Republic of the Philippines

University of Northern Philippines

Tamag, Vigan City

College of Nursing

FAMILY CASE STUDY

Acas Family
(Cabalangegan, Vigan City)

In partial fulfillment of the

Requirement in
CHN (Related Learning Experience)

Presented to:
Mrs. Deborah Azurin-Pagaoa
(Community Instructor)

Presented by:
Grace Bernadette A. Pamani
BSN II-Delphinium
(Group III)

October 10, 2009

INTRODUCTION:

Community Health Nursing is a synthesis of nursing practice, Public

Health practice, Health Promotion and Primary Health Care. The practice of
community health nursing expands into the areas of disease prevention,
health enhancement, empowerment, advocacy, community development
and research. The nature of community health nursing is comprehensive
directed towards the individual, families and the community at large. The
community health nurse fulfills a unique role in the community, promoting
and protecting the health of the community, whilst using a framework of
sustainability. Community health nursing acts to promote optimum health
of individuals and the community by promoting the right to informed
choice, advocacy and self determination. Community health nurses identify
and challenge barriers to wellness and empower people to change the
agents that affect their health adversely. Community health nursing
practice is built upon the foundation of nursing science.

OBJECTIVES:

1) This case study aims to show the family’s demographic data in terms
of their age, sex, civil status, educational attainment, occupation, and
religion.
2) The study also aims to identify normal health of the individual
members, family’s status, health problems, and abilities of the family.
3) To acquire more knowledge, develop skills of communication, develop
trusting relationship to the community.
4) To determine home and environmental conditions conducive to health
development.

FAMILY DATA:

 Head of the Family: Domingo Q. Acas

 Address: Caabalangegan, Vigan City
 Age: 65 years old
 Gender: Male
 Civil Status: Married
 Religion: Roman Catholic
 Occupation: Brgy. Kagawad and Farmer
  Educational Attainment: Elementary Graduate

MEMBERS OF THE HOUSEHOLD:

NAME RELATION AGE SEX CIVIL STATUS

1) Frocina J. Acas Wife 62 Female Married
2) Bernard J. Acas Son 38 Male Single

EDUCATIONAL OCCUPATION RELIGION

ATTAINMENT
Elementary Graduate Housekeeper Roman Catholic
Elementary Graduate Farmer Roman Catholic

INITIAL DATABASE:

A. Family Structure, Characteristics and Dynamics

Via direct interview and observation, sufficient information was able to

elicit about Acas Family.
The head of the family is Domingo Q. Acas, 65 years of age and Brgy.
Kagawad for two term. He happily lives with her wife Frocina J. Acas, 62
years old and one of his son Bernard Acas, 38 years old and single man.
They lived in Cabalangegan, Vigan City. The household is nuclear and and
the decision making is equally shared both of the couples. The couples are
also open to each other and no conflicts are made as long as they talked
about any untoward problems that arise.

B. Socio-Economic and Cultural Characteristics

The family’s expense comes from OFW remittances and their

income in farming because Lolo Domingo and Bernard are farmers.
They also have poultry as one source of their food. The 20,000 worth
money they received from one of their child in abroad would be a help to
them buy their daily needs and meet their necessities like clothes and
medication. Lola Frocina is the one responsible budgeting their money.
Lolo Domingo and Lola Frocina are both elementary graduate and
so who their son Bernard. They are all Roman Catholic. They actively
participate in seminars and meetings in their community.
 They have animals that help Lolo Domingo and Bernard in farming.
They kept in the farm. The house is owned by the couples.

C. Home and Environment

The house ids located at the back of family. They walked through a
small street corner where they put block of woods as their bridge. Because
when it rains, the ground is flooded and muddy. Their house is heavy
constructed. It is made of galvanized sheet roofing, cemented, finished and
painted walls. The whole floor of the house is covered with tiles. That is a
risk for the family to slip when the floor is wet. It is a two story house with 6
bedrooms, a sala room, dining room and kitchen room.
They have current connection. They have appliances as a source of
entertainment. Sometimes, Lola Frocina would go out to talk to her
neighbors. Left overs are kept in the refrigerator or in the cabinet. They
cooked in gas stove and sometimes they cooked in their dirty kitchen.
Their water supply comes from NAWASA. And store it in jug or place it
in a plastic bottle and put in refrigerator. They also have water pump. Their
flushed toilet is located in the side of their kitchen. And they make sure that
it is always clean. They let the water flow coming from their sink to the
backyard.
Their garbage waste is collected in a closed receptacle and burned it
in a secluded area. They ride in tricycle as mean of transportation in their
community whenever they want to go for check-up or in the market.

