207528705 family-case-study-1

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College of Nursing Education3rd Floor, DPT Building

Matina Campus, Davao City

Telefax: (082)

Phone No.: (082)300-5456/300-0647 Local 141

A Family Case StudyPresented

To theCollege of Nursing

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In Partial fulfillment of the Requirement in Community Organizing Participatory Action

Research Family Case Study

Submitted to:Ms. Arlene D. Layupan, RNMr. Henrries Dan Tulas, RNMr. Ronald Allan Ramo, RN

Submitted by:Celedonio, Precy Babe B.

September 21 2013

T A B L E O F C O N T E N T S

I.TITLE PAGE.....................................................................................................1

II.TABLE OF CONTENTS................................................................................2

III.ACKNOWLEDGEMENT...............................................................................3

IV.INTRODUCTION...............................................................................................4 V.OBJECTIVES of the CASE.........................................................................5

VI. IDENTIFICATION OF THE CASE....................................................................6

VII.FAMILY BACKGROUND............................................................................7

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VIII.SOCIO- ECONOMIC BACKGROUND............................................................8

IX.FAMILY MEDICAL and HEALTH HISTORY...................................................9

X.GENOGRAM....................................................................................................10-11

XI.FAMILY APGAR........................................................................................12

XIII.FAMILYCOPING INDEX...............................................................................13-17

XIV.NURSINGTHEORY......................................................................................18-19

XV. MANAGEMENT

A.MEDICAL MANAGEMENT....................................................................................................20-24

B.NURSING MANAGEMENT

B.1 Problem List (Maslow’s Hierarchy).....................................................25-27

B.2 Problem Identification (Health Threat/ Deficit/ Foreseeable Crisis)...28-29

B.3Family Nursing Care Plan....................................................................30-33

B.4Health Teachings (Three Levels of Prevention)..................................34-35

XVI.IMPLICATION................................................................................................36-37

XVIII.HEALTH UPDATES.............................................................................................................38-40

XIX.REFERENCES...............................................................................................41

ACKNOWLEDGEMENT

I, would like to express the heartfelt gratitude to the following people for their

professional direction.

To Mr. Ronald Allan Ramo, RN, Mr. Henrries Dan Tulas RN; Miss Analyn

Salamero RN; and Miss Arlene Layupan, RN and for their valuable guidance and

help during the entire community exposure.

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To Dean Ofelia C. Lariego , RN, MAN; for allowing us to have our exposure

and giving us the chance to improve our knowledge and skills in Community Health

Nursing.

To my beloved family, who always there to support me in any problems. For

the financial support that they gave to me in order to attend school and duties.

The fourth year BSN students would like to extend their sincere appreciation

to their individual family for their unstoppable financial support and for unending

prayers to keep us safe during the community exposure.

To the Brgy. Captain Robert Olanolan, for permitting us to conduct the

community exposure.

To all residents who willingly cooperated in all our activities.

And finally, I would like to thank our Almighty God for His guidance and

protection during our activities and difficulties in going to the community.

INTRODUCTION

Hypertension, also referred to as high blood pressure, is a condition in which

the arteries have persistently elevated blood pressure. Every time the human heart

beats, it pumps blood to the whole body through the arteries.

Hypertension is considered as the biggest single risk factor for deaths

worldwide. According to the World Health Organization 2012, hypertension causes 7

million deaths every year while 1.5 billion people suffer due to its complications.

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We chose Ms. XY’s case because her case is one of the most common

disease worldwide afflicting humans, which is hypertension or high blood pressure. It

is known as silent killer because in the initial stage it presents no symptoms. It is only

after an organ in the body is irritated or damaged, that the consequences of high

blood pressure are realized.

Lifestyle nowadays is one of the major precipitating factors of the condition.

These lifestyle factors include high sodium intake, excessive calorie intake, and

obesity, physical inactivity and excessive alcohol consumption.

OBJECTIVES

After 12 days of span of nursing care:

Determine the level of cognition in the determination and prioritization of

problems that exist in the community.

Develop the skill of intervention prompt to the social health care problem in

accordance with its appropriateness and effectiveness.

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Provide services and facilitate for the better and appropriate solutions present

in a particular community.

