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HOLY ANGEL UNIVERSITY

College of Nursing
Angeles City

A
FAMILY
CASE
ANALYSIS

Presented to the College of Nursing

In partial fulfillment
Of the requirements in
Nursing Care Management 102 – Related Learning Experience

January 15, 2009


I. INTRODUCTION

1. Objectives (student-centered)

After 3 weeks of accomplishing the family case analysis, the student nurses shall
have:

Cognitive:
• Collected facts regarding the demographic data of the family
• Performed physical assessment for each member of the family
• Determined existing problems with the family
• Formulated nursing diagnosis related to family problems
• Explained existing problems identified to family
• Implemented some activities that will make the home conducive for health
development and improvement

Psychomotor
• Practiced therapeutic communication
• Gained knowledge as they interact with family

Affective

• Introduced to one’s self the family and emphasized the purpose of the home visit
in order to establish rapport
• Built a harmonious working relationship with the family members
• Discussed the problems identified and pointed out solutions to prevent the
problem
• Perform interventions associated with the diagnosis of the family to promote
wellness
2. Entry
“What you leave behind is not what is engraved in stone monuments, but what is
woven into the lives of others”
-Anonymous

Simple deeds that are done by student nurses may be left behind or remembered
but it won’t mean anything if it didn’t affect the people. It’s hard to change how the
world is but trying to improve how one lives and giving hope in little ways can affect the
way people choose to live and their perspective in life. For this Family Case Analysis, the
mission is not how student nurses are going to help them but it should be how the student
nurses are going to help the family help themselves.

For this rotation, the Family Case Analysis was conducted in the area of Cuayan,
Angeles City. The researchers had the freedom to choose who the respondent would be as
long as it follows the criteria given. Group 3 were clueless of who they were going to
interview and render services to since it was their first time being at that community. This
may be a way to train the student nurses to give services to people they don’t know and
how to earn trust and cooperation by the residents.

The criteria that were given for choosing a family for the subjected Family Case
Analysis are as follows: The family must consist of at least five members (three
children), there must be a member who belongs to the vulnerable groups (pregnant
women, children, and old-age adults) and the youngest child must be at least 1 year old.
At first, the Group 3 of section N-306 had a prospective family per student. They
each interviewed a family and assessed the family members and noted down present
problems. Trying to figure out who would best fit the criterions, they discussed their
adopted family to the other group mates and mentioned why their family adopted would
be fascinating to study. After talking and analyzing who they should interview,
consultation with their instructor occurred. Given the advice of choosing a family with
evident health problems and interventions that can be carried out, Group 3 found the
family that would be excellent to study and entailed all the criteria, Mr. and Mrs. Cuayan.

After the discussion between the researchers, simple preparations such as


questions ready written down and reviews of how to do assessment were gathered; they
then went to the house of Mr. and Mrs. Cuayan. They saw the children wearing no
footwear, shorts, had running nose and the mother pregnant caring an infant. The
researchers then without hesitation introduced themselves and stated their purpose. To
their surprise, the mother agreed to be the family involved for their Family Case Analysis
and showed some interest in learning. All members got up and started doing something.
Data collection and assessments were then being started.
II. Family Constellation
Name Age Position Sex Civil Status Educational
Attainment

Mr. Cuayan 29y/o Father Male Married Elementary


Graduate

Mrs. Cuayan 29y/o Mother Female Married High School


Under
Graduate

Dipsie 8y/o 1st Child Female Elementary


Level

Teletubbies 2y/o 2nd Child Male Not yet in


studying

Po 1y/o 3rd Child Male Not yet


studying
III. Health Assessment

Mr. Cuayan

a. General Description

Mr. Cuayan is the head of the family. He has brown skin; his hair is above
shoulder, poorly shaved mustache. Upon initial contact, the student nurses
observed that the father was hungry because of his work. He is kind and
approachable. He wears a blue t-shirt and denim shorts; he does not wear any
footwear, or any other accessories.

b. Vital Signs

Final home visit – January 10, 2009


T: 36.5 °C P: 67 bpm R: 17 bpm BP: 120/70 mmHg
(Due to his work, we only met the father once.)

c. Physical Assessment
Skin
• Dark Brown skin complexion
• Dry
• Presence of tattoo on the right lower leg and back
• Presence of scar on left arm and right leg
• Dirty and long nails
• Good capillary refill test (2 seconds)

Head
• Hair is shoulder length, black and equally distributed
• With unshaved mustache
Eyes
• With dark brown iris
• White sclera
• Pupils equally round and reactive to light accommodation (PERRLA)
• With pink palpebral conjunctiva

Ears and Hearing


• Ears recoils after folding
• No discharge
• Without any obstructions

Nose and Sinuses


• With thick nasal hair
• No presence of scar
• No discharge

Mouth and Throat


• With tartar
• Seven dentures
• With dark lips
• With slightly dark pink gums
• With halitosis

Neck
• No masses
• No presence of swelling

Breast
• Symmetrical in size
• Brown nipple
• Slightly protruded

Thorax and Lungs


• Symmetrical in size

Abdomen
• Flat in contour

Upper and Lower Extremities


• Blood vessels on his arms are prominent

• Toenails and fingernails are long and dirty

• Presence of tattoo in the right lower leg

d. Health History

Mr. Cuayan was never been hospitalized. He previously had coughs, colds, fever
and diarrhea. When feeling sick, he usually gets enough rest and his wife gave him
adequate water. And if illness does not subside in three days, he usually goes to the health
center to avail of medicines. Mr. Cuayan is at high risk of having heart disease since
hypertension runs in their family. He has allergies on grass and other type of grassy
plants. Presently, he has no illness.

e. Growth and Development

Mr. Cuayan is twenty-nine years old. Under Sigmund Freud’s Theory of


Psychosexual Development, he is in Genital Stage, wherein his sexual interest should be
matured already and show or establish satisfactory with his opposite sex. The student-
nurses think that Mr. Cuayan achieved it.