D. Health Status of each Family Member

As I personally interviewed Lola Frocina, she told me that they have a

history of hypertension. When she was young, her father died first and they
thought that the cause of his death is tuberculosis. Lola Frocina added that
his father fell down in the chapel and it causes him to have a heavy cough
and difficulty of breathing. Lola Frocina’s mother is hard working and her
too munch work causes her mother to have hypertension. Her mother died
because of heart attack.
 Talking of the family’s health status, Lolo Domingo was diagnosed to
have diabetes. His physician prescribed him to take Medpormin and
Glubitor as his medication.
Lola Frocina inherited her mother’s disease which is hypertension.
Before the typhoon Peria came, year 2001, she was confined to Dr.
Figurrues due to high blood pressure. She had her 3 days confinement and
went out April 9, 2001. When she consulted in Polyclinic Hospital, the result
of her X-ray is she has a heart problem. Dr. Figures prescribed her to take
Indur as a treatment of her condition. After then, she was diagnosed to
have asthma and she takes Salbutamol as a treatment of it. After the
typhoon, September of the same year, she was again rushed to Dr. Agura
for 3 days due again to her hypertension. For the past 7 years, Lola Frocina
stopped taking her medications because of the advice of her physician. She
taught that her condition was gone. Until such time, in Dec. 5, 2008, Lola
Frocina was rushed to hospital and they diagnosed it as hypertension. Not
also that, her sugar level went up more than 300. When she had her visit in
Gabriela Silang, Gen. Hospital to Dr. Rabara, she had then her mild stroke.
Now, she had to go for check-up to monitor her health condition.
Lola Frocina showed me her medicines and they are the following:
Atenolol, Glucon, Medpormin, Lozartan, Simbastatin and Indur. She takes
this in time. As to their son Bernard, she has no serious health problem
except only for common cold, cough and fever. Some problems occur
seldom like sometimes Lola Frocina is lazy to go for her check-up, Lolo
Domingo would scold her.

E. Values, Habits, Practices on Health Promotion, Maintenance

and Disease Prevention

As one measure to prevent their disease, the couple lessens their food
in fats and sweets. For they knew that it is one cause their health problem.
They eat more on vegetables and sometimes, Lola Frocina takes an
exercise by cleaning their house and watering some of her plants.
Whenever Lola Frocina had her hypertension, she stops her work and takes
a rest. To relax their tired body in working, the family take a nap for a while
or watch TV.
 TYPOLOGY OF NURSING PROBLEM IN THE FAMILY NURSING
PRACTICE

A. FIRST LEVEL ASSESSMENT

1) Presence of Wellness Condition

Acas family has readiness for enhanced capability for healthy
lifestyle and health management. They are aware of their health
condition and they try to prevent their disease by taking their
medicines, eating vegetables and limiting eating fatty and sweet
foods.
Lola Frocina tries to exercise amidst her age. The couples takes
their medicines as prescribed by doctors as a treatment for their
health condition. And they go for check-up for them to know their
health status.

2) Presence of Health Threat

As I observed, the family is at risk of accident hazard. The floor is
well covered with tiles in which the family could slip if the floor is wet.
The water is pump is located in the side of their kitchen which is
always wet. This may also cause for the family to slip if they're not
careful. The stair has sharp edges which can also be a risk of
accidents. The street corner they walked is flooded and muddy when
it rains and they just put a block of woods as an alternative foot
bridge.

3) Presence of Health Deficit

 Lola Frocina has hypertension and asthma. She’s been carrying this
for more than 8 years. She has also mild stroke. But to prevent her
health problems, she takes her medications as prescribed by her
doctors. She takes a rest whenever she feels that her hypertension
occurs. She limits to eat fatty foods and takes an exercise as a
preventive measure.
Lolo Domingo hay diabetes for 8 years. He limits taking sweets and
takes his medications. The family eats more vegetable and go for
check-up.

B. SECOND LEVEL ASSESSMENT

I. Inability to recognize the presence of the problem
The family doesn't recognize the presence of the problem. The
floor covered with tiles, the side of their kitchen, edges of stairs and
the flooded and muddy street corner where they walk are factors for
the family to get slip or fall. For them, they sees it to be normal
around their house even though it's not. For 8 years, Lolo Domingo is
carrying his health condition which is diabetes. Even he's taking
medicines and limiting to eat sweet foods, he is not fully aware of the
nature of his diabetes. Noticing him, he continue to work and serve his
fellows. Lola Frocina is aware that she has asthma but she more
prioritize her hypertension. That, makes her unaware of the nature and
severity of her health condition.

II. Inability to make decisions with respect to taking

appropriate health
As for 8 years that Lolo Domingo is carrying his health condition,
he failed to comprehend the nature of his diabetes. He is aware of it
but he takes it mildly as a normal health problem. As Lola Frocina is
telling their history of hypertension, I noticed that she taught her
hypertension is maybe due to her lifestyle and because she inherited
her mother's disease. Knowing the fact that she is concerned to her
health. In addition, Lola Frocina said that she was also diagnosed to
have asthma. She told me, whenever she feels difficulty of breathing,
she just takes a rest to lessen it. The couple is punctual in going to
hospital for them check their health status. But sometimes Lola Frocina
is lazy to go. Lolo Domingo would scold her for shes also concern to his
wife's condition.
III. Inability to provide adequate nursing care of the sick
members of the family
As mentioned at the first part of assessment, there are so many
risk factor of accident hazards for the family. They seem not to mind
it. Like the street corner where they walk, they just put a blocks of wood
as their alternative foot bridge. If this can be noticed by the family,
maybe they can seek help to the barangay for this to be fixed. And
inside of their home, they should make sure that the floor is not wet
and they must be careful in walking at the side of their kitchen.

