Imci 2003

FAMILY CASE STUDY
[IMCI ROTATION]
CRITERIA
MUNISET FAMILY
________________________________________
I.
A Case Study On
Introduction In Partial fulfillment of the and Objectives

Requirements in NCM 102 RLE
5%
II. III. IV. V. VI.
Initial Data Base (Integrated Management of Childhood Illnesses) 25% Family Coping Index
________________________________________ Submitted to:
15% 15% 15% 25% 5% 5% 5% 5%
Claudette Advincula, IMCI checklist and Narrative RN Clinical Instructor
Prioritization Tzarina Cleo Cisneros,St. N

Practicing Clinical Instructor
Family Nursing Care Plan Submitted by:

Sison, Neil Karlo St. N Solamo, Jeremiah St. N Suribas, Riza Grace St. N Taoy, Kathreen Emille, St. N BSN 2L Group 4 / Subgroup 2 January 8, 2011
Promptness References Neatness Format

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_________________________________ TOTAL 100 %
FAMILY CASE STUDY
[IMCI ROTATION]
TABLE OF CONTENTS
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I. II. III. IV. V. VI. VII.
Introduction...... 4 Objectives...... 8 Initial Data Base .... 11 Family Genogram . 35 Spotmap 39
IMCI checklist and Narrative.. 41 Prioritization. 43
VIII. Family Coping Index... 70

