVENTION PLAN
ANALYSIS OF METHOD
THE PROBLEM NSG. INTERVENTIONS RATIONALE
CONTACT
S> Mrs. Inability to Short Term: >Explore the > To obtain a Mrs. Kisses
Kisses have make family’s ideas baseline data Family shall have
verbalized decisions After 2° of NI about a good for the health Resources: restated
the with respect Mrs. Kisses ventilation teachings to be H actions that
following: to taking will be able to condition. given to the O >Manpower could be done
appropriate restate actions family. M resources to improve
“ay action due that could be E such as time their
malisangan to negative done to >Discuss with >To increase and effort. ventilation
keni alang attitude improve their the family the the family’s condition as
hangin towards the ventilation importance of awareness evidenced by
lulub” problem. condition as having a good about good Student Mrs. Kisses
evidenced by ventilation ventilation V Nurses will be able to
“malwat ne Mrs. Kisses condition its condition and I Resources: repeat the
yan, anyang will be able to benefits such promote a good S teachings
anak ku pa repeat the as it prevents attitude I >Knowledge, given
makanyan teachings easy transfer of towards the T skills, time according to
ne yan given diseases, and problem. S and effort of her own
matatakpan according to also the the student understanding.
ne keng her own consequences nurses.
harap mi” understanding of having a The family
. poor ventilation shall have
O> The condition. showed an
student Long Term: improvement
nurses have on their
observed After 6 days of >Reinforce the > To increase/ ventilation
the NI the family family’s suffice the condition as
following: will be able to knowledge on inadequacy of evidenced by
show an ways on how to the family’s removal of the
> improvement provide a well knowledge clothes that
Obstructed on their ventilated about other obstruct the
window ventilation house ways of windows.
condition as improving their
evidenced by ventilation
removal of the condition.
clothes that
obstruct the >Explore the > To measure
windows. family’s the
reaction about understanding
the health of the health
teachings teachings
given. presented.
VII. FAMILY COPING INDEX
Initial Final
Category Justification
1 3 5 1 3 5
1. PHYSICAL
INDEPENDENCE  Initial Visit:
This category is concerned During the initial visit, the group had
with the ability to move observed that Mrs. Kisses has failed
about, to get out of bed, to to provide required personal care for
take care of daily grooming, herself and her children as
walking, etc. Note that it is evidenced by the presence of lice
the family competence that infestation, poor hair care and long
is measured- even though fingernails of the children. The
an individual is clothes of her children too are soiled
independent, if the family is with sweat and dirt.
able to compensate for this.
The family is important-
hence, if the focus of care  Final Visit:
is poor, for instance, if the
mother is giving care to a The Student nurse had given them
handicapped child that she health teachings about the
shared with other members importance of proper hygiene; the
of the family, the family was cooperative to fully
independence might be comply with it. The mother has
considered incomplete. The allotted time and effort to manage
causes of independence the hygiene of herself and her
may vary however. Lack of children. The fingernails of her
independence in the family children were trimmed and they
may be due to actual were also seen wearing their
physical incapacity, the slippers most of the time especially
inability of “know-how”, the when they are outside the house.
willingness or fear of doing
necessary tasks.
2. THERAPEUTIC  Initial Visit:
COMPETENCE
The group gave the family a score of
three because Mrs. Kisses gives
This category includes all some over the counter medications
to her children or other family
the procedures or
members when needed. She
treatment prescribed for the sometimes asks for the opinions of
care of illness, such as health workers at the health center.
giving medications and They are not able to provide other
using appliances, therapeutic measures to some
dressings, exercises, and illness like cough and colds because
relaxation and special of their financial limitation and lack
of knowledge as well.
diets.
Final Visit:
 The family has recognized their role

in health maintenance and improved
seeking medical assistance from a
physician or from the barangay
health center in order to avoid
further complication or aggravation
of minor illnesses.
3. KNOWLEDGE ON
HEALTH CONDITION  Initial Visit:
This category is concerned Mrs. Kisses has very limited