SPECIFIC OBJECTIVES:

After 12 days of span of nursing care:

1. Apply knowledge and skills on how to give health education to the community

in relation to their identified problem;

2. Discuss briefly and explain the etiology of prioritized problem, its causes and

effects and ways on how to eradicate it;

3. Determine the families Apgar score and family coping index in assessing the

functioning and potential areas of family strength and resources.

4. Established a nursing care plan which would be beneficial to the family, as

well as to the community;

5. Formulate a clear and specified plan of action to give solutions to the existing

health problems identified within the community

6. Present data and proof about the common health problem of the community

residents;

7. Relate existing health problems with different nursing theories; and

8. Evaluate the effectiveness of the plan of action and the entire program

performed in the community;

9. Give summary, evaluation and implication;

IDENTIFICATION OF THE CASE

Code Name: Mrs. XY

Nationality: Filipino

Religion:      Roman Catholic

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Address:       Barangay 76-A, Bucana, Davao City

Age:              47 years old

Occupation: Housewife, carpenter

Civil Status: Married

Menarche:    14 years old

Parity:          5

Gravida:       5

Abortion:       0

Menstrual Cycle: Irregular usually her menstrual cycle interval is 2-3 months

Diagnosis:           Hypertension (2009)

Date study Begun:  August 30, 2013

Date study Ended: September 21, 2013

Informants: Daughter

FAMILY BACKGROUND

The XY family, an extended type of family is the chosen to be the subject of

my case study. They are currently residing at Barangay 76-A, Purok 6-A, Bucana,

Davao City. Mrs. is 47 years old, a college undergraduate, a housewife but

sometimes works as a carpenter in Bucana earning not less than 3000 a month but

lately experiencing Dizziness. She is also the one making the decision in terms of

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their financial budget. Her husband Mr. XY is 48 years old, an elementary graduate,

and works as a trisikad driver in Bucana was diagnosed with hypertension last

2011.Mr. XY is the one making the decision in relation to health, problems in the

family and sometimes the one who budget with regards to financial. They have 5

children but only 2 are still dependent and living with them. Their eldest child is 29

years old, a high school graduate, married with 4 children and work as a domestic

helper at Kuwait. Their 2nd child is 26 years old, also a high school graduate, single

and working as a construction worker. Then, their 3rd child is 25 years old, married

and works as a farmer at Bucana. Their 4th child is 23 years old single and works as

a saleslady at Lachmi San Pedro street, Davao City. Lastly, their 5th child is 17 years

old, still student and studying at Kapitan Tomas.

Their family has owned their house that is made of light wood and cement

with 2 rooms. They have no enough furniture. They have one Television, DVD,

internet, telephone, karaoke and an insufficient lighting facility. They also have a

public water supply, a water sealed type of toilet facility near their kitchen, has also

an open drainage system. They are also composting their garbage and uses

firewood in cooking

SOCIO-ECONOMIC BACKGROUND

Mrs. XY is 47 years old, and is married to Mr. XY who is a Trisikad

Driver in Barangay 76-A, Bucana. She is a housekeeper and a loving mother to her

five (5) children. The eldest child works as a domestic helper at Kuwait. Their 2nd

child is working as a construction worker. The third child works as a farmer at

Bucana. The fourth child works as a saleslady at Lachmi San Pedro Street, Davao

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City. Their 5th child is 17 years old, still a student and studying at Kapitan Tomas.

According to her, they have a good family relationship; they are close to each other.

Mrs. XY is a college undergraduate. She works in her place as a carepenter, and she

also have small business. They earned P4000 to P5000 per month together with her

husband. They ate 3 times meal in a day. According to XY when there are health

emergencies, her two (2) children give a small amount as financial support. If there is

no support coming from her children, Mrs. X will borrow money from their neighbor

with an interest. The structure of their house is made of wood and cement. It has two

rooms for her children and they have a comfort room. The location of their house is

near to stagnant water. The setting of the houses is much closed and they are prone

to fire cases.

FAMILY MEDICAL and HEALTH HISTORY

The XY family is residing at Barangay 76-A, Bucana, Davao City is compose

of 7 members; Mr. and Mrs. XY with their five children. The eldest and the 2nd child

are known smokers and occasional alcohol drinkers. The third, fourth child and the

youngest have no known disease or illness. They experience common colds and

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cough especially during rainy season, they usually self-medicate and they do not

have any regular check-up.

Mrs. XY, 47 years old, who experience dizziness especially when she’s

overworked. She is not interested to go for check-up due to lack of financial

resources and at the same time her perceptions of services delivered by the health

care provider in their health center is not appropriate, according to her, the services

are not complete and sometimes they don’t prioritized people.

