FAMILY SERVICE AND PROGRESS RECORD

HEAD OF THE FAMILY: Masalunga, Rolando

ADDRESS: 061 Sabang, Nagsaulay, San Juan, Batangas

I. Assessment of the Family, Home and Environmental Conditions:

A. Members of the Household

FAMILY MEMBER RELATION TO SEX Birthdate Marital HIGHEST OCCUPATION REMARKS/

No. Name HEAD Month Year Status EDUC. Type of Place DATE ENTERED
COMPLETED Work
1. Rolando HEAD M Nov. 5 1971 Married Grade 1 Tuba Nagsaul Dec. 12, 2007
Masalunga Gatherer ay
2. Riza WIFE F Mar. 14 1972 Married HS Graduate Housewife n/a Dec. 12, 2007
3. Mark SON M April 16 1993 Single HS- 2 year
nd
None n/a Dec. 12, 2007
4. Melvin SON M May 19 1994 Single Elementary None n/a Dec. 12, 2007
Graduate
5. Marvin SON M Oct. 23 1999 Single Grade 1 None n/a Dec. 12, 2007
6. Marnel SON M Nov. 29 2001 Single Nursery None n/a Dec. 12, 2007
7. Mariel SON M June 23 2006 Single n/a None n/a Dec. 12, 2007
II. Home and Environment

Date assessed: 12/12/07

1. Home
A. Ownership: (/) owned ( ) rented ( ) rent- free
B. Construction materials used: ( ) light (/) mixed ( )strong
C. Number of rooms used for sleeping: 2
D. Lighting Facilities: (/) electricity ( ) kerosene ( ) others: specify__________________
E. General sanitary condition: Masalunga’s residence is a bungalow type house with 2 bedrooms, a
living room and a kitchen. The main entrance is approximately 5 meters away from the main road.
The area around the house is not cemented thus muddy on rainy days. Coconut trees and banana
plants surround the house. Inside, the house is generally clean and orderly. The floor is cemented
with linoleum and furniture is arranged in such a way that would maximize space. No scattered
garbage or trash can be seen.

2. Drinking water supply

Source: (/) private ( ) public
Distance from house: deep well or poso 5 meters away from the backdoor of the house
Storage: ( ) none (direct from faucet or pipe)
( ) large covered container without faucet
(/ ) others: specify plastic water jug with built-in faucet

3. Kitchen
Cooking facility: ( ) electric stove ( ) Gas stove ( / ) Firewood/charcoal
Sanitary condition: The kitchen and the dining area are located on a separate room adjacent of the
house. Walls are made of pawid and the floor is not cemented. The kitchen counter is not tiled. Food
ingredients and other food are placed on a cupboard near the sink. Plates are placed in a dish rack.
Dirty dishes are washed immediately after use. No trash or garbage is seen scattered on the kitchen
area.
Drainage facility: ( ) Open Drainage ( ) Blind Drainage ( / )None water used for washing the dishes
is thrown on a vacant lot beside their house

4. Water Disposal
 A. Refuse and Garbage
Container: ( ) covered ( / ) open ( ) None ( ) others: specify______________
Method of Disposal:
( ) hog feeding
( ) open dumping
( /) open burning
( /) burial in pit
( ) composting
( ) others, specify: _________________

B. Toilet type:
( ) none
( ) overhung latrine
( ) open pit privy
( ) bored- hole latrine
( ) pail system
( ) Antipolo
( ) water- sealed latrine
(/ ) flush type
( ) others, specify: ______________
Distance from house: located 5 meters from the backdoor of the house
Sanitary Condition: The comfort room has no foul odor though molds can be seen on the toilet
bowl. The bathroom is not tiled and walls are made of pawid. Water from the poso (approximately
2 meters away from the bathroom) is readily available.

5. Domestic animals: None

6. The Community in General

a. General sanitary condition: Coconut trees and banana plants are a common site in Sabang.
Other vacant lots are used for vegetation and pig sties. Most of the houses in Sabang are made of
light materials such as pawid and bamboos. The main road (P.D. Road) is cemented though most
of the area is not. After raining, ground is usually damp and muddy. Dried coconut husk and
banana leaves are seen scattered. Animal excreta are also noticed. The community is generally
clean, orderly and peaceful.
b. Housing Congestion: ( ) Yes ( / )No
c. Presence of Breeding Sites of Vectors of Diseases:
( / ) Yes. Specify: Dumped garbage and mud puddles
( ) None

d. Recreational facilities: A basketball court and a billiard hall are at walking distance from the
Masalunga Residence.

e. Availability of health care services (describe briefly): The Nagsaulay Health Center offers free
maternal care, vaccination and immunization for infants, children and pregnant women, family
planning program, free medications and free doctor consultation. A private emergency clinic and
the RHU are a one jeepney ride away from Nagsaulay.

f. Distance of house from nearest health care facility: The health center is about 1500 meters away
from client’s house.
 INITIAL DATABASE

A. Family Structure

LEGEND:
Rolando
Riza C&C- Cough &
HTN
Colds
H-Hypertension

Mark Marvin Marnel Mariel

Melvin C&C C&C

The family structure is patriarchal. The family head is Rolando Masalunga, a 36 year old
Filipino male who is a tuba gatherer in Nagsaulay. He is married to Riza, a 35 year old
housewife. They have five sons who live with them, two of which are in hisghschool, one in
elementary and the other in kindergarten. The family is presently living at Sitio Sabang in
Nagsaulay, San Juan, Batangas. When it comes to making decisions regarding their health it is
Riza who is most concerned and usually takes action. They had been happily married and
according to Mrs. Masalunga it takes a lot of sacrifices to make a marriage work. They seldom
fight or have arguments but if they do it is Mr. Masalunga who apologizes and reconciles first.
Family problem is usually about financial matters.