IX. X. 2 |Page
Family Nursing Care Plan.. 81

Documentation
FAMILY CASE STUDY
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INTRODUCTI ON
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It is important to establish in this situation report that children are located in families
and local communities and that the realities of these units and systems help shape childrens status and position. Thus, children mirror what lies in the environmental forces. Any change in the environment most likely affects the status of children. How the community views children reflect the kind of responses or interventions to their condition. Children as human resource and index of development play a role in all development initiatives. It is a challenge for all duty-bearers to prepare the ground for children to be part of the change processes-for the maturation of their physical, mental, emotional and social self so that with these personal resources they too could participate in making society a better place to live in. Infant and childhood mortality are sensitive indicators of inequity and poverty. Children who are most commonly and
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severely ill, malnourished and most likely to die of their illness are those of the most vulnerable and underprivileged populations of low-income countries. Even within middle-income and so-called industrialized countries, there are often neglected geographical areas where childhood mortality remains high. For this alarming reason, our World Health Care Providers had sought way to lessen child mortality rate and provide Health care protection to the vulnerable young ones by a program where all communities throught the world would use, the IMCI. IMCI is a strategy developed by the World Health Organisation's Division of Child Health and Development and UNICEF. It has been introduced in more than 30 countries around the world to address morbidity and mortality in children under five years. The strategy focuses on the child as a whole, rather than on a single disease or condition. Sick children often arrive at primary health care facilities with a number of sicknesses and have to be managed in an integrated manner at home and at the clinic. IMCI is a strategy that integrates all available measures for disease prevention and health problems during childhood, for their early detection and effective treatment, and for promoting healthy habits within the family and community. IMCI offers the knowledge and abilities to sequentially evaluate and integrate the status of child health and, in this way, detect the diseases or problems frequently affecting it according to the epidemiological patterns of the respective location. Based on this evaluation, IMCI gives clear instructions on disease classification and problems, establishing the treatment that should be administered for each one. The strategy also provides instructions on how to control the progress of treatment, in order to identify the need for applying prevention measures as well as how to inform and educate parents on disease prevention and child health promotion. On this basis, IMCI is currently regarded as the most efficient strategy for reducing the burden of disease and disability among the population in this age group. It main goal is to contribute to healthy growth and development during the first five years of life. In 2009, 8.1 million children across the world died before their fifth birthday. Most of these children lived in developing countries and died from a disease or a combination of
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diseases that could easily have been prevented or treated. Undernutrition contributes to over a third of these deaths. According to the latest estimates generated by the Inter-agency Group for Child Mortality Estimation, substantial progress has been made towards the achievement of MDG 4. Globally, the number of deaths among children under age five has fallen from 12.4 million in 1990 to 8.1 million in 2009. This means that more than 22,000 children under five die each day 12,000 fewer than in 1990 [childinfo.org]. In the National view, The Philippines Health statistics as of 2010 states that the Infant Mortality rate of Filipinos amounts upto 24.24 deaths per 1000 live births ranking #84 among 179 countries in the world. The probability of Dying before the age of 5 for the Filipino children is 37 per 1000 children ranking 90th among 187 countries in the world [Nationmaster.com]. In the Local view The Davao City Children Beyond survival Article of Region XI states some of the important statistics. With the Infant mortality rate (IMR) as an indicator, the region is well behind target. From an IMR of 9.6 in 2003, the figure shot up to 12 in 2005. All provinces and even Davao City increased its IMR instead of reducing. Overall the probability of the region attaining its target is low, Department of Social Welfare and Development 11 (DSWD) Regional Director Mercedita P. Jabagat said in her State of the Regions Children report in 2006. For under-five mortality rate, the region did not do well. In 2003, the under-five mortality rate of the region was at 18 but went up to 29 in 2006. Davao del Norte and Compostela Valley registered the highest mortality for 2006 at 26 and 35 respectively, followed closely by Davao City at 24, Jabagat said. Davao City infant mortality rate increased to14.28% infant mortality rate compared to the 2005 rate of 9.71%. In Lieu with this study, Our group chose the Muniset Family of Niego St. Agdao Davao City as the subject of our Family Case study in the IMCI rotation. We chose the Muniset family primarily because we have observed their current condition to be needing a stress on Health Teachings both environmental and sanitation and they have met the criterias that we should take into consideration in picking families.Also, part of our reason for picking them is their acceptance and openess to us student nurses. We are
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lucky to be accepted and allowed to interview the family as they have very approachable and welcoming family members. In turn, we value their sense of trust and we use this as our motivation to secure the family the best teachings and interventions we can elicit. This family case study is geared towards the development of our nursing education, practice and research. This study provides and opens the discovery of new information, especially about the families, communities and disease that can be acquired from it. Through the gathering and understanding of new nursing concepts and theories, we will be able to test ourselves through complete and effective data gathering, the most ideal way possible. Lastly, the effectiveness of our practice may be again, studied, put into research, and hopefully improved for the betterment in the delivery of carein the community setting. This study develops our skills through actual practice of the necessary nursing procedure in the actual community setting, enhance knowledge in the sense of giving our health teachings to the parents so they would receive a holistic care teachings in all aspects environmental, social, spiritual , mental , emotional and physical Health.
OBJECTIVES
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General objective: By the end of our 4-week IMCI rotation, we will be able to come up with an allinclusive mini family case study which aims to present adequate information regarding the general well-being of our selected family. Our target is to have an acquisition of new knowledge and enhancement of skills in the application of the community health nursing concepts and principles reflected on our act of service to our client family.
In specific, we aim to:
select a family that has the qualifications to be subject for this case study; establish rapport with the family to initiate cooperation in line with the trusting nurse-client relationship throughout the process;
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gather data regarding the familys over-all status to compose the initial data base for a more systematized presentation of our chosen family through interviews and observations using the family assessment guide;
Conduct an IMCI check-up if one of the children has 1 or more of the major symptoms and if he/she is an infant or 5 years and less. Assess the familys coping mechanisms in response to different situations to provide a basis for estimating the nursing needs of our selected family through the family coping index;
Identify existing and potential problems of the family in their environment, safety, personal hygiene, finances, resources, social relationships, or spirituality; Prioritize the recognized crises to determine what should be considered first and what problems doesnt need immediate solutions; devise appropriate nursing interventions in order to meet the needs of the family through nursing care plans; Implement the proposed nursing care plans that will solve the familys existing problems, if not, prevent potential problems to occur or to improve the familys way of living;
Evaluate the implemented plans whether there was an improvement or otherwise; provide health teachings to the family regarding health, its maintenance and promotion towards wellness. determine the implication of this case study to nursing education, research and practice.
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INITIAL DATA BASE
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I. Demographic data
Address: Iniego Street Agdao Davao City House no.: N/A Barangay House no.: N/A The family we had chosen as a subject for the case Study is the Muniset family, a young family with 4 nuclear members. The house is situated at Niego Street Agdao Davao City. The land is owned by the government but the built house is owned by our informants sister, Lailani Muniset wherein they pay a monthly rent of 500php to her . On the April of 2010 Lailani Muniset brought the house and land for 6000php. She had entrusted the house to her sister, our informant Mary Grace Muniset which in turn pays a monthly fee for the house and land. On the July of the same year when Mary Grace is currently pregnant with her first baby for 1st month, the Muniset Family had moved in there to live permanently. II. Family Data
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Table 1: Family Dynamics Table Family Members Age Sex MC/ CS I. Christian de la Cruz II. Mary Grace Muniset 22 F M 24 M M Relationship to the head Of the family Head of the Family Wife Educational Attainment High School Graduate (Sta. Ana National High School) High School Graduate ( Sta. Ana National High School) III. Christian Dave Muniset IV. Natasha Kate Muniset 3 F C Daughter N/A 4 M C Son N/A
Table 1 shows pertinent demographic information about the members of Casas family. There are 4 immediate family members, with Christian de la Cruz, being the husband of Mary Grace, as the dominant family member. The couple is not married thay is why they retain their own family names. They are only livingin with the blessings of each sides of the family but without the blessing of the Church. Christian and Mary Grace, has 2 children a son named Dave and a daughter named Natasha. Currently,the two children are not studying in their nursery levels. The edlest stopped in his schooling because he didnt like the remaining schedule that is available in their nearby school which is the afternoon session. Mary Grace said that they would just wait for the next school year to enroll earlier so they could catch the morning session. Christian and Mary Grace both finished a high school degree at Sta. Ana National High school Davao City.
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The head of the family is Mr.Christian de la Cruz. He is 24 yrs. old born on the Christmas day December 25, 1987 at Suason, Uyanguren Davao City his home town where he grew up and lived until he and Mary Grace chose to live in at the july of 2010. He is the sole provider of the family and he works as a delivery boy to deliver stock of boxes at the DavCheck Company at Uyanguren. He works just 15 days a month consecutively including Sundays from 8am to 7pm witha salary of 187php per day thats 2805php per month. His Livein partner, Ms. Mary Grace Muniset, 22 yrs. old and born on March 22, 1988 lives at her mothers house just in Niego St. Agdao Davao City where she grew and spent her childhood and teenage days. They have been together as lovers for 4 years and decided to live together in the house owned by Marys sister as rental just recently, on July 2010, when Mary was pregnant with her first child for the first month.
The couple had their first child Christian Dave on March 4, 2006 and is presently 4 years old. Their second child, the youngest is a girl born on December 16, 2007 named Natasha Kate and is now 3 years old. The Muniset familys current residence is in Niego St. Agdao Davao City. All the members of the family are Dabawenyo and all are baptized as Roman Catholic. In terms of the dialect spoken, the visayan dialect is used.
II. Family Characteristics and Dynamics
The Muniset Family follows a traditional family structure, specifically a nuclear arrangement.The family comprises the couple, father and mother and the 2 children. It is Patriarchal because in their family culture, the father, Christian, is the one prevailing in delivering decisions and options especially as the head of the family, Christian, is the sole Provider of the family. The decision making is primarily priviledged to the head of the family. According to our informant Christian will always have the final say in every family decisions. Mary Grace will also have her views heard but she admits that
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sometimes she would go against Christian yet he will still follow his lead. Mary Grace still respects his husbands views and decisions for the family. The Primary conflict between the family which is the source of their family fights is related to financial problems. Mary would admit that Christians salary is really not enough for their daily consumption especially that they are still paying 500php for their rent in the house. When bills in water and light comes, budgeting money disagreement usually arise also they have difficulty in asking financial help to their relatives because according to Mary they also have their own financial priorities.Family fights also arise when Christian would go about in his bad habits like alcohol and going home late withour telling Mary. Mary doesnt like it when his husband gets drunk because sometimes he may be violent like would throw things away that would scare the children so she avoids it when her husband would go drink with his friends every Sunday. Mary would bring her children to the Cementary instead to visit his fathers grave and afterwards stay at her mothers house just in Agdao not far from their house. The family fights seldomly happen and tends to be short-lived. With an affectionate grin, Mary Grace shares that she loves her family and whenever misunderstandings arise in the morning there will be time they wont talk with each other but they cant stand ignoring each other. Mary immediately dissolve her pride and talk to Christian again tomorrow morning. Mary is the one that always goes first and fixes any misunderstanding because according to her, men have really a high pride and she doesnt want her children to see them fighting or ignoring each other, so she initiates to get things resolved. In terms of their relationship with the child, both of them discipline their the children accordingly but since Christian is always off for work, the motherchildren bond is the one strengthened. As for their childrens behavior Mary Grace admits that they often get naughty and irritable due to their petty fights. Oftentimes they would quarrel and of course the eldest one, Dave, would win leving Natasha crying. The mother often responds to her childrens attitude and immediately disciplines them, and they would often follow thereafter. These fights would originate with rivalry from toys where the other has and the other one doesnt have. Dave would often be jealous if his sister has something and he doesnt , so fights start. But these cats and dogs