A 48 year old female client, Mr. XY was diagnosed with hypertension last

2011 in a medical mission within their community. Initial blood pressure was taken

with a reading of 140/100 mmHg. She was then prescribed with Captopril 50 mg OD

@ HS as maintenance medication but he had poor compliance due to lack of

financial resources.

A medical check-up was conducted again last August 30, 2013 and she had

her 2nd check-up and had the same findings with a blood pressure of 120/100 and

same drug was prescribed.

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G E N O G R A M

LEGENDS:

Deceased Female Married

Deceased Male Male

Identified Client

Identified Client’s husband Female

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Interpretation

This Genogram shows the family diagram of the XY Family from the 1st

generation to the 3rd generation. Included in this diagram are the diseases that were

experienced by the selected members of the family.

Mrs. XY can still recall the age of her parents who already died. According to

Mrs. XY her mother died due to hypertension at the age of 72 while her father also

died due to hypertension with the age of 74.

Mr. XY’s parent’s both died last 2007. His parent’s died due to hypertension.

According to Mr. XY, one of her sister died due to cyst in the breast while his other

sibling’s most common illness is hypertension.

The second child complaints also of difficulty in breathing but according to

Mrs. XY they just let his son to have rest and eat plenty. While there 5th child has

history of asthma since he was 5 years old. But it just triggers when his child is

exposed to dust.

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Family Apgar

Adaptation 2 Both parents help each other in terms of financial

and health problems.Partnership 2 They have a good

relationship when it comes to decision making such as

financial concerns. The couple discussed it

together with their children. In terms in decision making to health, the father is the one who decides and plan

for a good health.Growth 2 The mother stated that

there were no vices are practiced in the family. But

her husband drinks occasionally and so with

her siblings. They can eat 4 times a day together with

snack.Affection 2 The family always has time

to bond with each other by doing recreational activities such watching movies and

videoke.Resolve 2 The family has no enough

time especially in problems with their children.

Total 10 The family Apgar result is 9 which mean that their

family is highly functional. It shows that their family is able to communicate well

and use the proper resource present in the

community.Scoring: Total score:

0 point = “Hardly ever” 0-3 = severely

dysfunctional family

1 point = “Some of the time” 4-6 = moderately dysfunctional

family

2 points = “Almost always” 7-10 = highly functional family

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FAMILY COPING INDEX

Family: Family XY Date: August 30,2013

Address: Barangay 76-A, Bucana,Davao City

Family Coping Areas Point scales Assessed Problems Justification

1 2 3 4 5 The family is capable of doing their activities of daily living independently

PHYSICAL INDEPENDENCE X None

THERAPEUTIC COMPETENCE

X Lack of financial resources to avail maintenance medication

Mrs. XY has lack of maintenance in medication because according to her she don’t practiced taking medications because it has no cure being given and it is expensive.

KNOWLEDGE OF HEALTH CONDITIONS

X Not enough knowledge in health conditions.

Mrs. XY verbalized that she lessen her intake of sweets but she is not aware of increased in salt can contribute to

bad health. She also does exercise in the morning.

APPLICATION OF PRINCIPLES OF GENERAL HYGIENE

X . Lack of action in cleaning their surroundings.

The family have improper disposal of garbage and the stagnant water is near their house. As we can see the

mosquitos are breeding to the stagnant water.

HEALTH ATTITUDES X They don’t have first aid kit and they do not have regular check-

up. They don’t trust the

Mrs. X once verbalized that they don’t have enough money to buy medications especially to their

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services given by the health center.

grandchildren.

EMOTIONAL COMPETENCE X None Mrs. XY verbalized that whenever they have problems in the family, they just talk about it. Sometimes they ask for help through their neighbors if it’s already big problems.

FAMILY LIVING X The family has enough resources because they also

have small business.

Mrs. XY verbalized that they can still eat 3x a day and can buy stuffs to their children because their children gave money also from their job. Mrs. XY’s sister who is in

abroad and gave enough money for their family.

PHYSICAL ENVIRONMENT X Their house is made of wood and cement. Stagnant water is near to their house.

Their house is near in stagnant water and there would be possibility that mosquito will live there and will attack to

children causing dengue.

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USES OF COMMUNITY RESOURCES

X Inability to take action to avail the services in the healh center.

