LICEO DE CAGAYAN UNIVERSITY Rudolfo N.

Pelaez Boulevard, Carmen Cagayan de Oro City COLLEGE OF NURSING

NCM501205 RELATED LEARNING EXPERIENCE

A Family Care Study of Basanta Family

Submitted by:

Hiram Gaven G. Abella

GROUP 2

Mrs. Elvyn Mabao RN, MAN.

RLE Clinical Instructor MARCH 15, 2012

Submitted to:

TABLE OF CONTENTS

I.

INTRODUCTION A. OBJECTIVE OF THE STUDY B. SCOPE AND LIMITATION

II. III. IV. V.

SPOT MAP FAMILY PROFILE FAMILY HEALTH HISTORY PRESENT HEALTH STATUS Nursing System Review Chart

VI. VII. VIII. IX. X. XI. XII. XIII. XIV. XV.

IMCI MANAGEMENT HOME AND ENVIRONMENT FAMILY COPING INDEX SCHEMATIC PRESENTATION OF FAMILY PROBLEMS ACTUAL IMPLEMENTATION FAMILY HEALTH CARE PLAN NURSING CARE PLAN EVALUATION BIBLIOGRAPHY DOCUMENTATION

I. INTRODUCTION: The family is the basic unit of society. It is composed of one or more individuals closely related by blood, marriage, or friendship. A family of parents and their offspring is known as the nuclear family. The familys major roles are to protect and socialize its members. Among the many functions it serves, of prime importance is the role the family plays in providing emotional support and security to its members through love, acceptance, concern and nurturing. This affective component holds families together, gives family members a sense of belonging, and develops a sense of kinship. In addition to providing an emotionally safe environment for members to thrive and grow, the family is also a basic unit of physical protection and safety. This is accomplished by meeting the basic needs of its members: food, clothing, and shelter. Provision of a physically safe environment requires knowledge, skills, and economic resources. In addition to providing environment conducive to physical growth and health, the family creates an atmosphere that influences the cognitive and psychosocial growth of its members. Children and adults in healthy, functional families receive support, understanding, and encouragement as they progress through predictable developmental stages, as they move in or out in the family unit, and as they establish new family units. In Families, where members are physically and emotionally nurtured, individuals are challenged to achieve their potential in the family unit. As individual needs are met, family members are able to reach out to others in the family and in the community, and to society. The family Care Study is designed to determine, plan, implement and evaluate health care of a certain family. The study involves assessment of the familys health-illnesses, home and environment conditions, past family history, drug study, and family

health care plan which highlights the family health problems, objectives of care, intervention, rationale and evaluation. These would enable the researchers to identify the current health problems of a family and can plan certain interventions for the specific problems identified. Community is a body of people having common rights, privileges, or interests, or living in the same laws and regulations; a group of people sharing common geographic boundaries and common values and interest The origin of the word community comes from latin munus, which means the gift, and cum, which means together, among each other. Community literally means to give among each other. Community could be defined as a group of people who share gifts, which they provide to all. Community health nurse has different clientele and these include the individual, family, population group and community itself. Family as one of the client the very important social institution that performs two major functions, reproduction and socialization. It is generally considered as the basic unit of care in the community health nursing for many reasons. It may contribute knowingly or unknowingly to the development of health and nursing problems of its members. It also performs health promoting, health maintaining and diseasepreventing activities. In many cases, it is the family that provides unfailing nursing care particularly to the chronically- ill members. Every individual has the right to receive good care. To give good care, a nurse must plan to support familys needs, abilities, interests, and preferences. Under the law, community health nurse and families are partners in this planning process. You have the right to give information, ask questions, participate in care plan meetings, offer suggestions, review care plan documents an accept or refuse offered

care. If clients get involved in the care planning process, it is almost certain that they will get better care and enjoy a higher quality of life. The data gathered through observations, interviews, consultations and home visits. Data are then compared with standards, analyzed, stated health care diagnosis and ranked nursing diagnosis in order of priority. The formulation of the Health Care Plan is based on a behavioral manner following SMART Specific, Measurable, Attainable, Realistic, and Time bounded.