with the particular health understanding regarding disease
condition that is the conditions. She recognizes
occasion for care, presence of disease but has limited
knowledge of the disease knowledge about what are the
or disability, understanding causes of each. She is not aware
of communicability of about what further complication a
diseases and modes of certain disease can bring.
transmission,
understanding of general
patterns of development of
a newborn baby and the
basic needs of infants for
physical care and tender  Final Visit:
loving care.
The student nurse provided health
teachings to the family, the family
did practice what was taught to
them. Mrs. Kisses’ knowledge on
diseases is well enough so as to
take actions on the health needs of
her family. They are able to go to the
Health Center to consult for their
condition.
4. APPLICATION OF
PRINCIPLES OF
GENERAL HYGIENE  Initial Visit:
This is concerned with The family’s hygiene is not

family action in relation to prioritized at the Chocolate’s
maintaining family nutrition, Residence. This was evidenced by
securing adequate rest and the lice infestation in the children,
relaxation for family dirty fingernails and toenails, and
members and carrying out dirty soles of the feet. The children
accepted preventive were also seen playing outside the
measures such as house without any slippers on.
immunizations, medical Choco Baby was seen sucking her
appraisal and safe pacifier even though if fell on the
homemaking habits in floor without washing it. The
relation to storing and environment around the house as
preparing food. well is unorganized and leftover
foods are just left on top of the table
covered with plate.
 Final Visit:
There are some improvements

noted on the appearance of the
children as evidenced by the
trimmed nails of the children and
wearing of slippers outside the
house.
5. HEALTH ATTITUDES
 Initial Visit:
This category is concerned
with the way the family Mrs. Kisses benefits from the
feels about health care in
services offered by the Barangay
general, including
preventive services, care of Health Center. She never fails to
illness and public health seek medical advice whenever her
measures. children need it.
 Final Visit:
The family maintains their positive

attitude towards health. They seek
medical advices as recommended.
6. EMOTIONAL
COMPETENCE  Initial Visit:
This category has to do In times of family crisis, the family

with the maturity and provides emotional support to each
integrity with which the other as their means coping with
their problems. The parents play a
members of the family are
major role in providing their children
able to meet the usual with guidance. They maintain an
stresses and problems of open communication to facilitate
life, and to plan for happy  family solidarity. However, there
and fruitful living. This times when they are not able to
involves the degree to solve other problems especially
which individuals accept when the nature of the problem is
financial.
the necessary disciplines
imposed by one’s family
Final Visit:
and culture; the
development and
The family’s emotional competence
maintenance of individual remains the same. Despite of their
responsibility and decision; low economic status were able to
and willingness to meet cope up on the problems they
reasonable obligations, to encountered and think of ways
accept adversity with where in they can provide their need
fortitude, and to consider such as food for the day.
the needs of others as well
as one’s own.
7. FAMILY LIVING
 Initial Visit:
This category is concerned
largely with the All of the members of the family get
interpersonal or group along. However, sibling rivalry
aspects of family life- how cannot be eliminated in the family.
Mrs. Kisses told the group also that
well the members of the
she and Mr. Ferrero also
family get along with one experiences petty fights but
another, the ways in which managed to solve them immediately.
they make decisions
affecting the family as a
whole, the degree to which
they support one another Final Visit:
and do things as a family, 
the degree of respect and The group taught the children that
affection the show for one petite fights may be normal but they
another, the ways in which should know that they should be
the manage the family patient with each other especially
budget, the kind of the older ones. Kitkat as the eldest
discipline that prevails. agreed to what the student nurses
said.
8. PHYSICAL
ENVIRONMENT  Initial Visit:
This category is concerned The Chocolate Family’s house

