II.

First and Second Level Assessment

A. Health Strengths
Health Strengths Supporting Cues
Seeking consultation for the sick member. “Pag nararamdaman ko na may kakaiba po sa pakiramdam ko
pumupunta ako sa clinic para mag patingin ng BP tsaka
humihingi na din ng gamot para sa BP ko pag mataas.”
Participating into different health related “Pumupunta ako pag may mga meeting sa clinic, o pag merong
clubs and organizations mga tinuturo yung mga studyante na tulad nyo din galing SLU
na tungkol sa kalusugan o pag may mga emergency ganun. ”

1st Level Assessment 2nd Level Assessment

Potential for Enhanced Capability of Health Ability to provide nursing care to the vulnerable family
Maintenance/Health Management (HPN) due to knowledge of the nature and existent of care
needed

 B. Presence of Heath Threats:

A. Family size beyond what Family Resources can
adequately provide
 They are 5 in the Family, They said that their Inability to provide adequate nursing care to the sick,
income in not enough sometimes to meet basic disabled, dependent or vulnerable/ at risk member of
needs because they are not earning that much the family due to: Inadequate Family resources of care,
from the farm and their relative in abroad is specifically: financial constraints
sometimes not sending them enough money.
Conclusion, inadequacy to meet basic
necessities using the total income, budget and
actual expenses as basis.

B. Threat of cross infection from a communicable

disease
 Not keeping water containers covered at times
 Poor environmental sanitation(presence of
chicken feces)
 Water used for food preparation is not that
clean.
Inability to provide a home environment conductive to
health maintenance and personal development due to:
Failure to see benefits (specifically long term ones) of
investment in environment improvement

C. Accident: Fall Hazards and Pointed/Sharp Objects

 Presence of stairs In the household without side Inability to recognize the presence of the condition or
rails (necessary) and with slippery rocks. problem due to: lack of awareness about the danger of
 Sharps and Pointed Objects are unkempt presence of health threats.

D. Poor home/Environmental Condition/Sanitation:

Presence of Breeding and resting sites of vectors of
diseases
 They have a dog and chickens without a cage.
Inability to provide a home environment conductive to
health maintenance and personal development due
to:Lack of adequate knowledge on preventing possible
health threats.

E. Unsanitary food handling and preparation

 They don’t cover leftover foods. Inability to provide a home environment conductive to
 Unsanitary kitchen/ working area health maintenance and personal development due
to:Lack of adequate knowledge

H. Unhealthful lifestyle and personal

habits/practices:
 Poor Personal Hygiene Inability to provide a home environment conductive to
 Lack of clean source of water due to health maintenance and personal development due
environmental location. to:Lack of adequate knowledge
 Lack variety of food
 Lack of physical activity

 C. Presence of Health Defecit

 Hypertensive patient Failure to utilize community resources for health care
related to inaccessibility of required service due to
location of environment.
 B. Health Problem

III. PRIORITIZATION OF HEALTH PROBLEMS

 Presence of health deficit

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 It is a health threat that
demands immediate
action

Modifiability of the 2/2 x 2 2 The resources and

Problem interventions needed to
solve the problem are
available to the family

Occurrence and
Preventive Potential 3/3 x 1 1 fluctuation of the
diagnosed problem can
be reducued and
minimized

Salience 2/2 x 1 1 Seen as a problem, have

knowledge and knows
that it is a threat to the
individual
SCORE:5

 Cross infection from a communicable disease

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 It is a health threat that
demands immediate
action

Modifiability of the 1/2 x 2 1 The Problem is partially

Problem modifiable due to
adequate knowlede from
the health personnel is
given, still don’t put
much action to it

If the knowledge has be

Preventive Potential 3/3 x 1 1 reinforced, the action
put will be more. Hence
lesser infection will be
passed to another

They see it as a problem

Salience 0/2 x 1 0 but doen’e give much
priority to it

SCORE:3

 Family size beyond what family can adequately provide

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 It is a health threat that
is in need of immediate
action

Modifiability of the 1/2 x 2 1 The problem is lowly

Problem modified since the
resources and the case
of their place has low
resources

Preventive Potential 1/3 x 1 0.33 There is low family

 resources that can be
utilized

Salience 2/2 x 1 1 The family perceives it

as a problem needing
immediate attention
SCORE:3.33

 Fall hazards as a Health Threat

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 Forseen problem that
needs attention and
prioritization

Inadequate resources
Modifiability of the 1/2 x 2 1 and funds to utilize for
Problem modification

Cannot be prevented due

Preventive Potential 0/3 x 1 0 to lack of resources that
can be utilized

Salience 0/2 x 1 0 Has not seen as a

problem
SCORE:2

 Poor home/Environmental Condition/Sanitation: presence of breeding sites

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 It is a problem that is
common to their
environment that
requires immediate
action and attention
Modifiability of the 1/2 x 2 1 It is partially modifiable
Problem due to the nature of
environment they are
living:mostly raining
and covered with trees
and plants and muds that
can form a puddle

