Southern Luzon State University College of Allied Medicine Lucban, Quezon S.Y.

2012-2013

Family Case Study

Submitted to: Prof. Maria Luisa E. Barretto Prof. Clarissa D. Maguyon

Submitted by: Roeder Max R. Pangramuyen BSN IV Group 7

Community Health Nursing - Family Case Study

ACKNOWLEDGEMENT

The researcher expresses his sincerest gratitude and profound appreciation to the special persons for their invaluable support which contributed to the completion and success of this study. The researcher particularly extends his thanks to: Mrs. Maria Luisa Barretto and Mrs. Clarissa Maguyon, the researchers two dearest clinical instructor during the times of community health nursing, for the support and motivation, and instilling knowledge regarding the techniques and guidelines for the completion of the family case study. The Pavino Family, for allowing the researcher to conduct interview, formulate nursing care plan and implement the nursing interventions, and active participation in the completion of the study. Rural Health Unit of Lucban, to all the BHWs and Midwives for their untiring support and in helping us in every way that they could. Your services are greatly appreciated. Team leader, Coco, group mates -BSN IV Seven upfor showing the support in finishing this paper.

All the people who extended their support and encouragement and contributed to the success of this study.

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And above all , to the Holy Trinity, God the Father, God the Son, and God the Holy Spirit, the researchers fountain of faith hope and love. The source of strength and good health for the most difficult time, most challenging and most crucial times, for the blessings, achievements, and successes in the nineteen years of existence, for the skills and talent, for wisdom and intelligent he had pass through and use in the conduct of this study and throughout his entire college life. R.M.R.P. The Researcher

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DEDICATION

The dedication of this research work is split seven ways: To my parents, Mama and Papa, thank you for the genes you passed, untiring reminding of the fulfillment of my dreams, I was able to this research with your utmost support.To my siblings, Ate Roma, Kuya Rodemar, Roan, and Roent who serves as my inspiration to continue this profession.To my cousin, Kuya Izee Mir, one of my closest cousin, my idol of outstanding leadership and optimistic view of life. To my WINNER friends, for understanding of my shortcomings as their friend, and in times of great challenge serve as my motivator To my groupmates, SEVEN up, for being a part of my nursing life and push my limits. To Albus Dumbledore, the wisest fictional character I ever met, one of the source of the words of wisdom. To Father Almighty, I will always give Him praise and thanks for the blessings of skills, knowledge and attitude.

R.M.(RoiedXamyen) R.P. The researcher

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TABLE OF CONTENTS

Title Page

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Acknowledgment Dedication .

Table of Contents Introduction.

A. Family Case Study Proper I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. B. C. Family Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family Members Chart. Family Characteristics

General Family Relationship Dietary Habits of the Family Source of Family Income . Family Health History/ History Felt Needs of the Family .

Home and Home Environment Health and Health Practices Family Environment . .

Awareness of Community Organization . . . . .

Identification of the Problems

Scale for ranking Family health Problem .

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D. E. F. G. H. I.

List of Identified Problem

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The List of the Health Problem according to Priority. Family Nursing Care Plan . Service and Progress Record . . . . . .

Summary, Conclusions and Recommendations . Appendices

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INTRODUCTION

According to Public Health Nursing in the Philippines by Cuevas et. al, (2007) Health is a right of every human being. Healthy people are a prerequisite to national development. The DOH uses the life span approach to design programs and assist in the delivery of health services to specific age groups. It views health care of individuals within the context of the family. The term family is defined as the basic unit of the community. All members of the family are empowered to maintain their health status. Hey must be free from disease or infirmity with no disabilities. In public health perspective, the health of the family is considered as a whole and not individually.

Moreover the family health office is tasked to operationalize health programs geared towards the health of the family. It is concerned with the health of the mother and the unborn, the newborn, infant, child, the adolescent and the youth, the adult men and women and older persons.

On the other hand according to Community Health Nursing Services in the Philippines by Niscee.t. al, (2000) , Home visit is a professional face to contact made

by a nurse to the patient of the family to provide necessary health care activities and to further attain an objective of the agency. It is made to the client or to a responsible member of the family.