with the home and condition is poor in nature because
community or work it is poorly ventilated and there is
environment as it affects some presence of accident hazards
family health. This includes that is not recognize by either Mr. or
the conditions for housing, Mrs. Ferrero Chocolate. One of their
presence of accident problems is the presence of the
hazards, screening, faulty wirings. Some big rats were
plumbing, facilities of also noted on the nearby drainage
cooking and for privacy; which can threaten their health. The
level of community clothes are also hanged inside the
(deteriorated or modern, house unorganized. The children
presence of social hazards are often found playing on streets.
such as bars, street gangs,
delinquency, pest such as
rats, etc.), availability and Final Visit:
conditions of schools and
transportation.  The family improved the cleanliness
of the interior of the house but the
surrounding environment still needs
more interventions. This was
evidenced by the cleaner
environment. Clothes are hanged
properly and the floor was properly
swept.
9. USE OF COMMUNITY
FACILITIES  Initial Visit:
This category has to do The Chocolate Family knows or

with the degree to which uses some available community
family members know resources that are needed. Mrs.
about and the wisdom with Kisses is aware of the programs
which they use available offered by the Barangay Health
community resources for Center but sometimes fails to attend
health, education, and or comply with it. They also attend or
welfare. The coping ability join some community activities like
does not indicate the level town fiesta and the like. Despite
of the need for services, their awareness, they still lack
but rather the degree to knowledge regarding other free
which they can cope when benefits that they can avail.
they must seek such aid.
 Final Visit:
The family acknowledges the

programs available at the health
center and agrees to seek advice as
necessary.
VIII. LEARNING DERIVED

I personally learned the importance of the family in the society, as the
basic unit of the society, it is important to maintain the health of the family.
Comparing the family with the human body, as when one part of the body is
infected, later on the whole body will be affected systemically, just like with the
family and society, when a family is considered ill, later on the society will be
systemically affected.
I also learned the importance of good communicating skill. With the

absence of a good communicating skill the student nurse will not be able to
establish rapport with his/ her client, thus affecting the assessment process,
making the problem identification and prioritization be difficult, thus, altering the
maximum care you may give to the family.
Assessment is the very crucial part of doing the family case analysis, with
all the data that you will gather throughout the assessment process, there you
will derived the problems you will intervene to correct this problems.
The most important thing that a student nurse must have is the initiative,
time, effort, and patience, without those things you will not be able to gather all
the information you need, the client’s cooperation and compliance is also a vital
ingredients for the success of making a family case analysis.
CARL ELIXER ANO

IX. SOCIOGRAM
This chapter illustrates graphic representation of the several home visits

made, including the interactions of the student nurses with the families, the
assessment, planning, interventions and evaluation done.
Legends:
Student Nurses Implementations
Chocolate Family Health Teachings
Home Satisfaction
Assessment & Rapport
Nursing Interventions
First Home Visit (July 15, 2008, Tuesday)
During the initial home visit, the student nurses went to the Chocolate’s
Residence for the first time and they have a vague feeling about meeting them
because they don’t know what to expect towards the response of the family upon
their arrival. Upon meeting them, they started to establish rapport and told the
family about the purpose of their study. The family responded towards the
student nurse’s request though it is obvious that they were not that comfortable
with each other yet.
Second Home Visit (July 16, 2008, Wednesday)
At the second home visit, the student nurses started the thorough
assessment of the two kids, Kitkat and Toblerone. They also imparted initial
health teaching regarding the existence of potential and actual problems that
may threaten the health of each family member. During this home visit, the group
is not yet that confident regarding their relationship with the family.
Third Home Visit (July 21, 2008, Monday)
During this home visit, the group assessed Mrs. Kisses and Baby Ruth.
They also imparted more health teachings to the family. This time the group is
more at ease with the family.
Fourth Home Visit (July 22, 2008, Tuesday)
During the 4th home visit, this time, the student nurses started their final
assessment at the same time they started implementing the plan of actions
regarding the problems diagnosed during the earlier home visits. The family’s
and the group’s relationship by now is very much established.
Fifth Home Visit (July 29, 2008, Tuesday)
During the 5th home visit, the student nurses continued assessing the
family and put their plan into action by means of implementation. They also gave
some health teachings that day.
Sixth Home Visit (July 30, 2008, Wednesday)
This is the last and final home visit conducted. The student nurses this
time assured that all data needed are complete and they gave further health
teachings regarding the potential and actual problems that may threaten their
health.
During this time, the family showed satisfaction and appreciation for what
the student nurses are doing. The group as well gave them a positive feedback
and thanks them for allowing the group to conduct the study with their
participation.
X. SPOT MAP AND DOCUMENTATION
Sto Rosario. St.
F. Lazatin
San Fabian
St. Jude
Chocolate’s Residence
Barangay Health Center

