Submitted by: Fernandez, Jobelline Mae Orque, Eurice Jane Pelayo, Christopher Philip Eijansantos, Ezra Ed Enriquez, Richelle

Marie BSN II-A

Submitted to: Prof. Nurhana T. Caranguian NCM Instructor

FAMILY PROFILE

Family Name: Marmol Residential Address: Block 1 Phase 5 A, Sinunuc, Zamboanga City

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A.

Family Structure, Characteristics and Dynamics

Demographic Data
Name Position the Antonio Marmol Lydia Marmol family J.Father 61 Mother 54 32 24 19 16 15 13 8 Male Female Male Male Male Male Female Female Female Married Married Single Single Single Single Single Single Single College Graduate College Undergraduate College Undergraduate College Undergraduate College Self-employed Part-time inAge Sex CS Education Occupation Estimated monthly income 5,000.00

baby 1,000.00 3,000.00 ____ ____ ____ ____ ____ ____

Michael Marmol1st child Melvin Marmol 2nd child Manfred 3rd child

sitter Factory worker None None

Marmol Jerwin Marmol 4th child Mary Marmol Mary Marmol Annalyn Marmol Grace5th child Rose6th child 7th child

Undergraduate 4th year Highschool None 4th year Highschool None 1st year Highschool None Grade 2 None

Type of Family: Nuclear Family Length of residency: 20 years Place of origin: Zamboanga City Family size: 9 members Religion: Roman Catholic (Husband) Roman Catholic (Wife)

Dominant Family Members: Father (decision-making and providing for familys needs) Mother (health care matters and budgeting of finances) General Family Relation: It is prevalent that the relationship among members of Marmol Family is good. There are no existing conflicts among the seven children, among the children and parents and as well as between parents. Members of the family interact well especially during meal time. They share their day-to-day experiences to one another. B. Socio-economic and Cultural Factors:

Income and Expenses Three members in the family share in the expenses. Mr. Antonio earns about 5,000 Php monthly. His wife Mrs. Lydia brings home 2,000 Php per month. As a factory worker, their son Michael is being paid approximately 3,000 Php every month. More or less 10,000 Php is the monthly expenditure of the Marmol family. 65% goes to the food. About 10% goes to the school needs of the children. 20% goes to electricity bills and water supply while the remaining percentage goes to other needs like grocery items and the like. The expenses are higher than their income, so there is no balance with their economic situation. The salary of the working members is not enough to support the needs of the whole family and worse, there are a lot of mouths to feed since the Mr. and Mrs. Marmol have seven children, six of which do not earn a living while the rest are still studying. As a result, some needs are left unmet. Educational Attainment Only the head of the family has finished a College Degree. The rest are undergraduates including his wife. Three of their children have stopped in the midst of their college life due to financial constraints, only one of them has a job and contributes to the familys expenses. Four children, however, are still pursuing their education in both elementary and secondary levels. Ethnic and Religious Background Both parents are of Roman Catholic in religion. Though they admit that they do not attend mass in a weekly basis, they see to it that each member of the family is instilled with faith towards the Supreme Being. Rare are the times that they pray together as a family. But this does not hinder their relationship with God. Relationship to Larger Community The place wherein the family stays is crowded. There are many people scattered out in the streets and in the sidewalks. There are also unattended children who are playing and running in the area. Most men are undressed from waist up which makes their tattoos visible to others. Despite these, they respect the nurses and other health care provider that visit their community. When we asked Mr. Antonio Marmol about their relationship to their community as well as to their neighbors, he said that sometimes there is some fighting in their area. He gives advice to his sons and daughters to avoid in the involvement of such. He kept on expressing his complaints to his barangay officials who, in their best effort, try to do something to solve this problem.

C. Housing

Housing and Environment

a.