A. GENERAL OBJECTIVE: At the end of the family care study, I will be able to: Identify health related problem Give nursing intervention regarding the problem Encourage the family members for independent strengthening of the intervention SPECIFIC OBJECTIVE: At the end of the family care study, I will be able to: Interview the family members for relevant information Assess each family member for baseline data Develop rapport between the family members and the student nurse

B. SCOPE AND LIMITATION

This family care study is a 6 weeks visitation of the chosen family. The visits include assessment, interview and application of nursing

intervention. These are intended to gather information that will help for the success of the study. The study focuses on the identification of health related problems that may put the family at risk if not given an intervention. Nevertheless the nursing intervention must follow the SpecificMeasurable-Attainable-Realistic-Time-bounded rule. This will be a great help for the family to sustain a healthy way of living if intervention are properly imparted and understood. To know this, the family will manifest independence alone even without the assistance of the student nurse.

II. SPOT MAP The point of reference going to Vicastro Street Carmen , Cagayan de Oro City and our starting point is Liceo de Cagayan University Campus. It took approximately 2 kilometers from the point of reference to Vicastro street Carmen, and a ride with a trisikad having a route of Vicastro with a fair of more or less 6php regular fare and 5 for students. A stop over was made through the SSS office intersection road and then rides trisikad going in Vicastro Street Carmen with a fare of Php 5 pesos.

III. FAMILY PROFILE A. Head of the Family Name: Nelly Cabriana Basanta Relation: Grandmother Age: 53 YEARS OLD Birth Date: October 11, 1958 Civil Status: Widowed Religion: ROMAN CATHOLIC Nationality: FILIPINO Address: VICASTRO STREET CARMEN, CAGAYAN DE ORO CITY Occupation: Maruya Vendor Educational Attainment: Elementary Graduate Smoking History: YES, during adolescent, cannot recall exact date Drinking History: YES, during adolescent, cannot recall exact date Allergies: NO KNOWN FOOD AND DRUG ALLERGIES Heredofamilial: HYPERTENSION Food usually included in the diet: Amapalaya w/ egg, chicken, meat, and foods that are usually bought in the karenderya beside their house.

Monthly Income: Elimination: B. Children

P25/a day BOWEL MOVEMENT Twice A DAY URINARY FREQUENCY 2 T0 5 TIMES A DAY

Name: Princess Joy Basanta Relation: DAUGHTER Age: 16 YEARS OLD Birth Date: Jan 15, 1996 Religion: ROMAN CATHOLIC Nationality: FILIPINO Address: VICASTRO STREET CARMEN, CAGAYAN DE ORO CITY Occupation: 3rd year STUDENT Educational Attainment: --Smoking History: N/A Drinking History: N/A Allergies: NO KNOWN FOOD AND DRUG ALLERGIES. Food usually included in the diet Amapalaya w/ egg, chicken, meat, and foods that are usually bought by her mother in the karenderya beside their house. Elimination: BOWEL MOVEMENT Thrice A DAY URINARY FREQUENCY 3 T0 5 TIMES A DAY Name: Merry Queen Basanta Relation: Granddaughter Age: 2 YEARS OLD Birth Date: July 21, 2009 Religion: ROMAN CATHOLIC Nationality: FILIPINO Address: VICASTRO STREET CARMEN, CAGAYAN DE ORO CITY Smoking History: N/A Drinking History: N/A Allergies: NO KNOWN FOOD AND DRUG ALLERGIES Food usually included in the diet: Amapalaya w/ egg, chicken, meat, and foods that are usually bought by her mother in the karenderya beside their house. Elimination: BOWEL MOVEMENT Twice A DAY URINARY FREQUENCY 3 T0 5 TIMES A DAY