Student nurse as member of health care team and future professionals, are instruments in reaching the family to obtain holistic health. During home visit planning

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should revolve around the essential needs of the individual and his/her family but priority should be given to those needs recognized by the family itself. Family case study as form of home visitation to the family, should take into consideration the following factors: the physical, psychological, and educational needs of individual and family; Acceptance of the family for the services offered; the willingness and interest to cooperate; take into account other health agencies and the number of health personnel already involved in the care of a specific family; A careful evaluation of past services given to a family and how this family made use of such nursing services and the Ability of the patient and his/her family to recognize their own needs, their knowledge of available resources and their abilities to use these resources on their own accord.As a student nurse we are entitled to gain the familys trust and confidence, we may look into more detailed aspects of the household and surroundings and other health problems/concerns. Student nurse as member of Public Health Care team have significant role in ensuring the health of the family. Every effort has to be made to provide packages of health services to the family for a better and quality life.

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A. FAMILY ASSESSMENT GUIDE

I.

FAMILY DATA

The Pavino family is headed by Mr. Medes Pavino natural born of Lucban, Quezon and currently resides at SitioBurol 32 Barangay TinamnanLucban, Quezon , he works as a farmer on the lot he rented, as well as he was being hired as harvester during harvest time.is wife is Mrs. Bernadete Ratio, again a natural born of Lucban, Quezon, she had no work and act as housewife. The couple had 4 children. Pavino familys house is situated near a river and they lives amicably on their house that was made of light materials. II. FAMILY MEMBERS CHART Table 1 List of Family Members Family Member Medes Pavino Bernadete Ratio Russel Ratio Rosemarie Ratio Diana Rose Ratio Danica Rose Pavino Age Sex Civil Position Relationship Educational Status in the to the Attainment Family Family Head Single Single Single Single Single Single Father Mother 1st child 2ndchild 3rdchild 4thchild Head Wife of head of the family Son Daughter Daughter Daughter Grade 4 Occupation

39 34 12 9 4 4 months

M F M F F F

Farmer/ Hired harvester 1st year High House wife school Grade 3 Student (schooling) Grade 3 Student (schooling) -

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Table 1 one shows the list of family members of Pavino family. The Pavino family is a nuclear family composed of Mr. Medes Pavino and his wife Mrs. Bernadette Ratio; they are not married and had a good relationship for almost 17 years. They were blessed with one son and 3 daughters. They are considered as patriarchal family since that Mr. Medes Pavino is the head of the family. Since that Mr. Medes only reached grade 4, he work only as farmer, the only thing he mastered and Mrs. Bernadette Ratio is a housewife and took care of her four children. The family belongs to 4Ps or the Pantawid Pamilyang Pilipino Program. Mrs. Bernadette was given 500 pesos every month. Russel Ratio is on his 3rd grade, he stopped schooling for some years because of failing grade and absenteeism, and Rosemarie Ratio is classmate of her brother. They were obliged to go to school because they were supported of 300 pesos each of the 4Ps, and the condition is that they need to attend school without absent for continuous support. Diana Rose Ratio is the 3rd child and undernourished and Last June 2, 2013 Mrs. Ratio gave birth to her last child Danica Rose Pavino, she was the only one to have the surname of her father and she is now 4 months old. Mr. Pavino is the only member of Philhealth in the family but the children are already covered.

From Left: Mrs. Bernadette Ratio, together with her three daughters; Danica Rose Rose Pavino, Diana Rose Patio and Rose Marie Patio

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III.

FAMILY CHARACTERISTICS

The Pavino family is a simple nuclear type of family composed of couple having four children. They are considered as patriarchal family since Mr.Pavino is the one who decides for the family. They are Roman Catholic however there are times that they do not go to mass as a whole but always tried to pray if unable to attend mass. They live amicably about their day to day expenses. It was very hard for them to manage the small income from farming and need to allocate money for the basic needs such as food.

IV.

GENERAL FAMILY RELATIONSHIP

As a family, Pavino family believes on closed family ties. They own an approximately 3.5 by 3.5 m2, bungalow house made of light materials. The couple sleeps of the floor, as their 4 child shares and sleep on bamboo bed. The familys bonding time were scheduled during night time as they watch television but was not able to stroll or go out during weekends due to financial constraint and lot of works. They help each other on cleaning the house but most of the time Mrs. Ratio is the only one to do the house hold tasks.