Aadequacy of living space

The family owns the house which is made up of both hollow blocks and wood. It has two bedrooms; a bathroom and a kitchen situated outside the house. Their house measures about 6 square meters. This living space is inadequate considering the number of family members occupying the area. b. Sleeping arrangement The parents sleep on one room with their two youngest children. The other five members, however, share spaces on the other room. The parents and two children share a bed made of wood with worn-out foam mattress while the second room consists of two mats for the others to sleep on. c. Presence of Breeding/resting sites of insects, rodents or other vectors. The family lives in an area that is suitable for vectors of diseases to make it as their breeding site. Each member of the family, however, plays their role to solve this problem. Thus, theres no existing issue regarding this matter d. Presence of accident hazards There are numerous protruding nails inside and outside of their house. There is also a number of hanging debris on the walls. These make their house an accident-prone one. The family is aware of the existing problem, but do not act to solve it. e. Food storage/cooking facilities They use wood for cooking purposes. They have no refrigerator but it is not a problem for them because there are no left-overs to be stored. f. Water supply The family does not have an existing problem regarding water supply because they live near the sea. Water supply in the house is provided by the water district. They also have a public deep well 10 meters away where they can get water for storage and other purposes. g. Toilet Facility The family owns the toilet which is flushed using a pale and a dipper. The whole structure of the comfort room is cemented but not tiled but the sanitary condition is not properly maintained. h. Garbage/referred disposal The garbage is thrown on garbage cans nearby which is then being collected by the garbage collector but not in a regular basis. This impedes the sanitation at home because of

the prevalence of flies. Odor coming from the accumulated garbage can be smelled even at the familys home. i. Drainage system They have a drainage system leading to a canal which is well maintained by the community. Kind of neighborhood The family lives in a congested area where houses are almost joined together. Their neighbors are fond of gambling and vices. Their neighbors houses are far worse than theirs, with unnecessary equipments scattered outside their houses. Social and Health Facilities Available There is an available health care facility 50 meters away from their house. There are also health care providers in the vicinity who oversee the health of the families in the community. Communication and transportation facilities available Public transportation vehicles are numerous in the community. Some of which are jeepneys, habal-habal and pedicabs. The family doesnt own a personal car, so they resort to public jeepneys for transportation. Communication is made easy because Mr. Antonio owns a cellular phone which is used by the entire family. D. Health Status of Family Members

Health History His two older sons had skin disease when they were young. Michael and Manfred took antibiotics and some prescribed drugs. The doctor gave them a skin ointment called opionate. It was applied to relieve the itchiness of their skin and to prevent further irritation. After quite a few weeks, the skin disease was cured Mr. Antonio is not using any tobacco or cigarettes for almost 2 years but he admits that he drinks alcoholic beverages occasionally. His wife has no vices, as well as his three daughters and younger son. His three older sons, however, follow Mr. Antonios footsteps. But unlike Mr. Antonio, his sons do drink alcohols as often as thrice a week or when invited by a couple of friends. Nutritional Assessment a. Anthropometric Data Name Weight Height BMI 57 53 57 56 23.8 21.3 22.9 22.6 W WC 35 in. 30 in. 31 in. 34 in. HC 40 in. 39 in. WHR 0.88 0.77

Antonio J.152 lbs. Marmol Lydia Marmol Michael Marmol Melvin Marmol 120 lbs. 146 lbs. 140 lbs.

35 in. 0.89 41 in. 0.83

Manfred Marmol Jerwin Marmol Mary Grace

141 lbs. 127 lbs. 119 lbs.

56 55 54

22.8 21.1 20.4

32 in. 29 in. 2 in. 27 8

40 in. 34 in. 34 in.

0.8 0.85 0.79

Marmol Mary Rose93 lbs. Marmol Annalyn Marmol b. Eating / Feeding Habits 53 lbs.

5 45

18.2 13.3

26 in. 18 in.

31 in. 24 in.