IV. FAMILY HEALTH HISTORY Basanta family health history status was taken through interview. The family comprises of four members namely: Nelly Cabriana Basanta (Grandmother / Head of the family), Princess Joy Basanta (Daughter), and Merry Queen Basanta (granddaughter) Grandmother / Head of the family Mrs. Nelly Cabriana Basanta has a hypertension as a familial disease. He has no history of hospitalization & no serious diseases other than that of cough, colds and fever. But he considers fever and cough as his health concern. When symptoms of this disease occur he only takes Entapril as prescribed by a german doctor near their town and refer for herbal medicines when they are in province like tawatawa. Nelly Cabriana Basanta stated that she smokes and drinks a small amount of alcohol during her younger years. Daughter Princess Joy Basanta is the youngest among her parents siblings, born through normal spontaneous. Breastfed and completed her immunizations during her infancy stage. She has no known food and drug allergy. She sometimes had a cold, cough w/sputum and fever. She has no history of a serious disease condition that requires hospitalization. Grand Daughter Merry Queen Basanta is the 1st and the only child, born through normal spontaneous. She completed her immunization and has no

known food and drug allergies. Encountered only minor illness such as fever, cough and colds and treated with prescribed medications. She has no history of a serious disease condition that requires hospitalization. V. PRESENT HEALTH STATUS A. Immunization Immunization Schedule BCG HepB1 HepB2 HepB3 DPT1 DPT2 DPT3 OPV1 OPV2 OPV3 Measles Princess Joy Merry Queen

An immunization is the inoculation of a vaccine or drug to make one resistant to a particular disease like tuberculosis for instance. The checkmarks indicates the immunizations that had been received by the corresponding child while the blank cells indicate that vaccines that have not been inoculated. B. Family Planning Family planning is basically birth control. It is the use of birth control methods to choose the number and timing of children born into a family. The basanta family has not used any family planning method anymore because Mrs. Nelly basanta is widowed and also not anymore in reproductive age.

C. Diet Eating the right foods can help us avoid certain diseases or recover faster when illness occurs. These and other important functions are fueled by chemical substances in our food called nutrients. Nutrients are classified as carbohydrates, proteins, fats, vitamins, minerals, and water. To the Basanata family however, they eat only the foods that are available in the karenderya beside their house, or only what they can afford which is usually vegetables and meat. They do eat a lot of fruits especially banana because they sell maruya.

NURSING SYSTEM REVIEW CHART

Name:______Nelly Cabriana Basanta_________________________________ Date:______March 6,2012___________ Temp.:____36.5_____ Pulse Rate:____82_____ BP:___140/100___ Respiration Rate:_____24___ INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X]. EENT: [ ] impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teeth Assess eyes, ears, nose throat for abnormalities. [x] no problem RESPIRATORY: [ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ ] cough [ ] barrel chest [ ] bradypnea [ ] shallow [ ] rhonchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic Assess resp. rate, rhythm, pulse blood breath sounds, comfort [x] no problem __________________ __________________ ______________ ___ __________________ __________________ High BP :140/100____ __________________ __________________ __________________ __________________ bowel sounds: normal_ ____________active__ __________________ __________________ __________________ __________________ __________________

CARDIOVASCULAR: [ ] arrhythmia [ ] tachypnea [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur __________________ [ ] tingling __________________ Assess heart sound, rate, rhythm, pulse, blood pressure. circulation, fluid retention, comfort [x] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass [ ] dysphagia [ ] rigidity [ ] pain Assess abdomen, bowel habits, swallowing bowel sounds, comfort. [x] no problem GENITO-URINARY AND GYNE: [ ] pain [ ] urine color [ ] vaginal bleeding [ ] hematuria [ ] discharge [ ] nocturia assess urine frequency, control, color, odor, comfort, gyne bleeding, discharge [x] no problem NEURO: [ ] paralysis [ ] stuporous [ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip assess motor, function, sensation, LOC, strength grip, gait, coordination, speech [x] no problem __________________ MUSCULOSKELETAL AND SKIN: [ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic [ ] moist assess mobility, motion, gait, alignment, joint function skin color, texture, turgor, integrity [x] no problem