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V.

FAMILY DIETARY PRACTICES

However the family experienced financial insufficiency, Mr. and Mrs. Make it to a point to complete healthy 3 meals per day. Sometimes if they dont have food to eat they borrow money from Mrs.Pavinos mother on their neighbourhood just to have something to eat, even the allowance of the 2 child are borrowed from her. Common breakfast is hot pandesal and coffee, sometimes if Mr.Pavino luckily has enough money they buy skinless, egg or hotdog and serve it with steam rice. During lunch time, on week days the 2 first children eat on school @ PEL, most of the times they prepare vegetables, it is often to have meat, fish or chicken as main dish. Dinner is same as lunch. Low price food such as noodles, sardines, egg, and dried fish is also served on their meals due to high price of foods.

VI.

SOURCE OF FAMILY INCOME

Table 2 Source of Family Income Family Member Medes Pavino Monthly Income Below P 5,000

Mr. MedesPavino is the only one who provides income for the family. He was a farmer with the lot he rented. He is the one to nourish, to plow, to plant, and to harvest on the said lot. It was lucky if there aresufficient amount of harvested

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vegetables. Some of the vegetables he plant are tomatoes, eggplant, okra, stringbeans and palay. He also sometimes is being hired as harvester on the lot of others. P5,000 and less was the total income of the family thats the reason why they are belong to 4Ps family and receive total of 1,100 pesos in a month. Sometimes the family has to borrow money from other relatives just to support the schooling of the two children and to buy food for their meals. VII. FAMILY HEALTH STATUS/ HEALTH HISTORY

The couple experienced and had history of asthma when they were child. By this time Mr. Medes Pavinoonly experienced fatigue after heavy work in the farm. Except from previous pregnancy Mrs. Bernadette Ratio had not been hospitalized. She only experienced tiredness after whole day of preparing the children to school, cleaning the house, taking care of the 2 last children and other house work. As to their children, they experienced fever, cough, and colds. The first two children experienced asthma attacks at times; Diana Rose the third child is considered under nourished and currently have her feeding program on the brgy. Tinamnan. Every month, weight of Diana is being monitored. The 4 months old Danica Rose only experienced cough and colds. All of the children were fully immunized children.Though financially scarce they try to keep themselves healthy by eating lot of vegetables and have check up on the RHU/BHS. Most of the timethey avail medicine from RHU/BHS, and they also visit hilot/suob as treatment. Currently the entire family have no major illness or condition that could affect their health status.

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VIII.

FELT NEEDS

Felt Needs Food Health Education Shelter Love, Security and Belongingness Clothing Self-Actualization Self-Esteem

Frequency Always Always Always Always Always Sometimes Seldom Seldom

Rank 1 2 3 5 4 6 7 8

Among all the needs food is considered as top priority of the Family, they believed that if they have enough food everyone could function well and have enough energy for the whole day of work and school. Health is also considered as one of the priorities sustenance equally since both of them is important in maintaining their holistic self.The family also values the education of first two children and they do everything just to encourage these children to finish school for brighter future. Love, security, and belongingness is also considered as their need because without these they would not able to act and fulfill their task if they were insufficient with these things. Selfactualization and self-esteem is seldom considered as need.

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IX.

HOME AND ENVIRONMENT

The Pavino Residence is made of mixed but predominantly light materials. It is bungalow house, approximately 3.5m by 3.5m. The house actually seems worn out, dusty, messy and full of weeds. The space of house is inadequate for all of them because the couples had to sleep on the floor as their 4 children were crowded on small bamboo bed. The small space of sala is also considered as dining area and it is the space used of couple to sleep at night. The house have electricity but it was faulty.Their abode is near the river which is a potential breeding site for mosquitoes and it is surrounded by trees which can be a resting site for rodents, roaches, and flies. The family own 3 cats which is pusang gala. most of the time kalan de uling was used for cooking and if luckily they can avail gas tank and used it for cooking. Charcoal and wood is used as the source of fire in cooking.The family own TV and DVD player and used use it for their relaxation. The family does not own any other appliances. They do not own a refrigerator so all their food preparation and left-overs are disposed or consumed immediately to avoid rotting. They typically prepare exact amount of food so there will be no leftover to be stored. Sometimes they missed to keep the foods safely and it was exposed to some insects. Water supply is Level I or communal faucet system. They ask for their neighbors to let them have water from their faucet and they will store it in a drum or water container. They covered the water storage carefully and sometimes they have to boil the water. The family never experiences any water borne disease like diarrhea. The family doesnt own toilet facility and they only ask their neighbor specifically mother of Mrs. Bernadette to let them void and share the toilet. They also segregate garbage, separating biodegradable to non-biodegradable as