0.84 0.75

Mr. Antonio makes it a point that he feeds his seven children because he believes to the saying health is wealth. Admittedly, his youngest daughter Annalyn has had poor eating habits as a child. She prefer a meal with rice and soy sauce rather than mixing it with other delicacy. She usually skips meals, prefers not to eat in regular intervals and lies to her parents about it when asked whether shes done eating not yet. The sleeping patterns of the Marmol family affect the eating pattern of the family. The other members of the family are able to skip their breakfast. But they usually take midnight snacks. Before they sleep the younger members of the family eats three meals a day. Their breakfast is usually consists of egg, dried fish, rice and fish while their lunch is usually composed of fried fish, vegetables and rice. They usually drink juice, soft drinks and water. The younger members of the family often demand for soft drinks rather than water. The parents do not tolerate their children for that thing, because they are aware that soda has negative effects in the body when it is consumed in large amount. Mr. Antonio and his wife make sure that their younger son and three daughters are not drinking any alcoholic beverages. The children eat junk foods and chips during merienda time. Because of their eating patterns, they tend to acquire the nutrients an individual must have. But still, the younger members of the family are prone to diseases and infections because of their not totally good resistance, especially Annalyn, the youngest of the children. E. Values and Practices on health maintenance Immunization Vaccines BCG DPT 1 DPT 2 DPT 3 OPV 1 OPV 2 OPV 3 HEP B1 HEP B2 HEP B3 MEASLES* Sleeping pattern: Marmol family does not sleep together at the same time. The younger members of the family sleep from around 8:00- 9:00 in the evening because they easily get tired after their school hours while some of the older members of the family usually sleep at 11 oclock in the evening because they are busy in doing things like having conversation with each other and also doing vices such as drinking alcoholic beverages and smoking cigarettes. 1st child / / / X X X X / / X X 2nd child / / / / / / / / / / / 3rd child / / / / / / / / / / / 4th child / / / / / / / / / / / 5th child / / / / / / / / / / / 6th child / / / / / / / / / / / 7th child / / / / / / / / / / /

The parents and the older son wakes up at around 5:00 or 6:00 in the morning to prepare the foods for the other members of the family. The children have no time in taking naps during afternoon because they always play and hang out with the other children in their neighborhood after school hours.

Healthy Lifestyle Practices The family seeks medical attention whenever needed. With the presence of barangay health clinic and sufficient health care providers in the area, they are able to aid the family with their health concerns. Mrs. Marmol admits, however, that they are not very particular on the promotion of health of each member of the family. They concentrate more on the curative aspect. Leisure and recreation: Marmol family spends most of their leisure time together. Their siblings are always around, they have the time to spend time together. But sometimes children are fond of playing in the sidewalks or to their neighbors house. The family of Mr. Antonio has enough time to have some discussion with one another. When there is a free time, the two older sons of Mr. Antonio drinks alcohol and at times they use cigarettes. Protective Measures The family owns several bed nets used during sleeping. They also use improvised katol every now and then. This is to protect themselves from mosquitoes because they are aware of diseases like Dengue. FIRST LEVEL ASSESSMENT
Health Deficit 1. 1. Malnutrition - eight-year-old Annalyn, stands 45 in height and weighs 53 lbs. Her BMI is 13.3 which is below the normal level. Health Threat Presence of vices in the family - frequent alcohol intake of Mr. Marmol - smoking (1 pack in 2 days) and drinking habits the older children 2. Poor sanitation -presence of flies inside and outside the house -unhygienic toilet facilities -presence of breeding sites e.g. house is near the garbage disposal 3. Accident Hazards of Foreseeable Crisis

a.

Numerous

protruding

rusty nails located inside and outside the house 4. Inadequate Living Space - nine family members in a six meters square house.

SECOND-LEVEL ASSESSMENT

CUES/DATA > Annalyn, eight years old, stand 45 in height and weighs 53 lbs. Her Body Mass Index measures 13.3 which is below the normal level. > The youngest child of the family looks pale, lethargic and apathetic; markedly underweight and malnourished. > Mr. Marmol verbalizad, Maskin de antes, hinde ya gayot le mahilig kome. Pirmi lang kanun nuay ulam ta kome. A.

