64901969 Family Case Study

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Table of Contents

I. Introduction

II. Objectives

III. Family Developmental Task

IV. Initial Data Base

V. Family Coping Index

VI. Genogram

VII. Family Web

VIII. Physical Assessment

IX. Prenatal Assessment

X. Prioritization

XI. Family Nursing Care Plan

XII. Health Teachings

XIII. Nursing Implications

XIV. Appendix A

XV. Appendix b

XVI. Gallery

XVII. Bibliography


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CRITERIA

Content

Introduction and objective 5%

Developmental Stage 5%

Family Coping Index 10%

Spot Map 10%

Prenatal Assessment 10%

Prioritization 10%

Family Nursing Care Plan 30%

Promptness 10%

Reference 5%

Format 5%

100%


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Introduction


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What its children become, that will the community become . A famous quote made

by Suzannea LaFollette when she explains a community. A community is unpredictable. No

one could tell or foresaw what they will do what they are thinking at the moment and how they

will act when youd meet them. A community is a group of interacting organisms sharing an

environment. In intent, belief, resources, preferences, needs, risks, and a number of otherconditions may be present and common, affecting the identity of the participants and their

degree of cohesiveness. In our community which is in Ubalde Health Center, Agdao. Strongly

endorses the importance of health among the members giving emphasize in young infants to

be immunize.

In the world 2.5 million deaths are averted through vaccination every year and

Smallpox was eradicated and poliomyelitis has been eliminated from most countries in the

world. In the national statistics 69% Filipino children received all suggested vaccinations while

in Davao city the Percent of a fully immunized child from 0 to 12h month grows with 22.22 %

from 63% making it to 77%. Immunization is one of the most useful programs that the

Department of Health has been implementing and this program was commonly rendered by

community health centers.

Families in the community are influenced by a lot of factors and one of these factors is

the services that they could get from their own health center. A community health center

commits in improving the health of the community. In the Ubalde Health Center they were

rendering services to their members with utmost care. They would even do house to house

just to ensure that everyone receives the right service that their family should have.

Taking care of a family is a vital role that all members of the community should be

aware because everything starts in the family. In the world there were about 34,691 000 and

still counting abortion that is being performed all over the world. This number is an eye

opening for all of us. To take care of a family was regretted at this part and one of the

responsibilities of a member of the health care team is to assure the safety of the family by

simply providing health teaching in our little way of guiding them. Among the many clients that

we had to choose to, we had chosen the Luciano family. At first you would think that they are

just a typical family that is beginning to meet the new life of a family with a preschooler stage

but when we get to know them. We realized that you would idolized the way they live with
http://www.famousquotesandauthors.com/authors/suzannea_lafollette_quotes.htmlhttp://en.wikipedia.org/wiki/Environment_%28biophysical%29http://en.wikipedia.org/wiki/Intentionhttp://en.wikipedia.org/wiki/Beliefhttp://en.wikipedia.org/wiki/Natural_resourcehttp://en.wikipedia.org/wiki/Preferencehttp://en.wikipedia.org/wiki/Need_assessmenthttp://en.wikipedia.org/wiki/Riskhttp://en.wikipedia.org/wiki/Identity_%28social_science%29http://en.wikipedia.org/wiki/Identity_%28social_science%29http://en.wikipedia.org/wiki/Riskhttp://en.wikipedia.org/wiki/Need_assessmenthttp://en.wikipedia.org/wiki/Preferencehttp://en.wikipedia.org/wiki/Natural_resourcehttp://en.wikipedia.org/wiki/Beliefhttp://en.wikipedia.org/wiki/Intentionhttp://en.wikipedia.org/wiki/Environment_%28biophysical%29http://www.famousquotesandauthors.com/authors/suzannea_lafollette_quotes.html


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each other, there was a special trait in them that you could not deny, they are hospitable

especially Mrs. Mona the mother in the family together with his Husband Mr. Paulito the head

of the family, the one who decides and provides financial support and their daughter Angel

Mikaela who is a very energetic child and who loves her mother more than anyone else. We

realized that their family was not typical at all evidenced by their gestures for each other andthe uniqueness of each character.

This case study would provide students with knowledge and reference regarding the

state of the Luciano family this would also provide baseline data for the creation of more

enhanced case studies in the future. Lastly, this would present proper understanding of the

patients illness and therefore maximize the care provided by all registered nurses locally and

internationally.


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Objectives


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General Objective

That at the end of our exposure in the Ubalde Health Center, Agdao, we will be able to

find a client for our nursing case study, and formulate a comprehensive Nursing Case Study

that will expand our knowledge and skills as student nurses in our nursing practice, nursing

education and nursing research towards our holistic care to our chosen Family by promoting

and preserving their health. We should also be able to utilize the information that we have

extracted to promote camaraderie among ourselves to learn from the community and lend to

them health teaching that could help them at the present and in the future.

Specific Objectives

In order for us to have a course of direction for our study, we formulated the following

specific objectives to help us achieve and organize flow in the completion of our nursing case

study. We aim that we may be able to:

establish good interpersonal and therapeutic relationship with the family to gain trust

and cooperation,

create a specific, measurable, attainable, realistic, and time-bounded objectives,

present a thorough family information and assessment on its family characteristics,

home and environment, health and health

practices , environment and awareness of community organization through a complete

and comprehensive Initial Data Base,

identify, understand and explain the stages of the family and their corresponding

developmental tasks;

trace the past and present health history as well as their genogram;

trace the illnesses within the family through the use of family web;


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provide a basis for estimating the nursing needs of the family through Family Coping

Index basing on its nine categories;

identify the needs, problems, illnesses of the family, and prioritize these through the

categories stated in prioritization of the problems in a family;

formulate a family nursing care plan based on the top five priority problems of the

family to be able to help and minimize the problems and occurrence of diseases and illnesses

in the family;

present a Nursing Implication of the study in Nursing Practice, Nursing Research and

Nursing Education;

provide health teachings based on the familys health condition, its needs and

problems, and lastly, present a documentation that will support the information and data we

have gathered and stated in this case study.


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Family

Developmental

Task


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Every individual undergoes different rates but passes through the same stages. Everyone is

unique and has their personalities unlike. A typical preschool child experiences the crisis

between initiative versus guilt they had their idea on finding their way out to overcome this

stage and complete it.

Parents especially those first time mothers and fathers may need a bundle of patience

and understanding since in this stage the childs energy is incomprehensible. Children in this

stage must be educated in toilet training and must be founded with a big space for learning

and growth.

A family with a preschooler according to our client is a serious, fun and tiring

experience all parents had probably passed and should not be missed. Based from our client

there was a lot of changes on the way they treat each other before and after their first baby

was born. They become focus to their baby than to their selves. Their attention in a whole day

was on their baby. When their daughter had turned 3 yrs. Old the child alone refuses to sleep

with her parents and wishes to sleep in the floor covered with clothing and foam. Our client

sometimes complains of her childs dynamic energy but understands that this is just normal to

a growing child. Their child goes to school as a preschooler child and the parents is happy

about it because it was their child not them who decided in going to school.