Dirty nails________ Walking Bare Footed __________________ [ ] absent pulses [ ] pain

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ both symmetrical during lung respiration______ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

NURSING SYSTEM REVIEW CHART

Name:______Princess Joy Basanta_________________________________ Date:______March 6,2012___________ Temp.:____36.4_____ Pulse Rate:____82_____ BP:___100/70___ Respiration Rate:_____21_______ INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X]. EENT: [ ] impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teeth Assess eyes, ears, nose throat for abnormalities. [x] no problem RESPIRATORY: [ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ ] cough [ ] barrel chest [ ] bradypnea [ ] shallow [ ] rhonchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic Assess resp. rate, rhythm, pulse blood breath sounds, comfort __________________ __________________ ______________ ___ __________________ __________________ __________________ Dirty Fingernails__ __________________ __________________ __________________ bowel sounds: normal active_____________ __________________ __________________ __________________

[x ] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachypnea [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur __________________ [ ] tingling __________________ Assess heart sound, rate, rhythm, pulse, blood pressure. circulation, fluid retention, comfort [x] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass [ ] dysphagia [ ] rigidity [ ] pain Assess abdomen, bowel habits, swallowing bowel sounds, comfort. [x] no problem GENITO-URINARY AND GYNE: [ ] pain [ ] urine color [ ] vaginal bleeding [ ] hematuria [ ] discharge [ ] nocturia assess urine frequency, control, color, odor, comfort, gyne bleeding, discharge [x] no problem NEURO: [ ] paralysis [ ] stuporous [ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip assess motor, function, sensation, LOC, strength grip, gait, coordination, speech [x] no problem __________________ MUSCULOSKELETAL AND SKIN: [ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic [ ] moist assess mobility, motion, gait, alignment, joint function skin color, texture, turgor, integrity [x ] no problem

__________________ __________________ __________________ __________________ __________________ [ ] absent pulses [ ] pain

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ both symmetrical during ausculation_______ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

NURSING SYSTEM REVIEW CHART

Name:_____Merry Queen_Basanta________________________________ Date:______March 6,2012___________ Temp.:____36.6____ Pulse Rate:____104_____ BP:__NO_______ Respiration Rate:_____25________ INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X]. EENT: [ ] impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teeth Assess eyes, ears, nose throat for abnormalities. [x] no problem RESPIRATORY: [ ] asymmetric [ ] rales [ ] bradypnea [ ] sputum [ ] orthopnea [ ] tachypnea [x ] cough [ ] shallow [ ] diminished [ ] labored [ ] apnea [ ] barrel chest [ ] rhonchi [ ] dyspnea [ ] wheezing __________________ __________________ ___________ ______ _ ________________ Untidy Appearance__ __________________ __________________ __________________ __________________ Eating with barehands __________________ __________________ __________________

[ ] pain [ ] cyanotic Assess resp. rate, rhythm, pulse blood breath sounds, comfort [x ] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachypnea [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur __________________ [ ] tingling __________________ Assess heart sound, rate, rhythm, pulse, blood pressure. circulation, fluid retention, comfort [x] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass [ ] dysphagia [ ] rigidity [ ] pain Assess abdomen, bowel habits, swallowing bowel sounds, comfort. [x] no problem GENITO-URINARY AND GYNE: [ ] pain [ ] urine color [ ] vaginal bleeding [ ] hematuria [ ] discharge [ ] nocturia assess urine frequency, control, color, odor, comfort, gyne bleeding, discharge [x] no problem NEURO: [ ] paralysis [ ] stuporous [ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip assess motor, function, sensation, LOC, strength grip, gait, coordination, speech [x] no problem __________________ MUSCULOSKELETAL AND SKIN: [ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic [ ] moist assess mobility, motion, gait, alignment, joint function skin color, texture, turgor, integrity [x ] no problem