Mrs. X verbalized “Dili man kaau mi naga adto ug health center kay dili nila mahatagan tanan na nanginahanglan ug dili ka mahatagan ug tambal.”

Scaling: 1- no competence, 3- moderate competence, 5- complete competence

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Family Coping Index

The score for Physical Independence is 5 because the family is capable of

doing all of their daily living activities independently.

The Therapeutic Competence scored 4 because Mrs. XY has no enough

maintenance in her medication. She is not used and practiced to take any drugs.

Knowledge of Health Education is scored 3 because Mrs. XY used to eat high

in salt foods, she is not aware what would it contribute to bad health. She also does

exercise in the morning.

For the Application of Principles of general hygiene we scored 3 the family

have improper disposal of garbage and the stagnant water is near their house. As we

can see the mosquitoes are breeding to the stagnant water

In Health attitudes we scored 3 because Mrs. XY once verbalized that they

don’t have enough money to buy medications especially to their grandchildren.

For Emotional Competence we scored 5 because Mrs. XY verbalized that

whenever they have problems in the family, they just talk about it. Sometimes they

ask for help through their neighbors if it’s already a big problem.

For Family living we scored 4 because Mrs. XY verbalized that they can still

eat 3x a day and can buy stuffs to their children because their children gave money

also from their job. Mrs. XY’s sister who is in abroad and gave enough money for

their family.

In Physical Environment we scored 3 because their house is near in stagnant

water and there would be possibility that mosquito will live there and will attack to

children causing dengue.

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For the use of Community Resources we scored 2 because Mrs. X verbalized

“Dili man kaau mi naga adto ug health center kay dili nila mahatagan tanan na

nanginahanglan ug dili ka mahatagan ug tambal.”

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Nursing Theory

Florence Nightingale’s (Environmental Theory)

Florence nightingale’s theory talks about how important environment is to our

health. Like the ventilation and warmth, light, cleanliness, health of houses, noise,

bed and beddings, personal cleanliness, variety, chattering hopes and advices,

taking foods, petty management and observation of the sick.

Florence Nightingale’s can be applied to my family case study because the

ventilation of our client’s house is not really good, because they don’t have enough

windows and the light of their house is insufficient. Cleanliness is fair, but they are

risk of having diseases due to the stagnant water near to their house. . The location

of the house is prone to fire cases because the setting of the houses are too near

and many stock water near to it. Mrs. XY cannot have diagnostic test because of the

financial constraints.

Virginia Henderson (14 basic Human Needs)

Henderson conceptualized the 14 Fundamental Needs of Humans, which are:

breathing normally, eating and drinking adequately, eliminating body wastes, moving

and maintaining desirable position, sleeping and resting, selecting suitable clothes,

maintaining normal body temperature by adjusting clothing and modifying the

environment, keeping the body clean and well groomed to promote integument,

avoiding dangers in the environment and avoid injuring others, communicating with

others in expressing emotions, needs, fears, or opinions and worshipping according

to faith. She believes that Health is a quality of life and a basic for a person to

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function fully. It is important for a healthy individual to control the environment but as

illness occurs, this ability is diminished or affected in caring for the sick.

Virginia Henderson’s theory in relation to my family that I chose to study is

essential information because this family has insufficient financial resources that

sometimes they can not even buy medicine if someone is ill. The family doesn’t have

any access to the services given by the health center. In times when there is

problems such as health concerns, they just let the member of the family who is sick

subsides his or her illness but if it get worst they easily take the sick child to the

hospital.Base on Henderson’s theory this family really has an alteration in their 14

Fundamental Needs of Humans.

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Medical Management for Hypertension

Overview of Hypertension

Hypertension or High Blood Pressure, medical condition in which constricted

arterial blood vessels increase the resistance to blood flow, causing an increase in

blood pressure against vessel walls. The heart must work harder to pump blood

through the narrowed arteries. If the condition persists, damage to the heart and

blood vessels is likely, increasing the risk for stroke, heart attack, and kidney or heart

failure. Often called the “silent killer,” hypertension usually causes no symptoms until

it reaches a life-threatening stage. Hypertension is a major risk factor

for cardiovascular disease   (CVD) - cerebrovascular event (CVE) and ischemic

heart disease (IHD) and, as such, is one of the most important preventable causes

of premature morbidity and mortality in developed and developing countries. Yet

studies still show that hypertension remains under diagnosed, undertreated and

poorly controlled. The benefits of antihypertensive therapy in reducing the incidence

of CVD depend largely on blood pressure (BP) lowering - so achieving stated BP

targets is important.