The following are the development tasks of preschool children

Settling into healthy daily routines of rest and activity.

o Almost every 8 in the morning angel takes a bath guided with his mom. Eats her

breakfast and her mother always assure that it is accompanied with bottled milk.

After that Angel plays with her cousins in the front yard, her mother or

grandparents would tell Angel to wear slippers when playing outside of the

house. Around 10:30 Angel goes to school escorted by her cousin Jessica on

the way. After school Angel bonds with her mom by watching the television

together and by her mom combing her hair. According to her mother, Angel is

very active during the day. She is a crowd entertainer whenever she meets new

people or their relatives not living near them.

Mastering good eating habits.

o Angel eats what her mother gives to her regardless of its vegetable or not. Her

mother sometimes had to force Angel while eating because according to her


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mother Angel should eat first before playing. Angel uses fork and spoon in

eating and often messes the table with rice that falls from her plate.

Mastering the basics of toilet training

o At the present her mother is training her to go to the comfort room and reminds

her often to never hold when she feels like urinating especially at night. Angelnow goes to the comfort room when she needs, her mom would accompany her

in the comfort room for safety.

Developing the physical skills appropriate to his stage of motor development.

o Angel does a lot of things already according to her mom. Angel often mimics

what her mother acts like massaging his father but she acts it like pushing her

hands towards his father back. Angel knows how to go down in the stairs alone

and can walk and run without any assistance. Her mother is still the one who

dresses her and buttons her blouse.

Becoming a participating member of his family

o Angel loves to entertain and is not a shy child as observed by the people. In our

span staying with the family, her mother would always kiss and hug angel would

do the same in return. Together with her cousins they would play inside their

house and does not show any signs of jealousy Beginning to master his impulses and to conform to others expectations

o Angel enjoys the company of her cousins and sometimes prefers to bond with

his mother. When we were interviewing her mother Angel would also listen and

would also act what her mother would perform. According to her mother she

would listen to his father whenever his father is talking and talks a lot when she

thinks her mom and dad would quarrel and say you them ayaw mo away.

Developing healthy emotional expressions for a wide variety of experiences

o Based from her mother Angel is expressive on what she feels and shows it into

action like entertaining visitors or her mom and shows participation when

attention is called.

Learning to communicate effectively with an increasing number of others


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o Angel expresses her thoughts through her actions like acting it out and doing

what others tell her to do right. She is able to stay close and comfortable to her

immediate family and also to us.

Developing the ability to handle potentially dangerous situations

o

When Angel goes down the stairs she would hold tight in the sides of the wood.Angel tells her mom whenever she wants to go to the bathroom since the door

of their bathroom is hard to open and it has a hole after the door that could be

dangerous for a child. Her mother also told us that they would tell Angel not to

touch objects that could harm her.

Learning to be an autonomous person with initiative and a conscience of his own.

o According to Angels mom it was Angel that decides that she wants to go to

school and both of the parents were happy about it. Her mother also said that t

Laying foundations for understanding the meaning of life

o According to her mom, Angel is very close to her but does not show any

jealousy when she is with his husband or vice versa. Angels explore things and

situations around her and tends to understand it by listening.

The following is the developmental tasks of Parents at the preschool stage

Parenting without a partner

o Both parents were aware of their responsibility as parents and they planned of itas having designated assignments that one should do. Mrs. Mona stays at

home and takes care of the house and the child as well as the necessary things

needed in the house like going to the market to buy foods and doing the house

chores. According to Mrs. Mona his husband is often stays in his work than at

home and she understands this because Mr. Lito works for his family for

financial support.

Relying on television- mixed bag

o Mrs. Mona watches television with her daughter since she was always at home.

Both mother and child love to watch the shows in ABS-CBN and Myx wherein

some of the short scenes in the program are not suitable for Angel but it was

unnoticed.

Accepting each other in the family


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o Mr. and Mrs. Luciano was very happy when they found out that Mrs. Mona is

pregnant in their first baby and now that Mrs. Mona is pregnant again they cant

wait for it to be born especially Angel who oftentimes touch his mother

abdomen.

Continuing to develop as married adultso The couple still has time to talk and renegotiate their marital relationship and

having a child at home does not hinder them to keep their marriage alive and

growing.

These are the familys developmental task with a preschool child.

Supplying adequate space, facilities and equipment for the expanding family.

o The family was planning on extending their house and having their own kitchen

and sink for their own convenience in the near December to January. They are

aware that it is important for their growing family to have complete facilities and

dreams to have a bigger house whenever theyll have financial stability

Meeting predictable and unexpected costs of family life with small children.

o The family pays 800 pesos for their childs studies. According to the mother as

for now they were able to provide their childs need and wants since their child

sometimes understands and listens to them whenever the childs wishes for a

thing is not granted. They were able to balance their expenses and save some

of it for any emergency that may come.

Assuming more mature roles within the expanding family.

o According to our client before when they were only the two of them they always

quarrel and sometimes fight but when they had their first baby their quarrels and

fights were reduced and practices in a give and take relationship. In deciding

both parents talk and the final decision is from the father in the family. The

decision is always in concern with the family especially for their child.

Maintaining mutually satisfying intimate communication in the family.

o Seldom was the family able to bond with each other whenever they are all

present in the house when the father is playing the playstation while the mother

is watching him play and the child is cheering for his father due to the fathers


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works that is always in his field of work. The child is more close to her mother

than to his father. According to the mother the child is somehow afraid of his

father because the father scolds her child whenever she does any wrong and a

single strike of voice from the father the child immediately listens and stops on

what she is doing. Rearing and planning for children.

o Both of the parents were planning to have three children at any gender. The

mother does not want to have a twin child because she thought it would be so

hard but when this happens she will accept it and raise the child together with

his a husband bond with good values and conduct. After the mother will give

birth, both of them wishes to have an interval of 2-3 yrs gap of age to their third

child.

At the present the family is still in the process of completing this stage of the family

development since they are still tasks that are to be noted and modified.


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Initial

Data

Base


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I. Demographic Data:

The Luciano family is our subject in our case study. They have been a resident

of house number 14 at the Del Pilar Street Jerome Extension Barangay Number 0132

for 5 years as a family.

II. Family Data:

The whole family is composed of three members and can be considered as

nuclear family where it is composed of the father, child and our pregnant client, the

mother. Mr. Pailito comes from Samal and their tribe is Waray. He is a Highschool

Graduate because of lack of financial support coming from his parents. Mrs. Monalisa

is truly a Bisaya and currently living since birth here in Davao City. Mrs. Monalisa is

also a Highschool graduate because at the age of 18 years old, she decided to stop

totally in school and get married after all. She wants to stay home and take good care

of her family especially her children. They are both Roman Catholic and receive their

sacrament of matrimony in Holycross church Davao City.

Mr. Pailito Luciano, 24 years old works as a business man delivering meat in

some places here in Davao City. On the other hand, Mrs. Monalisa Luciano, 23 years

old works plainly as a housewife. Mr. Pailito is the head of the family but together with

his wife, Mrs. Monalisa shares and works hand-in-hand in deciding and supporting all

the needs of the family. They have a daughter namely Angela Mikaela Luciano, she is

3 years old studying as a Nursery student at the Immacon Learning Center in Ubalde,

Agdao. She is fully immunized child.