__________________ __________________ __________________ __________________ __________________ Dirty Foot_________ Walking Barefooted__ [ ] absent pulses [ ] pain

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ both symmetrical during ausculation _______ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

VI. HOME AND ENVIRONMENT

Housing House is owned Construction materials used are purely wood and light materials Poor foundation of shelter Smaller space for the family size Kitchen They have a dirty kitchen and uses firewood for cooking

 Does not have food storage facility Water Supply Drinking water is stored in a plastic covered container or gallon Water supply is from the Water District. Toilet They have a water sealed type Clean and small bathroom with a cloth for a screen Garbage Disposal They collection is scheduled weekly, every wednesday Drainage System Their home doesnt have a proper drainage system. Possible breeding place for mosquitoes and bacterial growth. Surroundings/Backyard/Domestic Animals Ornamental flowers are also observed in the area. Dogs and cats are roaming near their house Social & Health Facilities available The health center is accessible from the place of resident just as 1000 meters away They dont have televisions and radio, in which these are important for them to be updated on important news report and entertained

VI. Integrated Management of Childhood Illness

Date: July 21, 2009 Childs name: Merry Queen Basanta Age: 2 years old Sex: Female Weight: 11.2kgs Temp: 36.6C ASK: What are the childs problems? None ASSESS CLASSIFY CHECK FOR GENERAL DANGER SIGNS IS THE CHILD NOT ABLE TO DRINK OR BREASTFEED? YES___NO__

DOES THE CHILD VOMIT EVERYTHING? HAS THE CHILD HAD CONVULSIONS? ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No___ For how long? __days Count the breaths for one minute. __breaths per minute. Fast breathing? Look for chest indrawing? Look and listen for stridor.

No pneumonia Cough or colds

DOES THE CHILD HAVE DIARRHEA? Yes___ No__ For how long? ___days Is there blood in the stools? Look at the childs general condition. Abnormally sleepy or difficult to awaken? Restless or irritable? Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink poorly? Drinking eagerly, thirsty? Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)? Slowly? DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes_ _ No___ Decide Malaria Risk Does the child live in malaria area? Has the child visited a malaria area in the past 4 weeks

No problem

If malaria risk, obtain a blood smear. Look or feel for stiff neck. Look for runny nose. + Pf Pv Not done For how long has the child had fever? _ days If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months? No Look for signs of MEASLES Generalized rash and One of these: cough, runny nose. Or red eyes. None observed

The Child has no fever Upon assessment

. If the child has measles now or within the last 3 months: N/A Look for mouth ulcers If yes, are they deep and extensive? Look for pus draining from the eye Look for clouding of the cornea. . Decide Dengue Risk: Yes___ N o If dengue risk, then ask: Has the child had any bleeding form the nose or gums or in the vomitus or stools? Has the child had black vomitus or black stool? Has the child had abdominal pain? Has the child been vomiting? Look for bleeding from nose or gums. Look for skin petechiae. Feels for cold and clammy extremitites. Check capillary refill _less than 3 __seconds. Perform tourniquet test if child is 6 months or older and has no other signs and has fever for more than 3 days DOES THE CHILD HAVE AN EAR PROBLEM? Yes___ No___ Is there ear pain? Is there ear discharge? If yes, for how long? ___days Look for pus draining from the ear Feel for tender swelling behind the ear. N/A No Ear Problem