B. Socio- Economic and Cultural Characteristics

Economic

Expenses/Month
a. Electricity 305
b. Food 2000
c. Groceries (soap, toothpaste etc) 500
d. Transportation 150

Income Php 3000

Expenses: -- 2955
45- Savings

Mr. Rolando is the bread winner of the family. The money he earns depends on the
number of orders of lambanog. According to his wife sometimes they can earn as much as 8,000
per week. But most of the time, they have an average income of 3000 pesos per month or 750 per
week. Mrs. Masalunga also said that their income is insufficient for their needs especially now that
the prices of commodities are getting higher. Most of their income is also spent on the education of
their 4 children. It is usually Mrs. Masalunga who handles and budgets the money.

Sociocultural and Political Characteristics

The family hears the current news and situations in the Philippines through the television,
radio and their neighbors. They usually ride jeepneys as a means of transportation. As earlier
stated, the most common problem in the family is money. Whenever they have problems they
usually ask help from Riza’s brother and other relatives. The Masalunga family is Catholic. They
seldom go to church because they usually have no time to go to the bayan. Their is a church in
Nagsaulay, however the mass is only held once a month.

Sabang is the “slope” part of Barangay Nagsaulay. Nagsaulay’s highest peak is

considered a part of Sabang. Sabang is a typical rural area, with goats, cows, pigs and ducks
typically seen along the road. Most of the houses are made of light materials such as pawid and
bamboos. The community is not congested and a lot of vacant lots are used for vegetation or are
made as pig sties. As earlier stated, the main road (P.D. Road) is cemented though most of the
area is not. The ground is usually damp and muddy especially after raining.
 There is a basketball court and a billiard hall in Nagsaulay a few meters away from client’s
house. The Masalunga family usually consults in the Nagsaulay Health Center which is
approximately 1500 meters away from their house so it is very accessible for the family. Mrs.
Masalunga had availed of the free pre-natal check up when she was pregnant. The family also
benefited from the free consultation, vaccines and medicines for the children. They had also
sought advice from the previous midwife regarding family planning. Mrs. Masalunga also
expressed her satisfaction and gratitude to the services offered by the health center.

Mrs. Masalunga is a member of a women’s group in Nagsaulay. During discussions she

participates by attentively listening to the speaker. She verbalized that she would willingly attend
seminars or meetings regarding health because she wants to enhance her knowledge on taking
care of her children when they are sick. For her, the most common problem in the community is
vices specially smoking among teenagers. Fights and other disturbances seldom happen in
Sabang. People in their neighborhood are kind and accommodating.

C. Home and Environment

Their house is about 20 square meters, with 2 bedrooms and a kitchen. The couple
together with their youngest son Mariel sleeps together. Though they have another bedroom, their
other sons sleep on the living room because it is more breezy and spacious. The house is owned
and is made of mixed materials. The walls of the living room and bedrooms are made of concrete
while their kitchen walls are made of pawid. Their lights and other appliances are powered by
electricity. The house is generally clean. They put their left over food on the table in a covered
container or they just feed it to their neighbor’s dogs. Utensils and other kitchenware are stored in
a dish rack.

The family gets water from a deep well 5 meters away from their house. They store
drinking water in a covered plastic water jug with built in faucet. Mrs. Masalunga verbalized that
they only boil the water that will be used for Mariel’s milk. She claimed that she boils it for 30
minutes and uses a strainer after just to make sure that the water is really safe. They cook their
food using firewood and charcoal though they have a gas stove. Mrs. Masalunga said that LPG
gas is too expensive and it’s impractical to use here in the province were charcoal and firewood
are abundant. They have no drainage system. They throw used water on a vacant lot near their
house or just let it flow on the ground. The usual method of garbage disposal of the family is
 burning and sometimes burying. Some of the usual house pests are cockroaches, flies and
mosquitoes. To drive away these vectors they clean their house regularly and burn grass to
produce smoke that will drive away mosquitoes. Their comfort room is of flush type and has no
foul odor though molds can be seen on the toilet bowl. The bathroom is not tiled and walls are
made of pawid. Water from the poso (approximately 2 meters away from the bathroom) is readily
available.