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fights could turn to very sweet moments according to Mary because Dave is very sweet with his sister. He shares everything he has and as a big brother she always protects her sisters from bullies and sometimes would go into fight when his younger sister is bullied. We have also observed that Dave already has a sense of responsibility because as he was playing outside he always follow his mother when she tells him to stop playing and requests to him errands like to change is clothes , close the door or even fix his toys and put them back properly. We did not see any problems with the childrens behavior. They follow and respect their mother accordingly and they did not show any displeasing behavior as we were talking with their mother. The younger sister is very silent and plays with her dolls together with her playmates. The way Mary and Christian discipline their children when they exhibit undesirable behavior is by spanking them in the buttocks. Mary would admit that she easily lose her temper and when the children become Hard headed, she spanks them with the belt or hit their hands. Mary is oftentimes guilty when she does these to her children and admits that she would often cry after hitting her children. The family knows that only through sincere communication can they settle whatever household problems and individual differences present. They possess 1 communication gadget, the cellphone but they do not have a telephone line so they just use the cellphone which Christian brings with him at work so Mary could text him in case of any concerns. There is an ensuing rivalry present in the acquisition of toys between Dave and Natasha and often times these would bringforth fights between the siblings. Both the children are an extrovert in the family. They would always want to mingle, talk,play outside with their neighbors and show or share their toys with them. They both like to move around and find a way to play/ talk with other kids may it be a girl or boy type of play. IV. Eating pattern Table 2. BMI calculation and corresponding calculation
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Family Member Christian Mary Grace Dave Natasha
Wt. (kg) n/a 78 14 11
Ht. (m) n/a 1.7 1.0 0.9
BMI
Malnourished BMI<16
Underweight 16-19
Normal 20-25
Overweig ht 26-30
n/a 26.98 14 13.58
Our body needs energy to get through the day and this energy comes from food. It is important to eat regular meals to ensure your body gets the energy it needs to perform. Good nutrition and a balanced diet helps one grow up healthy. To improve and correct nutrition, one can basically assess from the eating pattern of the Muniset family. Table 2 presents the respective Body Mass Index of each family members with its respective classifying range and interpretation, except with the father because we did not have the chance to see him as he is always at work in our every home visit. The Body Mass Index was computed by dividing the weight of the individual (in kilograms) by the square of the height (in meters). Based from the calculations, Natasha and Dave were classified under malnourished but Mary Grace was classified as overweight. The Factors that can affect Natasha and Daves malnourished BMI is their hyperactive state which is common in children as well as the diet and nutrition intake they receive. The family eats three square meals a day including snacks of the children in the afternoon. They consume an equal size and follow the proper timing in meal time. As for how they prepare their food, Mary Grace usually just buys their food in a nearby carenderia for Breakfast, lunch and dinner. They prefer to just buy food viands instead of cooking for its convenience of preparing cook utensils its and availability since they do not have a refrigeartor or a stove. Mary usually just cooks rice for the meal with their
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Kaldero. If Mary would want to cook food for dinner she just visits the market and buys enough ingredients for the meal this usually happens when they have enough money to spend for food ingredients.In case of any left overs or extra plate of food they cannot consume, they do not throw it or give to the cats but instead they just give and share it to their neighbors. They usually buy food viands like soup with accompanying meat and leafy vegetables and fried foods, seldomly sauced viands and sauted vegetables. Mary also seldomly buys chicken meat because the price is considerbaly more expensive. The Muniset family usually take their breakfast at 7am during weekends and weekdays, Lunch isserved by 11am and Dinner taken by 7pm. Christian often comes home 8 in the evening so they usually do not wait anymore for him instead they eat dinner ahead of him at around 7. Table 3 shows the 72 hr. Dietary recall of the family as mentioned by Mary our informant.
Table 3: 72 hr. Dietary recall
Meal Breakfast Lunch Dinner
December 20, 2010 Ribs soup and Choriso Batchoy Law- uy
December 21, 2010 Mongo soup and Choriso Batchoy Fried Egg
Based on the table above, the family prefers Batchoy as their lunch and they take a heavy breakfast. We can also observe that they do not have chicken meat in their diet but is readily replaced by pork meat and complete protein with the egg. They also eat a considerable amount of green leafy vegetables with the Law uy and mongo soup but fruits are not a part of their diet which is not a complete meal based on the food pyramid for filipino diet. Basically, the food that the family buys and prepares are rich in protein and carbohydrates, high in fat but low in sugar. Among the family members, the children are considered
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picky eaters. They pick out the vegetables they eat like squash,
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potatoes and some leafy ones like malungay, alugbati and petchay only. Their favorite foods are the fried ones like fried fish, egg, hotdog and Choriso while their favorite snacks are biscuits with filling. Mary shares that she initiates the action to refrain the husband in taking too much fat because she knows that it is bad for the health and may increase cholesterol level.
V.
Sleeping pattern Along with genetics and circadian rhythms, one important factor that helps
determine the amount of sleep a person needs nightly is stage of life.Newborns sleep an average of 16 to 18 hours a day. By the age of one, children usually sleep 13 to 14 hours with that number decreasing until they reach adolescence. Sleep patterns vary widely according to each individuals age, activities, and various other factors.
Table 4: Summary of familys sleeping pattern
Name
Retires at
Wakes Up
Afternoon Naps
Sleeping Difficulty
Total No. of Sleeping Hours
Christian Mary
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9 pm 10-12md
6 am 6 am
No Yes
No Yes
9 6-8
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Dave Natasha
11 pm 8 pm
7 am 7 am
Yes Yes
No No
8 11
Table 4 presents the summary of the time each member o fthe family wakes up and retires as well as the total hours of their sleep a day. It is seen that Mary is the latest to sleep of them all , she gets used to sleeping late already. She mentioned that she usually sleeps late because she spends her time outside chatting with her friends. Dave would also want to be outside with her mother so Mary and Dave usually sleeps together. Christian and his daughter Natasha usually sleeps together by 8-9pm. Mary was quick to note that Natasha couldnt sleep if she would not cuddle and sleep beside her father. The family do not have a television and had mentioned they could stand not watching tv for the whole day. They did not mention anything of catching up any telenovelas or watch tv in their neighbors house before sleeping. The usual routines that Christian does before sleeping is sweeping or sitting outside and cleaning the house afterwhich he would lie down together with his daughter Natasha and listen to the radio together until they would feel sleepy. Sometimes Dave joins them at bed and play pillow fights or pinching with Natasha until they will be warned by Christian so Dave just joins her mother outside. Mary Grace and Christian wakes up in the morning together as Mary would go outside and buy food for breakfast then, she would proceed towards doing the household chores just to keep her busy like doing the laundry. Christian would boil hot water for coffee and would prepare to cook rice becasue he will soon be off for work. The children wakes up early in the morning by 7am and together eat their breakfast. People naturally feel most sleepy (have the greatest "drive for sleep") at two times of the day about 12 hours apart, for example at 2:00 AM and 2:00 PM. At those two times, the body clock "kicks in" for a short nap. Mary stated that after lunch she and the children takes a nap for 2-3 hours and then would wake up afterwards for snacks. Mary stated that of all members of the family she has difficulty in sleeping at times. She stated that because she barely does anything for the day except for laundry and caring for the children she feels not sleepy at night, also a reason why she sleeps very late. At times she would wake up in the middle of the night and will be unable to go back
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to sleep. All the other members of the family does not have sleeping pattern difficulty, when everyone lies down to bed, they would immediately retire and sleep soundly. She also added that there was no time that the family barely slept because of the magnitude of what still needs to be done. The Muniset family sleeps in the same room in their room upstairs. They sleep over a mat /Banig and they use 5 pillows. They do not have an electric fan but it does not give them discomfort because they have a wide window in the room which gives a breeze of air at night so they can sleep comfortably. Christian , Mary and Natasha sleeps adjacent with each other while dave positions horizontally at their head part.
The total number of sleeping hours just at night for Christian, Mary, Dave and Natasha are 9, 6-8, 8, and 11 hours respectively.
VI.
Leisure and Activity
Leisure is a breakaway from all stress - life, work, and psychological alike. Even how simple their activity is, may it be just listening to music or chatting out with neighbors outside the Muniset family would take the chance as long as it would comfort and relax their tired and busy minds ,as long as it would not take too much cost financially and as long as it would fill their schedules during the day. According to Mary, there isnt much stress in her physically just financially . Mary spends the whole day keeping busy with household chores and with her children. Simply Being together with her children gives her a sense of safety and relaxation without worries. Chatting with her neighbors is already a part of her routine when the household is done this is also a part of her rest and relaxation after the work.She shares that talking brings comfort where they are able to share, appreciate, sympathize, and learn from each others stories and
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experiences. It is also one of Marys past time to read pocket books or listen to the songs on the radio that span her generation. Every Sunday morning, the family seldomly go to mass and Mary mentioned that she last attended mass on December 16, on the 3rd birthday of Natasha. However, Mary relates that Sundays are still not family days for them because Christian still goes to work but it is only for 2 Sundays for Christian just works 15 days a month. Oftentimes Mary together with the children would spend the Sundays in her mothers house. It is every Sunday that Christian would spend time with his workmates or relatives drinking alcohol, at this time Mary would not go home afraid of catching Christian runk instead would go home the following morning. The family is not fond of window shopping or getting groceries at any malls or going out to any parks because Mary is afraid that she may spend money. Mary says she gets groceries less often becasue she often buys miscellaneaous just at the nearby sari sari store. If ever she would need to go the the department store to buy canned goods , she goes to WDP store at Bangoy. During Holy Week or Christmas, the whole family just stays at the house or celebrate the holiday seasons at the house of Marys mother together with her younger siblings and her other relatives. As leisure, The children play outside with friends sharing their toys like tiny billiards game, trucks , plastic guns and dolls and a kitchen plasticwares for Natasha. Mary mentions that some toys are gifts from her sisters to the children. The Children often run around and play taguan, tagaanay and slipper throwing under the supervision of his mother staying outside. Mary shares leisure is really a privilege, but not that too high to achieve for her husband Christian. Often times Christians break away from the stresses of the work would be a massage from Mary or he would often enjoy listening to the radio or cuddle with his children after he returns from work. The 2 adults communicate frequently and share their daily views and experiences that appear significant to their family and their relationship. Their common concern for their family is their responsibility towards their 2 children Dave and Natasha VII. Socioeconomic Factors
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FamilyMembers
Educational Attainment
Employment Status
Occupation
Net Income
Other Sources of Income
I. Christian de la Cruz II. Mary Grace Muniset III. Christian Dave Muniset IV. Natasha Kate
High school graduate High school Graduate N/A
Stable Employment Unemployed
Stocks Delivery boy None
P 2805.00 / month N/A
Cargo boy(van) 100-200php (not constant)
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Table 4: Socioeconomic Status The undeniable aspect common in the community we worked with is indeed poverty. Poverty can be manifested clearly with the type of housing facilities, and other indicators. Common reasons why people are left jobless is their lack of education. Most of the people havent finished their schooling and so, they become jobless leaving the basic needs of the family unattended.In the case of the Muniset Family, the sole provider of the family is Christian who is working only 15 days a month and receives his salary of 2805php /month. The family depends on his earnings from the work and in Christians side line of cargo boy in stocks carried in a truck where he is serving Taiwanese people. The pay that he is receiving in the cargo ranges from 100-200php the work and pay is not constant and only depends if there is available spot for him or his friend would call out to him for a sideline. Mr. de la Cruz is working at the Davcheck Comany at Uyanguren as a Delivery boy. He is working 11hrs a day from 8am-7pm, 7 days a week including Sundays for 15 days a month. He is earning 187php/ day amounting to 2805php a month, this money provides for 4 persons including the expenses for water, electricity, food and other miscellaneaous. Mr. de la Cruz just
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started his work recently this year on the month of July approximately 6 months newly hired from his work. Mary Grace chose to be a full time housewife taking care of the house hold chores and being busy nurturing and caring for their 2 children. She never planned to work which is alright with Christian too because their kids are still young and they will be needing full attention and guidance in their growing up. Among the family, since Christian is the only one who has a stable employment, he is the only one who is a member of Phil Health which can also cover up his immediate family, Social Security System (SSS).The adults are not a member of the Government Service Insurance System (GSIS) and Caritas Program. They are not entitled to sickness, retirement, and disability benefits. The family does not also have benefits for inpatient and outpatient hospital care nor avail the outpatient department services in the Southern Philippines Medical Center (formerly DMC) or any hospitals. They just avail of the Free Health services that is given at the Miniforest Health center in Boulevard or get free medicines whenever there are oppurtunities at the Agdao health center and in the Almendraz gym. Whenever her children gets sick and needs medical intervention she inquires first to clinics. Natasha or Dave goes to their pedia doctor in Sales a clinic behind Asia glass to Dr. Ranquillo. Table 5: Division of Monthly Expenses of the Casas Family
Division of Monthly Expenses