For Erik Erikson’s Theory of Psychosocial Development, he is in the stage of


Generativity vs. Stagnation. Generative adult is a type of person that concerned to his
own family, community, and country. Due to their situation in life, Mr. Cuayan as we
observed is only focusing on his family, on how they survive and give a better life to his
family.

f. Activities of Daily Living

Mr. Cuayan works as a construction worker. He wakes up five in the morning,


eats breakfast, takes a bath and goes to work by 7:00 a.m. By eight o’ clock, he arrives at
the construction site and works until five in the afternoon with a 1-hour break in between.
After work, he then go home and play with his children. Then, he, together with his
family, spends the night watching television after dinner and sleeps by ten in the evening.
This is Mr. Cuayan’s routine for the whole week except for Sunday which is his
only day-off.

Mrs. Cuayan

a. General Description

Mrs. Cuayan is the wife of the head of the family. She has brown skin,
her hair is shoulder level, and well combed. Upon initial contact, the student
nurses observed that the mother is busy watching her child, because she’s alone at
that time. She’ so kind and hospitable, she entertained the different questions that
the student-nurses asked. He wears a white t-shirt and denim shorts; she does not
wear any footwear, or any other accessories.

b. Vital Signs
Final home visit – January 10, 2009
T: 35.3 °C P: 80 bpm R: 21 bpm BP: 90/60 mmHg

c. Physical Assessment

Skin
• Dark Brown skin complexion
• Dry and warm to touch
• Clean and short nails
• Good capillary refill test (2 seconds)

Head
• Hair is shoulder length, black and equally distributed
• No abnormal palpable lumps
• Well combed hair

Eyes
• With dark brown iris
• White sclera
• Pupils equally round and reactive to light accommodation (PERRLA)
• With pink palpebral conjunctiva

Ears and Hearing


• Ears recoils after folding
• No discharge
• Without any obstructions
• Has ear piercing

Nose and Sinuses


• With thick nasal hair
• No presence of scar
• No discharge
• Symmetrical with the midline

Mouth and Throat


• With tartar
• With dark pinkish lips
• With slightly dark pink gums
• With halitosis

Neck
• No masses
• No presence of swelling
• No stiffness present
• No swollen lymph nodes

Breast
• Symmetrical in size
• Brown nipple
• No palpable Lumps
• Lactating

Thorax and Lungs


• Symmetrical in size

Upper and Lower Extremities


• Toenails and fingernails are short and clean
d. Health History
Mrs. Cuayan had never been hospitalized or acquired any serious illness in
the past except for Urinary Tract Infection. She had experienced simple cough
and colds some years ago but was resolved through home remedies such as
taking more fluids and citrus fruits and sometimes over-the-counter
medicines. At present, she has no known disease.

e. Obstetrical History
Mrs. Cuayan is 29 years old, within the reproductive age and is still
capable of childbearing as evidence by she is pregnant at the moment.
According to her, she did not use any family planning method because during
those times, it is still not widely known. Her Obstetric score is G4P3 and
T3P0A0L3. All of her children were born via home delivery assisted by a
midwife.
She got pregnant with her first child in the year 2000. By then, she was only
21 years old. She had an initial check up in the public hospital or sometimes in
the health center. She gave birth on her first child on the twenty seventh of
September. According to her, she really had difficulty on her labor. On her
following pregnancies, she no longer experienced difficulty because her labor
takes only about 2 to 4 hours. Succeeding deliveries were dated, 2006, and
2007 respectively.
All her pregnancies did not have any complications or abnormalities. She
strictly adheres to the instructions of the health care providers regarding the
proper foods to eat, taking of vitamins and managing stress. She also follows
some superstitious beliefs such as eating two bananas that are adjacent will
result to twins.
Mrs. Cuayan has a regular 28-day cycle menstruation ever since. She had her
menarche at the age of 12 or 13 (as far as she can remember).

Immunization Status (Tetanus Toxoid)


TT1 TT2 TT3 TT4 TT5
1 1 0 0 0

f. Growth and Development

Mrs. Cuayan is twenty-nine years old. Under Sigmund Freud’s Theory of


Psychosexual Development, she is in Genital Stage, wherein her sexual interest should be
matured already and show or establish satisfactory with his opposite sex. The student-
nurses think that Mrs. Cuayan achieved it.

For Erik Erikson’s Theory of Psychosocial Development, she is in the stage of


Generativity vs. Stagnation. Generative adult is a type of person that concerned to his
own family, community, and country. Due to their situation in life, Mr. Cuayan as we
observed is only focusing on his family, on how they survive and give a better life to his
family.

g. Activities of Daily Living

Mrs. Cuayan starts her day at around Six o’clock in the morning. Upon rising, she
will go to buy for their breakfast at the sari-sari store near their house. She will then
prepare for their food and also prepare the uniform of her eldest daughter in going to
school. After the daughter and her husband had left, she will do her usual routines—
washing the dishes, sweeping the floor and washing the clothes (usually every three days)
and watching her two children. At around eleven o’clock, she will start to prepare for
their lunch. She will serve the lunch at twelve noon. After eating, she will rest for a while
together with two children. Upon waking up she will look for merienda for her two
youngest children. When the clock strikes at six o’clock, she will then prepare for their
dinner. At seven or eight, the family will eat their dinner and watch their favorite
primetime show. Mrs. Cuayan, together with her husband sleeps at around ten o’clock
after watching TV.
Dipsie

a. General Description

Dipsie is the eldest child in the family. She has fair skin, her hair is long.
Upon initial contact, the student nurses observed that Dipsie was eating. She is
kind and shy-type person. She wears a black t-shirt and shorts; she does not wear
any footwear, or any other accessories.

b. Vital Signs

Final home visit – January 10, 2009


T: 36.7 °C P: 71 bpm R: 17 bpm BP: 90/60mmHg

c. Physical Assessment

Skin
• Dark Brown skin complexion
• Dry and warm to touch
• Dirty and long nails
• Good capillary refill test (2 seconds)