Household Sketch
 Legend:
- TV
- Cooking area
- Sink

-Bed
-Toilet bowl
-Poso/ Deep well
-Chairs
-Doors
-Bamboo
Fence

D. Health Status

Rolando Masalunga

Rolando Masalunga had been a tuba gatherer since he was a teenager. He cannot recall
having diseases such as meascles, chickenpox, and mumps during his childhood. He has no
immunizations and allergies. Last 2001 he was hospitalized when he fell from a “karetan” (or
bamboos that serve as bridge to reach other coconut trees) that resulted to a fractured hip. He was
then admitted in Batangas Regional Hospital where he had stayed for weeks. The doctor advised the
patient to undergo an operation but due to lack of financial assistance the family decided to leave the
hospital and go to a medico instead. His wife claimed that the medico cured him. After a month of
resting he resumed working, still as a tuba gatherer. He has no familial history of hypertension,
diabetes, cancer, and tuberculosis. When nurse asked him what would be his rating of his overall
health from a scale of 1-10 (10 being the highest) he verbalized, “Eight. Dapat sana sampu kaso
simula nung aksidente, bumagal na ang katawan ko.” He complains of occasional back pain but is
relieved when his wife massages his back with oil.
Client said that since the accident he had been more careful regarding his health. He had
not experienced any sickness since then aside from the usual cough and cold which lasts for five
days. To keep his body healthy, he eats right and rests well. Client drinks lambanog sometimes and
smokes a pack of cigarette a day. When asked if he had tried smoking cessation, he said that
though he knows the bad effects of smoking in his body he still has no plans of quitting- “Siguro
pag-matanda na lang ako hihinto.”
He sleeps at least 8 hours a day and according to her wife he snores when he sleeps.
Client has good appetite in eating and has no difficulty in defecating or urinating. He claimed that
there are no changes in his sexual relationship with his wife.

Riza Masalunga

Mrs. Masalunga had been a housewife since she got married. As a kid, she recalls that
she was never sickly and had not experienced having chickenpox, meascles or mumps. She had
been vaccinated with tetanus toxoid and hepatitis A and B when she was pregnant with her youngest
son Mariel.
Client has familial history of hypertension, CVA, TB and Rheumatic Fever. She is a
diagnosed hypertensive since 1994. Riza said that when she started using DNPA or injectables in
1994, she had gained weight and began to experience pain on the back of her neck “batok,” severe
headache and pagkahilo. Because of this she went to the health center for consultation regarding an
alternative family planning method which is to take birth control pills. The midwife refused to give her
birth control pills because she is hypertensive. Since she doesn’t want to take DNPA or be ligated
she still bought birth control pills in a pharmacy and had been using it against the advice of the
midwife. She used pills for five years.
After she stopped taking the pills, Riza verbalized that she had experienced severe
headache and “pananakit ng batok.” She managed it by resting & lying for a while, drinking
pineapple juice or drinking “salay” decoction (a local plant that is believed to reduce blood pressure).
Her blood pressure is constantly monitored by a BHW.
In 2005, when she was pregnant with Mariel, she was admitted to the RHU due to pre-
eclampsia. She recalled that before she was hospitalized, she experienced severe headache,
“panghihina ng buong katawan” and “pagdidilim ng paningin.” After a few days of confinement, she
was sent home and was ordered to be in complete bed rest. On June 23, 2006, she was again
admitted to a rural hospital to give birth to her youngest son.
To keep her body healthy and to lower her blood pressure she claimed that she eats a lot
of vegetables and limits her rice intake. She considers taking care of her children and doing the
households chores as a form of exercise. She usually has at least 6 hours of continuous sleep
everyday.
Para 5 Gravida 5. Patient had normal spontaneous deliveries. Four of which were
delivered by a midwife and a “hilot” at her house except on her last pregnancy where she was
admitted to the ER in the RHU. After giving birth to her youngest son she was then ligated. She
claimed that there are no changes in her sexual relationship with her husband.

Mark Masalunga

Mark is the eldest son of Riza and Rolando. He will graduate in highschool this March.
Aside from the usual common cough and colds, he said that his body is generally healthy. He has
no difficulty in defecating and urinating. He has a good appetite and prefers to eat fish and
vegetables most of the time. His mother verbalized that he has complete immunization.
Mark is a smoker. He said that he started smoking when he was in 1 year highschool. He
st

consumes at least a stick of cigarette per day. When asked if he had plans of quitting smoking, Mark
verbalized that he knows the bad effects of smoking in the body that’s why he is only consuming at
most 3 sticks per day, “Hindi naman parati, pa isa-isang stick lang kadalasan.” He drinks lambanog
only during especial occasions. As a form of exercise he plays basketball. For relaxation, he hangs
out with his friends or play billiards. He sleeps at least 8 hours a day.

Melvin Masalunga

Melvin a 13 year old male said that his usual illness is cough, colds and fever. He
manages the said illnesses by consulting in the health center or by self- medicating. He has
complete immunizations. He had been hospitalized once when he was 6 months old due to diarrhea.
He has normal elimination pattern, has good appetite and has at least 8 hours of sleep
everyday. He considers taking care of his youngest brother and helping his mother in doing the
household chores as a form of exercise. He doesn’t smoke or drink alcohol. As a form of
relaxation, he usually sleeps or hangs out with his classmates.

Marvin Masalunga

Marvin a Grade 2 pupil, is currently studying in Nagsaulay Elementary School. According

to her mother, Marvin usually has recurring cough and colds which usually lasts for 3-5 days. Mrs.
Masalunga manages it by bringing him to the health center for consultation then if the cough and
colds did not stop she will then consult a medico. She said that she consults both the health center
and the medico for assurance, “Mas maigi ng sigurado.” Marvin has complete immunizations, good
appetite, enough rest and has no difficulty in urinating or defecating.