17% 11% 45% Food Water Bill Electric Bill Rice Misc. and toiletrees Rental fee 18% 5% 4%
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The figure above shows the monthly expenditures of the Muniset Family in percentage. The breakdown of the monthly expenditures of the family are as follows: 1300.00 for food viands, 100.00 for water bill, 150.00 for electricity bill, 520.00 for the Rice, 500.00 to pay for their house rental fee, 100.00 for the transportation and 300.00 for miscellaneous items like toiletrees and aesthetic needs. Total is 2970.00 pesos, which is quite enough but is still not in exact amount with Christian's salary of 2805.00 pesos a month. This is how they budget Christian's salary to fit for their expenses a month. We can see that Health or medicinal expenses are not seen and not a part of their budget it is because they make use and avail of th free health services of the Agdao Health center or the Miniforest Health center. They ask and try to avail of the free medicines they offer for the public. Mary mentions that the sole earnings of Christian is really not enough to compesate for the demands of their expenses monthly. Though it can provide for their basic necessities like food, clothing and shelter, there are really times that it is difficult for them to budget things for the electricity and food because they still have to pay 500php rental fee monthly to Marys sisiter. So Christian's salary which is given every 15 days of Christians work is deducted by the rental fee they pay monthly. When time comes that they gey short of money, Mary would just list a debt from the carenderia to buy food and pay them when they have extra money to spend. Whenever hard times and rainfall comes to their financial stability,they would compensate by just asking to
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borrow money in their neighbors or would just ask food to her mother who lives ina house nearby still in Agdao. According to Mary, they cannot ask for financial help to their other relatives because they also do not have extra money to spend for their own and her mother still supports the youngest of the siblings who is in Highschol still. Mary is the one in charge of the budgeting in the family and Christian respects her duty to budget the expenses of their family. Mary knows that she needs to spend money wisely prioritizing only the needs and setting aside the wants with the updraft of soaring prices of commodities nowadays.
VIII. Home and Environment The Muniset family rents their house for Php 500 per month. The house is owned by Marys sister and the lot is a government property. Their house is built right beside a road. As we have observed, their surrounding is covered with partly earth and cement. There were some ornaments seen beside the house. Aside from that there were trees grown in their neighbourhood and as related by Mary, the lot behind their house is filled with tall grasses. The type of housing materials is mixed. Among them, wood is the main stuff used for the skeleton and most of the houses structure including their fitments. The roofing of the house is made up of galvanized iron. The base of their domicile is composed of both wood and cement. Part of the houses walls is just covered with galvanized iron and old tarpaulins. The house has two stories. The first
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floor serves as a multipurpose room. It is their living room and at the same time, it is where Mary does their laundry and it is where they take a bath. The second floor serves as their bed room and dining room. Mary related that they just squat on the matted floor of the houses second story whenever they dine. During the night, they just place a sleeping mat flat on the floor of the second story. Placed with two pillows and a blanket, that serves as their bed and they fix it up and keep it again the next day. Beside the entrance of the house, there located their cooking area and they only use charcoal for cookery. Basically, they have a small kitchen where their utensils and other kitchen wares are located. They place their eating utensils on a closed plastic container and beside them are their cooking casseroles. They lack food storage and other necessary containers such as water container. They just have 1 pitcher and two gallons for water storage. Since they cannot store food, they seldom cook. They usually cook rice and buy viands from an eatery nearby. They just cook a viand if they were able to go to the market. They cook by fire with the use of charcoal. They have 2 casseroles for cooking rice. They dont store food or left over because their food is just bought enough for the whole day and besides, they dont have food containers and a refrigerator for food storage. If there is food left, they usually give it to her sister-in-law instead of throwing it. A square table and a small cabinet is the only furniture they have and they only use plastic chairs. The only appliance the family owns is their DVD player and they use it to play some music. They also own a cell phone. They use it for emergencies only and Mary takes hold of it but whenever his husband goes to work, hes the one who uses it. Whenever he wanted to tell his wife about something while his working, he contacts his wifes mother who lives a block away and shell relay his message to her.
In terms of electricity facilities, the Davao Light Power and Company provides the electrical energy of their house but their line is just connected with their neighbours line. They just pay them Php 150 every month. They only use one light bulb to illumine their home during the night. If theyll be staying upstairs, they just transfer the bulb to another
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socket in the second floor. Regarding their water source, they just buy their water from their neighbour. It is where they get the water they use for drinking, bathing, laundry, etc. They pay one peso per pail of water. They dont have their own lavatory. They just go to the house of Marys mother whenever they need to use a comfort room. There is only one door for entrance made up of wood and they have three windows ---two on the second floor and one downstairs. All their windows are not screened and two of it is draped with curtain. Mary said it is not too hot inside because air freely passes in. With regards to this, we have computed the ventilation of their house.
For us to determine whether the house has good ventilation, we first compute for the total floor area: TFA = L x W = 3 m x 1.33 m = 3.99 m2 Since they have 2 floors, we multiplied the floor area of the first floor to 2 to get the total floor area of their house. TFA = 3.99 m2 x 2 = 7.98 m2
Then, we get the total window opening through the following: Window: WO = L x W = 1.03 m x 0.7 m = 0.721 m2 x 3 windows WO = 2.163 m2
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[IMCI ROTATION]
Door:
DO = L x W = 1.47 m x 0.61 m DO = 0.8967 m2
Total window opening: 2.163 m2 + 0.8967 m2 = 3.0597 m2 After which, we account for the ventilation: Ventilation = Total Window Opening / Total Floor Area x 100 = 3.0597 m2 / 7.98 m2 x 100 = 38.34 %
As interpreted, the Monesit familys residence has good ventilation because ventilation above 17% is considered good.
To compute for the overcrowding, we have to identify the Total Floor Area and the number of household members. In their case, they have TFA of 7.98 m2 and there are 4 members of the household composed of 2 adults and 2 children. To compute for the total space requirement of the family, we have: TSR = (2 x 3 m2) + (2 x 1.5 m2) = 6 m 2 + 3 m2 = 9 m2 There is overcrowding if the TFA is lesser than the TSR. Since their total floor area is lesser than their total space requirement, therefore there is overcrowding. In terms of waste disposal, they lack a garbage container and they dont observe proper segregation. They just throw their trashes on a basket located outside their
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[IMCI ROTATION]
house. This basket of trashes is thrown in a common garbage bin and collected by the CENRO. They practice wrap-and-throw waste disposal. We have identified the type of their drainage system as open because they just draw off the water used in their laundry and bathing at the base of their abode and they dont even have a latrine. Mosquitoes are one of the common pests that thrive in their residence. She said this is due to the tall grasses at the back of their house. Because of this, they use mosquito nets when they sleep. They have also observed rats running along the ceiling of the house as well as cockroaches, and flies. They dont carry out any preventive measures to avoid these kinds of pests like spray repellents, place mouse traps, etc. but Mary said that they clean their house and their surrounding every now and then. They dont have pets or any animals kept at home. There are also accident hazards that we have identified in their dwelling. Their cooking area is very near their house. It is a fire hazard since their house is made up of light materials that can easily catch fire. Mary washes their clothes inside their house which makes a part of their floor slippery. Other accident hazards include their stairs structure which is too steep and their houses distance from the road where a lot of tricycles and motorcycles pass by.
IX. Health and Health Practices
Mary had no serious illness before. The noted hereditary diseases in their family which even caused death to some of their relatives are hypertension, asthma, heart disease, Diabetes mellitus, and goiter. She had no hospitalizations due to any disease. She was only hospitalized when she gave birth to her two children at Southern Philippines Medical Center. She had 2 pregnancies which both have lived and she never had an abortion. She had her prenatal care at Mini-forest health center but she never followed the right schedule for prenatal check up. She said she only went for prenatal once a month when she was pregnant with her 2 children. Mary said that when her first child turned 3 months old, she stopped breast feeding him because she is not comfortable with it since it was her first time. After a few months, her breast became
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[IMCI ROTATION]
tender and swollen. She learned that it was because she stopped breast feeding. And so, on her second baby, she already practiced breast feeding. At present, shes not experiencing any illness. She has related that she is currently using pills (Ethinyl Estradiol + Levonorgestrel) which were given free at Barangay 27. She started taking it last December 6, 2010. Since she is the mother and she manages their home, she takes the responsibility for the familys health. When one of the family members is sick, shes the one who decides whether to relieve it with some drugs or to consult a physician or any health worker if the ailment becomes severe.
Christian, on the other hand, didnt have any severe illnesses before. Diabetes mellitus, obesity, heart disease, and hypertension are the only hereditary diseases common in his family. Before, as related by Mary, he drinks alcohol every night with his brother but now he lessen his intake of such beverages. At present, he only drinks during Sundays. He also smokes but not every day. Mary doesnt how many cigarette sticks he can consume in exact but she said he just smokes whenever he drinks. Mary stated that Christian avoids taking medicines for any illness. For instance if he has fever, he just ignores it and he wont take any actions to relieve it. We asked what his reason is but Mary doesnt know what is the real reason but when she asked him before, he just said that medications cannot relieve his sickness so whats the point of using them anyway. He also experiences localized muscle pain due to excessive work. To relieve it, Mary massages the site of discomfort and often applies liniment.
Dave and Natasha are fully immunized children. They received all the immunizations at Mini Forest Health Center. Dave has a problem in his left eye. He sometimes looks cross-eyed because of it. Mary said they went to SPMC once to have his eye checked by a physician. The doctor told them that it is really strabismus and to correct it, he has to undergo a surgery and wear eyeglasses after the operation. The doctor instructed them to return for the surgical procedure but his grandmother opposed the idea of doing it because she thinks that Dave is too young to experience such. Dave
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[IMCI ROTATION]
also has cough at present and to treat this, Mary gives him Salbutamol or Carbocisteine. Natasha, on the other hand, had no previous hospitalization or any serious illness. They also have no vitamin supplements taken daily.
NATASHAS IMMUNIZATION Immunization BCG Date 1st dose 12-16-07 birth) DPT OPV Hepa B Measles Vit.A 2-6-08 2-6-08 1-23-08 10-8-08 10-8-08 3-5-08 3-5-08 3-5-08 4-23-08 4-23-08 4-23-08 6-24-09 (at 2nd dose 3rd dose Booster
During the times when they experience deviations in their health condition, they just self-medicate taking OTC drugs like common paracetamol (Biogesic) for fever, and Neozep for colds except for Christian. For consultations, they go to free medical checkups conducted by different organizations. Mary stated that last year, they have benefited from a medical check-up conducted at Almendras gym and they have also received free medicines. When there is a necessity to seek an advice from a health professional, they go to the clinic of Dr. Ronquillo.
Rest, Sleep and Exercise
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Among the family members, Mary is the only one who has inadequate rest and sleep because she usually retires at around 12 pm and wakes up at 6am the next day so she only gets about 6 hrs of sleep. She stays late at night because she waits for her husband. While waiting, she just sits outside their house and enjoys chitchatting with their neighbors. She also related that she has trouble sleeping. Whenever she wakes up, she has difficulty to go back to sleep again. On the other hand, Christian gets adequate sleep and rest as well as Natasha and Dave. Christian wakes up early in the morning at around 6 am because of work and he goes home at around 8 or 9 pm so he has 8 hrs of sleep or more. Dave has an irregular sleeping pattern. He wakes up at around 7 am. During the night, he joins his mother in waiting for his father and so he also sleeps as late as 11pm. But despite it, he still gets enough sleep though it is not really good for children sleeping late. They also take naps in the afternoon at around 12nn. Mary and her 2 children stay at home every day while Christian goes to work. Because Mary only spends the entire day at home doing household chores, Mary doesnt get enough exercise like walking, etc. In the case of their 2 children, they have adequate exercise because they constantly play. On Christians part, he also gets adequate exercise because his work comprises a lot of physical activities.
Relaxation and Stress Management Activities
Playing serves as the relaxation activities for Dave and Natasha. Because they are still little kids, all they wanted to do is to engage in recreation and fool around the whole day. Mary said that aside from managing the house, what she does during her spare time are reading pocket books and conversing with their neighbor. Drinking
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[IMCI ROTATION]
alcohol and smoking, however, are the relaxing things Christian prefers to do to loosen up and relieve his stress. In addition, the family spends their quality time and unwinds through listening to music.
Environment As we have observed, they are not really acquainted with their neighbors except her sister-in-law who lives beside them because we never saw them having conversations with the other people who lived there. This is may be due to the fact that they have just transferred there last July 2010. In terms of social and health facilities, both are very accessible. They are near the Brgy. Hall of their place and also the Agdao Heath Center can be walked from their residence. Transportation is also readily available in their place. Tricycles and jeepneys constantly pass by the streets of their baranggay so they dont have problems in transportion.
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[IMCI ROTATION]
FAMILY GENOGRAM
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[IMCI ROTATION]
MUNISET FAMILY Rodolfo,62 Jovita, 56 Manolito,58
DE LA CRUZ FAMILY Redalisa,42
Rodolfo,34
Lainlani,36
Jane Rose,32
Myla,30 Mary ,22 Mark,18
Denise, 25 Christian,24 Christine,20 Joan,18 Rodell,15 Reden,13 Andy,4
L LEGEND:
- Smoker
- Goiter
Natasha,3
Dave,4
-Deceased - Asthma D
-Male - Diabetes
- Alcoholic
- Obese
-Female F
-Enlarged Heart
-DOB,Dyspnea - Feet Edema -Hypertension - Tuberculosis y
Narration:
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[IMCI ROTATION]
The diagram being shows the familial medical history of our patient up to the third generation of their family. The schematic diagram primarily aims to seek a definite answer to the query how and from whom did the patient might have possible gotten his present illness, considering the fact that most Hypertension have familial tendencies which implies that the illness can be passed from one generation to another. Both of the couple's family are quite big. The Muniset family have 6 siblings while the De la Cruz family have 7 siblings. It can be observed from the legend that both families acquired quite a number of inheritable charachteristics like alcoholism and smoking as well as inheritable diseases specifically invovling the heart and lungs which are the common parts affected in alcoholism and smoking. As for the Muniset family, the Maternal side, our informants father already died at the age of 62 due to a Heart attack. It was stated by Mary that her father is always complaining about headache in the occipital area, which is an indicative sign of Hypertension. Her father, being a diabetic and hypertensive quite explains the reason for his death. Our informants mother, Jovita Muniset at 56 is currently diagnosed with an enlarged heart, hypertension and also has asthma. Mary stated that her mother is presently taking medications for her heart and hypertension. Jovitas hypertension eventually brought way to an edematous feet,which was experienced by her mother once as mentioned by Mary. Lailani, the eldest sibling of Mary experiences hypertension too. Rodolfo, the 2nd of the sibling, is an alcoholic and a smoker as described by Mary and he as well, is hypertensive. Myla, her 4th sibling had experienced Goiter and Mary mentions that her sisters Goiter is recurring often. Mary, and her other two siblings Jane Rose and the youngest Mark are all presently well without symptoms or unhealthy habits.
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[IMCI ROTATION]
In the paternal side, the De la Cruz family consist of 7 siblings including our client, Christian. The Chritians father, Manolito had experienced Tuberculosis but it was already treated bythe Agdao Health center Tuberculosis Treatment Program (DOTS) and is currently well. The clients mother, Redalisa is a full pledged Alcoholic as described by our clients sister, Christine. An effect with Redalisas alcoholism is obviously Hypertension because she is currently experiencing hypertension. Among Christians siblings three of them are currently experiencing the effects of their parental heritageof characteristics and as well as the diseases that are affected by these habits. Denise Carlo , the eldest among the siblings is a Diabetic and is suffering obesity with his gigantic size as described by Christians sister. Christian as well is an Alcoholic who is currently experiencing abdominal aching at the upper left quadrant where the liver is located. The liver is the commonly affected part in persons who are alcoholic. Christians sister, Christine is complaining of Difficulty of Breathing and Dyspnea especially at night which hinders her sleeping pattern as verbalized by herself. All the other siblings of the client, namley Joan, Rodell, Reden and Andy are presently well, young and do not present any symptoms of sickness as well as unhealthy habits.
We can fairly deduce that with the appearance of the disease every generation, although it cannot be verified that others have it, genetically-linked diseases like Diabetes, Hypertension, Heart problems and Tuberculosis are the major predisposing risks in offsprings who would inherit a part of the Muniset-De la Cruz genes.
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FAMILY CASE STUDY
[IMCI ROTATION]
SPOTMA P
THE MUNISET RESIDENCE
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FAMILY CASE STUDY
[IMCI ROTATION]
I
N I E G O YAMAHA
IMCI NARRATIVE
JVT Building
F. B A N G Agdao Barangay Hall and Gym LYNS BAKESHOPPE Y