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regard to the waste collection policy. The wet rubbishes are thrown in a pit and are covered with soil while the dry ones are thrown in a specific area where it is collected by the garbage collectors of Lucban, Quezon. The Pavino family lives in a clear, uncongested neighborhood. Houses are built far apart. Houses on their neighborhood are mixed of bamboo and anahaw, stone houses and some are mixed. In the area, there were also other families that are member of the 4Ps. Health station in brgy.Tinamnan where far from the house of Pavino family, yet they walk from their house to health station to avail medical management to their diseases. Dining Area/ Sala / Bedroom

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Kitchen Area/ Cooking Area

Entrance door

Dining Area

X.

HEALTH AND HEALTH PRACTICES

For the past few months the family experience common illness such as cough, cold and fever and the first and second child experienced asthma attacks, Mrs. Bernadette had her initial interventions then quickly approach the RHU/BHS. Third child Diana Rose, considered as malnourished was involved in the feeding program of the barangay.Sometimes the family considered visiting to suob/hilot/ and herbolarios. Often times Mrs. Bernadette Ratio prepare herbal medicines as it was available on the nearby

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houses. The family doesnt engage in exercise because they were busy of their oth er activities. The children practice hygiene but sometimes they are forgetful of washing

hands, cutting nails, oral care and other hygiene practices. Mrs. Bernadette Ratio, uses her spare time of talking with her neighbors but never forget to breastfed her 4 months old daughter. XI. FAMILY ENVIRONMENT

The Pavino Family resides in Sitio Burol, Barangay Tinamnan, which is quite far from the National Road. It is far to Barangay Health Station - Wakas, Gulang-Gulangof Barangay Tinamnan. The house is located near the river, and it seems that there are lot of plants and trees around them.The church, school, and market were also not convenient to be visited because the family had to ride jeepney or tricycle to the poblacion which is often practice. The area is near a river where they wash their clothes and dishes and sometimes and take a bath. The family were not fully aware of the environmental hazards around their residence.

Surroundings

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Front House of Pavino Family

XII.

AWARENESS OF THE COMMUNITY ORGANIZATION

Since that the family is a member of 4Ps they have slight awareness on the different programs and activities of barangay Tinamnan. As requested to them for the continuous support and membership to 4Ps they actively participate on the program that was being implemented on the barangay. They visit Rural Health Unit especially if they have diseases because the medications were given to the priority family like them. Mrs. Bernadette Ratio frequently brought her third child to the feeding program and monthly weighing and her fourth child to Expanded Program in Immunization. Mrs. Bernadette Ratio also tried to visit BHS/RHU during mothers class. As a member of 4Ps, Mrs. Ratio and the rest of the family had been active member of the community and partakes on the activities.

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B. IDENTIFICATION OF THE PROBLEM PROBLEMS Poor environmental Sanitation CUES/ DATA FAMILY HEALTH PROBLEM First Level Second Level Health Threat Inability to decide which action to take from among a list of alternatives Failure to see benefits (specifically long-term ones of investment in home environment improvement)

With messy house With unwashed dishes With unfolded clothes With dust and spider webs on the ceiling With garbage on the front of the house House made of Light House made of materials (accident bamboo and scarp prone e.g. to fire) materials such as old aluminium and broken hollow blocks Electrical Wirings are not properly arranged on the ceiling Cooking inside the house using coal and woods Cough, Fever and Most of the children had these conditions lately due to the weather and crowed area of house (approximately 3.5m by 3.5 m) a. Communicable because of inadequate living space st Asthma of 1 and The children second child experienced asthma at times, and the parents had history of asthma before Cold,