Marnel Masalunga
 Like his older brother Marvin, Marnel also has recurring cough and colds. According to
mother Marnel usually has cough and colds at the same time as Marvin “sabay silang nagkakasakit
ni Marvin.” Marnel a pre-schooler in Nagsaulay Day Care Center, is reported to have good appetite
in eating and loves to eat vegetables.
He usually plays with his brother Marvin and seldom takes naps. He is also completely
immunized, and has not experienced having meascles, mumps or chickenpox.

Mariel Masalunga

Marnel was not breastfed since birth. According to Riza, Mariel doesn’t want her breastmilk
so she gave formula milk instead. Mariel can consume at least three 100 ml bottle of Milo everyday.
His mother also claimed that Mariel has a good appetite. He is fond of eating bread and biscuits for
merienda and also eats rice and fish during lunch and dinner.
Like his two older brothers, Mariel often has recurring cough and colds which lasts for 2-5
days. He also experiences fever that usually lasts for 2- 3 days. Mariel has complete immunization
and had not experienced having chickenpox, mumps, and meascles.

E. Values and Practices

For the family being healthy means the person has a good appetite, is active and has
sufficient energy to do everyday task. On the other hand, they describe an unhealthy person as
someone who is pale, sickly and gloomy. To maintain a healthy body they believe that a person
should have a well balanced diet, complete immunization and sufficient rest. They believe that if one
gets sick, it might be because of bacteria, insufficient nutrient intake, “kulam” or “bati” or is
inherited.
They consult the Health Center or a “medico/albularyo” when they are sick. They also
self medicate by using herbal medicines or drugs such as Alaxan, Neozep and Biogesic . When it
comes to taking medicines mother claimed that they are compliant and takes the medicine until the
designated date.

F. IMMUNIZATION RECORD
 MMR BCG DPT OPV HepA HepB TT
Rolando - - - - - - -
Riza - - - - + + +
Mark + + + + + + -
Melvin + + + + + + -
Marvin + + + + + + -
Marnel + + + + + + -
Mariel + + + + + + -

G. NUTRITIONAL COMPUTATIONS

1. Rolando Masalunga
Ht: 163 cm
Wt: 61 kg  Normal (based on the weight for height for Filipinos of the FNRI)
BMI: 23 overweight
WHR: 0.98 cm  Normal
TEA (moderate) = 61 kg x 40 = 2440 kcal
CHO = 2440 x .65 = 1586/4 = 396.5 g
PRO = 2440 x .20 = 488/4 = 122 g
FAT = 2440 x .15 = 366/9 = 41 g

2. Riza Masalunga
Ht: 152 cm
Wt: 45 kg  Normal (based on the weight for height for Filipinos of the FNRI)
BMI = 20  Normal
WHR= 1.01 cm  (+) UBO
TEA (moderate) = 45 kg x 40 = 1800 kcal
CHO = 1800 x .65 = 1170/4 = 292.5 g
PRO = 1800 x .20 = 360/4 = 90 g
FAT = 1800 x .15 = 270/9 = 30 g

3. Mark Masalunga
Ht: 163 cm
 Wt: 44 kg  underweight of 6 kg (based on the weight for height for Filipinos of the FNRI)
BMI: 16. 54  underweight
WHR: 0.77  normal
TEA (moderate) = 44 kg x 40 = 1760 kcal
CHO = 1760 x .65 = 1144/4 = 286 g
PRO = 1760 x .20 = 352/4 = 88 g
FAT = 1760 x .15 = 264/9 = 29 g

4. Melvin Masalunga
Ht: 160 cm
Wt: 40 kg  underweight of 6 kg (based on the weight for height for Filipinos of the FNRI)
BMI: 15.6  underweight
WHR: 0.79  normal
TEA (moderate) = 40 kg x 40 = 1600 kcal
CHO = 1600 x .65 = 1040/4 = 260 g
PRO = 1600 x .20 = 320/4 = 80 g
FAT = 1600 x .15 = 240/9 = 27 g

5. Marvin Masalunga
Ht: 125 cm
Wt: 23 kg
MUAC: 15 cm
Abdominal Circumference: 55 cm

6. Marnel Masalunga
Ht: 110 cm
Wt: 16 kg- Normal according to the weight for age chart of FNRI
MUAC: 15 cm
Abdominal Circumference: 49 cm

7. Mariel Masalunga
Ht: 80 cm
Wt: 11 kg- Normal according to the weight for age chart of FNRI
MUAC: 15 cm
Abdominal Circumference: 32 cm
24 HOUR FOOD RECALL (December 11, 2007)