Familys Members Chart

FAMILY

MEMBERS

AG

E

SEX CIVIL

STATUS

POSITION IN

THE FAMILY

RELATIONSHIP

O FAMILY HEAD

EDUCATIONAL

TTAINMENT

OCCUPATIO


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III. Family Characteristics:

A.)Family Structure

The type of the family structure that they have is a nuclear family which is

composed of the mother, child and father. They belong to a Patriarchal type of family

where Mr. Pailito Luciano acts as the head of the family. His wife also helps in

decision-making and works is in the budget concerns but the final say of a certain

decision comes from Mr. Pailito.

B.)General Family Relationships/Dynamics

The Luciano family works together in order to sustain the family needs. Parents

are very supportive in the activities of the child in school and provide good nutrition to

all the members and eat three times a day. Mr. Pailito works hard in order to gain

Monalisa

Luciano

23 F Married Mother Wife HG Housewife

Angel Mikaela

Luciano

3 F Single Child Daughter N Preschoole

Pailito

Luciano

24 M Married Father Head HG Business m


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money. His monthly income is 8,000 a month and pays all the bills in their house such

as electric bills, water bills and etc. Although problems arise within their family, they

have the ability to adapt and seek far any solutions and plan for a better future. They

respect each other and they practice give and take or consult each other in order to

solve problems easily and come up into a right decision. They maintain an opencommunication that make their bond strong and have a harmony and a productive

living.

Their family sleeps by 10pm and wakes up by 6am. The monthly income of the

family is 8,000 pesos which comes from the head of the family. Upon asked about their

family health history, our client told us that her husband has a history of Diabetes

Mellitus and cancer. Her husband has a health history of hypertension and Diabetes

Mellitus and their child had a diarrhea last 6 months and given antibiotics such asNifuroxazide, ercefuryl and other anti bacterial drugs. Their child has already

completed her immunization since she already received 1 dose of BCG, 3 doses of

DPT, 3 doses of OPV, 3 doses of Hepatitis-B and 1 dose of Measles Vaccine.

Immunization of Children

Childs Name BCG DPT OPV HEPA B MEASLES

Angel Mikaela

Luciano 3 doses 1 dose 1dose 1dose 3 doses

The child is fully immunized child (FIC) because she receives 3 doses of BCG, 1 dose of

OPV, 1 dose of DPT, 1 dose of Hepa B and 3 doses of Measles before the child reaches 1

year old.

Immunization of Mother

Mothers

name TT1 TT2 TT3 TT4 TT5


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Monalisa

Luciano

1 dose 1 dose 1 dose

The mother is not yet a fully immunized mother but the giving of the Tetanus

toxoid for her is currently on going and she is willing to complete this activity to prevent

diseases and promote wellness within her.

a.) Home and Environment

Mr. and Mrs. Luciano own the house but they shares on the expenses regarding

the electric as well as water bills with their relatives in the other area. The type of

housing material that they have is mixed and they have 3 ventilations/windows. The

total area is 13.84 m2

and their total ventilation is in over satisfactory with a result of

22%. They only have one room for the sleeping with one sofa bed. Inside the house

the appliances are organized but the eating utensils are not well kept and are exposed

to external environment. Outside the house it was so messy in which you can see

waste wrappers and also nails on the floor. The pond was also dirty with the presence

of mosquito larvae in the bigger pool. Their water system comes from DCWD and they

dont store any foods or water inside their house because they have no refrigerator atall. For their lighting facilities, they use a bulb as their source and they pay it to Davao

light monthly. They have a common toilet which is a water-sealed and they dispose

their garbage in a sack .It is collected by the Brgy truck. Their drainage system is a

closed system and they use to raise chickens in the yard.

b.) Health and Health Practices

Illness or Condition OTC (Specify) Herbal (Specify)

1. High Cholesterol Vitamin B12

2. Tonsilitis Antibiotics


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3. Diarrhea Nifuroxazide, ercefuryl

(anti-bacterial drugs)

4.) Cough Carbociestiene, cephalaxin Lagundi

5.) Fever Paracetamol

6.)

The family uses OTC drugs to provide some medications to ill members in the

family and use community resources such as the barangay health center when the

condition turns to be out of control. They do immunization for the prevention of the

occurrence of the disease but they are not aware and dont recognize any problem or

even the existing problem at all. Sometimes, they are not willing to go to the health

center anymore because of the attitudes of the health workers that makes them

unaware and not updated. During our assessment, their eating utensils are not

properly kept in a container and which it serves as a mode of transmission for some

diseases. However, they still provide nutritious foods and eat three times a day.

c.) Weekly Dietary Recall

The family manages to prepare different viand and most nutritious food for their

members. In the morning the family always serves a heavy breakfast which is good for

the development of their daughter. As we could see, they ate more on protein and less

in veggies.

Monday Tuesday Wednesday

Milo

Pan

Luncheon

Meat

Juice

Milo

Pan

Sabaw

Rice

Kinilaw

Gatas

Pan

Rice

Bola-bola

Fried egg


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Beef loaf

Rice

Fried rice

Fried egg

Rice

Egg and hotdog

Paksiw

Sabaw

RicePiniritong

Isda

Saging

PinakbetHinalang

Na baka

durian

RiceAdobong baboy

Sabaw

Isda

Durian

Family Members Weight Height Body Mass Index

(BMI)

Monalisa Luciano 51 kgs 1.52 m 22.0741 kg/ m

Angel Mikaela

Luciano

12 kgs .87 m 15.854142 kg/ m2

Pailito Luciano 70 kgs 1.60 m 27.34375 kg/ m

Interpretation for adults:

15 18.4 kg/ m2= underweight

18.5 22.9 kg/ m2 = normal

23 27.5 kg/ m2 = overweight

27.6 40 kg/ m2 = obese


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d.) Activities of Daily Living

The pattern of the familys retiring and getting up hours vary from one member

to the other. It is dependent on the time of each individual. They have the freedom on

when to sleep and wake up except if they have responsibilities to attend to especially

work and school. Most of the time, the familys source of income is the fathers

occupation as a business man. He works 6 days per week. The mother sleeps late but

still can manage the house properly and take good care of the child carefully. They

have a friendly neighborhood and they communicate each other via cell phones. They

use trisikad as a source of their transportation.

e.) Awareness of Community Organization

The family is not actively participative in the activities in the community. She is

not aware of the existing organizations in the community such as Womens association

and GKK and is still not a registered voter. On the other hand, she is aware and

participates in the fiestas in their Barangay and the use to celebrate it with a simple

gathering within their family.

f.) Socio economic

The familys economic staus is a low class family since their income is below

20,000 according to the National Statistics Office:

Low class Income lower than 20,000 a month

Middle Class- Income is 20,000 160,000 a month

High Class- Income is higher than 160,000 a month.


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Family

Coping

Index


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FAMILY COPING INDEX

The Family Coping Index provides a basis for estimating the nursing needs of a particular family. The

table below presents the rating of the Luciano family during our home visit last September 28, 2009

until September 30, 2009 respectively.