Foreseeable Inability to recognize the crisis presence of the condition or problem due to: Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically: a. Economic/cost implications b. Lack of or inadequate family resources Health Inability to provide Deficit adequate nursing care to the sick, vulnerable / at risk member of the family due to: a. lack of / inadequate knowledge and skill in carrying-out necessary intervention for care Financial resources e.g. cost of medicine prescribed Health Inability to provide Deficit adequate care to the sick, vulnerable / at risk member of the family due to: lack of / inadequate knowledge and skill in carrying-out necessary intervention for care Financial resources e.g. cost of medicine prescribed

Community Health Nursing - Family Case Study

Malnourished 3rd Child

Age in months 54 Weight 16.8 kilos Height 118.5 cm Weight not appropriate for months in age Thin With easy fatigability after playing

Health Deficit

Lack of/inadequate knowledge about child development and care Unable to feed the child with healthy and nutritious food due to a. Financial constraint b. Lack of knowledge of the foods that are not costly that can used as substitute

Family Size beyond what family resources can sufficiently provide

Big family size (6 in the family)

Financial Member of Pantawid Constraints / Limited Pamilyang Pilipino Financial Resources Program Inadequate Monthly Income of parents (almost less than P5,000. per month) Big family size (6 in the family) Household of the family finished grade four level and currently working as a farmer The mother finished 1st year high school and unemployed Presence of House is not being breeding sites of clean regularly rodents that are House is dirty and vectors of diseases slightly dilapidated Has poor sanitation Cockroaches are seen inside the house

Foreseeable Inability to make decisions Crisis with respect to taking appropriate health actions due to lack of knowledge as to alternative courses of action open to the family Foreseeable Inability to provide a home Crisis environment conducive to health maintenance and personal development due to: a. lack of skill in carrying out measures to improve home environment b. inadequate family resources specifically financial constraints/ limited financial resources

Health Threat

Inability to provide a home environment conducive to health maintenance and personal development due to: a. lack of / inadequate knowledge of importance of hygiene and sanitation b. lack of skill in carrying out measures to

Community Health Nursing - Family Case Study

Dangerous pathway to their house

Their house has a narrow stair, stiff and slippery due to presence of algae. Mrs. Ratio always carry her 4th child and increase risk for fall The family doesnt own refrigerator Letting the food left uncover at times Foods are not properly kept and let it exposed to insects.

Improper food storage

improve home environment c. inadequate family resources specifically financial constraints/ limited financial resources Foreseeable Inability to recognize the Crisis presence of the condition or problem due to: a. Lack of or inadequate knowledge and skills b. Unavailability of financial support for renovation or transfer of place of living. Health Inability to recognize the Threat presence of a problem due to: Ignorance of facts

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C. SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES CRITERIA STANDARD SCORE 3 2 1 2 1 0 3 2 1 2 1 0 WEIGHT ACTUAL SCORE 1 2/3 1/3 2 1 0 1 2/3 1/3 1 0

1. Nature of Health Deficit the Problem Health Threat Foreseeable Crisis 2. Modifiability Removable of the Partially Modifiable problem Not Modifiable 3. Preventive High potential Moderate Low 4. Salience of Needs immediate attention the problem Does not need immediate attention Not a problem

Scoring : 1. Decide on a score for each of the criteria. 2. Divide the score by the highest possible score and multiply by the weight : ( Score / highest score ) x Weight 3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight.

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G. SERVICE AND PROGRESS RECORD Date of Home Visit First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6, 2013 Fourth Visit: October 8, 2013 Health Problem Malnourished 3rd child Nursing Observation and Action Nursing Observations Age in months 54 Weight 16.8 kilos Height 118.5 cm Weight not appropriate for months in age Thin With easy fatigability after playing Easily get sick Nursing Actions a) Help the family realize the importance of proper nutrition trough health education b) Impart family to be awareness of the factors that affects and discussed it may affect health. c) Discussed and shared information about malnutrition. d) Encouraged to provide well balance diet and to increase body resistance e) Encouraged the family to implement proper food selection f) Emphasized prevention of sickness to prevent lessening appetite during meals g) Persuaded family to regularly checked the weight and height of the child or bring her to the RHU Asthma of 1st and 2nd child Evaluation of Progress On the last visit the mother verbalizes that her child continuously join the feeding program of barangay The mother stated continuous visit to RHU/BHS for weighing of her child She was not too thin at all and gain weight from 16.8 kilos to 18.7 kilos The child looks more active and playful Resolved