Members Breakfast Snacks Lunch Snacks Dinner

Rolando 2 cups rice none 2 cups rice None 2 cups rice
2 fried 1 fried galunggong 1 fried medium sized
galunggong 1 cup ginataang tulingan
2 glasses of papaya 1 cup ginataang dahon
water ½ cup ginataang ng sili
malunggay 3 glasses of water
3 glasses of water
Riza 2 cups rice 2 pieces 2 cups rice 1 turon 2 cups rice
2 fried banana 3 fried galunggong 2 fried medium sized
galunggong saba 1 cup ginataang tulingan
2 glasses of papaya 1 ½ cup ginataang
water 1 cup ginataang dahon ng sili
malunggay 1 ½ glass of water
2 glasses of water
Mark 1 cup rice 1 pack of 1 cup rice None 1 cup rice
1 fried skyflakes 2 fried galunggong 1 fried medium sized
galunggong ½ cup ginataang tulingan
 2 glasses of papaya ½ cup ginataang
water ½ cup ginataang dahon ng sili
malunggay 1 glass of water
2 glasses of water
Melvin 1 cup rice 4 pcs 1 cup rice None 1 cup rice
2 fried tasty with 1 ½ fried galunggong 1 fried medium sized
galunggong 6 1 cup ginataang tulingan
2 glasses of teaspoon papaya 1 cup ginataang dahon
water of 1 cup ginataang ng sili
mayonnai malunggay 2 glasses of water
se 2 glasses of water
Marvin 2 cups 1 cup ½ cup rice None 1 cup rice
Maggie lugaw 1 fried galunggong ½ fried medium sized
chicken ¼ cup ginataang tulingan
noodles papaya 1 glass of water
240 ml of ¼ cup ginataang
Milo malunggay
1 glass of water
Marnel 1 cup Maggie 1 cup ½ cup rice None 2 cups Maggie Beef
chicken lugaw ½ fried galunggong noodles
noodles ¼ cup ginataang 1 glass of water
papaya
½ cup ginataang
malunggay
1 glass of water
Mariel 1 cup rice 3 pcs of ½ cup rice 200 ml of 2 cups Maggie Beef
1 fried “kalihim” ½ fried galunggong Milo noodles
galunggong bread ¼ cup ginataang 400 ml of Milo
100 ml of papaya
Milo ¼ cup ginataang
malunggay
100 ml of Milo
II. Health Condition and Problem Sheet

1. Cough & Colds as a Health Deficit for Marvin, Marnel and Mariel Masalunga.
1 Level Assessment
st
2 Level Assessment
nd

• Mother verbalized that Marvin, Marnel and Mother verbalized, “Madalas magka-ubo yang mga

Mariel’s usual illness is having cough and colds batang yan kapag biglang init tapos uulan. Madalas din
pag malamig.”
that lasts for 3-5 days.
• Mother associates their having of cough and
Mother verbalized, “Normal lang naman yang ubo’t sipon
colds to abrupt change in climate and to cold
sa mga bata. Gagaling din yan ng kusa.”
weather.
Mother verbalized, ”Kapag mag-iisang linggo na ang

Marvin ubo’t sipon at may lagnat ng kasama don ko lang sila

dinadala sa center para mabigyan ng gamot, pag hindi pa
• VS: RR- 17 breaths/min PR- 65 bpm T- 36.7°C
din gumaling pumupunta nako sa medico para
• Skin smooth and warm to touch, good turgor
madasalan.”
• Pinkish conjunctiva
• (+) mucoid discharge clear and whitish in color, Mother verbalized, ”Talaga, pwedeng maging pulmonya

non- tender sinuses ang simpleng ubo’t sipon?”

• (-) mouth sores,

• (+) cough, tonsils not inflamed, (-) phlegm
• Nonpalpable lymph nodes
• I&E ratio: 2:1, eupneic breathing pattern,
symmetrical chest expansion
• (-) abnormal breath sounds
• Flat and normodynamic precordial area, PMI @
4 ICS L MCL
th

• Distinct heart sounds

• S1<S2 at base, S1>S2 at apex
• (--) S3, S4, murmur
• Ht: 125 cm
Wt: 23 kg
MUAC: 15 cm
Abdominal Circumference: 55 cm
• Based on client’s 24 hour food recall, fruits rich
in vitamin C are not included. It is
recommended to eat 1 or 2 servings of vitamin
 C rich foods everyday. (FNRI, 1998)

Marnel
• VS: RR- 18 breaths/min PR- 60 bpm T- 36.5°C
• Skin smooth and warm to touch, good turgor
• Pinkish conjunctiva
• (+) mucoid discharge clear and whitish in color,
non- tender sinuses
• (-) mouth sores, tonsils not inflamed
• Nonpalpable lymph nodes
• I&E ratio: 2:1, eupneic breathing pattern,
symmetrical chest expansion
• (-) abnormal breath sounds
• Flat and normodynamic precordial area, PMI @
4 ICS L MCL
th

• Distinct heart sounds

• S1<S2 at base, S1>S2 at apex
• (--) S3, S4, murmur
• Ht: 110 cm
Wt: 16 kg- Normal according to the weight for
age chart of FNRI
MUAC: 15 cm
Abdominal Circumference: 49 cm
• Based on client’s 24 hour food recall, fruits rich
in vitamin C are not included. It is
recommended to eat 1 or 2 servings of vitamin
C rich foods everyday. (FNRI, 1998)

Mariel
• VS: RR- 20 breaths/min PR- 67 bpm T- 36.7°C
• Skin smooth and warm to touch, good turgor
• Pinkish conjunctiva
• (+) mucoid discharge clear and whitish in color,
non- tender sinuses
• (-) mouth sores, tonsils not inflamed
• Nonpalpable lymph nodes
• I&E ratio: 2:1, eupneic breathing pattern,
symmetrical chest expansion
• (-) abnormal breath sounds
• Flat and normodynamic precordial area, PMI @
4 ICS L MCL
th