THEN CHECK FOR MALNUTRITION AND ANEMIA Look for visible severe wasting. None Look for edema of both feet. No edema Look for palmar pallor. Both palms are in normal color Severe palmar pallor? Some palmar pallor? Determine weight for age CHECK THE CHILDS IMMUNIZATION STATUS Circle immunization needed today ____ ____ ____ _____ BCG DPT1 OPV1 HEPB1 ____ ____ _____ _____ DPT2 OPV2 HEPB2 MEASLES ____ _____ ______ DPT3 OPV3 HEPB3

No anemia and not very low weight

Return for next immunization on:

(date)

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older Is the child six months of age or older? Yes__ NO__ Has the child received Vitamin A in the past six months? Yes___ No__ CHECK FOR DEWORMING STATUS for children 12 months or older. Is the child 12 months or older? YES__NO__ Has the child received albendazole/ Mebensdazole for the past 6 months? YES___NO__ ASSESS CHILDS FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old. Do you breastfeed your child? Yes__ No__ If Yes, how many times in 24 hours? 8 times. Do you breastfeed during the night? Yes__ No___ Does the child take any other food or fluids? Yes No __ If Yes, what food or fluids? _ _______________________________ How many times per day? __times. What do you use to feed the child? _________________ If very low weight for age: How large are servings? _________________________________ Does the child receive his/her own serving? ____ who feeds the child and how? During the illness, has the childs feeding changed? Yes __ No___ If yes, how? ASSESS CARE FOR DEVELOPMENT: Ask questions about the mother cares for the child. Compare the `mothers answer to the recommendations for care for Development of Childs age. How do you play with your child? The grandmother brings her to another house with other children to play with them. How do you communicate with your child? The grandmother communicates to her child by talking.

Vitamin A needed today Yes___ No__

albendazole/Me bendazole needed today Yes_ No__ Feeding Problems:

Child has no feeding problems

Care for Development Problems

VII. FAMILY COPING INDEX

5 Complete Competence Competence

AREA

3 - Moderate Competence

1 - No

RATE

JUSTIFICATION

1. Physical Independence

The family can provides the basic needs each of the members but cannot give on emergency situation

3 2. Therapeutic Independence

Whenever there is a family member who is sick, they consult to the health center. They also adhere to the herbal medicines if there are no medications available.

3 3. Knowledge of Health Condition

The family members dont know that much regarding hypertension and the healthy ways about living a healthy lifestyle. Nevertheless, She is still willing to; learn more about hypertension and other disease condition.

4. Application of Principles of Personal General Hygiene 5. Health Attitude 3 The family is able to take care of its members. The family members believe in some of the superstitious 3 beliefs but sometimes consult practices which are often considered unproven in science. However, they seek for medical attention when

they needed to. 6. Emotional Competence 3 The family members are able to cope with the usual stresses of life.

7. Family Living

It is normal for a family to have misunderstandings and conflicts. However they are able to resolve it anyway.

8. Physical Environment

They had enough space for the tree of them; they kept it clean, simple and accessible to every member. The family members do go to the health center And for in a the consultation. actively also they

3 9. Use of the Community Facilities

participate

immunization program. Some programs are not.

VIII.SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM Environment Social Behavioral

Garbage segregation is not practice

Do sometime s burns plastics

muddy surrounddings when raining; no proper drainage system

Unpaved road Dusty surrounddings Presence of stagnant water/ Risk for breeding sites of mosquitoe s

House made of light material

Economic

Political

Culture

Window s dont have screens

Low educationnal attainment

Selective health center participati on of accessible programs regarding to health

The family does not practice general preventive measures.

Poor skills and knowledg e about diseases

The house has no good foundation

The father is a wood vendor.

Inadequat e space for living with a 5 occupants in a small vicinity;

Php50 per day or less.

The mother stays in the house does not actively participate in zonal activities

Unsafe practice of utilization of water: drinking without boiling

Increased Environmental Risk

Possible to Continue Wrong Practices

Psychological

Biological Physical

Low Self Esteem Poor Personal Hygiene Lack of Motivation

Dirty Finger Nails

Lack of Knowledge Does not know the importance of general preventive measures.