Ideal Medical Management

Physicians recommend that people with prehypertension undergo diet and

lifestyle changes, such as losing weight and quitting smoking, in order to prevent a

rise in blood pressure. Some patients can lower their blood pressure by limiting salt

in their diet. Increasing physical activity and reducing alcohol consumption to less

than two drinks per day for men and one drink per day for women may also lower

blood pressure.

For those with stage 1 and stage 2 hypertension, a physician may prescribe diet

and lifestyle changes, as well as one or more drugs known as antihypertensive.

Diuretics are antihypertensive that promote excess salt and water excretion, reducing

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the amount of fluid in the bloodstream and relieving pressure on blood vessel walls.

Beta blockers reduce heart rate and the amount of blood the heart pumps. ACE

inhibitors prevent the narrowing of blood vessel walls to control blood pressure.

Calcium channel blockers slow heart rate and relax blood vessels. Studies show that

two drugs are more effective than one drug at lowering blood pressure to less than

140/90 mm Hg.

Laboratory and diagnostic test for hypertension

Besides taking your blood pressure, your doctor will do a physical exam and

ask you questions about your medical history. Your doctor may also have you get

other tests to find out whether high blood pressure has damaged any organs or

caused other problems. These tests may include:

Urine tests to check for kidney or liver disease.

Blood tests to check your levels of potassium, sodium, and cholesterol.

A blood glucose test to check for diabetes.

Tests to measure kidney function .

An electrocardiogram (EKG, ECG) to find out whether there is any damage to

the heart. Your doctor may also check your risk of coronary artery disease.

In some cases, you may be asked to check your blood pressure at home and

keep a record of the readings. If you can't do this, you may need ambulatory blood

pressure monitoring. This means wearing a special device for 24 to 48 hours. The device

automatically takes your blood pressure throughout the day.

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Actual Medical Management

Mrs. XY tell us that she was diagnosed with hypertension by a doctor last

2009.The doctor prescribed her with antihypertensive drug which is Captopril 50 mg.

1 tab per day. Aside from that, she also practices traditional medicine which

is”pinakuluang guyabano” as an alternative if she cannot buy Captopril. She also

practices eating less salty and fatty foods as advised by the doctor.

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Drug Study

Brand Name: Captopril

Generic Name: Capoten

Drug Classification: Anti-hypertensive drug, cardiovascular agent

Indications: Hypertension; in conjunction with digitalis and diuretics in CHF, diabetic

nephopathy

Contraindications: Pregnancy, lactation. Safe use in children not established.

Mechanism of action: Lowers blood pressure by specific inhibition of the

angiotensin-converting enzyme. This interrupts conversion sequences initiated by

renin that lead to formation of angiotensin II, a potent endogenous vasoconstrictor.

Dosage: She took 1 tab Captopril 50 mg. Adult Is PO 6.25-25 mg TID may increase

to 50 mg TID.

Side effects: Hyperkalemia, pruritus, azotemia, nephrotic syndrome, urticarial,

dizziness, photosensitivity

Nursing responsibilities:

1. Monitor BP closely following the first dose. A sudden exaggerated

hypotensive response may occur 1-3 of first dose especially those with

high BP.

2. Advise bed rest and BP monitoring for the first 3 hours after the initial

dose.

3. Monitor therapeutic effectiveness at least 2 weeks of therapy may be

required before full therapeutic effects are achieved.

4. Consult physician promptly if vomiting or diarrhea occurs.

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5. Report darkening or crumbling of nail beds (reversible with dosage

reaction)

6. Use OTC medications only with approval of the physician.

7. Emphasize the importance of routine follow up exams or check-ups.

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MASLOW’S HIERARCHY OF NEEDS

An interpretation of Maslow's hierarchy of needs, represented as a pyramid

with the more basic needs at the bottom. As one moves to higher levels of the

pyramid the needs become more complex.

Maslow’s Hierarchy of Needs

Physiologic Needs

Food

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The client has inadequate intake of nutritious food such as fruits and vegetables

due to socioeconomic factor such as low financial income and she lacks supply in the

backyard.