Head
• Hair is long, black and equally distributed
• Well combed hair

Eyes
• With dark brown iris
• White sclera
• Pupils equally round and reactive to light accommodation (PERRLA)
• With pink palpebral conjunctiva
Ears and Hearing
• Ears recoils after folding
• No discharge
• Without any obstructions
• With ear piercing

Nose and Sinuses


• With thick nasal hair
• No presence of scar
• With nasal discharge
• Symmetrical in midline

Mouth and Throat


• With tartar
• With pinkish lips
• With slightly pink gums

Neck
• No masses
• No presence of swelling

Breast
• Symmetrical in size
• Brown nipple

Thorax and Lungs


• Symmetrical in size
• Presence of wheezing upon auscultation

Abdomen
• Flat in contour

Upper and Lower Extremities


• Blood vessels on his arms are not prominent

• Toenails and fingernails are long and dirty

d. Health History

Dipsie had not acquired any serious disease or illness in the past and had
not been confined in a hospital. At present, she is experiencing cough and colds
which begun in the last week of December.

e. Growth and Development


Dipsie is eight years old. Under Sigmund Freud’s Theory of
Psychosexual Development, she is in Latent phase, the student-nurses failed to
assess this.

For Erik Erikson’s Theory of Psychosocial Development, she is in the


stage of Industry vs. Inferiority. In this stage the children is in the phase of doing
things right or observing if what she is doing can give her accomplishment. Dipsie
showed some of the characteristics of this phase.

f. Activities of Daily Living


Dipsie is currently studying, so she wakes up at seven o’clock in the
morning and prepares her self going to school. By twelve o’clock she will arrive
in their house to eat for her lunch, and goes back in school by one o’clock. That’s
her daily routine for Monday to Friday. By Saturday and Sunday she helps her
mother in household chores, also in cooking and in taking good care of Po.

Teletubbies

a. General Description

Teletubbies is the second child of the family. He has fair skin, his hair is
blonde and at the shoulder level. Upon initial contact, the student-nurses
observed that the child was dirty and that there is presence of nasal discharge. He
is kind and approachable. He was wearing a red t-shirt, that alone. He was not
wearing any footwear. He was shy and timid.

b. Vital Signs

First home visit – January 8, 2009


T: 36.7 °C P: 89 bpm R: 21 breaths/min
Second home visit – January 9, 2009
T: 34.9 °C P: 87 bpm R: 19 breaths/min
Final home visit – January 10, 2009
T: 35.6 °C P: 90 bpm R: 20 breaths/min

c. Physical Assessment

Skin
• Brown skin complexion
• Dry and warm
• Presence of rashes on the hip and buttocks
• Presence of abrasion on right knee
• Dirty and long nails
• Good capillary refill: 2 sec

Head
• Hair is shoulder length, blonde and equally distributed

Eyes
• With dark brown iris
• White sclera
• Pupils equally round and reactive to light accommodation (PERRLA)
• With pale palpebral conjunctiva
• Blurred lenses

Ears and Hearing


• Ears recoil after folding
• Presence of dirt and cerumen
• Late response when being called

Nose and Sinuses


• Presence of discharge, green in color
• Nasal septum in midline

Mouth and Throat


• Pink mucous membranes
• Presence of seventeen teeth
• Yellowish tooth enamel
• Presence of tooth cavities

Neck
• Chin can touch the anterior chest
• No masses
• No presence of swelling
• No difficulty in swallowing
• Lymph nodes not palpable

Breast
• Symmetrical in size
• Brown nipples and areola
• Slightly inverted nipples

Thorax and Lungs


• Symmetrical in size

Abdomen
• Round and protuberant
• Umbilicus in midline

Upper and Lower Extremities


• Toenails and fingernails are long and dirty

• Presence of abrasion on right knee

• Good capillary refill

d. Health History
Teletubbies has allergies to grass and weeds like his father. Presently, he has
cough and colds and it has been present since the first week of December. Nasal
discharge is already green in color and has a thick consistency.

e. Growth and Development

Teletubbies is two years of age. Under Sigmund Freud’s Theory of Psychosexual


Development, he is on the Anal Stage, wherein his sexual interest should be focused on
the anal region and must have begun toilet training which Teletubbies gets interested
with. He also shows signs of independence.

According to Erik Erikson’s Theory of Psychosocial Development, his


developmental task is Autonomy vs. Shame and Doubt wherein he learns to be
independent in his own little ways such as buying from the store, eating by himself and
taking pride in things he does.

f. Activities of Daily Living

Teletubbies usually wakes up by seven or eight in the morning and eats breakfast.
For the rest of the day he would only be seen playing inside or outside of the house with
other children in the neighborhood. He takes a bath with the assistance of his mother by
midday, and then sleeps in the afternoon. He wakes up again by three or four and plays
again. He takes his meals with his family and eats without his parents’ assistance. After
watching television with the whole family in the evening, he sleeps by 8 or 9 p.m.

g. Immunization Status

VACCINE FIRST DOSE SECOND DOSE THIRD DOSE


BCG 
DPT   
OPV   
HEPATITIS B   
MEASLES 

 - administered

 - not administered
Po

a. General Description

Po is the third child of the family. He has fair skin, his hair is blonde and
above the shoulders. Upon initial contact, the student-nurses observed that he was
not wearing undergarments and that there is presence of rashes on his hips and
buttocks. He was wearing a white sando and had a pacifier put into his mouth.

b. Vital Signs

First home visit – January 8, 2009


T: 35.7 °C P: 114 bpm R: 20 breaths/min
Second home visit – January 9, 2009
T: 36.5 °C P: 110bpm R: 25 breaths/min
Final home visit – January 10, 2009
T: 36.6 °C P: 114 bpm R: 25 breaths/min

c. Physical Assessment

Skin
• Fair skin complexion
• Dry and smooth
• Presence of rashes on the hips and buttocks
• Dirty and long nails
• Good capillary refill: 2 sec