Affected ability to cause change

Sometimes incompetent to healthy living

Health Threats: Low Family Income, Improper Garbage Disposal, Poor Hygiene, Weak and Presence of breeding sites of vectors

IX. ACTUAL IMPLEMENTATION First Visit During my First visit at the community, I was doing the profiling with the company of my partner to have us group B5 update the data in the health center, the main task given by our clinical instructor. As we do the task in the profiling of every families residing at Calaanan. Canitoan Cagayan de Oro City, I had found a family fit for the case study as for individual requirement. The family chosen for the study is the family of Mr. and Mrs. Cimafranca. I did introduced myself and told them about my purpose of visitation, asking for their consent and approval to let me have a case study with the said family. I did try to establish a good rapport and trust with Mrs. Cimafranca and the rest of the family members. I did interview some data regarding for the case study like some of the family health history and some of the pertinent data. I took vital signs of all the family members and did assess their health status regarding health deficit and problems. Also I did include some of the factors that may contribute to the current condition as like of social concerns, financial reasons, environmental sanitation, resources availability and the like. Also I did take note of the problems presented by housing, cleanliness, water supply, drainage, toilet type as part of the preliminary interview. Second Visit On the Second Visit, I did discuss with the family the problems I did notice and presented with them a good plan on how to eliminate or as to improve the deficit presently observed to carry out health promotion and prevention of illnesses from affecting the individual

family members. With their eagerness and cooperation, they perceive the said problems presented as priority to be first solve and improve.

Third Visit On the third day of my family visitation, I did make some of intervention together with the family, to solve the seen problem as a priority in promoting health and eradicating the possible cause for an illness. I did also discuss with the family some tips on how to improve the lifestyle and make use of the resources available in the community. I did invite the family for the seminar we had prepared and to discuss with the community people the problems we had seen and had put it on a priority on its list.

Fourth Visit As for the fourth visitation, I did notice some of the improvement that had taken place since the first visitation. In addition, I did appreciate the good implementation and the improvement seen in the environment. The family had taken measures and intervention as planned. I did further assist of the said family.

Fifth Visit As for the last visitation, Ive seen a good output for my care of the Cimafranca family, somehow I was able implemented and help them solve some health related problems just as the like of improvement of the drainage system, measures to control breeding sites for mosquitoes and given health teaching that somehow educate the family of possible causes that may threat the health condition of the

individual family members. And lastly, the termination process was done with a good understanding of the both sides between the family and the student.

X. FAMILY CARE PLAN

HEALTH PROBLEM FAMILY NURSING PROBLEMS Inability to provide home environment conducive to health maintenance and personal development due to: A. Inadequate family resources, specifically: 1.Financial constraints/limit ed financial resources GOAL OF CARE OBJECTIVES OF CARE INTERVENTION MEASURES METHODS OF NURSEFAMILY CONTACT - Home visit - Family Interaction RESOURCES REQUIRED

CUES

Subjective: wla akong trabaho, iyong husband ko lng ang mayroon, nagbabantay lng ako sa mga bata namin at dito lang s bahay Objective: Father more or less with an income of 300/day.

Low income in the family poses as a seen foreseeable crisis

The family will find enough resources that could sustain family health needs.

Identify ways to utilize family income wisely and earn money from extra work.

Encourage the family to find additional ways to earn money. Encourage family to prioritize needs. Food should always be available. Encourage the family to minimize unnecessary spending like buying junk foods. Invite the family to attend to a seminar that will somehow help them generate extra income.

Time and effort of both the student nurse and the family.

CUES

HEALTH PROBLEM Poor home/ environmental condition like the presence of breeding or resting sites of vectors of diseases as health threat

FAMILY NURSING PROBLEMS Inability to provide a home environment conducive to health maintenance and personal development due to: - Inadequate knowledge of preventive measures on dengue and malaria.