Homeostasis

The client usually suffers from headache when she lacks sleep and elevated

blood pressure, thus unable to continue all the household chores in the remaining

hours of the day.

Shelter

Mrs. X’s house is made up of wood and some cement, as we visit their house we

observed that the materials used were already old and brittle.

Safety and Security

Prone to fire and dengue

Setting of the house is not ideal for living. Their house is built near the stagnant

water where mosquitoes can live. The setting of the house is too close to each other,

causing fire.

Mrs. XY is 47 years old. Last 2009 she was diagnosed with hypertension by a

doctor and was prescribed with antihypertensive drug which is Captopril 50mg. This

is the cause why sometimes she suffer headache when performing different

household chores, lacks sleep, and elevated blood pressure. When we took her last

vital signs we noticed that her blood pressure is high 140/90mmHg. She also told us

that when her headache occurs, she took Captopril and after how many minutes she

was relieved.

Financial security

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The client is a simple housewife. She cooks one set of viand and sells it for a

living. Her husband is a trisikad driver that earns a monthly income that ranges from

P2000-3000 per month.

Love and Belongingness

Family

Closely knit relationship with the family but with readily conflict between members.

Self-esteem

Self-esteem is low

When we conduct our interview to her she is quite shy though she welcomed us

warmly. She is quite conscious about the condition of their house. And we observed

that she lacks confidence to herself.

Self-actualization

On-going process to reach this stage.

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PROBLEM IDENTIFICATION

(Health Threat, Health Deficit, Foreseeable Crisis)

Health Threats

The house is made of wood and cement. The houses setting is too near to

each other and they are prone for fire cases.

The location of the house is prone of diseases because they are near in

stagnant water.

They do not have proper storage of food like refrigerator or food cabinets,

thus, their food is prone to contact with flies or other pests which might cause

disease.

Their toilet facility is near their kitchen, there is possibility that flies from the

toilet will come in contact with their food when they are just preparing or

cooking for their meal.

The father and son are occasional alcohol drinkers.

Health Deficits

Hypertension (mother of the family is diagnosed last 2009)

The father also has hypertension and was diagnoses last 2011

Foreseeable Crisis

Father’s occupation is unstable and does “padyak” for a living; monthly income

ranges from 500-1,000 pesos

Mother has token business and a carpenter. With a monthly income of 2,000-

3000 pesos.

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LACK OF FINANCIAL

RESOURCES

INTERPRETATION FORMULA SCORE

Nature of the problem

Foreseeable crisis = 1 Score/3 x 1 1/3 x 1 = 0.33

Modifiability of the problem

Partially modifiable = 1 Score/2 x 2 ½ x 2 = 1

Preventive Potential Moderate = 2 Score/2 x 2 2/3 x 1 = 0.66..

Salience Needing immediate attention = 2

Score/2 x 1 2/2 x 1 = 1

TOTAL SCORE 2.99

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HEALTH PROBLEM

FAMILY NURSING PROBLEM

GOAL OF CARE

OBJECTIVES OF NURSING CARE

NURSING INTERVENTIONS

METHODS OF NURING FAMILY CONTACT

RESOURCES REQUIRED

EVALUATION

Hypertension Inability to recognize the presence of health problem due to:

A. Lack of or inadequate knowledge.

B. Inability to make decision with respect taking appropriate health actions

After nursing intervention the family will make necessary measures to properly manage, control, and lessen the risk factors of hypertension

After nursing intervention the family will be able to:

A. Have adequate knowledge, a good proper nutrition that reduces hypertension, prevents the occurrence of relative complications in the future.B. Be able to determine the risk factor that contribute hypertension such as family history, and age, salt and alcohol intake, and obesity

Practice proper lifestyle with regards to

Assess the family level of understanding regarding the health problem

Discuss with the family the nature signs and symptoms and complication that might arise due to hypertension

Discuss with the family/client the risk factors of hypertension such as family history, age, salt and alcohol intake and obesity.

Promote healthy lifestyle such asa.Encourage proper food intake like reduce salty and fatty foods and include DASH diet plan.

Home visit and

Clinic visit

Material resources: Visual aid FNAT,NAT FCS format

Human resources: Time and

effort of the student nurse and family/client.

Financial resources:Transportation expenses of the student nurse to conduct home visit.