S O
Agdao Public Market
Agdao Health Center

.
Lapu- Lapu Street
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FAMILY CASE STUDY
[IMCI ROTATION]
IMCI Narrative
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[IMCI ROTATION]
Last January 4, 2011, we have assessed one of Marys children who, at that time, has cough. Christian Dave Monesit is a 58 months old male. He weighs 14 kg. During our assessment, he has a temperature of 35.4oC. He lives at Inigo St., Agdao, Davao City. The childs problem was cough which he experiences for two days already. We check for the general danger signs and we have found out that he has none of the four. He is not abnormally sleepy or difficult to be awakened. He is able to drink, he does not vomit everything he eats and he never had convulsions. Mary said that Dave has cough and that he had this for 2 days already. We counted his breaths for one minute to determine whether his breathing is fast or not. His respiration rate is 33 breaths per minute and it is not fast breathing. We also checked for the other signs of pneumonia. As we have observed, he has no chest indrawing and upon auscultation, we have not heard stridor or the abnormal sound heard during inspiration. With all this data, we have classified it as NO PNEUMONIA: COUGH OR COLD. After assessing the child for cough, we proceeded to the assessment of the other major symptoms and we found out that he does not have diarrhea, fever, and ear problem. Since he doesnt have the other major symptoms, we then checked for malnutrition and anemia and we have noted that there is no signs of malnutrition and anemia such as visible severe wasting, edema on both feet and palmar pallor. We also have determined his eight for age and it is normal. We have classified it as NO ANEMIA AND NO MALNUTRITION. We asked his mother whether he has received all the immunizations or not to check for his immunization status. Dave is a fully immunized child; he has received all the immunizations needed. And for his vitamin A supplementation status, we asked Mary whether he was given vitamin A and she said he has received one together with the other immunization years ago. Regarding his deworming status, Mary cannot remember or is doubtful about it.
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[IMCI ROTATION]
PRIORITIZATI ON
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[IMCI ROTATION]
Health Problem: Presence of Breeding Sites

Criteria Score Highest Possible Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) 2 3 1 2/3x1 2/3 Insects, rats and pests in the environment could inflict a lot of diseases especially to the family members living in a malaria risk area. They could acquire airborne and vector acquired diseases, such as malaria and dengue which could possibly contribute to their illness condition. This is a health threat that may cause diseases to the client and her family since there is presence of rats, mosquitoes, and rodents that can cause rabies, dengue, and food contamination. Weight Computation Actual Score Justification
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[IMCI ROTATION]
Modifiability of the problem Easily modifiable (2) Partially modifiable (1) Not modifiable (0)
2/2x2
The family can modify the condition easily through applying measures of eradicating vectors of diseases that can be taught by the nurse. Their willingness to cooperate, learn and acquire knowledge about the diseases that they may get through this can possibly help in this kind of problem. Simple cleaning and maintaining good environment can be a good strategy in eradicating those pests that can affect the health of the cleint.
Preventive potential High (3) Moderate (2) Low (1)
2/3x1
The preventive potential is moderate since the family has no experience in pests and mosquito related illnesses and had also not used spray insecticides yet. The availability of resources could also be a factor since they and have financial repellant constraints, the materials needed like insecticides mosquito materials cannot be easily provided yet , frequent cleaning is really the best way to prevent the problem to worsen whichis
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[IMCI ROTATION]
affordable and easy to do. They clean their sorroundings and home everyday before cooking and also use mosquito nets when sleeping. Salience Needing immediate attention (2) Not needing immediate attention (1) Not perceived as a problem (0) TOTAL 4.166 1 2 1 1/2x1 1/2 The family perceives this as a problem that does not need an immediate attention because they said that they employ measures to eradicate pest like cleaning and keeping their home clean at all times. They also said that it is not only their problem but the whole community also perceives it as a problem.
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[IMCI ROTATION]
Health Problem: Fire hazard

Criteria Score Highest Possible Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) 2 3 1 2/3x1 2/3 This problem is a health threat that possess to a strong risk to fire incidents since their house is made of light materials such as wood and nipa. Also their neighborhood is congested. The houses nearby are made up of wood and fire could cause a major destruction if improper handling of candles and other fire-causing materials is observed. The cooking area is surrounded by galvanized iron which is a conductor of heat and can possibly trigger the cause of fire in the area. Weight Computation Actual Score Justification
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FAMILY CASE STUDY
[IMCI ROTATION]
2/2x2
It is easilly modifiable because this problem might not require additional expenses but they must be cautious that a little fire can cause distraction to their house. Moreover, this problem doesn't require a lot of financial expenses but a matter of environmental modification is imperative to solve this kind of problem. Our knowledge and health teachings on how to prevent fire is imparted to our client.
3/3x1
Preventive potential is high since the family knows what the risk of this problem is. the family is also careful in handling fire-causing materials to prevent this kind of problem. Moreover, they did not experience lost of house because of fire.
Salience Needing immediate attention (2)

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2/2x1
Our client does recognize it as a problem needing immediate attention since she knows the risk being homeless because of fire. The family also knows how to handle burning materials and applying preventive
FAMILY CASE STUDY
[IMCI ROTATION]
Not needing immediate attention (1) Not perceived as a problem (0) TOTAL 4.66
measures to eliminate this kind of situation to happen. Dapat jud mag amping mi kay basig masunogan, sige lang kay muabot to akong igsoon tabangan ko niya og paayo sa balay. She verbalized.
Health problem: Lack of proper toilet facilities

Criteria Score Highest Possible Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) 3 3 1 3/3x1 1 Lack of sanitary toilet is considered as health decicit because the family does not have their own comfort room and not having their own private comfort room where they can defecate and urinate can pose a number of health problems such as UTI and other problem urinary needs or to anal be infection.This
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Weight
Computation
Actual Score
Justification
FAMILY CASE STUDY
[IMCI ROTATION]
corrected because improper place to eliminate waste can affect the body by accidentally ingesting of contaminated water that may cause Typhoid Fever not only to the client but also to the community. Modifiability of the problem Easily modifiable (2) Partially modifiable (1) Not modifiable (0) 1 2 2 1/2x2 1 It is partially modifiable because it needs to be planned and requires money. Moreover the need of manpower is greatly needed in order to build a Comfort Room in their house.However the familyknows that they need to build their own comfot room because they are planning ti rebuild the house to fit I a small comfort room. Nevertheless, the knowledge and skills that we acquired in school was shared for them to be more responsible and for to know where are the proper place to eliminate our body waste.
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FAMILY CASE STUDY
[IMCI ROTATION]
2/3x1
2/3
Preventive potential is moderate since our client knows the risk of having diseases if they will depend on using public CR and using the CR of their mother and not have to build their own comfort room.
Salience Needing immediate attention (2) Not needing immediate attention (1) Not perceived as a problem (0)
2/2x1
Our client does recognize it as a problem needing immediate attention. Dapat maghimo jud mig CR para dili magsalig sa uban, unya basig magkasakit mi tungod ana. Verbalized by the mother. They know that they lack an important part of their house and they are now planning to make a comfort room of their own with the financial help of Marys sister
TOTAL
3.66
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[IMCI ROTATION]
Unhealthy lifestyle and personal habits specifically drinking/smoking