Nine Areas of

Family NursingDescription

ADMISSION

(September 28, 2009)

DISCHARGE

(September 30, 2009)

Rate Justification Rate Justification

Physical

Independence

This is

concerned with

ability to move

about, to get out

of bed, to take

care of daily

grooming,

walking, etc.

5 All members in the

family can perform

their activities of

daily living such as

bathing, grooming,

walking, eating and

etc. Parents are

able to provide the

needs and care of

all the members.

5 The family

members still

maintains their

independence by

performing their

activities of daily

living and providing

physical needs and

appropriate care

among the

members.

Therapeutic

Competence

This is

concerned with

all of the

procedures or

treatments

prescribed for

the care of

illness, such as

giving

medications,

using

appliances,

3 The family is able

to provide some

interventions to ill

members in the

family but fails to

use modeate Over

the counter drugs.

5 The family

maintains its

competence in the

treatment and

proper

management of its

members.


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dressings,

exercise and

relaxation,

special diets,

etc.

Knowledge of

Health

Condition

This is

concerned with

the particular

health condition

that is the

occasion for

care.

3 The family has

general knowledge

towards the

condition or

disease but is not

aware of the

problems that can

affect the health oftheir family. The

family doesnt

recognize any

problem at all.

5 The family has

increased its

awareness towards

problems that can

affect the condition

of its members and

also through our

health teachingsthe family has

acquired

knowledge about

the problem that

can be prevented

or lessened.

Application of

Principles of

General

Hygiene

This is

concerned with

family action in

relation to

maintaining

family nutrition,

securing

adequate rest

and relaxation

for family

members,

carrying out

accepted

preventive

measures such

3 The family serves

different nutritious

food and they eat

three times a day

but the problem is

that the eating

utensils they are

using are not kept

in a container and

which it serves as

a mode of

transmission for

diseases. The

family sleeps for

about 8 hours a

5 The family used the

dish organizer that

weve donated.

While our health

teachings for the

mother was a

success because

she was able to

sleep early the

night before.


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as immunization

and medical

appraisal, safe

homemaking

habits in relation

to storing and

preparing foods.

day except for the

mother.

Health Care

Attitudes

This is

concerned with

the way the

family feels

about health

care in generalincluding

preventive

services, care of

illness and

public health

measures.

5 The family utilizes

the existing

community

resources for

prevention such as

immunization. Thefamily understands

the need of

medical care in

illness.


to understand the

condition of its

member and gives

early interventions.

Emotional

Competence

This is concern

with the maturity

and integrity

with which the

members of the

family are able

to meet the

usual stresses

and problems of

life, and to plan

for happy and

fruitful living.

5 The family is in

equilibrium and has

the sense of

maturity on both

parents. In the

phase of conflict

their daughter acts

as a referee

because of her

they are able to

solve the problem

in the state of

calmness.


to maintain maturity

and integrity in

times of crisis.

Parents are able to

understand each

other and deal with

problem in

harmonious way.


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Family Living

Patterns

This is

concerned

largely with the

interpersonal or

group aspects

of family life,

how well the

members of the

family get along

with one

another, the

degree of their

respect and

affection they

show for one

another.

5 The family

members respect

each other even in

decision making

they tend to listen

with each other.

Every evening they

would wait for each

other until

everyone is in the

table and start their

supper together.

5 The family

maintains its

interpersonal

connection with

each other by doing

things together if

possible.

Physical

Environment

This is

concerned with

the home, the

community and

the workenvironment as

it affects family

health.

3 In the house the

appliances are

organized but the

eating utensils are

not well kept andexposed to

external

environment.

Outside the house

it was so messy in

which you can see

waste wrappers

and also nails on

the floor. The pond

was also dirty with

the presence of

mosquito larvae.

3 Some of the

problems were

solved because

weve donated dish

organizer andcleaned the area by

picking up the nails

and throwing the

wrappers in the

trash can. The

pond remained as it

is because the

family doesnt own

that pond.


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Use of

Community

Facilities

This is concern

with the degree

to which the

family knows

about the

wisdom with

which they use

available

community

resources for

health,

education and

welfare.

3 The family is

oriented about the

facilities that are

available in the

health center. The

problem is about

the attitude of the

health worker that

is why they dont

usually avail those

free services. The

family also attends

mass every

Sunday in the

community.

3 The attitude of the

family is still the

same as before

and the mother is

already fixed in her

decision that she

would deliver her

baby in Well-

Family.


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Genogram


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Family Web


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CHURCH

BEACH

PEOPLE

S PARK

G-MALL

WORKING

PLACE

HEALTH

CENTER MARKET

LEGEND:

SELDOM =

ALWAYS =


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It is important for a family to have widened their intimacy though they are already

married and already had a child. This is indispensable to build a more strong foundation in

every family.

Most of the time Mr. Lito is always at work leaving her wife and daughter in the house.

They seldom go to church and at least for a year they could all visit the house of God

twice.Six days and a half during Sundays in a week Mr. Lito goes to his work selling pigs

while Mrs. Mona stays at home with his child. When Mrs. Mona is not busy doing the house

chores she carries Angel to Peoples Park for at least ones a month. With Mr. Lito the head of

the house they sometimes go to the beach to swim and have fun bonding with each other.

Everyday Mrs. Mona goes to the Market or the store near them to buy food for breakfast,

lunch and dinner since they dont have storage for easily spoiled food like fish and the like.

When they have money they sometimes go to the Mall. They seldom go to the health center

except when her daughter was receiving immunizations. Angel also goes to school every

weekdays.


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Physical

Assessment


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PHYSICAL ASSESSMENT

Name: Monaliza T. Luciano Citizenship: Filipino

Sex: Female Birth date: April 19, 1986

Age: 23 years and 5 monthsDate of Assessment: September 29, 2009

Time of Assessment: 9:35 10:55 am

I. GENERAL SURVEY

On our encounter, she was coherent, responsive and not in any kind of

respiratory disturbance. Upon observation, she is mesomorphic with a proportional

weight and height and her movements were coordinated while walking. Body and

breath odor is absent during our interaction with no signs of distress as well as the

present of any illnesses.

She was in the mood and willingly cooperated to what we are saying. Her

responses were understandable and the thought also makes sense.

ANTHROPOMETRIC MEASUREMENTS

Weight: 51 Kilogram Head Circumference: 52 cm

Height: 155 cm Abd. Circumference: 93.5cm

VITAL SIGNS

Vital Signs Patients Vital Signs Normal Values

Temperature 36.6C 35.6-36.7 C

Pulse Rate 83 bpm 80-90 bpm

Heart Rate 86 bpm 80-90 bpm

Respiratory Rate 21 cpm 16-20 cpm

Blood Pressure 120/90 mmHg 110/70-130/90 mmHg


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II. APPEARANCE AND MENTAL STATUS

She was wearing a loose, black sleeveless and a pink shiny short with black

single stripe on each side extending two inches from the knee. A towel was also with

her for the sweat and it was usually placed on her right shoulder. Her hair was pulled

backed into a pony tail.

She is oriented with the time, place and persons who is with her and her

responses about the things that happened that day were in a chronological order.