Head
• Hair-length is above the shoulders, blonde and equally distributed
Eyes
• With dark brown iris
• White sclera
• Pupils equally round and reactive to light accommodation (PERRLA)
• With pink palpebral conjunctiva

Ears and Hearing


• Ears recoil after folding
• No discharge
• Without any obstructions

Nose and Sinuses


• No presence of scar
• No discharge

Mouth and Throat


• With moist and pink mucous membranes
• Presence of four teeth
• With sucking reflexes

Neck
• No masses
• No presence of swelling

Breast
• Symmetrical in size
• Brown nipples and areola
• Slightly inverted
Thorax and Lungs
• Symmetrical in size

Abdomen
• Slightly protuberant

Upper and Lower Extremities


• Toenails and fingernails are long and dirty

• Good capillary refill

d. Health History

Po was rushed to the hospital when he was months old because of a chief
complaint of convulsion. Besides that, he has not yet experienced any severe forms of
childhood illnesses.

e. Growth and Development

Po is one year and two months old. Under Sigmund Freud’s Theory of
Psychosexual Development, he is at the Oral Stage, wherein the mouth is the center of
gratification. It has been evident enough that with his pacifier on his mouth, he gains
satisfaction since he does not have cries and tantrums while it is put on.
According to Erik Erikson’s Theory of Psychosocial Development, he is in the
stage of Trust vs. Mistrust. Since Po is being taken cared of, he renders trust even to
strangers, but with ample visual stimulation for a more active child involvement. When
he is being cuddled, his discomforts are easily and/or quickly removed.
f. Activities of Daily Living

Po wakes up anytime in the morning, usually at seven or eight. When his mother
does not have to wash their clothes, he stays at home and was cared by his mother. When
his mother has a lot of chores to finish, he was left on his grandmother’s home.
What he does all day is to suck his pacifier, be bottle-fed, sleep, and be carried by
his mother or his father, and at times, by his grandmother.

g. Immunization Status

VACCINE FIRST DOSE SECOND DOSE THIRD DOSE


BCG 
DPT   
OPV   
HEPATITIS B   
MEASLES 

 - administered

 - not administered
IV. SOCIO-ECONOMIC, CULTURAL, and ENVIRONMENT ASSESSMENT

A. Family Structure, Characteristics, and Dynamics

i. Members of the household and relationship to the head of the family

Mr. Cuayan is the man of the house, breadwinner and head of the family. He is
married to Mrs. Cuayan and blessed with three children. A girl is the eldest then
followed by two boys. Mrs. Cuayan is now 5 months pregnant.

ii. Demographic profile of each member-age, birth date, and birth place

Member Age Birthday Birth place


Mr. Cuayan 29 August 16, 1979 Montalban, Rizal
Mrs. Cuayan 29 August 3, 1979 Lubao, Pampanga
Dipsie 8 September 27, 2000 Quezon City
Teletubbies 2 September 25, 2006 Quezon City
Po 1 and 2 mos October 26, 2007 Cuayan, Angeles
City

iii. Place of residence of each member –whether living with family or elsewhere

All of the family members live together at Gawad Kalinga Center, Purok 5, Brgy.
Cuayan, Angeles City.
iv. Type of family structure

The type of family they have is a nuclear type. Consisting of the mother, father,
and their 3 children. They are practicing traditional Filipino family.

v. Dominant family members in terms of decision making, especially in matters


of health care

The dominant family members that are responsible for decision-making are both
of the parents. The father makes decision regarding economic aspects of family life
while the mother manages the home and care for the children and also budgets their
daily expenses. Whenever there are emergency cases, they usually go to the health
center.

vi. General family relationship/dynamics-presence of any obvious/readily


observable conflict between members, characteristic
communication/interaction patterns among member

Mr. and Mrs. Cuayan try to keep a good relationship with the members of their
family. Like other families they also encounter problems but they try their best to
manage and don’t let it affect the relationship with each other. Whenever the family is
complete, they bond together in simple ways such as watching television, playing
with their children and going to mass regularly. When Mr. Cuayan saves extra cash
he treats his family out by taking them to the malls.

B. Socio-economic and Cultural Characteristics

i. Educational attainment of each member


Mr. Cuayan finished elementary while Mrs. Cuayan finished third high school
due to financial constraints. Dipsie is currently a 3rd grade student at Cuayan
Elementary.

ii. Significant others / relatives roles in the family’s life

The significant other who plays a major role in the family’s life is Mr. Cuayan.
Mrs. Cuayan cannot turn to her brothers and sisters for the reason of being so far
away from them, except for her one sister. But when a problem occurs, the family
takes action first and when all fails, they ask for help from the mother’s sister.

iii. Relationship of the family to larger community

The house of Nallatan family is lies a little far for the Barangay Hall and
Barangay Health Center. However, they still utilizes the program of the Barangay such
as the Elementary School and immuzation program of Barangay Health Center.

iv. Occupation, place of work and income of each working member

The father starts his day by waking up around 6am, and works at the construction
site from 8:00-5:00pm. As stated by the mother, she watches their children and does the
household chores whole day.

v. Source of income

Mr. Cuayan is a construction worker who earns 9,000 pesos a month while the
mother is a housewife.

vi. Mode of expenditure


Mrs. Cuayan gives the eldest kid 10 pesos each day for her allowance. Regarding
expenses for their food, they buy ready made food at the carinderia as a medium for food
with a budget of 150 pesos a day. For their water and electricity resources, they spend an
amount of 9000 pesos a month.

vii. Ethnic background and religious affiliation

Mrs. Cuayan is from Lubao Pampanga, while Mr. Cuayan grew up in Rizal,
Manila. After their marriage, they decided to reside at Quezon City and then moved to
Pampanga in 2007. Within the members of the family, they use Tagalog more often as
their medium of communication.