Partially Met

After the nursing intervention: the client verbalized understanding of dieases process and treatment. As evidence by Mrs. XY verbalization “Dili nako magkaon ug mga bawal na pagkaon, mga taba ug mga parat. “

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nutrition and physical fitness

Prevent obesity through proper nutrition and exercise.c. Smoking cessation.

Provide information regarding community resources; support the patient in making lifestyle changes and initiate referrals to the medical practitioner like doctors.

HEALTH PROBLEM

FAMILY NURSING PROBLEM

GOAL OF CARE

OBJECTIVES OF NURSING CARE

NURSING INTERVENTIONS

METHODS OF NURING FAMILY CONTACT

RESOURCES REQUIRED

EVALUATION

Insufficient income to provide all the needs of every

Inability to provide a home environment conducive to health maintenance and personal

The family will decide on appropriate action(s)

After the nursing intervention the family will be able to:

Discuss the implication of insufficient income in

Home visit and

Clinic visit

. Material resources: Visual aid FNAT,NAT FCS format

The patient was able to verbalize understanding of the

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member in the family

development due to:a. Inadequate

family resources, specially:

Financial resources

Physical facilities, i.e. living space and water

Health maintenance

and alternative solution to properly manage the problem related to inadequate family income.

a. Enumerate the various ways of livelihood plan.

b. Explain the importance of having health action with the readily available resources.

c. Plan a budget for their health maintenance.

the family.R: Awareness on the effect of not having a budget for their health.

Encourage attendance at appropriate educational program, i.e. pangkabuhayan and other livelihood programs.

R: other sources of income

Discus with the family the courses of action that they have identified.

R: Lead into a successful planning.

Human resources: Time and

effort of the student nurse and family/client.

Financial resources:Transportation expenses of the student nurse to conduct home visit.

disease process and treatment regimen.

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Discus the consequences of failure to take appropriate action to the problem.

R: Lack of knowledge lead to heath deficit.

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HEALTH TEACHINGS

Diet

Encourage the family members to eat a well-balanced diet, minimizing the intake

of fatty, oily and salty foods. Explain the risk factors and causes of hypertension.

Emphasize to the client the importance of reducing sodium intake or to have a

low salt diet, in any case, salt should not exceed more than three grams or about

half a teaspoon per day.

Exercise

Emphasize the family members the importance of increasing aerobic physical activity

(30-45 minutes most days of the week) like brisk walking which promotes proper

blood circulation. Regular exercise has been shown to be a powerful tool in the

prevention of hypertension.

Unhealthy Habits

Educate the family members on the disadvantages of smoking and intake of alcohol

and its effect to the body.

Sleep/Rest Pattern

Emphasize to thefamily membersthat each of them must have an adequate rest or

sleep everyday which is very important to prevent fatigue, exhaustion and stress that

can be a predisposing factor to some diseases like hypertension.

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Environmental Sanitation

1. Teach the family members the importance of proper hand washing and its benefit

to our health.

2. Emphasize the importance of exposing the pillows and foams to the sunlight.

3. Teach the family members the importance of proper waste disposal or having a

proper toilet facility.

4. Teach the family members about oral care and proper grooming.

5. Tell client to cover the water containers as well as to cover their garbage

containers.

Encourage the client to get her whole family involved in her care plan as well as

to remind the other family members how important it is to be sensitive to client’s

present situation

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IMPLICATION OF THE STUDY

NURSING EDUCATION

The nursing family case study enlightens us to the real scenario in the

community. It also gave us the opportunity to know that community health nursing is

important so that nursing students would be able to experience how it works.The

availability of health services is necessary in the community. It gave us the view that

every community must have two public health nurses to accommodate each family.

The maintenance of the ability of both public health agencies and private

provides to manage day to day operations and the capacity to respond immediately to

the community should always be accessible.

Through nursing family case study we were able to assess the health needs of

the family, plan, implement, and evaluate the impact of health services in the community.

It gave us the basic knowledge and skills in community health nursing that one that

formulate policies and develops on nursing aspect of specific program such as health

teaching of hypertension.

NURSING PROFESSION

In the nurse profession, competence, credibility, commitment and knowledge are

needed in the profession. The dedication of a nurse to serve in the community is

remarkable and outstanding. However, nurses must continuously enhance their

knowledge and skills to explore the capability to be used in the community.

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The nurse and the community must collaborate in order to achieve the nursing

intervention when dealing with diseases like hypertension and smoking habits. This

nursing case study will give the public health nurse the awareness of how the community

does the home management in their disease.