• Distinct heart sounds

• S1<S2 at base, S1>S2 at apex
• (--) S3, S4, murmur
• Ht: 80 cm
Wt: 11 kg- Normal according to the weight for
age chart of FNRI
MUAC: 15 cm
Abdominal Circumference: 32 cm
• Based on client’s 24 hour food recall, fruits rich
in vitamin C are not included. It is
recommended to eat 1 or 2 servings of vitamin
C rich foods everyday. (FNRI, 1998)

2. Hypertension as a Health Deficit for Riza Masalunga

1 Level Assessment
st
2 Level Assessment
nd

• Riza Masalunga verbalized, ” Hindi naman ako

• Client has familial history of hypertension and
sobrang high blood, minsan lang naman pag
CVA. Client’s father died of stroke and two of
kumakapal na ang batok ko. Kaya ko naman
her siblings are also hypertensive.
dalhin ang sarili ko. Paminsan- minsan lang
• She is a diagnosed hypertensive since 1994.
naman to.”
• Client associated her having of hypertension
• Riza Masalunga verbalized, “Sapat na ang
from using DNPA.
pineapple juice at pag-inom ko ng nilagang
• Client verbalized experiencing symptoms such
salay, okay naman kahit walang gamot.”
pain on the back of her neck “batok,” severe
• Riza Masalunga verbalized, ” Pag high blood
headache and pagkahilo.
ang isang tao, depende naman yan, may iba na
• Client used pills as an alternative family
pahinga lang okay na wala ng gamot, tulad ko.”
planning method for five years against the
• Riza Masalunga verbalized, ”Hindi ko alam na
advice of the midwife.
ang stroke pala ay pwedeng dahil sa high
• Client manages symptoms by resting & lying for
blood”
a while, drinking pineapple juice or drinking
 “salay” decoction (a local plant that is believed
to reduce blood pressure).
• Client claimed that her blood pressure is
constantly monitored by a BHW.
• Had pre-eclampsia in 2005
• Client has not been taking any maintenance
medication.
• Claimed that she avoids eating fatty and salty
foods
• Considers taking care of her children and doing
the households chores as a form of exercise
• Usually has at least 6 hours of continuous sleep
everyday.
• Client’s blood pressure as of December 12,
2007 is 150/100 mmHg. Pulse rate is 80.
• Pre cordial area flat, normodynamic
• (-) heaves, thrills and tenderness, good capillary
refill and skin turgor
PMI equal to AB at 5 ICS LMCL
th
•
• Distinct heart sounds
• S1<S2 at base, S1>S2 at apex
• (--) S3, S4, murmur
• Ht: 152 cm
• Wt: 45 kg  Normal (based on the weight for
height for Filipinos of the FNRI)
• Ht: 152 cm
• Wt: 45 kg  Normal (based on the weight for
height for Filipinos of the FNRI)
• BMI = 20  Normal
• WHR= 1.01 cm  (+) UBO
• TEA (moderate) = 45 kg x 40 = 1800 kcal
CHO = 1800 x .65 = 1170/4 = 292.5 g
PRO = 1800 x .20 = 360/4 = 90 g
FAT = 1800 x .15 = 270/9 = 30 g
• Based on client’s 24 hour food recall, fried and
viands with “gata” are frequently eaten.
III. Nursing Care Plan

INTERVENTION PLAN
HEALTH PROBLEM OR GOAL OF CARE/OBJECTIVES OUTCOME/CRITERIA Evaluation
WELLNESS CONDITION OF CARE Nursing Intervention Method Resources Required Methods/ Tool
& FAMILY NURSING of
PROBLEM Nurse
Family
Contact

Cough and colds as At the end of nursing 1. Discuss with the Home Material 1. Mother will explain Question and
a health deficit for intervention mother will be family the nature of Visit Resources: and discuss in simple Answer
Marvin, Marnel and able to appropriately cough and colds, its • Visual aids terms the nature of
Mariel Masalunga manage cough and colds symptoms, causes • Pamphlets cough and colds, give
of her children and and complications. at least 3 symptoms, 3
1. Inability o prevent its recurrence. Human causes and 1 possible
recognize the 2. Discuss and Resources: complication.
presence of the Mother will: explain the • Time,
condition or problem appropriate effort 2. Mother will be able
due to lack of or 1. Discuss and explain in management of knowledge to verbalize the
inadequate simple terms the nature of cough and colds and & skills of appropriate
knowledge. cough and colds, its prevention of its the nurse. management of cough
symptoms, causes and recurrence by • Cooperatio and colds and
complications. teaching the ff: n of the prevention of its
2. Inability to make family. recurrence by
decisions with 2. Discuss and explain • Nutrition discussing in simple
respect to taking the appropriate • Chest Financial terms the ff:
appropriate health management of cough Physiotherap Resources:
action due to: and colds and prevention y • Expenses • Nutrition Return
of its recurrence • Proper for the • Chest Demonstratio
a. Failure to through the ff: personal teaching Physiotherapy n
comprehend the habits aids. • Proper
nature/magnitude of • Nutrition • Importance personal habits
the problem • Chest of consulting • Importance of
Physiotherapy a physician consulting a
b. Low salience of • Proper personal physician
the problem habits 3. Demonstrate
• Importance of correct skills in doing 3. Mother will correctly
3. Inability to provide consulting a CPT. return demonstrate
adequate nursing physician CPT skills.
care to the sick and
dependent member 3. Correctly return-
of the family due to: demonstrate skills in CPT.