III. THE SKIN

The general skin color complexion of our client is brown, the complexion of atypical Filipino. Hyperpigmentations on the skin were not been identified exept for the

linea nigra at the abdomen and moles . Striae gravidarum were also evident.

An irregular shaped scar was identified at the left acromial area extending to the

deltoid site with a length of 20cm. No edema, vesicles, and other abnormalities were

known. The skin was also moist and warm to touch with a good skin turgor.

IV. THE HAIR

The hair is thick and hair growth on the scalp is evenly distributed upon

inspection. Her hair is silky and salient without any evidence of infection and

infestation. Any lacerations, lesions and any break ups are absent and her body hair is

evenly distributed.

V. THE NAILS

Her nail plates are colorless and the shape of it is a convex curve. It seemed

that the nails are not well trimmed and pinkish in color. Both of her nails of the toe and

the fingers are smooth in texture. The tissues around the nail have no lesions and are

intact, with the result of the blanch test of 2 seconds.


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VI. THE SKULL AND FACE

The head is round and normociphalic, without any observable and palpable

deformities. The skull contour is uniform and smooth, with depressions and nodules or

any other masses absent. She was observed to have symmetric facial features and

movements. Lesions, bruises and edema were not noted on the face.

VII. THE EYE STRUTURE AND VISUAL ACUITY

Her eyebrows are aligned equal movement, hair equally distributed and intact

skin, without any observable lesion, scars and flakes. The eyelashes are slightly curledoutward and hair is evenly distributed. Upon observation of the upper and lower

eyelids, the skin is intact without any discolorations and discharges. When the lids are

open, the upper and lower borders of the cornea are slightly covered and the rim of the

sclera is not visible between the lid and the iris. There was no tenderness noted upon

palpation on the site where the lacrimal gland, lacrimal sac and nasolacrimal duct. The

palpebral conjunctiva was observed to be pinkish, with no signs of inflammation and

any observable masses. The bulbar conjunctiva is clear and transparent. She has 15

involuntary blinks per minute, with bilateral blinking. The blinking reflex is evident when

the cornea is lightly touched, indicating the intactness of the trigeminal nerve. Pupils

are dark brown, with brisk reaction upon stimulation and with isocoric size of 3mm. She

does not use any corrective lenses and has a normal vision, being able to read fine

print from paper placed 12 inches away from her eyes.

VIII. EARS AND HEARING

Her ears have the same color as facial skin. The size and the position are

symmetrical. After folding the pinna, it immediately recoils back to its original position,

with no tenderness noted as well as lesions, flaking or any signs of inflammation. A

little amount of wet cerumen can be observed in the external auditory canal and there

were no lesions and any discharges noted. She was able to hear the sound of the


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watch place on the back of the ear and the examiners whisper as well as the normal

voice. The tympanic membrane was not examined due to the unavailability of the

otoscope.

IX. NOSE AND SINUSES

As we have observed, the external nose has a uniform color with her facial skin,

without localized areas of redness or lesions. It is straight and symmetric without any

discharges. Tenderness was not noted upon palpation and other masses and

displacements as well. Patency of both nasal cavities was good, air freely moving

through the nares upon breathing. The mucosa of the nasal cavities appeared to be

normally pink, studded with hair follicles and redness, swelling, growth and discharges

were absent. The nasal septum is intact and in midline. The frontal and maxillary

sinuses were non tender during palpation.

X. MOUTH AND OROPHARYNX

The outer lips was observed to be symmetrical in contour and are soft, moist and

smooth in texture with a uniform dark pink color. Her buccal mucosa is uniformly pink,

with a moist, soft, and elastic texture. Mucosal cysts, ulcerations, and nodules are not

found on both the inner part of the lips. The second molars of the lower jaw are missing

as well as the first pair of incisors of the upper jaw. Only those missing teeth of the

upper jaw were replaced by dentures and the rest of her teeth appeared to have

caries. Her gums were moist, firm, and pink in color, without any bleeding, lesions and

inflammation noted. The tongue is positioned at the center and observed to be moist

and pink in color, with a thin whitish coating. It has some raised papillae and has no

visible lesions. It moves freely in all directions. No palpable lesions, nodules, lumps,

and masses were observed and the tongue base is smooth with some prominent

veins. Soft and hard palate was is pinkish and both palates were free from

discolorations and abnormal growths. The uvula is intact and positioned in midline of

the soft palate. The oropharynx is pink and free from edema, lesions, and discharges.


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The tonsils are pink with no signs of inflammation or discharges. Upon pressing the

back portion of the tongue, the gag reflex has been observed.

XI. THE NECK

Muscle size is equal and head centered, upon inspection with no swelling or

masses noted. The client is able to move her head freely; flexes 45 hyperextends

60,laterally flex 40 and laterally rotates 70. The strength of the clients neck muscles

is equal with the examiners resistance. Upon palpation, no masses where felt and

tenderness was also not noted. The trachea is located at the midline of the neck with

equal spaces on both sides. There was no visible local enlargement noted while the

client was asked to swallow. The jugular veins are observed to be non-distended andthe pulsations of the carotid arteries are full, symmetrical, and consistent, without the

presence of a bruit.

XII. THORAX AND LUNGS

Chest expansion is symmetric during respiration. APL ratio is 7.5 inches: 15

inches (1:2). The costal angle is approximately less than 90. The right and left

shoulders and hips at the same height. The spinal column is straight and verticallyaligned. Bulges, lumps, depressions, and areas of tenderness were absent on the skin

and chest wall with intact and uniform normal temperature. Respiratory excursion is 2

cm. On the posterior chest of our client, the vocal fremitus is bilaterally palpable and is

best felt at the apex of the lungs. The client breathes without any difficulty, has

rhythmic and has an effortless respiration. Upon auscultation on all lung fields, clear

breath sounds can be heard.

XIII. HEART AND CENTRAL VESSELS

The precordium is observed to have no abnormal pulsations, lifts or heaves.

Abdominal aortic pulsations were palpable at the epigastric area. The aortic and

pulmonic pulsations can easily be listened to upon auscultation. However, the tricuspid

and apical pulses can only be minimally heard due to the size of the clients breasts.


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XIV. THE BREAST AND AXILLAE

The breasts of our client are round, generally symmetric, but slightly unequal.

Skin color is the same with the abdomen and without any localized discolorations,

retraction, and edema. The areolae having a dark brown color are generally the same

and a minimal of hair follicle is present on the Montgomerys glands. The nipples areround, everted, equal, and pointing at the same direction. Crusts and cracks are

absent. When using the concentric-circle pattern no masses, nodules, or lesions were

also palpable on the breast. The axillary lymph nodes were non-tender and non-

palpable.

XV. THE ABDOMEN

Stretch marks and fading linea nigra was evident on the abdominal skin without thepresence of visible lesions and discharges. Our clients abdomen is generally round,

symmetrical, and without any evidence of enlargement of the liver or spleen when the

client was doing deep breath. Symmetric movements caused by respiration are visible

as well as the aortic pulsations at the epigastric area. Bowel sounds were active upon

auscultation and there were no arterial bruits or friction rubs noted. Superficial masses,

areas of tenderness, and abdominal guarding were absent, during palpation.