CUES / DATA FAMILY NURSING PROBLEM

1) Risk for Accident Hazards: Slip and
Fall
 The family doesn't recognize I. Inability to recognize the presence
that the floor that is well of the problem due to:
covered with tiles could be a >Lack of knowledge
reason for them to slip
including the stairs in which I
noticed that the edges are
sharp.
 At the side of their kitchen,
on which their water pump is
located, the cemented floor is
always wet.
 The street corner where they
walk is flooded and muddy.
II. Inability to provide adequate
 They just put a block of nursing care to the sick member of the
woods as their alternative foot family due to:
bridge of the flooded and > Inadequate knowledge of
muddy ground on the street necessary equipments, facilities
corner where they walked. and supplies for care

2) Hypertension

 Lola Frocina taught her I. Inability to make decisions with

hypertension maybe respect to taking appropriate health
because of her lifestyle and action due to:
because of that she get her > Low salience of the condition
mother's disease.

 Sometimes, Lola Frocina is > Conflicting opinions among

lazy to go for check-up that's family members regarding actions
why Lolo Domingo would to take
scold her for them to know
their health status.

3) Diabetes

 Lolo Domingo is not fully I. Inability to recognize the presence

aware of the nature of his of the problem due to:
diabetes. >Inadequate knowledge

 Lolo Domingo recognizes the II. Inability to make decisions with

presence of his health respect to taking appropriate health
condition but he takes it action due to:
mildly as a normal health > Failure to comprehend the
problem. nature of the problem

4) Asthma

 Lola Frocina more prioritize I. Inability to recognize the

her hypertension although presence of the problem due to:
she is aware that she has >Inadequate knowledge
 asthma. And this make her
unaware the nature and
severity of her asthma.

 Lola Frocina verbalizes that it II. Inability to make decisions with

is normal for her to have respect to taking appropriate health
difficulty of breathing when action due to:
she feels tired in working. > Low salience of the problem

PRIORITIZATION
1) Risk for Accident Hazards
CRITERIA COMPUTATION ACTUAL JUSTIFICATION
SCORE
1) Nature of the 2/3 x 1 2/3 The problem is a health
Problem threat of the family for
it requires immediate
attention and
intervention.
2) Modifiability of 2/2 x 2 2 It is easily modifiable
the Problem cause the solution of
the problem is at hand
of the family and
community. Resources
are accessible.
3) Preventive 3/3 x 1 1 Accidents can be
Potential prevented if the family
will do the immediate
action.
4) Salience of the 0/2 x 1 0 The family is unaware of
Problem the problem that may
happen.
TOTAL SCORE 3 2/3

2) Hypertension
CRITERIA COMPUTATION ACTUAL JUSTIFICATION
SCORE
1) Nature of the 3/3 x 1 1 The problem is health
Problem deficit for it requires
immediate intervention.
2) Modifiability of 1/2 x 2 1 Patient's condition can
the Problem be partially modified.
3) Preventive 3/3 x1 1 Through continuing
Potential medication and lifestyle
change, the problem
can be prevented.
4) Salience of the 1/2 x1 1/2 The family is aware of
Problem the problem but it is
 does not need
immediate attention.
TOTAL SCORE 3 1/2

3) Diabetes

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE
1) Nature of the 3/3 x 1 1 The problem is health
Problem deficit and it requires
immediate intervention.
2) Modifiability of 1/2 x 2 1 Patient has already DM
the Problem however preventive
measures could be done
to avoid complications.
3) Preventive 3/3 x1 1 Proper knowledge about
Potential the nature of the
disease can help
prevent the
complications.
4) Salience of the 2/2 x 2 2 Patient is aware of the
Problem problem and it requires
immediate attention.
TOTAL SCORE 5

4) Asthma

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE
1) Nature of the 3/3 x 1 1 The problem is a health
Problem deficit for it requires
immediate intervention.
2) Modifiability of 1/2 x 2 1 The problem is partially
the Problem modifiable.
3) Preventive 3/3 x1 1 Through proper lifestyle,
Potential the problem can be
prevented.
4) Salience of the 2/2 x 1 1 The patient is aware of
Problem the problem and it
requires immediate
attention because the
patient more prioritize
her other disease.
TOTAL SCORE 4
Prioritized Health Problems:

Risk for Accident Hazards 3 2/3

Hypertension 3 1/2
Diabetes 5
Asthma 4

DOCUMENTATION

The street corner where they walk.

The barefoot of Lola Frocina

walking in their tiles floor.
 Entrance

The stair

Lolo Domingo cleaning their toilet.