The family goes to a Catholic church regularly, and they usually spend the whole
Sunday together.

viii. Family health habits, beliefs and practices, superstitions

The family believes in modern medicine with regards to its effect. However, due
to financial constraints, they often leave diseases untreated and remain quite prolonged
and if the sickness doesn’t disappear they result to self-medication.

C. Home and Environment


i. Housing

1. Adequacy of living space


The family stays inside the house most of the time and usually in front of the
house which is also covered, resembles a patio when looking at it. But when looking at
the 8 members of the family in the house, there is an obvious evidence of inadequate
living space. It is hard to understand how they can all manage to live in such a limited
space of area. But seeing that they do not have too much furniture and appliances, you’ll
slightly see that they can move around the house.

LIVING SPACE

FORMULA:

TFA (IN SQM) = LENGTH ON THE HOUSE x WIDTH OF THE HOUSE

TSR = NUMBER OF HOUSEHOLD MEMBERS x CORRESPONDING SPACE


REQUIRED FOR THAT MEMBER

CONSIDER:

ADULTS (13 Y/O AND ABOVE) = 15 SQM


CHILDREN (1 Y/O TO 12 Y/O) = 8 SQM
INFANTS ( BELOW 12 MONTHS) = 0 SQM

COMPARE THE TFA (TOTAL FLOOR AREA) WITH THE TSA (TOTAL SPACE
REQUIREMENT)

CROWDED IF: TFA < TSR


NOT CROWDED IF: TFA > TSR

TFA = 21 SQM

TSR = 2 (15) + 3 (8)


= 30 + 24
= 54

INTERPRETATION: TFA< TSR (CROWDED)

2. Sleeping pattern
The family usually wakes up at 6am to get ready for work and school for Dipsie.
When Mr. Cuayan and Dipsie aren’t at the house, Mrs. Cuayan is busy doing her
household chores. They usually take a nap in the afternoon and just wait for the two to
come home. At night, they bond while watching their favorite television shows and after
that they go to bed by 10:00 p.m.
3. Breeding or resting sites of vectors of diseases
They also found that there are a lot of mosquitoes present at the house which can
be a source of dengue fever. The mother doesn’t use any precautions to prevent diseases
caused by mosquitoes and other insects. Protective clothing for the children was not
observed by the researchers. The two boys weren’t wearing footwear also shorts.

4. Accident hazards
Even though the children are young and love to play, safety precautions aren’t
given attention by the parents. The researchers observed that the children are prone to
accidents because of evident risk hazards such as sharp objects within the reach of the
children, cooking facilities placed on the ground.

5. Food storage and cooking facilities


Mrs. Cuayan cooks outside the patio, they do not have a refrigerator, and as stated
they do not need one for what they cook is just enough for the whole family. But in cases
of leftovers, they simply cover the food with another plate, and leave it on the table. All
their cooking utensils are kept away for the children to reach. But there are other tools
lying around the house which could be an accident hazard to the children.

6. Water Supply
Their water is supplied by a water faucet (gripo). This serves as their source for
water needs such as in taking a bath and cooking as well as their source of drinking
water.

7. Water storage
For drinking water it is placed in a plastic jar and water for taking baths or others
purposes are stored in a big plastic container with no cover.

8. Toilet facility
The family uses a private toilet facility. They make use of pail system when it
comes to the use of their toilet.

9. Garbage/refusal disposal
Family Cuayan disposes their garbage in a sack that is not covered. When the
sack is filled, every week they dispose it at the public garbage trucks.

10. Drainage system


They have an open and stagnant drainage. There are no canals which are present.
The water just goes to the soil and dirt of the lot.

ii. Social and health facilities communication and transportation facilities


The family hardly goes out of their barangay except for Sundays. The father uses
a bicycle as a source of transportation to work, and when it’s Sunday, they all commute
to visit the mall and walk around, or walk around the market for the kids to see. They do
not have any cellphone or any source of communication, but in cases of emergency they
would use a payphone.
V. Problem Identification

a. List of the problems identified with cues


Health Problem Score

1. Presence of Accidental 4.17

2. Malnutrition 3.67

3. Presence of Cough and Colds 3.22

4. Inadequate Living Space 2.5

5. Inadequate Ventilation 2.01

6. Poor Personal Hygiene 1.34

b. Priority Setting
Presence of Accidental Hazards

CRITERIA COMPUTATION
SCORE JUSTIFICATION
Nature of Problem 2/3 x 1 0.67 This is a health threat
because there is an
improper placement of
sharps and cooking
equipment within the
reach of the children. It
may cause harm and
burn to the members of
the family especially to
children.
Modifiability 1x2 2 The problem is partially
modifiable. The family
does not have adequate
knowledge on the
remedy of the problem.
They are somehow
aware to the problem,
but do not recognize it
as a felt need. And
through the health
teachings, knowledge
about the interventions,
of the student nurses the
family had come to
realize such
interventions in
minimizing the
problem. No financial
resources are needed for
them to resolve the
problem. Willingness
and cooperation by the
family is very vital.
Also, no community
resources are needed to
solve the problem
Preventive Potential 3/3 x 1 1 The problem is highly
preventable. Sharp
objects can lead to
accidents and injury of
the members of family
mostly to the children.
The problem is not that
severe and it exists in a
short duration.
Management to the
problem is currently
available.
Salience 1/2 x 1 0.5 The family recognizes
the problem but they do
not feel it needs
immediate action.
Total 4.17
Malnutrition
CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the 2/3X1 0.67 The problem is considered as


problem health deficit. Malnutrition is also
a contributing factor in acquiring
diseases easily. Lack of vitamins
and minerals which are essential
to our body weakens the immune
system, thus harmful bacteria and
microorganisms could easily get
through the body’s immune
system causing diseases and
infections. Also, a malnourished
individual cannot function well
with his/her outermost potential
since he/she lacks energy to
sustain his/her desired activities.

2. Modifiability of 2/3X2 1.33 The problem is partially


the Problem modifiable due to:
 Knowledge of the Family:
The family is knowledgeable
about the effects of the situation
but due to their financial
problems, the family could not
sustain adequate nutritional
needs.