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6,

Nursing Observations The mother The children experienced asthma at verbalize that times, and the parents had history of incident of asthma asthma before attacks were lessened for the Nursing Actions past month and she was able to Health teaching given with the carry interventions importance of the following: given to her a) Remove house pets such as cats Partially Resolved or dogs

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2013 Fourth Visit: October 8, 2013

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6, 2013 Fourth Visit: October 8, 2013

Poor environmental sanitation

b) Maintain cleanliness of the house by daily dusting and cleaning c) Maintain normal home humidity d) Reduced exposure of the child to cold air e) Maintain childs normal weight f) Take medications as prescribed g) Stressed the importance of BHS/RHU in terms of medical management Nursing Observations With messy house With unwashed dishes With unfolded clothes With dust and spider webs on the ceiling With not segregated garbage on the front of the house Nursing Actions a) Assessed house condition b) Discussed importance of waste segregation c) Explained the effects of untidy environment to a healthy living d) Encouraged the family to utilize resources like empty rice sacks or cans as garbage containers, making sure that they are left covered. Pointed out the result of piles of garbage settled along the river to the health of the people by using water on the river, adding up to air, land and water pollution. Nursing Observations The family doesnt own refrigerator Letting the food left uncover at times Foods are not properly kept and let it exposed to insects. Water supply are not properly covered Nursing Actions

The house looks more organize than before The clothes were folded The dishes were washed immediately after use There are still some spider webs but lesser in number than before There are garbage outside the house but it is already segregated and for collection Resolved

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6,

Improper water and food storage

The foods were seen covered with plate The water is properly stored in container with cover Resolved

a) Established therapeutic

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2013 Fourth Visit: October 8, 2013

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6, 2013 Fourth Visit: October 8, 2013

Cough, Cold Fever

communication with the family b) Discussed to the family the possibilities of contaminating the food if not properly stored. c) Explained the possible consequences and compilation that they may acquire from contaminated food due to improper storage. d) Encouraged covering food properly with plates or any available and appropriate cover. Nursing Observations Most of the children had these conditions lately due to the weather and crowed area of house (approximately 3.5m by 3.5 m) Communicable because of inadequate living space Nursing Actions a) Demonstrated and explained importance of tepid sponge if body temperature is increased b) Discussed the use of herbal medications as resources c) Demonstrated back rubbing and tapping techniques for cough and colds d) Emphasized importance of adequate ventilation e) Discussed use of herbal medications as resources Stressed the importance of BHS/RHU in terms of medical management

On the second and third visit the children doesnt experience cough and colds Mrs. Bernadette Ratio verbalize that she already know interventions On the last day of visit the fourth child had cough and colds Continuous breastfeeding were given and she was brought o a paediatrician Partially Resolved

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit:

Family Size beyond what family resources can sufficiently provide

Nursing Observations Big family size (6 in the family) Nursing Actions a) Assessed the mothers knowledge regarding budgeting b) Interviewed mother about the current family budget

The family still borrows money from other relatives at times Unresolved

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October 6, 2013 Fourth Visit: October 8, 2013

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6, 2013 Fourth Visit: October 8, 2013

c) Explained the importance of proper budgeting d) Encouraged mother to continue utilizing family planning e) Showed sample budgets appropriate for the monthly income of the family f) Gave examples of cheap meals with high nutritional content g) Advised the family to use their money wisely and buy things that are needed h) Provided the family with information regarding different methods in earning extra money such as recycled papers and bottles i) Encouraged the family plant backyard vegetables such as malunggay, eggplants, etc. j) Encouraged the family to prioritized their needs from wants Instructed the family to have a list when buying foods k) Emphasized use of family planning method Presence of Nursing Observations breeding sites House is not being clean regularly of rodents and House is dirty and slightly dilapidated other insects Has poor sanitation that are Cockroaches are seen inside the vectors of house diseases With hanging clothes outside the house Nursing Actions a) Assessed the salience of the family toward the problem in poor environmental sanitation b) Listened the family mention the measures they are doing in controlling rodents and mosquitoes c) Provided health teachings on the importance of clean environment d) Discussed with the family the diseases that these vectors might