HEALTH PROBLEMS Malnutrition as a health deficit 1. Inability of to recognize in the a presence knowledge 2. Inability to decide about taking appropriate health action due to failure to comprehend the nature, magnitude and scope of the problem 3. Inability to provide adequate nursing care to a member suffering from malnutrition due to: a.lack b. of knowledge about health condition lack of knowledge on the nature and extent of nursing care needed c.inadequate resources for care i.e., financial constraints B. Accident Hazards as Health Threat malnutrition

dependent member due to lack of

> A number of protruding nails exist in and out of the house. >The mother said, Pirmi gayot kame ali ta iri tiene kel diya, ya liba gat kame kun Rose na health center porkawsa kunese.

1.

Inability to recognize how hazardous

the environment is due denial about its existence or severity as a result of fear of consequences of diagnosis of problem specifically economic or cost implications. 2.Inability to make decisions with respect to taking appropriate health action due to: a. failure to comprehend of of the the the nature/magnitude problem or condition b. c. Low salience problem/condition inadequate family resources for care 2. specifically financial constraints Inability to provide a home environment conducive to health maintenance and personal development due to: a. failure to see benefits in of investment home

environment improvement

> Poor sanitation in their environment > Existence of flies and other insects that can cause illness > Poor maintenance on the sanitation of the familys toilet facility. >Tiene aki serka butahan de mga basura poreso muchu moskas na kasa. Asta aki, ta ginda gayot el olor. Anad ya man kame, poreso ta deha ya lang. Bahala ya, as stated by Mrs. Marmol.

C. Poor Sanitation as Health threat 1. Inability to recognize how hazardous the environment is due to lack of knowledge 2.Inability to make decisions with respect to taking appropriate health action due to: b. failure to comprehend of of the the the nature/magnitude problem or condition c. Low salience problem/condition 3.Inability to provide a home environment conducive d. to health to maintenance see benefits in and of personal development due to: failure investment e. home

environment improvement Lack of inadequate knowledge of importance of hygiene and > The father is not a good role model for his children. He is seen with other friends drinking alcoholic drinks. > Mr. Marmol stated, Ta abla man tamen yo kanila kay poko poko lang puma y toma. Normal lang man se, basta numa sobra. El problema, hinde sila ta pwede kontrola di ila pumada y tomada. >Older children of the family are into drinking and smoking. b. D. sanitation. Presence of vices in the Family as Health Threat a. by Inability vices due to to recognize lack of the or its presence of problem brought about inadequate Inability knowledge to provide about

effects to their health adequate nursing care to the vulnerable or atrisk member of the family due to: i. lack of carrying interventions therapeutic regimen or inadequate out like knowledge and skill in

ii.

Philosophy in life which hinders caring of the at-risk

member of the family c. Failure negative to utilize in community life which resources for health care due to attitude hinders utilization of community resources for health care Inadequate Living Space > The family is composed of nine members in a six meters square house. > Five children share space on the floor and on the bed inside a small bedroom while the other two younger children sleep with their parents in the other room. b. 1. Inability to recognize the presence of problem brought due to: a. lack of or inadequate knowledge about its effects to their health Lack of knowledge

2. Inability to make decisions with respect to taking appropriate action due to: a. failure to comprehend the nature of the problem or condition; b. low salience of the problem. 3. Inability to provide adequate nursing

care to the vulnerable or at-risk member of the family due to: a. inadequate family resources, specifically resources; b. failure to see benefits of investment in home environment improvement. limited financial

PRIORITIZATION OF HEALTH PROBLEMS

1.

Inadequate living space

Criteria 1. Nature of the

Computation

Actual Score

Justification
The problem is a health threat. There is a possibility to acquire different diseases, which is easily to transfer to other member of the family, most specially the younger ones due to insufficient space.

problem 2/3 x 1 2.Modifiability of the Problem 0/2 x 2 0 0.67

The problem is not modifiable because this problem involves social problem, specifically financial constraints. It is difficult to solve the problem when resources are not available.

3. Potential

Preventive

3/3 x 1 1

Occurrence of the disease or illnesses can be prevented if they recognized the importance of having enough space for the family.