 Family's Resources:
Mr. and Mrs. Cuayan make
certain that their children, as
much as possible, will be able to
have a complete meal for
everyday to prevent from being
sick.

 Nurse's Resources:
The student nurses provided
health teachings and recommend
alternative foods which are
nutritious and affordable.

 Community Resources:
The community provides
program concerning about
proper nutrition in order to
alleviate the occurrence of some
health problems within the
community.

3. Preventive 2/3X1 0.67 The problem has a moderate


Potential preventive potential because of
the extent of the problem shows
that 3 out of 4 of the children in
the family are already
malnourished.
The condition has already
occurred even before the student
nurses have their home visits.
 Management:
Student nurse must be able to
teach parents on preparing an
appetizing meal with their
resources available. Also
encourage adequate rest and
exercise.

Exposure:
There is the exposure of some
members since there’s no
sufficient food to accommodate
all their needs.

4. Salience 2/2X1 1 The family considered it as a


condition needing an immediate
attention AEB Mrs. Cuayan’s
verbalization, “di nga sila
nakakaen tatlong beses sa isang
araw, kya nangangayayat sila”
TOTAL SCORE 3.67
Presence of Cough and Colds

CRITERIA COMPUTATION
SCORE JUSTIFICATION
Nature of Problem 3/ 3 x 1 1 This is a health deficit
because Dipsy, and
Telatubbies were
experiencing runny and
clogged noses with the
presence of nasal
discharges.
Modifiability 1/ 2 x 2 1 This problem is
partially modifiable
because the nurse’s
skill is limited and is
not sufficient to solve
it. Also, many
problems cause this and
this condition is self-
limiting. The sudden
changes of weather
may also be a cause.
Preventive Potential 2/ 3 x 1 0.67 The preventive
potential is moderate
since the problem
exists for about 2
weeks. Resources of
the health center as
well as the health
teachings provided by
the student nurses are
available.
Complications such as
pneumonia can be
prevented if proper
interventions are given.
Salience 2/2x1 1 The mother sees this as
a problem but does not
continue medications
due to the lack of
financial resources.
Total 3.22
Inadequate Living Space

CRITERIA COMPUTATION
SCORE JUSTIFICATION
Nature of Problem 2/ 3 x 1 0.67 The problem is a
health threat because
it makes
communicable
diseases easily
transmitted.
Modifiability 1/ 2 x 2 1 It is not possible to
widen their area. The
family can be taught
of how to arrange
and organize their
things in the house to
widen the space.
Preventive Potential 1/ 3 x 1 0.33 The problem has a
low preventive
potential since the
family had adapted to
the place and they
have no plans in
transferring to
another place that is
more spacious.
Salience 1/ 2 x 1 .5 According to the
mother, they are
already used of that
kind of living space.
She said they don’t
have other choice but
to leave there.
Total 2.5
Poor Ventilation
INADEQUATE VENTILATION

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the 2/3x1 0.67 The problem is considered as a health


Problem threat because improper ventilation
makes it easier for communicable
diseases, specifically those transmitted
via air-borne, to be transferred if a
member of the family gets infected.

2. Modifiability of the 1/3x2 0.67 The problem is partially modifiable


Problem with the use of the following:

Knowledge of the Family:


The family is not aware about the
problem because as verbalized by them,
they got used to hanging thick curtains
unaware that it adds gloom and makes
their house impermeable to air.

Family Resources:
The family may open the windows
during the day thus allowing a free flow
of air in the house. They may also open
the door to add fresh air exchange.

Student Resources:
The students may provide health
teachings on ways to prevent the
possible occurrence of the effects of the
problem.

Community Resources:
The BHC can provide a seminar on the
effects of inadequate ventilation to
health.

3. Preventive Potential 2/3x1 0.67 The problem has moderate preventive


potential because the family can make
remedies in order to solve the problem
but may only be limited to opening
their windows and door present in the
house.

 Management:
The family may open the windows and
the door to facilitate entry of air and
may use thin curtains.

 Exposure:
All the family members are exposed
since they all reside in that area.

The family are not aware to this


4. Salience 0/2x1 0 problem.
TOTAL SCORE 2.01
Poor Personal Hygiene

CRITERIA COMPUTATION
SCORE JUSTIFICATION
Nature of Problem 2/3 x 1 0.67 The problem is a health
threat as it could cause
certain disease
condition such as
parasitism to the family
especially to the
children.
Modifiability 0/2 x 2 0 The problem is not
modifiable since the
family does not have
the knowledge of how
communicable diseases
are transmitted and
resources of the family
and community with the
limited knowledge of
the nurse is not
sufficient to solve the
problem.

Preventive Potential 2/3 x 1 .67 The problem has


moderate preventive
potential since the
student nurse is there to
give some interventions
that can help the family
improve their personal
hygiene.
Salience 0/2 x 1 0 The family does not
perceive this as a
problem needing
immediate change
Total 1.34
VI. Family Case Analysis

Presence of Accident Hazards


Cues Family Nursing Objectives Interventions Rationale Evaluation
Problem
Subjective: Ø 1. Inadequate Short Term: >Provide >This will help the Short Term:
knowledge After 2 home visits information about family to realize the The family shall be
of nursing the consequences of importance of able to recognize
Objective: 2. Attitude in life in interaction and having pointed keeping pointed the importance of
>Sharps are placed which hinders nursing objects upon reach objects to prevent having a safe home
near the table, recognition of a intervention, the of children accidents environment
where it is reached problem family will be able
of children. to recognize the >Instruct the family >This will prevent
>cooking area is in 3. Inadequate importance of to keep sharp injuries such as
the ground. resources for care having a safe home objects in a safer cuts, accidental fall
>tools of the father (i.e. responsible environment place of sharp objects that
in construction is family member and can possibly hit the
placed anywhere. financial Long Time: children
Inability to constraints) After 2-3 weeks of
recognize the home visits the >Advise the family >To provide safety
presence of the family will be able to place sharp and prevent the risk
problem due to to demonstrate objects far from of injury
compliance on the children’s reach
health teachings >Encourage the >prevent burns
given. family to place the among children and
cooking area out of fire.
reached of children
and out to fire
hazard.