a. Inadequate
knowledge about the
disease (nature,
severity,
complications,
prognosis and
management)
b. Inadequate
knowledge of the
nature and extent of
nursing care needed

c. Inadequate
knowledge in
carrying out the
necessary
interventions

d. Inability to provide
a home environment
conducive to health
maintenance due to
inadequate
knowledge of
preventive measures
Hypertension as a At the end of nursing 1. Discuss with the Home Material 1. Client will explain Question and
Health Deficit for intervention Riza family the nature of visit Resources: and discuss in simple answer
Riza Masalunga Masalunga will be able to HTN, its symptoms, • Visual aids terms the nature of
manage hypertension and causes and • Pamphlets HTN, give at least 3
1. Inability to make prevent occurrence of complications. symptoms, 3 causes
decisions with future complications. Human and 2 possible
respect to taking 2. Explore and help Resources: complications.
appropriate health Client/SO will: client eliminate the • Time,
action due to: possible aggravating effort 2. Client will be able to
1. Discuss and explain factor of client’s knowledge identify and verbalize
a. failure to hypertension, its hypertension. & skills of the possible
comprehend symptoms, causes and the nurse. aggravating factor/s of
the nature/ complications. 3. Discuss and • Cooperatio his HTN and will
magnitude of emphasize the n of the formulate a way to
the problem 2. Identify and eliminate importance of a family. eliminate or decrease
b. low salience or decrease the possible healthy lifestyle in this factor/s.
of the factor/s that aggravates preventing HTN as Financial
problem client’s hypertension. well as its future Resources: 3. Client will be able to
c. misconceptio complications by • Expenses verbalize the
ns or 3. Discuss and explain teaching the ff: for the importance of
erroneous the importance of teaching practicing a healthy
information practicing a healthy • Diet aids. lifestyle by explaining
about lifestyle for HTN Modification and discussing the ff.
proposed prevention and prevention • Adequate in simple terms:
course of of future complications Exercise • Diet
action through the ff: • Stress Modification
Management • Adequate
2. Inability to provide • Diet Modification Exercise
adequate nursing • Adequate 4. Accompany client • Stress
care to the sick Exercise to the health center Management
member of the family • Stress for prescription of
due to: Management maintenance drug. 4. Client will go to the
a. Inadequate health center for
knowledge about the 5. Encourage client prescription of her
disease (nature, 4. Verbalize willingness to
severity, be accompanied to the
complications, health center for
prognosis and prescription of
management) maintenance drug and for
regular BP monitoring.
5. Verbalize willingness to
continue taking
maintenance drug
prescribed.
IV. Service and Progress Notes
Date Nursing Conditions/ Nursing
Problems
Dec. 11, 2007
Dec. 11, 2007
to continue taking maintenance drugs.
maintenance drug as
well as going to the 5. Client will verbalize
health center at least continuous intake of
once a week for BP maintenance drug as
monitoring. well as having her BP
monitored at least
once a week in the
health center.
Nursing interventions, Actions taken, Responses and Evaluation of Progress SIGNATURE
Outcomes
First nurse- client contact. Nurse established rapport with Mrs. Riza
Masalunga.
Nurse explained purpose and system of visit. Client willingly agreed.
Krys Adalla A.
Family Assessment was agreed to be scheduled the following day. Cantillo
Health history and Physical Assessment of the whole family were done.

Jan. 10, 2008 Health Problems and Family
Nursing Problems identified.
(refer to PROBLEM SHEET,
problems 1 & 2, for first and
second level assessment and
nursing diagnosis.)
Jan. 16, 2008 1. Cough and colds as a health
deficit for Marvin, Marnel and
Mariel Masalunga
• See NCP, Problem no.
1, Column 1 for Family
Nursing problems
• Please refer to Problem
Sheet, Problem no. 1
for first and second
level assessment
24 hour food recall and home and environment assessment were also Krys Adalla A.
done. Cantillo
Nurse visited and relayed to the family the problems identified.
Nurse and family determined the priority setting of the identified problems.
Nurse and family agreed to schedule the interventions for first problem:
Cough and colds as a health deficit for Marvin, Marnel and Mariel Krys Adalla A.
Masalunga on January 16, 2008 Cantillo
(See NCP, Problem No. 1, Column 3 for Nursing Interventions performed
or Problem no. 4 Column 3)
After the nursing intervention, Mrs. Riza Masalunga:
1. was able to explain and discuss in simple terms the nature of cough
and colds, give at least 3 symptoms, 3 causes and 1 possible
complication. She verbalized,
• “Ang ubo’t sipon ay hindi normal sa mga bata. Ito ay sanhi ng
isang virus.”
• 3 symptoms identified
“ may uhog na kulay berde o puti..”
“ pamumula ng lalamunan”
“ hindi makahinga ng mabuti dahil barado ang ilong…”
• 3 causes identified
” kulang sa masusustansyang pagkain..”
 ” nagkahawaan..”
” mahina ang resistensya..”
• 1 possible compication identified
” baka maging pulmonya...”