4. Salience of the Problem 1/2x 1 0.5 2.17

The family does not see it as a problem which needs immediate attention because the family has already adjusted to this kind of lifestyle.

2.

Presence of vices in the Family Computation Actual Score Justification

Criteria

1.

Nature

of the

The problem is a health threat. Smoking may lead to respiratory problems which may be fatal over time if not solved. Drinking alcoholic beverages can also lead to kidney diseases and the like.

problem

2/3 x 1

0.67

2.Modifiability the Problem

of

The problem is partially modifiable.

The

1/1 x 2

family is aware of the effects of these vices to the body because they are experiencing it physically and psychologically but they tend not to stop it because of dissatisfaction. They consider taking cigarettes or alcohol as a past time activity. Resources of the community- they can easily buy any kinds of alcoholic beverages and cigarettes in the store in the front of their house or anywhere in the community.

3. Potential

Preventive

The problem is moderate in preventive

2/3 x 1

0.67

potentialLength of the problem- The problem has long existed. The head of the family sets a bad example to his children. Presence of high risk individuals- Their siblings especially the youngest are exposed to that kind of action and eventually they can imitate those practices. Availability of resources- There are absence of resources to be used to stop this kind of practices.

4. Salience of the Problem

The problem is not yet and perceived- The family does not think that it is a serious problem. They see it as normal because

0/2 x 1 2.34

almost everyone practices it in the community.

3.

Poor Sanitation

Criteria 1.Nature of the problem

Computation 2/3 x 1

Actual Score 0.67

Justification
The problem is a health threat. The family is prone for having many diseases and illness because the environment in where they live is unclean and not properly organize.

2.Modifiability of the Problem

It is partially modifiable. Current knowledge- They are not aware that poor sanitation may cause lot of diseases. Resources of the nurse- The nurse has knowledge and skills that is applicable for the solution of the problem. There is an available resource like: plastic bags, different cleaning materials and trashcans.

1/2 x 2

3.

Preventive

1/3 x 1

0.33

The

problem

is is

low a

in

preventive of the

Potential

potential. There

severity

problem because of poor sanitation. Their community as a whole does not practice healthy living and promoting lifestyle that is why it is very difficult to implement preventive measures regarding this matter.

4. Salience of the Problem 1/2x 1 0.5

The

problem

doesnt

need

immediate

attention because in this condition the family is already immune, and they can easily go with the flow in this kind of environment.

4. Malnutrition
Criteria Computation Actual Score 1,Nature Problem of 3/3 X 1 1 It is a health deficit that requires immediate management consequences 2. Modifiability of the Problem 2/2 x 1 2 The problem is easily modifiable since the nurses sources are available; she can help the family on effective budgeting of money and scheduling of time; she can develop the skills of other members to achieve good 3. Preventive 3/3 x 1 1 Susceptibility to other diseases and infections can be prevented if malnutrition is eliminated; normal growth and development 4. Salience of 0/2 x 1 0 can thus be achieved. the Problem nutrition. Potential to eliminate untoward Justification

It is not a felt problem for the family. The family does not pay much attention to this problem considering the number of members in that particular family. Total Score 4

5. Accident hazards Criteria Computation Actual Score Justification

1. Nature of the Problem

2/3 x 1

0.67

It is a health threat which is conducive to infections, diseases and accidents.

2. Modifiability of the Problem

2/2x 2

1.00

It

is

easily the

modifiable community

since which

there are available resources within could solve the problem.

3. Potential

Preventive

3/3 x 1

1.00

It

has

high

preventive

potential since if the hazards are eliminated, the members of the community will be safe and free from possible diseases and accidents.

4. Salience

2/2 x 1

1.00

The family sees this problem as something that needs immediate attention because of the different accidents it may cause.

Total Score

3.67

List of Health Conditions and Problems Ranked according Priorities 1. 2. 2. 3. 4. Malnutrition Accident Hazards Poor Sanitation Presence of vices in the Family Inadequate Living Space 4 3.67 2.50 2.34 2.17