Malnutrition
Cues Analysis of the Objectives Nursing Intervention Rationale Expected
Problem Outcomes
S> 1. Inability to provide Short Term: > Assess each members > To have a Short Term:
“nangangaya adequate nursing care After 2 hours of present nutritional status baseline data The family shall
yat nga sila to dependent and nursing interventions, have verbalized
di kasi vulnerable at risk the family will be able understanding of
kumakaen members of the family to verbalize > Discuss with the family >To make the health teachings
minsan” resources for care, understanding of health presence of malnutrition family aware of and able to give
O>Dipsy specifically financial teachings and is able to the presence of causes and effects
Wt: 22kg constraints. give causes and effects such problem and prevention of
BMI: 15.28 and prevention of > Discuss with the family malnutrition.
>Telatabies 2. Inability to malnutrition. a list of suggested
Wt: 12 kg recognize presence of nutritious food
BMI:17.41 the problem due to lack > To correct
>Po of knowledge of faulty food habits
> Discuss and identify
Wt: 7.7kg present condition. causes and effects of > To increase
BMI:15.26 malnutrition like having knowledge;
3. Inability to decide low body wt., decrease
about taking resistance to diseases and stimulate family
appropriate action due easy fatigue to attend the
to failure to situation as soon
comprehend the nature, > Emphasize the as possible
magnitude & scope of importance of having
the problem. ideal body weight to
become healthy > To serve as a
gauge for the
family in
identifying their
> Encourage mother to current nutritional
make use of community heath status and
resources like ampalaya, be able to monitor
talbos-kamote etc. it effectively
> For low-cost
> Explain to them what food alternatives
specific vitamins and having the same
minerals they need for nutritional value
their respective ailments
and health. > To be able to
inform the family
> Discourage eating junk what deficiency
food in between meals they could
acquire, if there is
a lack on these
vitamins and
minerals
> To encourage
> Considered criteria in proper food
planning meals by intake, prevent
involving mother in loss of appetite
planning meals in prior to meals and
accordance to available promote healthy
resources in the eating habits
community

> To guide family


in preparation of
meals without
sacrificing
nutritional value

Presence of Cough and Colds


Cues Analysis of Objectives Nursing Intervention Rationale Evaluation
Problem

Subjective : The mother is After 2 home visits >Suggest to the mother to >Rest will decrease Family would be

nga aware that this is of student nurse- provide enough rest for the chances of able to perform
“sinipon
a problem but family interaction, the children and increase lowering body the health
halos sila e”
lacks knowledge the family will be their fluid intake. resistance and the teachings given
on how to cure able to verbalize fluid promotes and eliminate the
Objective:
children and prevent it understanding that expulsion of mucus presence of the
>The
experience runny from occurring the present condition secretions on the disease and

and frequently. She is a problem needing upper respiratory minimize its


noses
also does not immediate action and >Encourage the mother to tract. occurrence.
presence of know of the conform with the feed the children with
discharges. possibility of health teachings foods rich in vitamin C >Vitamin C will

has spreading the given. like oranges, guava and increase the body’s
>Dipsy
upon infection easily fruit juices. resistance against
wheezes
and the possible infection.
auscultation.
complications it >Demonstrate to the
may cause such children in covering their >This will prevent
as pneumonia. mouth when coughing the spread of the
and wiping the nasal area infection.
when secretions are
flowing out.
>Encourage the children >For better
to drink plenty of water. expectoration of the
mucus secretion.

> Advise the mother to >This will help


bring her children to the them for when they
Health Center for a check- have problems
up and to seek regarding health,
medications they can confide to
the Health Center to
seek medication and
have daily check-
ups

Inadequate Living Space


Cues Analysis of Objectives Nursing Intervention Rationale Evaluation
Problem
Subjective: The family is not After 2 home visits >Provide general >To increase After 2 home visits
“Pasensya na aware of the of Student nurse knowledge on how awareness of the of Student nurse
kayo maliit lang problem that family-interaction, communicable diseases family about family-interaction,
ang bahay could arise from the family will be could be easily possible illness the family will
naming.” this condition convinced that this transmitted in a limited they could acquire. become aware and
due to lack of may lead to health space. be cautious enough
Objective: knowledge about problems. > To maximize the in prevention of
Total floor communicable > Assist the family in space of house. illness.
area= diseases. arranging and organizing
21sqm their things such as
Their desired furnitures and appliances. >lessen the waste
TFA must be and obstruction
54m2. This > Advise the family to causing inadequate
means that the remove thing that are space.
family has unnecessary and not
crowded living being use.
space.