GOAL OF CARE After Nursing Intervention, the family will realize the need of the prevention of dengue and malaria occurrence and the help of covering water containers and avoiding stagnation of water to prevent such illnesses.

OBJECTIVES OF CARE After Nursing Intervention, the family will be able to: - Eliminate breeding sites of mosquitoes. - identify hazards at home regarding dengue or breeding sites of mosquitoes.

INTERVENTION MEASURES

METHODS OF NURSEFAMILY CONTACT - Home visit - Interaction with the family

RESOURCES REQUIRED Time and effort of both the student nurse and the family.

Subjective: marami nga ang lamok dito, minsan nga pagumuulan eh nababarahan ung kanal, kaya nililinis ko yan. Objective: - mosquito bites in arms and legs -stagnant water of the drainage -Uncovered water containers - windows are open; no screens

-Establish methods to minimize exposure to insect bites like: practice the 4 oclock habit encouraged the family to use mosquito net when sleeping encouraged family to cover water containers together with the family, help in taking action in actual cleaning of the drainage system.

CUES

HEALTH PROBLEM poor home/ environmental conditions: - unsanitary waste disposal - Improper garbage As a health threat

FAMILY NURSING PROBLEMS Inability to provide home environment conducive to health maintenance and personal development due to: a. lack of knowledge on proper waste management, like of the proper garbage segregation process and burning of only organic materials.

GOAL OF CARE After the nursing interventions, the family will be able to understand the importance of garbage segregation and hygiene.

OBJECTIVES OF CARE After the nursing intervention, the family will be able to: - Identify and classify wastes as biodegradable, non-bio -degradable, and recyclable. - Will be able to dispose garbage properly. - Will be able to practice waste segregation.

INTERVENTION MEASURES

METHODS OF NURSEFAMILY CONTACT - Home visit - Family Interaction

RESOURCES REQUIRED - Time and effort of both the nurse and the family.

Subjective: inilagay na naming lahat ang klaseklasing basura. May kukuha naman dito. Minsan susunugin lng naming. Objective: -Unsanitary waste disposal -burned garbage can be seen at the back of the house.

Emphasize to the family the importance of throwing their trash in a garbage bag using the segregation method. Encourage the family to cover the trash bags to minimize the flies. Make the family aware of the risks and effects of improper waste disposal.

XII. EVALUATION The outcome and the output of care of the Cimafranca family were good. They are cooperative and compliant to the suggested plan that will help them improve their living condition and minimizing factors that may pose a health threat to the individual. Taking preventive measures were done with the help of the family. Somehow I can say that their attitude towards a good partnership in health promotion and prevention of illness will yield a good result as part for their health and living. Although the income may seem or just as not yet realized, they have a good coping that may and somehow less to affect them of the near future. A medium size family that has a small income but is an active partner of health care services.

REFERRAL The family was instructed to visit the Barangay Health Center to keep noted and posted of updates regarding the disease prevalent to the area and to follow up immunization with her infant. Noted also the importance a completed immunization and an active partner to the health center helps in health promotion and prevention of the diseases and illnesses.

XIII. BIBLIOGRAPHY

Doenges, M. Nursing Care Plans, guidelines for Individualizing patient care, 6th edition Doenges,M. et al. Nurses Pocket Guide; Nursing Diagnoses with Interventions, 3rd Edition, F.A. Davis Company.1991 Reyala, Jean P, et. al. Community Health Nursing Services in the Philippines, 9th Edition CHN Section, National League of Philippine Government Nurses, Inc. 2000 Kozier, Barbara et. al. Fundamentals of Nursing. AddisonWesley Publishing Company, Inc. California, U. S. A.2000. Smeltzer, S.et al: Textbook of Medical-Surgical Nursing, 10th Edition, Lippincott Williams & Wilkins 2004 Aracli Maglaya. Community Health Nursing . National League of Philippine Government Nurses, Inc. 2000