For a Nurse should enhanced the knowledge like political science helps the nurses

to understand the health care delivery system for them to better respond to clients and

use academic principles like sociology and psychology to know better on how to

understand the community.

NURSING RESEARCH

Hypertension is one of the most common worldwide diseases; 17.1 million

deaths per year are caused by hypertension. The major causes of hypertension are

physical inactivity, an unhealthy diet and through family history. Philippines reported that

around 12.6 million of Filipinos have hypertension.

This research found out that the people in the community resolve to deal with

hypertension on their own rather than seeking medical help. This is because of their lack

of knowledge, ignorance and poverty. The researches therefore recommend that future

studies in hypertension cases in community should focus on determining tangible ways

to educate the people about the disease and the value of medical treatment in general.

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Health Updates

Uncontrolled Hypertension Is Common, but Untreated, Worldwide

Sep. 3, 2013 — A global study has found that many patients don't know they have hypertension and, even if they do, too few are receiving adequate drug therapy for their hypertension.

This is true in high income countries, like Canada, as well as middle and low income countries, say an international team of researchers led by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences

.The report, which was published today by JAMA, the journal of the American

Medical Association, is part of the PURE (Prospective Urban Rural Epidemiological) study.

"Our study indicates over half of people with hypertension are unaware of their condition and, amongst those identified, very few are taking enough treatment to control their blood pressure," said Dr. Clara Chow, lead author, a member of PHRI and an associate professor of medicine of Sydney University and the George Institute for Global Health in Australia.

Dr. Salim Yusuf, senior author and professor of medicine of McMaster University's Michael G. DeGroote School of Medicine, added that drug treatments that work to control hypertension are well known, however this study found only about a third of patients who are aware of their condition were achieving target blood pressure control."Blood pressure lowering drugs are generally inexpensive and commonly available treatments," said Yusuf. "However only a third of patients commenced on treatment are on enough treatment to control their blood pressure. This is worst in low income countries, but significant in high and middle income countries too."

This is important because hypertension or high blood pressure is the leading cause of cardiovascular disease, which is associated with at least 7.6 million deaths per year worldwide.Participants in the PURE study included 154,000 adults between 35 and 70 years old, with and without a history of heart disease or stroke, from 17 high, middle and low-income countries.

Each participant had their blood pressure measured and medication use recorded, along with information about their age, gender, education, and key risk factors, including whether they knew they had hypertension. The study found 46.5% of those with hypertension were aware of the diagnosis, while blood pressure was controlled among 32.5% of those being treated.The authors could only guess at potential solutions for the poor detection and inadequate treatment of hypertension."The findings are disturbing and indicate a need for systematic efforts to better detect those with high blood pressure," said Yusuf. "Early use of combination therapies, that is,

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two or more types of blood pressure-lowering treatments taken together, may be required."Yusuf is the executive director of the PHRI which initiated the PURE study, the only multi-country study of its kind. The study was funded by more than 25 organizations including the Canadian Institutes for Health Research, the Heart and Stroke Foundation of Ontario, similar organizations in several countries and by unrestricted grants from several pharmaceutical companies.

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REACTION

This article shows the uncontrolled hypertension is common, but untreated,

worldwide. The study shows that the global study has found that many patients did not

know they have hypertension and even if they do, too few are receiving adequate drug

therapy. As we know that hypertension is a silent killer type of disease, so it is very

dangerous for us to self medication. That’s why it is necessary for us to consult a

physician if signs and symptoms occur. This will facilitate us to know the recommended

medication, diet and lifestyle.

As a health care provider, we know that prevention is better than cure. As much

as possible. Give health teaching to the people you may encounter especially if they are

at risk of having hypertension. Health teaching to them includes, low salt and low fat diet,

proper exercises, treatment regimen and also good sleep may help. Our teaching is

already a big help to them so that they can work on through their lifestyle and change it

for the good of their health.

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References

Mendez- Chacon et al (2008, August 5).Factors associated with hypertension prevalence, unawareness and treatment among Costa Rican elderly.BMC Public Health, 8;275.Bio Med Central Ltd.

http://sciencedaily.com

McMaster University (2013, September 3). Uncontrolled hypertension is common, but untreated, worldwide. Science Daily. Retrieved September 20, 2013, from http://www.sciencedaily.com /releases/2013/09/130903193651.htm

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