Breeding sites were eliminated as The house looks more organize than before The clothes were folded The dishes were washed immediately after use There are still some spider webs but lesser in number than before There are garbage outside the house but it is already segregated and for collection Resolved

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First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6, 2013 Fourth Visit: October 8, 2013 First Visit: September 11, 2013 Second Visit: September 17, 2013

Dangerous pathway going to their House

cause e) Encourage the family to clean every corner of their house including the outside of their house f) Instructed them to remove any stagnant water g) Instructed the family to remove the junks surrounding their house h) Instructed the family to remove the hanging clothes inside the house i) Encouraged the family to sleep with a mosquito net j) Encourage the family to make use of cheap pesticides like chalk pesticides k) Encourage the family to clean the house and the surrounding frequently Nursing Observations Their house has a narrow stair, stiff and slippery due to presence of algae. Mrs. Ratio always carry her 4th child and increase risk for fall Nursing Actions a) Assessed the knowledge of the family regarding the safety precautions. b) Encouraged to have handles at the stairs. c) Stressed importance of removing algae to stones of the stairs d) Instructed children to avoid running down the stairs.

The pathway still looks the same but algae were lessened Mr. Pavino is planning to put cement and reconstruct the stair Partially Resolved

Financial Constraints / Limited Financial Resources

Nursing Observations Member of Pantawid Pamilyang Pilipino Program Inadequate Monthly Income of parents (almost less than P5,000. per month) Big family size (6 in the family) Household of the family finished grade four level and currently working as a

The Family still borrows money from other relative but only on the most important situations Still member of 4Ps Unresolved

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Third Visit: October 6, 2013 Fourth Visit: October 8, 2013

farmer The mother finished 1st year high school and unemployed Nursing Actions a) Encouraged to search for jobs according to their skills. b) Emphasized the importance of income as means of satisfying the needs of the family. c) Explained ways and give information regarding government agency hiring. d) Encouraged to actively participate on the programs being implemented by 4Ps Nursing Observations House made of bamboo and scarp materials such as old aluminium and broken hollow blocks Electrical Wirings are not properly arranged on the ceiling Cooking inside the house using coal and woods Nursing Actions a) Discussed the importance of preventing fire b) Explained the possible life threatening effects of fire to the family and its destructing effects c) instructed to keep out fire once not in use pour water onto the fire flame or with wet blanket dispose fire ambers after use and keep it away from children d) Instructed to cook far from the house if uses coal e) assign a responsible member of the family to cook f) prepare water to keep out fire in case of emergency teach techniques on how to safely escape fire

First Visit: September 11, 2013 Second Visit: September 17, 2013 Third Visit: October 6, 2013 Fourth Visit: October 8, 2013

Fire hazards due to house made up of light materials

The tools used for cooking such as kalan de uling were brought outside the house Wirings are still not arrange Partially Resolved

Community Health Nursing - Family Case Study

H. SUMMARY, CONCLUSION, AND RECOMMENDATIONS Summary This case study was done to assess the Pavino Family. History taking were done at the visit visits and noted the following: Family Data, Family Members Chart, Family Characteristics, General Family Relationship, Dietary Habits of the Family, Source of Family Income, Family Health History, Felt Needs of the Family and assessed the Home and Home Environment, Health and Health Practices, Family Environment, and Awareness of Community Organization. After that the researcher was able to identify problems, rank them according to priority and able to formulate nursing care plan for the family. On the second and third visit the researcher implemented the different interventions for each problem identified. The family cooperates to the researcher by doing the health educations and instructions given to them. There is seen improvement on family health status and environment, but still financial problems were there. On the last visit, it was seen that some of the problems were resolved, others partially resolved and commonly the problems related to financial status is unresolved.

Conclusions Home Visitation and Formulation of nursing care plan for the family had a big impact to bring the family on the state of wellness. Even though there were problems that are unresolved it is very important to do continuous health education and visits. It is also important to encourage each family member to act, intervene and manage their on health as well as environment. A healthy family creates a healthy community and each member of the family has significant role to attain optimum health.

Community Health Nursing - Family Case Study

Recommendations Based on the findings of the study, the following recommendations were made:

Community Health Nursing - Family Case Study