Criteria Score Highest Possible Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) 3 3 1 3/3x1 1 The problem is considered as health deficit since the husband of our client suffers pain in the left upper quadrant which places the liver at risk for damage because of alcohol drinking This may result to liver diseases, immediate intervention should be done in order to prevent further complication that may require prompt care. Weight Computation Actual Score Justification
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FAMILY CASE STUDY
[IMCI ROTATION]
1/2x2
1/2
It is partially modifiable because it is hard for a smoker to stop smoking, minizing sticks per day may be a good strategy for his treatment. Marys husband, our client , must also have a willing heart to change for the betterment of his health. teachings are shared what Health are the
possible illnesses that may be acquired if he continues to drink and smoke. Preventive potential High (3) Moderate (2) Low (1) 2 3 1 2/3x1 2/3 The preventive potential is moderate since the Mary, Christians wife does her part in making strategies to encourage her husband to minimize the lacohol drinking and smoking. 2 2 1 2/2x1 1 Our client does recognize it as a
Salience Needing immediate attention (2) Not needing immediate attention (1)
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problemthat requires immediate attention. Mary sees it as an important thing that her husband must change his vices because it will really affect his health and of course his work and living mechanisms. Problema jud na, dapat jud muundang
FAMILY CASE STUDY
[IMCI ROTATION]
Not perceived as a problem (0)
siya anang inom-inom ug pag sigarilyo na kay kung di maswertehan magkasakit na siya mahal baya ang tambal. She verbalized. TOTAL 3.166
Spirituality: Lack of spiritual nourishment (not going to mass)

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FAMILY CASE STUDY
[IMCI ROTATION]
Criteria
Score
Highest Possible Score
Weight
Computation
Actual Score
Justification
Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1)
2/3x1
1/3
This
problem
is
foreseeable
crisis
because our client does not go to church for they have no time for it they also verbalized that they do notoften pray just when problems arise. They must do this kind of activity to strengthen the bond of the family that can be a motivation for the welfare of the family.
2/2x2
It is easily modifiable because it only requires the willingness of the family to go to church and pray. Nurses are not only equiped with knowledge about healthcare but also we can share our religious beliefs to our patients by sharing with them the messages that God wants us to know and be part of our lives as Catholics.
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FAMILY CASE STUDY
[IMCI ROTATION]
3/3x1
2/3
Preventive potential is moderate since our client knows the importance of going to church it may not affect their health but the influences of the church may help in attaining good perception in life as well as to the family.
0/2x1
Our client does recognize it as a problem They told us that even if they do not usually go to church they believe that Christ the son of God is our savior.
TOTAL
1.99
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FAMILY CASE STUDY
[IMCI ROTATION]
Accident Hazard: Falls

Criteria Score Highest Possible Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) 3 3 1 3/3x1 1 We rate this problem as health deficit because later part of our home visit the mother shared to us that his son Dave, was accidentally fall down from the window and cause some injuries to Dave but was remedied by a massage. be Precautionary measures should Weight Computation Actual Score Justification
doubled since Daves accident may occur again to the rest of the family. Modifiability of the problem Easily modifiable (2) Partially modifiable (1) Not modifiable (0) 1 2 2 1/2x2 1 It is partially modifiable because it is hard to reconstruct the house, sufficient money and manpower is also required in this kind of plan. We student nurses shared some tips on how to minimize the risk or the actual problem that may affect the health of the family.
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FAMILY CASE STUDY
[IMCI ROTATION]
1/3x1
1/3
The preventive potential is low since the problem is not a risk anymore but it is an actual problem to the family, since Dave suffered injury from falling.
2/2x1
The family perceive this as a need and requires immediate action because when the accident happened to Dave the client thinks that it is dangerous to them having that kind of stair that may result to further injuries and expenses. Dapat jud na namo epa ay okay delikado, sagdi lang akoang igsoon mutabang to sa amoa. She verbalized.
TOTAL
3.33
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[IMCI ROTATION]
Home & Environment: not sturdy house foundation and composure which gives an easy risk of destruction in a calamity
Criteria Score Highest Possible Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) 2 3 2 2/3x2 2/3 We rate this problem as health deficit because we observe that their house has break walls and the wooden strusture that supports the house is not sturdy which may lead to destruction during a calamity like a flood or rain with strong winds, and possibly may cause injuries not only to the family but also to the people around. Modifiability of the problem Easily modifiable (2) Partially modifiable (1) Not modifiable (0) 1 2 2 1/2x2 1/4 It is partially modifiable because funds and manpower is required in repairing the break walls and cements that supports their house, but we student nurses told them what that are the precautionary occur in the measures if earthquakes and natural disasters community.
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Weight
Computation
Actual Score
Justification
may
FAMILY CASE STUDY
[IMCI ROTATION]
1/3x1
1/3
Preventive potential is low because they know what are the possible disadvantage of having those break walls, they also know some interventions on how to act if accidents may happen related to the unrepaired materials.
1/2x1
The family knows it is a problem not needing immediate attention because for them food is their top priority and maybe if the Father has an extra income they will act and repair those problems.
TOTAL
2.24
Home & Environment: Inadequate Living Space
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FAMILY CASE STUDY
[IMCI ROTATION]
Criteria
Score
Highest Possible Score
Weight
Computation
Actual Score
Justification
60 | P a g e
FAMILY CASE STUDY
[IMCI ROTATION]
2/3x1
2/3
We rate this problem as health threat because we observe that their house is lacking on space, the possibility of spreading airborne diseases is high and may be a threat for the health of the family. In addition to this, accidents may also potentiate because of the small range of living space where the members of the family could move.
1/2x2
1/4
It is partially modifiable since it requires reconstruction increasing a living space may require a lot of financial resources from the family and the family doesn't prioritize this need because they still have a lot of expenses and debts. Yut the knowledge we share to them may decrease the susceptibility of the family to some diseases.
Preventive potential High (3) Moderate (2)

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2/3x1
2/3
Preventive potential is moderate since the client knows ways on how to prevent widespread of diseases like covering their mouth whenever they cough or sneeze.
FAMILY CASE STUDY
[IMCI ROTATION]
Low (1)
1/2x1
They dont perceive it as a problem because she told us that they have sufficient room for themselves.
TOTAL
2.57
Health Problem: Lack of Food Storage

Criteria Score Highest Possible Score
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Weight
Computation
Actual Score
Justification
FAMILY CASE STUDY
[IMCI ROTATION]
2/3x1
2/3
It is a health threat because vectors of diseases such as rats, flies and cockroaches have increased chances of contaminating the food due to lack of storage facilities. In line with this, members of the family are prone to diseases which are carried by these vectors. Moreover, the risk of food poisoning is increased as food may spoil quickly if not properly stored.
1/2x2
The and
condition knowledge
is
partially
modifiable to be
because though the nurses time, skills are available imparted to the family and the family is willing to participate. In addition, the family already addresses the problem of food storage though they do not have appliances for the storage of food.
Preventive potential High (3) Moderate (2)

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2/3x1
2/3
The problem is moderately preventable because it can be readily reversed if the familys awareness in proper food storage is supplemented by the nurse and if they
FAMILY CASE STUDY
[IMCI ROTATION]
Low (1)
apply that knowledge.
0/2x1
The family does not perceive this as a problem because they would stress out that they will just prepare enough food for them to consume and for them they could tell if the food is spoiled by its smell and appearance.
TOTAL
2.33
Health Problem: Presence of Sharp Objects