Preventive Potential 2/3 x 1 0.66 Partially preventive due

to the environment they
are living

Salience 2/2 x 1 1 They see it as a problem

and a health threat
SCORE:3.66

Unsanitary food preparation as a Health threat

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 It is a High problem or
risk that needs attention
and modification

Highly modifiable using

Modifiability of the 2/2 x 2 2 adequate teaching
Problem lessons

Partially preventive due

Preventive Potential 1/3 x 1 0.33 to lack of resources that
can be utilized

Salience 0/2 x 1 0 They don’t see it as a

problem

SCORE:3.33

 Unhealthful lifestyle and personal habits/practices as a threat

Criteria computation Actual score Justification
Nature of the problem 3/3 x 1 1 It is a health threat that
demands and requires
immediate action and
prevention

It is highly modifiable
Modifiability of the 2/2 x 2 2 using proper and right
Problem teaching materials

Preventive Potential 2/3 x 1 0.66 Partially preventive:

They have adequate
knowledge of the
adverse effect of their
habbit

Salience 0/2 x 1 0 They don’t see it as a

problem
SCORE:3.66

IV. List of Prioritized Health Problems

Health Problem Rank Total Score
A. Hypertension as a health 1 5
deficit
B. Poor home/Environmental 2 3.66
Condition/Sanitation:
presence of breeding sites
C. Unhealthful lifestyle and 2 3.66
personal habits/practices as a
threat
D. Family size beyond what 3 3.33
family can adequately
provide
E. Unsanitary food preparation 3 3.33
as a Health threat
F. Cross infection from a 2 3
communicable disease
G. Fall hazards as a Health 1 2
Threat

V. Family Nursing Care Plan (Top 2 Problems)

Example:
A. Health Problem (First Level Assessment)
1. Family Nursing Diagnosis/es (Second Level Assessment):
a. Pitting edema
2. Supporting Cues
a. Subjective Data:
 “Di sya gaanong kumikilos. Nasa wheelchair sya lagi” stated by the wife in Ilokano.
 According to the wife, husband is taking amlodipine only when blood pressure is high.
b. Objective Data:
 Presence of pitting edema on the left  Lack of exercises
foot  Poor skin turgor
 150/90 blood pressure  Coldness of the lower extremities
 Clubbing of nails
  Poor capillary refill
3. Goal/s: The family will manage pitting edema as a disease and a health threat.
4. Objectives
a. Long-term Objectives: All members of the family will carry out preventive measurements in
the reduction of pitting edema.
B. Short-term Objectives: The sick member will medicate himself according to the drug, doses
and duration.
5. Nursing Interventions

HEALTH GOAL & PLAN OF EVALUATION PLAN

CONDITIONS/ OBJECTIVE INTERVENTION OUTCOME METHODS/
PROBLEMS/ NURSING CARE CRITERIA/ TOOLS
FAMILY INDICATORS/
NURSING Px STANDARDS
Pitting edema GOAL: Asses the family Fully Met: The Human
As a health After the 2 weeks of level of patient Resources:
deficit nursing intervention, understanding remember Time and
the family will learn regarding the average points of effort for the
Subjective what is pitting edema present health what has been both part
cues: and necessary problem. taught to them of the
“Highblood ako measures to properly Partially Met: student-nurse
pero di ako manage, control, and remembered but and the
umiinom ng lessen its risk factors cannot state what family.
gamot para dun” as manifested by Discuss with the has been taught
enumerating at least family risk factors Unmet: did not
the average for each of of edema. remember Visuals such
Objective what has been taught anything as pictures
cues:BP: to them about the
190/70mmHg Discuss with the Fully Met: pitting
OBJECTIVES: family signs and remembered 2 or edema.
After 15 minutes of symptoms of 3 risk factors of
health teaching the edema. edema.
family will be able to Partially Met:
identify risk factors remembered
of edema as only 1
manifested by stating Unmet: did not
2 or 3 risk factors remember
anything
After 15 minutes of
health teaching the Discuss with the Fully Met:
family will have family the good remembered 2 or
adequate knowledge food that reduce 3 good proper
and good proper or prevent edema. nutrition for
nutrition that reduce edema.
edema and prevent Partially Met:
the occurrence of remembered
relative complications only 1
in the future as Unmet: did not
manifested by remembered
knowing atleast 2 or 3 anything
proper nutrition for
edema. Fully Met:
remembered 5
Discuss with the complications
After 15 minutes of family the Partially Met:
health teaching the complications of remembered 2 or
family will be able to edema. 3
give 5 complications Unmet:did not
of edema. remember
anything

Discuss with the Fully Met:

After 15 minutes of family how to demonstrate 2 or
health teaching the lessen or control 3 ways of
family will be able to edema. lessening edema.
understand how to Partially Met:
control and lessen remembered and
edema by showing 2 demostrated 1
 or 3 ways of lessening Unmet: did not
it. remembered
anything

VI. Learning Insights

I have learned that the case of my family is being taken for granted. It is not seen nor recognized by
the family as a health deficit. As an aspiring nurse, in the field of community health nursing it is very
crucial in giving attention to the family especially thst the time allotted for our community duty. I
have learned that being a community health nurse makes you realize your worth as a medical
practitioner.