2. was able to verbalize the appropriate management of cough and colds

and prevention of its recurrence by discussing in simple terms the ff:

• Nutrition
Mrs. Masalunga verbalized, “ Kailangan makakain ng kahit isang
prutas na may Vitamin C ang mga bata tulad ng senturis.
Kailangan din kumain ng maraming berde at madadahong gulay.”
”Kapag may sipon din ugaliing uminom ng maraming tubig o ng
sariwang juice mula sa senturis.”

She was also able to discuss and identify the RDA for her
children. She was able to identify and explain the different
measurements for every food group for her children when asked
by the nurse by reading what is written in the pamphlet.

• Chest Physiotherapy
Mrs. Masalunga verbalized, “ Nakakatulong ito na alisin sa baga
ng bata ang nakadikit na plema para ng sa ganun ay makahinga
sila ng maluwang.”

• Proper personal habits


Jan. 17, 2008 2. Hypertension as a Health
Deficit for Riza Masalunga
• See NCP, Problem no.
2, Column 1 for Family
Nursing problems
• Please refer to Problem
Sheet, Problem no. 2
for first and second
level assessment
Mrs. Masalunga verbalized, “ Dapat pag may ubo’t sipon ang
isang anak ko hindi ko ito dapat itatabi sa iba kong anak pag
matutulog.”
“Sa pagpunas ng sipon dapat ang isang bimpo ay para sa isang
bata lang.”
”Maya’t maya rin dapat naghuhugas ng kamay.”
• Importance of consulting a physician
Mrs. Masalunga verbalized, “ Kapag masyado ng bumibilis ang
paghinga ng anak ko at hindi na epektibo ang pag-inom niya ng
maraming tubig, importante ng magpakunsulta sa doctor sa
center.”
3. was able to correctly return demonstrate each step in doing chest Krys Adalla A.
physiotherapy to Mariel. Cantillo
4. Mrs. Masalunga, Marvin and Marnel were able to do correct hand
washing technique upon return demonstration.
(See NCP, Problem No. 2, Column 3 for Nursing Interventions performed)
After nursing intervention, Mrs. Riza Masalunga:
1. was able to discuss in simple terms the nature of HTN, “ Eto ay dahil sa
tabang nakabara sa gilid ng ugat kaya nahihirapang dumaloy ng maayos
ang dugo..tumataas din ang presyon”
• Verbally enumerated 3/3 symptoms of hypertension
 “pagkahilo”
“madalas na paghabol ng hininga”
“paninikip ng dibdib”

• Verbally enumerated 3/3 causes of HTN

“paninigarilyo”
“sobrang katabaan”
“pagkain ng matataba at maaalat”
• Verbally enumerated 2/2 possible complications of HTN
“sakit sa bato”
“stroke”

2. Mrs. Masalunga was able to identify and verbalize the possible

aggravating factor/s of her HTN. She verbalized, “ Siguro yung pagkain ng
magata at mga prito ang isang dahilan ng high blood ko. Mahilig kasi rin
ako sa gata at sa mga sawsawan tulad ng bagoong....Sisimulan ko na nga
ang pagbabawas ng pagkain ko ng magata...”

3. was able to verbalize the importance of practicing a healthy lifestyle by

explaining and discussing the ff. in simple terms:
• Diet Modification- “ Kelangang umiwas sa mamantika at maaalat
na pagkain dahil nakakadagdag ito ng taba sa katawan at sa
paligid ng ugat… iwasan din ang magagatang pagkain dahil
mamantika rin ang mga ito… kumain ng mas maraming gulay at
prutas at iwasan na rin ang pag- inom ng kape..”
 She was also able to discuss and identify the RDA for her. She
was able to identify and explain the different measurements for
every food group when asked by the nurse by reading what is
written in the pamphlet.

• Adequate Exercise- “ Ang ehersisyo ay nakakapagpaganda ng

sirkulasyon ng dugo sa katawan.. 30 minuto apat na beses sa
isang linggo ang dapat..”

• Stress Management- “wag masyado mag- iisip ng kung ano- ano..

wag puro trabaho ng trabaho kelangan din ng panahon para mag-
isip at magrelaks...”

(4. Note: Patient was scheduled to be accompanied by nurse for

prescription of maintenance drug on January 24, 2008 (Thursday
afternoon) however clinic service that day was cancelled to give way to the
PAR survey presentation of the UP College of Medicine and the UP Social
Workers. Clinic day in Nagsaulay is every Wednesdays and Thursdays
only. Since the nurse’s last community duty is on January 25, 2008, she
was unable to accompany the patient to the Health Center. Nurse
apologized for the unanticipated cancellation of the appointment. However,
she still advised the patient to go to the health center for check-up and
drug prescription.)

Riza Masalunga verbalized, “Okay lang walang problema.. ako na lamang

ang pupunta don para makapagpareseta ng gamot...”
 Krys Adalla A.
5. For the evaluation of outcome criteria number 5, client will first be Cantillo
endorsed to the next nurses assigned in Nagsaulay. Evaluation to follow.
Jan. 25, 2008 TERMINATION OF THE Nurse told Mrs. Masalunga to apply everything that she learned about
PROCESS hypertension and cough and colds to improve the whole family’s health
status.

Mrs. Riza Masalunga thanked the nurse. All her children also said their
farewells and gratitude. Krys Adalla A.
Cantillo
Nurse thanked the family for their cooperation and hospitality.