DOCUMENTATION:
CHOCOLATE FAMILY
Kitkat, Mrs. Kisses, Snickers

ChocoBaby
Snickers, ChocoBaby, Kitkat

THE STUDENTS NURSES
with
THE CHOCOLATE FAMILY
XI. BIBLIOGRAPHY
Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational

Publishing House, 2005.
Maglaya, A. Nursing Practice in the Community. Marikina City: Argonauta Corp.,

2004.
Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed. Philippines:
2007
http://wisdomquotes.com
http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm
http://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htm
Handouts from:
Primary Health Care II (2007-2008)

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Angeles University Foundation

Related Learning Experience

“Family Case Analysis”

Ms. Kristine Joy Villarosa R.N.

Ano, Carl Elexer C

“The family is the nucleus of civilization.”

Community health nursing is a response to the health needs of the

Family Case Analysis (FCA) is a means by which student nurse

 Student Nurse Centered

B. Entry, Climate of acceptance, First few words, Number of home visit

First Home Visit (July 15, 2008, Tuesday)

The student nurses further introduced themselves to the family. They

Second Home Visit (July 16, 2008, Wednesday)

The groups arrived on their respective families on a rainy afternoon, at

Third Home Visit (July 21, 2008, Monday)

Fourth Home Visit (July 22, 2008, Tuesday)

The student nurses returned around 2:30 pm as requested by Mrs. Kisses.

Sixth Home Visit (July 30, 2008, Wednesday)

Name Age Ordinal Sex Educational Present Health

Mrs. Kisses 30 Mother F Not going to Mrs. Kisses has a

Her vital signs are as

Her vital signs are as

Snickers 7 Eldest son M Going to Snickers was seen

His vital signs are as

Her vital signs are as

Lola Tootsie 50 Grandmother F Not going to Lola Tootsie Roll

Brother 34 Brother M Not going to Brother Crunch

MR. FERRERO CHOCOLATE

MRS. KISSES CHOCOLATE

Mrs. Kisses’ vital signs were taken and recorder as follow:

Cranial Nerve Assessment Technique Normal Response Client’s

Reaction to Pupils constrict Her pupils

Body Mass Index

Age: 30 yrs. old

History of Past and Present Illness

⇒ Ears and Hearing

Body Mass Index

Age: 9 yrs. old

⇒ Mouth and Oropharynx

• Tongue and Floor of Mouth: in central position, pink in color,

Growth and Development

Upon arriving from school, Snickers will do his assignments or homework

Body Mass Index

Age: 9 yrs. old

History of Past and Present Illness

Activities of Daily Living

⇒ Ears and Hearing

Growth and Development

Erik Erikson’s Psychosocial Stage – Autonomy vs. Shame and Doubt

Chocobaby is fond of climbing up to high tables, chairs and drawers. She

Sigmund Freud’s Psychosexual Stage- Anal Stage

FNRI= normal (9.9-15.6)

Activities of Daily Living

The Chocolate Family is considered as an extended type of family. An

B. Dominant family member/s in terms of decision-making especially to

C. Source of income and expenditures

Mr. Ferrero works as a tricycle driver, he works from 5 am until 10 pm from

F. Significant other’s roles in the family life

The family participates in the community activities such as celebrating

The house is made of concrete wood. It has a floor area of 5.76m x

The Chocolate Family have different appliances such as television, radio,

K. Food sources, storage and cooking facilities