XVI. EXTREMITIES

Upper Limbs

Our patients fingers are complete. Her shoulders, arms and hands are

symmetrical, and edema is absent. Contractures, fasciculations, and tremors were not

noted. On each body side, the client exhibited smooth coordinated movements with

equal strength. The bones and joints of the arms were free from any types of

deformities, and can move freely within its specified range of motion.

Lower Limbs

Both feet are symmetrical and have a complete set of toes. No areas of

tenderness noted. Muscle strength and movement is equal with bones properly

aligned. The joints are free from crepitations and swelling, allowing the patient to move

her legs and stand with ease.


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XVII. NEUROLOGIC STATUS

The patient is well oriented and well organized. Sharp and dull pain can be

differentiated. Her stereognosis, extinction phenomenon and 1-2 point discrimination was

good. She has an upright posture but has a little difficulty in walking. Heel-toe walking was

able to maintain by our client along a straight line and finger-nose test was repeatedly and

rhythmically executed. The examiners finger can simultaneously touch by her with

coordination. Her eye opening was spontaneous and obeys all commands. As a result,

she has an RLS of 1 and GCS of 15.

Cranial Nerves

Cranial Nerve Type Function Assessment

Olfactory Sensory Smell The patient was

able to determine

various objects

through their scent

or smell.

Optic Sensory Vision and visual fields Patient can read

fine print from a

paper without any

corrective lenses

Oculomotor Motor Extraocular movement,

movement of the

sphincter of the pupil;

movement of ciliary

muscles of lens.

Supplies fibers to four

of the six mucles of the

eye(superior, inferior

and medial rectus and

inferior oblique.)

Pupils has a brisk

reaction to light

stimulation and

accommodation.

Pupil size (3mm),

Her eyes was able

to move in different

directions.


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Trochlear Motor EOM specifically

moves eyeball

downward and laterally.

Patients eyes were

able to move

downward and turn

laterally

simultaneously.Trigeminal Sensory Sensation of cornea,

skin of the face, and

nasal mucuso.

Sensation on both

part of the face was

felt. Blink reflex is

present.

Abducens Motor EOM; elevates and

turns it laterally,

elevates the eye,

moves the eye medially

and depress the eye.

Without difficulty,

able to move her

eyes up and turn it

laterally and

downward

Facial Sensory and Motor Facial expression and

taste (anterior two

thirds of tongue)

She closed her eyes

tightly, puffed her

cheeks, frowned,

raised her eyebrows

and smile.

Vestibulocochlear Sensory Transmit impulses for

the sense of balance

and cochlear branch

transmits impulses for

sense of hearing.

She was able to

hear both the

whispered and

normal voice.

Glossopharyngeal Sensory and Motor Swallowing ability, gag

reflex, salivary

production, taste(posterior tongue)

Her gag reflex was

present and was

able to swallow.

Vagus Sensory and Motor Sensory of pharynx and

larynx, swallowing;

vocal cord movement

Roughness of the

voice was not noted

and was able to

swallow.


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Accessory Motor Shrugging of shoulders

Head movement.

She was able to

move her head with

symmetrical

strength and

shoulders wereshrugged.

Hypoglossal Motor Protrusion of the

tongue, moves tongue

up and down and side

to side.

Her tongue was

able to protrude and

can be moved in

different directions.


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Prenatal

Assessment


44/69

A Prenatal Assessment was by group conducted last September 29, 2009 at around 10:00am,

with the consent of Ms. Monaliza T.Luciano, the client. Our client is 23 years old and at present

pregnant to her second baby. She is also now on the 7 th month of Gestation.

I. General Survey

On our encounter with Mrs. Monaliza T. Luciano, our client, she was coherent, responsive and

not in any kind of respiratory disturbance.

LMP: February 24,2009

EDC: December 1, 2009

AOG: 31 weeks

Fundic height: 28 cm

FHR: 121 bpm

Height: 155 cm

Weight: 51 kg.

Immunization status: 3rd dose of TT given

Last prenatal visit: September 22, 2009

Procedure done: Prenatal Check up

II. Vital Signs

Vital Signs Patients Vital Signs Normal Values Diagnosis

Temperature 36.6C 35.6-36.7 C NORMAL

Pulse Rate 83 bpm 80-90 bpm NORMAL

Heart Rate 86 bpm 80-90 bpm NORMAL

Respiratory Rate 21 cpm 16-20 cpm NORMAL

Blood Pressure 120/90 mmHg 110/70-130/90 mmHg NORMAL


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III. Neurological System

Upon interviewing our client, she has said that there are times that she had headache and 5-10

minutes after the onset, it will just disappear. Any sudden unconscious involuntary twitch of movement

was not identified to be present.

IV. Cardiovascular System

After checking the blood pressure of our client, the result was 120/90 mmHg. It is in the normal

range which means theres a low chance that our client will be experiencing eclampsia but even

though we need to instruct our client what she needs to know.

Our client is not experiencing any chest pain that may be a sign of any cardiovascular related

complication.

Varicosities are evident and only few of blood vessels are noticeable.

V. Respiratory System

Upon auscultation, both lung fields have clear breath sounds. The client stated that shes not

experiencing any difficulty in breathing of any kind. Her respiration rate slightly higher than the normal

but it those not mean that any problem at all.

V. Gastrointestinal System

Our client those not complained of nausea and vomiting. As we have observed, our client likes

to eat. Her gums were not swollen but she told us that she had a tooth that was growing on the back

part of the mouth. Our client also told us that she had no dental problems even though our client has a

pair of missing teeth.


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VI. Renal SystemClients average urination per day is 6-8 which does not mean that she is dehydrated. There

were traces of glucose in the urine and protein is absent, proven by the test for Albumin, as we

conducted our crude urinalysis in the community.

VII. Endocrine System

Our client has no history of diabetes mellitus and we have proven that with the use of our urine

testing.

VIII. Reproductive System

During our assessment, the clients breast is not swollen and there were no masses and

tenderness noted. The breast was observed to be slightly unsymmetrical cause our clients left breastis a bit bigger than the right. The areola is dark-brown in color.

X. Integumentary System

Her skin is moist and with good skin turgor. Skin was is normal color and warm to touch upon

palpaton. Signs of pregnancy were present such as linea nigra, striae gravidarum, chloasma as well

as vascular spider with increase hair growth on scalp.

XI. Skeletal System

Our client has slight complain at her lumbar area but she doesnt mind that as a problem at all

because she finds it normal to every pregnant women.


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XII. Nutritional Status

For only about 3 days we found out that the family of our client eats food rich in protein.

XIII. Lifestyle Habits

Our client is in a simple living. She is already happy with her life having her loving and caringhusband and her lovely Angel. Every night they tend to wait for each other and eat together for

bonding purposes. Our client has no vices at all.


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Prioritization


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PRESENCE OF BREEDING OR RESTING SITES OF VECTORS OF DISEASES

CRITERIA COMPUTATION ACTUAL

SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM

2/3 x 1 2/3 The problem is a health

threat that needs

immediate action.

MODIFIABILITY OF

THE PROBLEM 2/2 x 2 2

The problem is easily

modifiable since all the

needed resources are

available and

accessible to the family.