Criteria
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Score
Highest Possible
Weight
Computation
Actual
Justification
FAMILY CASE STUDY
[IMCI ROTATION]
Score Nature of the problem Health deficit (3) Heath Threat (2) Foreseeable Crisis (1) Modifiability of the problem Easily modifiable (2) Partially modifiable (1) Not modifiable (0) 1 2 2 1/2x2 2 3 1 2/3x1
Score 2/3 The problem is a health threat because presence of sharp and pointed objects can harm and injure the people moving around the house especially children.
1/2
The
problem
is
partially
modifiable
because our client needs to be insructed how to prevent ways in making their home safe and free from objects that can hurt not only themsleves but also others. The nurses time, skills and knowledge are available to be imparted to the family. Moreover, the family members themselves can be the manpower in removing and keeping sharp objects.
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FAMILY CASE STUDY
[IMCI ROTATION]
2/3x1
Preventive potential is moderate because the fact that the condition may occur now or later the safety should be in high but the family dont show some ways order to prevent such injuries.
0/2x1
The
family
does
not
recognize
the
condition as a problem because they would stress out that they are careful in moving inside their house and another thing is that they already master every corner of their house so there would be no chance of hurting themselves accidentally. In addition, for them, eventhough Psalmsjwelljun is very hyperactive and playful, they defended that they do not let him roam around the house as he would stay always near Lisa. TOTAL 2.16
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FAMILY CASE STUDY
[IMCI ROTATION] RANK 1 2 3 4 5 6 7 8 9 10 Identified Problem Fire Hazard Presence of Breeding or Resting Sites of Vectors and Diseases Lack of proper toilet Facility Fall Hazard Unhealthful lifestyle and personal habits specifically drinking and smoking Inadequate Living Space Lack of food storage facilities Not sturdy House foundation and cimposure Presence of pointed/sharp objects Lack of spiritual Nourishment (e.g. not going to mass) 2.57 2.33 2.24 2.16 1.99 3.66 3.33 3.16 SCORE 4.66 4.16
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FAMILY CASE STUDY
[IMCI ROTATION]
FAMILY COPING INDEX
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FAMILY CASE STUDY
[IMCI ROTATION]
Categories I. Physical independence Rate 5
Admission Justification We had this rating just by observing that the family is able and each member of the family except the youngest child Natasha can do the activities of daily living since she is 2 years old which we considered as still dependent to the care of the mother and her brother Dave which is 4 years older and is slightly dependent to his mother since hes able to do some self care such as putting on clothes and brushing. The parents Mr. de la Cruz andMs. Muniset are able to provide the needs of their children or to their family especially the basic needs and they are able to take care
Rate 5
Discharge Justification We still gave them such rating since as we can see there are no changes happened regarding their capability to do selfcare and there are no member of the family became disable for them not to do such things such as their daily routines or doing their activities of daily living. Still Natasha is still dependent to her mother and Dave now knows slightly to bath himself already but with her mother supervising.
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FAMILY CASE STUDY
[IMCI ROTATION]
of themselves and other members of the II. Therapeutic independence 5 family if needed. The family always goes to the nearest clinic specifically to Dr. Ronquillo or to the nearest health center when one member of the family experiences illness and then having the prescribed medications and health teachings there, the mother now knows how or when to medicate her children Dave and Natasha with appropriate medications when the their past illness pneumonia will occur again. She knows the medications prescribed to her children where in fact, she stated to us all the medications even though it was
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After the span of our implementation, the family specifically the mother has still the capability to carry out prescribed procedures including giving medications to her children and to manage the signs and symptoms related to their past illness cough or pneumonia. They would still go to the clinic or the health centers to seek for check up and for prescription of drugs to be taken. They can still provide medications and preventions for the illnesses that may be acquired by one of the family member. Still, they go to her sisterin-law for a massage or hilot for relaxation.
FAMILY CASE STUDY
[IMCI ROTATION]
stock in their house quiet long time ago. And Mr. Christian as the breadwinner can also help to carry out those medications since he is the one paying all the expenses for the prescribed medications. But still when they have not enough budgets, they would ask for some medications such as paracetamol for fever. She also told us that she lets her children to go for a hilot to their aunt which is just in the next door as a type of relaxation.
III. Knowledge of condition
We rated it by 3 since the family particularly the mother stated that she knows her
After some teachings and sharing our knowledge of such illness, we are able to see and assess that
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FAMILY CASE STUDY
[IMCI ROTATION]
childrens conditions by stating that her children experienced pneumonia when they were still in early childhood stage but she can only state some signs and symptoms such as fever, cough and difficulty of breathing. We consider it that she or they only have small knowledge about other underlying principles related to the disease that Dave and Natasha had she had acquired those knowledge after going to that doctor and after experiencing it to IV. Application of principles of personal hygiene 3 Dave. As the interview was rendered, it was revealed that their having a good and pleasant household and they are able to
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Mrs. Mary was able to learn something out from it which is evidenced by her verbalization mao diay na noh na magkalintura ang bata pag naa pulmonya kay maghubag man diay iyang lungs ana? Ako jud na bantayan ila ubo ug basig naa na dayon kalintura. She also verbalized that she would not administer some drugs but to seek help to the professionals or to a health care provider.
Doing all our teachings especially to Dave about his sleeping pattern which is really not appropriate to his age
FAMILY CASE STUDY
[IMCI ROTATION]
consume three meals per day without miss and those meals are not really that well since they sometimes order batchoy but sometimes they cook some of their selected vegetables they like . Sometimes other member of the family particularly Mrs. Mary and Dave often sleeps late at night because of waiting for Mr. Christian to come home which will reach up to 11 oclock in the evening.
since he needs more time to sleep while he is in his growth stage. Also we had advise the mother that they must select other meals even they cant cook, food that are less expensive yet healthy thats why now, they are able to plan for their meals and Dave now agrees to sleep earlier and her mother was encourage to apply it to him.
V. Attitude towards health care
The family had their occurring illness especially the children. In line with this, the mother stated that they never self medicate
After home visits, they still have their attitude that when the member of the family has illness, they would immediately seek for assistance to a health
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FAMILY CASE STUDY
[IMCI ROTATION]
that they only medicate when it was only ordered by a physician. By this, we can see that they understood the need for assistance for medical care for their illnesses and also they depend on what will the physician would advise and not with those belief and other procedures that are not prescribed by a professional since Mrs. Mary grew with that practice during her childhood. Only that we are advising her to let her husband be checked because her husband had his pain in the left upper quadrant of his abdomen which occurs often times and she said that they dont have time of doing so because
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care provider only when needed. They would not allow selfmedication but instead is to wait for the doctors prescription or order to medicate. As the mother verbalizes, kung naa gud kwarta muadto magpatambal, muadto jud mi. by this, we can see that they still have a good attitude in dealing their health.
FAMILY CASE STUDY
[IMCI ROTATION]
her husband is so busy doing a lot of VI .Emotional competence 5 job. In dealing with family problems such as arguments between the parents, illness of one or more members of family and financial problems, though Mr. Christian tend to lose his temper when they argue often because of money, Mrs. Mary calms down to let the conflict calm also and when it comes to family illnesses, they deal with it with confidence that they can stand still and confidence that it will only pass. 5 After the last home visit, we have assessed that they did not argue already last Sunday after we had assessed. Since we have advise the mother to calm things up and let God intervene to her husbands temper when he is drunk and also we can still see that they live happily because we can see that they always smiles even though they are in their difficult times when the mother shares about their conflict with her husband. As she verbalized, lipay VII .Family living patterns 3 Being together is hard for the family sometimes because not all the time the father is always with
75 | P a g e
man gihapon mi. We have rated the family by this score since we have heard from the mother that still they cant meet
FAMILY CASE STUDY
[IMCI ROTATION]
them because of being busy in his job which he needed to attend for them to have a food to spare or to provide their needs. They get along together only at Sundays and what they would do is that they play with the children, talk to each other but there are times that Sundays also is the time where her husband goes out to drink and to enjoy with his friends which is also a hindrance for them to get along together. But in spite that they are not that cohesive, their children have a lot of respect to them though they would sometimes be a hard headed child, they are still obeying them and making their parents happy by
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each other that long since Mr. Christian has his work to do during weekdays till Saturday and still they are not that bonded or cohesive. Though still, they have respect for each other especially the children to their parents.
FAMILY CASE STUDY
[IMCI ROTATION]
playing with them and not answering back when VIII .Physical environment 3 confronted. We can see after assessing their environment particularly their house that it really needs repair because by seeing to the side of it, we can see that their house is not straight but it is slightly leaning backwards and their corner posts are already destroyed maybe with termites or by the water. They also have inadequate space in their house particularly their bedroom. It was like only 2 people can be fitted in there but they can manage to adjust themselves to IX. Use of community resources
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They still have the same house or living space but they said that they would repair their house as soon as Mrs. Marys sister can provide the needed money for renovation or repair in their house. They would also add some additional facilities such as toilet in their house and add additional space in order for them to move freely and they will be comfortable when they go to sleep.
it. The family was able to make use of the resources in their
The family is still able to make use of the resources available in
FAMILY CASE STUDY
[IMCI ROTATION]
community in line with their health which is the health
the community wherein they can use it to maintain their
FAMILY NURSING CAREoptimum level of center. They also PLAN have considered that wellness and to have their neighbors are a better PLAPLAMNPLANCASSTUD way of living. also their source of Barangay health Y
their needs they need medications when they experience low grade fever or mild coughs and cold. centers near them specifically Agdao health center is a big help for them that they can be able to receive free accommodations, check up and medications helping them regarding their health. particularly when
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FAMILY CASE STUDY
[IMCI ROTATION]
Accident hazard: Fire Hazard as health threat
DATE/CUE S
HEALTH PROBLE M
FAMILY NURSING PROBLEM
GOAL OF CARE
OBJECTIV ES OF CARE
NURSING INTERVENTI ON
METHO DS OF INTERV ENTION
RESOURCE S REQUIRED
EVALUATION
December 13, 2010
Accident hazard: Fire SUBJECTIV hazard E: as health Nagkasuno threat d na diri bag-o lang katong September pero wala kaabot sa amoa. Mahadlok mi ba basin mahitabo na pud to usab as verbalized
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a. lack of ability to provide an environme nt contributin g to health promotion and maintenan ce, and individual developme nt b. inability to recognize the
After all my nursing interventio ns, The family will be able to perform appropriate actions to promote safety and prevent accidents from fire hazards.
At the end of all nursing Intervention s, the family will be able to: a.) be aware of the presence of fire hazard in their residence b.) verbalize preventive
1.) establish rapport to the family Rationale: To promote an open communicatio n 2.) assess clients knowledge regarding the existing threats to their health Rationale:
Human resources: H O M E Time and effort of the nurse and family Financial resources:
January 5, 2011 @ 10:30am Goal partially met After the implementation of all nursing interventions, the family was able to:
V I S I
Expenses for transportation of the nurse a.)Recognize in visiting the the presence of family fire hazard in their residence. possible jud diay na
FAMILY CASE STUDY
[IMCI ROTATION]
by the mother.
occurring threats within their vicinity c. lack of knowledge about the preventive measures that should be carried out
OBJECTIV E: - The main material of their house is wood and other light materials - Their cooking area is located beside their entrance. - Their neighborho od uses lawn meter where in they share the same line of electricity
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measures that can promote safety and avoid occurrence of fire accidents c.) recognize and eliminate presence of heat conductors that may contribute to the effects of fire hazards d.) emphasize importance of safety measures in
To be able to know whether they are aware of the fire hazards in present in their dwelling 3.) inform them about the existing fire hazards within their residence such as improper location of their cooking area, faulty and exposed wirings, etc. Rationale: for them to be aware of the factors that threatens the entire family
magkasunog diri ky duol lang kayo ang among lutoanan sa among balay as verbalized by the mother. b.)Verbalized preventive measures that can promote safety and avoid occurrence of fire incidents. delikado man diay pag wala nakatago ang mga wiring sa among balay kay possible na kit-kiton sila sa mga ilaga unya basig mao pay mahimon dahilan sa
FAMILY CASE STUDY
[IMCI ROTATION]
- faulty and exposed wirings noted - history of fire accident in their community
preventing threats to health
4.) encourage them to eliminate the identified fire hazards Rationale: To decrease risk for fire incidents 5.) suggest safety measures they can implement for the prevention of possible accidents such as building a cooking area away from light materials that easily catch fire
sunog. Pati ang duol kaayo na luto-anan sa balay delikado pud diay labon nag kahoy halos and tibuok sa a ong balay. as verbalized by the mother. c.) recognized and eliminate only some of the heat conductors that may contribute to occurence of fire accidents. inig magluto mi, dili na lang kaau namo ipaduol sa among bungbong and among luto-
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FAMILY CASE STUDY
[IMCI ROTATION]
Rationale: To widen their knowledge of preventive measures and to enhance their ability to identify appropriate actions to avoid fire hazards 5.) accentuate the importance of a safe and healthy environment in the promotion and maintenance of good health in their family Rationale: To encourage
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anan ug bantayan gyud namo among ginaluto pero dili pa namo mausab ang wiring sa among balay. as verbalized by the mother. d.) emphasized importance of safety measures in preventing threats to health. kanunay na namong tanawon ang among palibot basin naay mga bagay na mahimong hinungdan ngano magkasunog
FAMILY CASE STUDY
[IMCI ROTATION]
them to initiate preventive measures for the safety of their family 6.) encourage the family to always keep their home free from any fire hazard Rationale: For them to maintain a safe and healthy habitat for their family.
diri kay para man pud ni sa amoa. As verbalized by the mother.
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Date Cues Health Family Goal of Objective Intervention Method of Reso Poor home or environmental condition: presence of breeding or resting sited of vectors of diseases (e.g. mosquitoes, flies) and Problem Nursing Care s of Care Measures Nursing- urces Time Problems Family Requ FAMILY CASE STUDY [IMCI ROTATION] Contact ired Subjective cues: The mother verbalized, daghan jud mi og lamok diri labi na sa likuran namo sa daghan sagbot pud dri hadlok gani ko pag daghan na pula2 akung mga anak sa bukton Objective cues: a. Presence of mosquito bites and scars on the arms of children. b. 84 | P a g e Presence of stagnant water Poor home/enviro nmental condition/sa nitation specifically presence of breeding or resting sites of vectors of diseases (specifically flies and mosquitoes) as a health threat Inability to provide a home environment conducive to health maintenanc e and personal developmen t due to: That within our 3 family home visits, the family will be able to employ alternative courses of preventive measures in pest managemen a.) lack of / t and inadequate be able to knowledge find ways to on sanitation carry out practices measures and to improve preventive the safety of measures; home environment . After our 1. Establish nursing rapport with the interventio family n, the R. to promote the family will client nurse be able to: relationship and a. gain the trust verbalize and confidence the of the client for importance the of body interventions hygiene and teachings sanitation we will render. and self 2. Assess the protection gravity of the to prevent presence of mosquito rodents,flies and bites. roaches within the vicinity b. R. to determine enumerate the gravity of at least 2 treatment and ways of action needed eliminating pests. 3. Enumerate the diseases that c. identify could result from at least 2 the presence of diseases breeding that could sites.Explain the be caused nature and by actions of the mosquito vectors. H O M E V I S I T
Evaluation
D E C E M B E R 13, 2 0 1 0 @ 9:30 am
b.) inadequate family resources, specifically limited financial resources.
January 5, Material 2011 resourc @ es: 10:30am brooms, Goal Met wash cloths, Within our 3 sprayin family home g visits the family agents was able to: and insectici a. verbalize the importance de used of hygiene to and proper demons sanitation to trate the prevent cleanlin mosquito ess bites promoti importante on and jud diay na proper manglimpyo use of sa balay ug commo labaw na n pud sa lawas pesticid knang es maligo adlaw2 Human kanunay Resour para ces: maiwasan Time, ang padapo rapport sa lamok and
FAMILY CASE STUDY
[IMCI ROTATION]
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Family Nursing Problem FAMILY CASE STUDY [IMCI ROTATION]
Date Cues Health Health Problem: Fall Hazard Problem
Goal of Care
Objective of Care
Nursing Interventions
D E C E M B E R
Subjective : Ay kapila na ni nahulog si Dave dira sa hagdanan katong last 13, kay tung Dec 31 2 katong 0 nahulog 1 sya dira sa 0 bintana. Naumud @ gyud siya sa gawas 9:30 ai , Maayo AM gani wala na grabihan nadala pa ug hilot2x. Gipahilot nlang nako sa akung ugangan, 86 |unyag e Pa naokay na man siya
Presence of accident hazards specificall y fall hazards as health threat
Inability to make decisions with respect to taking appropriate health action due to: a.) low salience of the problem/ condition b.) lack of insight as to alternative courses of action to prevent the certain accidents.
Within 2 weeks span of nursing intervention, the family will be able to take appropriate actions about the familys current problem regarding health hazards specifically risk for fall
Within our 2 weeks span of nursing intervention, the family will be able to: a.)verbalize understandin g of consequenc es if the health hazard is not fixed such as the possible incidence of fall and injury b.) enumerate at least 4 ways to prevent fall
1. Provide information about the possible effects of the problem such as injury and Hospitalizatio ns. 2. Instruct the adults of the family to refrain the children from playing near the stairs to avoid accidents 3. Encourage the client to place a barrier at the opening of the stairs to control the children from going up and down without the supervision of
Metho d of NurseFamily Contac t H O M E V I S I T
Resources required
Evaluation
Financial Resources: expenses for the transportati on Human resources: Time, knowledge and effort of the student nurse
January 5, 2011 @ 10:30A.M Goal Met Within our 2 days span of Nsg. Interventions, the family was able to: a.) Verbalized understan ding of conseque nces if the health hazard is not fixed. Hadlok lagi ko tungnahulog si Dave sa bintana Basig nabagok ang ulo ba sus dili na gyud to dapat mausab kay maospital gani dako napud ang gasto. As verbalized by the client. b.) Enumerat
FAMILY CASE STUDY
[IMCI ROTATION]
Unhealthful Lifestyle and personal habits specifically drinking and smoking
Date
Cues
Health Problem
Family Nursing Problem
Goal of Care
Objective of Care
Nursing Intervention
Method Resou of rce Nursing Requir Family ed Contact H O M E V I S I Human Resour ces: Time and Effort of both studen t and
Evaluation
D E C E M B E R
Subjective: Nagasigari lyo og inom akong bana unya usahay pag-abot niya sa balay mag-
Unhealthy Lifestyle specifically smoking/dri nking As health threat.
Inability to provide a home environment which is conducive to health maintenance and
Within 2 weeks span of nursing intervention, the family specifically the father will be able to know what are the bad effects of
Within 2 weeks span of nursing intervention, the family specifically the father will be able to: a. Verbalize
1. Review family history, explores roles of family members and circumstances involving smoking/alcohol use.
January 5,2011 GOAL MET Within our 2 days of nursing interventions the family specifically the client was able to:
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FAMILY CASE STUDY
[IMCI ROTATION]
13, 2 0 1 0 @ 8:30 am
away mi, maghilomhi lom nalang ko pag hubog na siya maabot diri.As verbalized by the client. Objective: -Presence of cigarette butts inside the house. -Empty Bottle of beer. -Halitosis of her husband upon talking when interviewed . With pale lips and
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personality development due to: Lack of knowledge of the disadvantage s of regular smoking and drinking.
smoking/drinkin g that may result to appropriate actions in minimizing the incidence of drunkiness and smoking.
understa nding the conseque nces if he continues to smoke and drink. b. At least minimize The cigarette consumpt ion per day from 10 to 5 and decrease the incidence of drunkines s.
2. Discuss current/past methods of coping
the family specifi cally the father.
3. Provide information regarding the harmful effects of smoking and drinking it may increase the level of awareness for him to tolerate himself from doing such a habit. 4. Giving tips or advices such as diverting his attention to sports and other
a. Verbalized Understan ding of consequen ces if he continues to do that kind of habit. Nag ingon akong bana sa ako na medjo mag hinay hinay na siyag undang sa iyang bisyo kay gasto ug basig magkasaki t siya. Verbalizati on of the wife.
FAMILY CASE STUDY
[IMCI ROTATION]
gums. -10 to 12 sticks of cigarette per day.
recreational activities.
b. Consumes 5 sticks of cigarettes per day and now he tends to minimize drinking alcoholic drinks. Murag nahadlok jud siya sa inyong gi ingon kay medjo hinay na siya mo sigarilyo og usahay nalang siya maginom. Verbalizati on of the wife.
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FAMILY CASE STUDY