Poor Ventilation
Cues Analysis of the Objectives Nursing Intervention Rationale Expected Outcomes
Problem
S> “sinara nga 1. Inability to Short term: > Assess the > To obtain base line Short term:
namen yung provide a home environmental condition data
bintanang yan. Di environment After 2 hours of the family The family was able
na nga nabuksan” which is of nursing > Provide health > To inform the family verbalize
O> There are adequately interventions information regarding the how ventilation helps understanding about
presence of: ventilated for the family will necessity of adequate improve our health effect of having poor
health be able to ventilation at home ventilation.
>the inside of the maintenance, verbalize > Improve ventilation
house is hot and growth and understanding > Explain to the family inside the house by
with thick curtains development due about the the need for more supply providing open
to financial effect of of air for proper windows
> one of their problems. having poor circulation on the house
window is covered ventilation > To make the family
with plywood. 2. Inability to such as poor > Inform family about aware and for the
recognize the circulation of possible complications or family to act on it
>Window are presence of air and prone risk for a congested place,
always close. congestion and its in cross such as easy transmission
probable/possible infection of of disease >For better circulation
effects to each communicable >Instruct the family to of air
member of the diseases. remove the cover in their
family window.
Poor Personal Hygiene
Cues Analysis of the Objective(s) Nursing Rationale Evaluation
Problem Interventions
S> O Inability to Short term: > Explain to the > To encourage the The family shall
After 2 hours of family the family to comply
O> Children have recognize the have understood the
nursing importance of with the instructions
soiled skin because presence of the interventions, the maintaining proper given. importance of
family will be able hygiene.
they don’t take a problem due to lack having a good
to verbalize > To motivate the
bath everyday of knowledge on the understanding on family in personal hygiene.
the importance of > Discuss to the maintaining proper
>Long and dirty causes and effects
having a good family the relevance hygiene
nails presence in of such. Personal personal hygiene of having good
AEB bathing the hygiene in
father and children hygiene is important
children everyday maintaining a > Nails are good
> Children wearing as a it is a and cutting of finger healthy life. source of
and toenails. contamination and
rugged clothes. contributing factor
> Instruct them to can be a reservoir
>Telatabies and Po to being healthy and cut nails regularly for microbes
and prevent nails
don’t wear shorts or keeping our
from becoming
any underwear resistance against dirty > To avoid injury as
well as to prevent
the seen walking infection stronger
parasitism
bare-footed during > Instruct the
children to wear > To prevent dental
the home visit
slippers inside and carries and promote
outside of the house healthy gums and
teeth
> Encourage family
to brush teeth at > To prevent food
least 2 times a day. borne diseases and
contamination of
> Encourage family food.
to wash hands
before and after > To have a clearer
meal. picture and
knowledge as to
> Demonstrate hand washing
proper hand technique.
washing technique
to the members of
the family.
VII. Family Coping Index
Initial Final
Category Visit Justification Visit Justification
1 3 5 1 3 5
1. Physical x All family member are x Same on what student-
Independence well and no disabilities. nurse observed on the
Sometimes the mother initial interview.
cannot do all household
chores because she’s
taking care of her 2
children that are
dependent to her.
2. Therapeutic x The 2nd son is x Health teachings were
Competence experiencing cold and done and the student-
flu since December and nurses saw the changes
there is no medication on the condition of the 2nd
given by the parents. son.
3. Knowledge of x The mother knows the x Health teachings were
Health Condition complication and done, the family is now
consequences of colds more knowledgeable
and flu. But there is about colds and flu.
know medication that
given or any preventive
measures that was
observed
4. Application of x The house is partially x The family gained more
Principles of clean, but there are knowledge about the
Personal Hygiene some area in the house importance of clean
that needs to be environment and proper
improve. The children hygiene.
takes a bath once a day,
but because of playing
outside they turn out
dirty.
5. Health Care x The student- nurses x The family gained more
Attitudes observed that the knowledge about seeking
family have knowledge health providers in
about the importance of dealing with different
health care but its quite illnesses. The family
not enough. knows now different
interventions in dealing
health problems.
6. Emotional x Sometimes family with x The family failed to
Competence different communities comply with the health
is lacking of security teachings done of
and maturity maybe student- nurses because
because of their of lack of resources and
unstable life due to at the same time because
financial and family of the condition of the
problem that they are mother. But we saw a
facing. The mother is willingness of the family
not enough watching to comply with the
her two small children teaching.
because she is pregnant
and she have a lot of
household chores that
should be done.
7. Family Living x The father is making all x As what we saw in the
Patterns the majority decision in initial visit. The family
the family, he is the doesn’t have any problem
bread winner of the with each other.
family. And the mother
is the light of the house
who’s making all the
household works. This
family is an example of
a traditional Filipino
family. Each of the
children is dependent to
the parents.
8. Physical x The house of the family x The family complied
Environment is partially clean that with the health teaching,
needs improvement. but because of financial
There is a part of the factor, some of the
house that is hazardous problem that observed
to the family and can are still present.
cause illness.
9. Use of Community x The family is aware of x After the health teaching
Resources the different services the mother knows the
offered by the barangay importance of visiting the
health center. But health center once a week
because of limited time because of her condition.
and the location of their
house, they cannot
avail those services.
VIII. Learning Derived

We all know that the Family is the Basic need of Society, meaning if there is no
Family, there is no society. We never expected to learn this much from a family whom
were just strangers at one point as well as from on another.

This FCA proved to show that this isn’t just a report that is required to pass. But
a report where you get so caught up and so involved, you tend to find yourself
understanding the real reason. This project has given us the meaning why
communication and interacting is so important. Communicating takes place so much in
everyday life but this time it felt different. Those words became actions and actions made
a difference.

The Family Case Analysis has taught us so many things. It taught us how to
really get involved in work, and take it seriously and of course emotionally. You cannot
just work without any feelings, what would that make you, numb? We all wanted to be a
reason for hope for a better life of this family and that being too serious isn’t enough,
loving and enjoying what you are doing will make the work more meaningful. We all
struggled to make this report possible but if you look deeper, this just proves to show that
cooperation, dedication and unity were combined.

The community is just not a place where they live in, but a place where many
people are affected as one and being there with the family made us feel that we too
gained something.

We learned that there are a lot of people who are less fortunate and health
education can teach them important information to help prevent certain infections,
diseases or unwanted outcomes. We can make a difference in people’s actions and it is
possible to change the way they perceive life.
With this report, it enhanced our social skills, and getting all the information
we’ve acquired showed that we can get along with people. How many people can go up
and ask all theses questions, not to mention when some of them are very personal. We
were able to gain the family’s trust, and that gave us a plus factor feeling knowing that
we’re doing a good job with them, and that they enjoy our company.

Socially, we were able to develop better therapeutic communication skills,


physically, we finally had time to exercise by going up to the family’s house,
psychologically, we used our minds to come up with possible writings and emotionally,
we learned how to be thankful of what we have and share our blessings with other people
who are in need.