PREVENTIVE

POTENTIAL

3/3 x 1 1 Changing and cleaning

the breeding sites of

mosquitoes can prevent

diseases like:

a.) Dengue fever/

Dengue

hemorrhagic

fever

b.) Malaria

c.) Filarasis

SALIENCE OF THE

PROBLEM

1/2 x 1 1/2 The family perceived

this as a problem but

does not need

immediate action due to

the small number of

mosquitoes at the area.

TOTAL SCORE 4 1/6


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POINTED/SHARP OBJECTS IMPROPERLY KEPT


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM

2/3 x 1 2/3 It is a health threat that

needs immediate

action.

MODIFIABILITY OF



modifiable since

resources needed are

available and

accessible to the family.

PREVENTIVEPOTENTIAL

3/3 x 1 1 Infections like Tetanuscan be prevented if the

problem is eliminated.

SALIENCE OF THE

PROBLEM



does not need

immediate action since

no one was available to

do it.

TOTAL SCORE 4 1/6

UNHEALTHFUL LIFESTYLE AND PERSONAL HABITS / PRACTICES DUE TO SMOKING


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM


needs immediate action

since it is dangerous to

the whole family

especially the unborn

child.


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MODIFIABILITY OF


The problem is partially

modifiable considering

the cooperation and

willingness of the father

to reduce or if possiblequit smoking.

PREVENTIVE

POTENTIAL

3/3 x 1 1 Minimizing or

eliminating cigarette

smoking will prevent the

risk of cancers, skin

disorders, and

complications to the

unborn child.

SALIENCE OF THE

PROBLEM

2/2 x 1 1 The family perceived

this as a problem that

needs immediate action

to prevent complications

for the whole family.

TOTAL SCORE 3 2/3

UNSANITARY FOOD HANDLING AND PREPARATION


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM


threat that needs

immediate action.MODIFIABILITY OF



modifiable since

resources are available

and accessible.

PREVENTIVE 3/3 x 1 1 Diseases such as Acute


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POTENTIAL Gastroenteritis can be

prevented if this

problem is eliminated.

SALIENCE OF THE

PROBLEM


this as a problem butdoes need immediate

action considering the

financial status.

TOTAL SCORE 4 1/6

ACCIDENT HAZARD: FIRE HAZARD


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM


needs immediate

action.

MODIFIABILITY OF


It is partially modifiable

since the house is made

in wood.

PREVENTIVE

POTENTIAL

3/3 x 1 1 Burns, death, and loss

of shelter can be

prevented if the problem

is eliminated.

SALIENCE OF THE

PROBLEM



does not needimmediate action due to

the scarcity of the

resources.

TOTAL SCORE 3 1/6


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LACK OF FOOD STORAGE FACILITIES


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM

2/3 x 1 2/3 It is a health threat

since foods are

exposed to dusts and

pests.

MODIFIABILITY OF


The problem was

partially modifiable

since financial

resources are

inadequate.PREVENTIVE

POTENTIAL

3/3 x 1 1 Having adequate food

storage facilities will

prevent food poisoning

from perishable foods.

SALIENCE OF THE

PROBLEM



does not need

immediate action

considering that the

family have adequate

knowledge about the

problem.

TOTAL SCORE 3 1/6

ACCIDENT HAZARD: FALL HAZARD


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM


threat considering that


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there is no presence of

handles for supporting

each member in going

up and down the stairs

that may lead toinjuries.

MODIFIABILITY OF


The problem is partially

modifiable since time

and effort of an

individual is unavailable

presently.

PREVENTIVE

POTENTIAL

3/3 x 1 1 Falling can be

prevented considering

that the materials are

available and

accessible.

SALIENCE OF THE

PROBLEM



does not need

immediate action since

they can manage on

moving up and down

the stairs.

TOTAL SCORE 3 1/6

GARBAGE DISPOSAL


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM

2/3 x 1 2/3 It is a health threat.

MODIFIABILITY OF It can be easily modified


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THE PROBLEM 2/2 x 2 1 since materials are

available.

PREVENTIVE

POTENTIAL

3/3 x 1 1 Foul smell and insects

which can cause

discomfort for the familywill be eliminated.

SALIENCE OF THE

PROBLEM

0/2 x 1 0 The family is unaware

of the problem and does

not find the improper

garbage disposal as in

need for change.

TOTAL SCORE 2 2/3

INADEQUATE LIVING SPACE


SCORE

JUSTIFICATION

NATURE OF THE

PROBLEM

2/3 x 1 2/3 It is a health threat

considering possible

transmission of

communicable diseases

to each member of the

family.

MODIFIABILITY OF


The problem is not

modifiable since the

familys finance

resources presently arenot enough considering

the daily expenses of

the family.

PREVENTIVE

POTENTIAL

3/3 x 1 1 Increasing the living

space will reduce the


56/69

possible transmission of

communicable

diseases, provides

privacy to each member

of the family, and toallow adequate

movements when

performing daily

activities.

SALIENCE OF THE

PROBLEM

1/2 x 1 1/2 The family is aware of

the problem but does

not need immediate

action since the family

had planned to have an

extension on the month

of January next year.

TOTAL SCORE 2 1/6


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Family

Nursing

Care

Plan


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Health Teaching

MEDICATIONS:

1. Instruct the family to take only those medicines which are prescribed by their

doctor/physician. Instruct to take the medicines at the right time, number/amount,

route and dosage. Elaborate the importance of taking medications, their side effects

and benefits.

2. Encouraging all the family members to have their monthly check- up in the health

center to maintain good health.

3. Instruct mother, father and other reliable family members to have a consultation

with their doctor or physician or went to the nearby health center if signs and

symptoms of diseases occur.

4. Inform the patient that not all drugs are safe to use while breastfeeding.

EXERCISES:

1.) Perform exercise and other relaxing activities at least 3 times in a week to help in

promoting good blood circulation; to avoid health problems and make their bodies

physically fit - such as jogging and walking.

2.) Encourage the family to participate in the organizations of the community and join

such organizations that help them grow as a more mature and responsible

persons.

3.) Encourage the family to do walking and do socialization among their neighbors.

TREATMENT:


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1.) Encourage the husband as well as the family members about the dangerous of

smoking and instruct not to smoke or gradually stop smoking for it endangers our

health. Frequent smoking affects the functioning of the respiratory system and might

cause lung cancer.2.) Teach and emphasize the family the signs, symptoms and complications brought by

smoking. This will make the family members to be aware of the effects of smoking in

the body.

3.) Encourage family members not to drink alcohol/beer for it damages the liver and could

lead to severe complications.

4.) Provide the mother and father some teaching programs especially for family planning

such as birth control and natural methods and give emphasis on the importance of

contraceptive methods.

5.) Discuss the mother with the importance of breastfeeding that promotes health not only

on babies but also for the mommies.

HYGIENE:

1. Take a bath everyday at least twice a day to clean the body from any dirt and foul

smell. Practicing good and proper hygiene will greatly affect our health.

2. Use soap while taking a bath to remove properly the dirt in the body. Lather it

thoroughly and gently to remove all microorganisms that is present in the body.

Using soap in taking a bath will easily remove the dirt and oil present in our skin.