Introduction In Partial fulfillment of the and Objectives

II. III. IV. V. VI.

15% 15% 15% 25% 5% 5% 5% 5%

Claudette Advincula, IMCI checklist and Narrative RN Clinical Instructor

Prioritization Tzarina Cleo Cisneros,St. N

Family Nursing Care Plan Submitted by:

Promptness References Neatness Format

_________________________________ TOTAL 100 %

FAMILY CASE STUDY

Introduction...... 4 Objectives...... 8 Initial Data Base .... 11 Family Genogram . 35 Spotmap 39

IMCI checklist and Narrative.. 41 Prioritization. 43

VIII. Family Coping Index... 70

Family Nursing Care Plan.. 81

FAMILY CASE STUDY

FAMILY CASE STUDY

FAMILY CASE STUDY

FAMILY CASE STUDY

FAMILY CASE STUDY

FAMILY CASE STUDY

In specific, we aim to:

FAMILY CASE STUDY

FAMILY CASE STUDY

INITIAL DATA BASE

FAMILY CASE STUDY

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II. Family Characteristics and Dynamics

FAMILY CASE STUDY

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FAMILY CASE STUDY

Family Member Christian Mary Grace Dave Natasha

Wt. (kg) n/a 78 14 11

Ht. (m) n/a 1.7 1.0 0.9

n/a 26.98 14 13.58

FAMILY CASE STUDY

Table 3: 72 hr. Dietary recall

Meal Breakfast Lunch Dinner

December 20, 2010 Ribs soup and Choriso Batchoy Law- uy

FAMILY CASE STUDY

Table 4: Summary of familys sleeping pattern

Total No. of Sleeping Hours

FAMILY CASE STUDY

FAMILY CASE STUDY

Leisure and Activity

FAMILY CASE STUDY

FAMILY CASE STUDY

Other Sources of Income

High school graduate High school Graduate N/A

Stable Employment Unemployed

Stocks Delivery boy None

P 2805.00 / month N/A

Cargo boy(van) 100-200php (not constant)

FAMILY CASE STUDY

Division of Monthly Expenses

FAMILY CASE STUDY

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FAMILY CASE STUDY

DO = L x W = 1.47 m x 0.61 m DO = 0.8967 m2

FAMILY CASE STUDY