3. Promote tooth brushing using toothpaste and toothbrush, doing it after meals at

least three times a day. Cleaning the teeth helps to prevent the accumulation of

tartar and plaque in between the teeth.

4. Teach the family how to do the proper hand washing especially before and after

eating meals to prevent the transmission of microorganism into our body.

5. Emphasize to the family the use of slippers in walking, playing and going inside or

outside the house in order to protect and avoid any accidental bruises and scars in

the feet. Using slippers will also help in preventing the invasion of microorganism

that might enter in any open part of our skin.


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6. Instruct the client to clean her nipples before and after breast feeding plainly with

water.

OUT PATIENT VISIT:

1.) Maintain an open communication among the family members.

2.) Continuing a warm relationship between the mother, father, child and others relatives

within the compound.

3.) Provide the mother and father some teaching programs especially for family planning

such as birth control methods and natural methods and give emphasis on the

importance of contraceptive methods.

4.) Encourage the family to properly dispose their garbage to maintain cleanliness of their

surrounding and to prevent acquiring diseases.

5.) Keep water containers empty to prevent mosquitoes from breeding.

6.) Clean properly all utensils such as spoon and forks, glass, plate, etc. before using.

7.) Motivate the family to utilize the available resources at home for proper food storage

and handling such as containers with cover for keeping their eating utensils as well as

their foods.8.) Inform the family about safety precautions on; avoiding children not to put objects in

their mouth keep sharp and fire objects away from their reach, keep insecticides,

solutions, and medicines from the reach of children.

9.) Encourage the family to communicate and coordinate with the health care officials or

team in the barangay health center.

10.) Encouraging the infants efforts to develop new skills, to cope up with problems

and to amuse, comfort, feed and progressively care for her.

11.) Educate the mother about the benefits of breastfeeding to the mother as well as

the newborn.

DIET:


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1. Encourage the family to eat nutritious foods such as fruits and vegetables that will

help to maintain our immune system since fruits and vegetables are highly rich in

vitamins and minerals.2. Instruct the family to drink clean supplies of water and if doubt, boil the water for 3x.

3. Encourage the family especially the mother to take foods rich in calcium, protein,

vitamins, carbohydrates and fats that will help in the normal functioning of our body

system. Foods rich in fiber are necessary in our diet since dietary fibers increase our

sense of fullness.

4. Always have a balance diet by having meals 3 times a day by eating natural foods

and different variety of foods which are prepared in a simple and tasty way.


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Nursing

Implication


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Nursing implications are necessary in the making of this family case study in different

nursing areas in such a way. Not only to help the family but for us to learn.

Nursing Education

Nursing education is the primary responsibility of ours that should be rendered to our

client. In such a way we are learning in the different situations and dynamics that we have

faced throughout the span of duty. This case study can also be a way to help our client

evaluate themselves. Nursing education does not focus on the gain of our selves alone to

learn and study their living in the family that could affect the community instead we are

promoting a nursing education that could lend them to stand strong in the society by knowing

the necessary education and achieving the important skills in battling the problems in the

community.

Nursing Research

This nursing study is a great help for us in the near future. We could apply our learning

in the different areas since this could study also sum-up our gained knowledge through our

previous years in studying and can be a great need for our future studies. This research can

be a great help for those student nurses like us who would undergo community health nursing

rotation.

Nursing Practice

A place for return demonstrations are different from those in the outside would.

Initiative is used and no procedure could say how you would do the practice in the real world.

We have pondered that though we meet a lot of people with different personalities it is

important for us to respect them and be courteous. These practices are essential for our

growing and will mold us to a competent student nurse someday.


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Appendix A

Ventilation (TWO/TFA x 100)

Total Floor Area

TFA = L x W

= 4.32308m x 3.2004m 13.84m2

= 13.84m2 x 2.75m2

*CR TFA = 16.59m2

= 1.8034m x 1.5240m

= 2.75m2

Total Window Opening

TWO = L x W

= 1.18872m x 0.7112m x 4 3.38m2

= 3.38m2 x 0.209m2

*CR TWO = 3.59m2

= 0.209m2

TWO/TFA x 100

= 3.59m2/16.59m

2x 100

= 22% - satisfactory


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Overcrowding

The family managed to live in the house but they were already planning to have an

extension for some important purposes. Their family is growing and considering the furnitures

they have, it lessens the space for the family the space is not enough especially for a child

who is in the growing stage of development.

LMP: February 24, 2009

EDC:

02 24 09

-3 +7 +1

12 01 09

AOG:

Feb-4

Mar-31

Apr-30

May-31

June-30

July-31

Aug-31

Sept-29

217/7 = 31wks.

Fundic Height: 28cm

28/4 = 7months

Fetal Heart Rate: 121bpm

Last Prenatal Visit: September 22,2009

BMI (Weight in kg/Height in meters

square)

Monalisa Luciano

51kg/(1.52m)2 = 22.50 kg/m2

Pailito Luciano

70kg/(1.60m)2 = 27.34kg/m2

Angel Mikaela Luciano

12kg/(0.87m)2= 15.85 kg/


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Appendix B


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From San Pedro College, we ride a jeep going to Barangay Ubalde, Agdao City.

The health center was cemented and is abundance of flowers in the front yard. Our

client's house is located at Barangay Ubalde, Agdao City Del Pilar street Jerome

Extension. From the baranggay health center just walk across the street and at the

basketball area turn into the right road entering the Del Pilar Street Jerome extension.

While entering the street, there are many houses at different types and a lot of people

are being encounter in which some of them greet us as Goodmorning maam/sir. You

need to walk and encounter 22 houses to get on the red gate and pass many stores

until you can arrive on our clients house. At the 23 hause is our clients house. Their

house and lot is not so big but the members of the compound are approachable and

willing to accept visitors. Their compound is composed of two houses, our clients house

built in the right side area while on the other side is the house of the husbands parents.

They raise chickens in their surroundings and they also have a small sari-sari store

owned by the parents of the husband.


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Gallery


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Bibliography

Book source:

Duvall, Evelyn Millis. Marriage and Family Developent, 5 th Editon. JB

Lippincott Company, Philidelphia 1977.pp 249-272

Pilitteri, Adele,PhD, RN, PMP. Maternal and Child health Nursing. Care of

the Childbearing and Childrearing family 5th

Edition. Lippincott

Williams and Wilkins. 2007,p 230-237

Kozier,Barbara, MN, RN , et al. Fundamentals of Nursing: Concepts,

Process and Practice, 7th

Edition. Pearson Education South Asia.

2004.pp 535-614

Internet source:

http://www.unicef.org/infobycountry/philippines_statistics.html

http://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.P

Entrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSu

m

http://www.nscb.gov.ph/RU11/davao_city/social_health.htm

http://www.worldometers.info/abortions/
http://www.unicef.org/infobycountry/philippines_statistics.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.nscb.gov.ph/RU11/davao_city/social_health.htmhttp://www.worldometers.info/abortions/http://www.worldometers.info/abortions/http://www.nscb.gov.ph/RU11/davao_city/social_health.htmhttp://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.unicef.org/infobycountry/philippines_statistics.html

64901969 Family Case Study

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