Systems Plus College Foundation

SYSTEMS PLUS COLLEGE FOUNDATIONMIRANDA ST. ANGELES CITY

IN PARTIAL FULFILMENT OF THE COURSEREQUIREMENTS IN INTENSIVE PRACTICAL

NURSING PRACTICUM

FAMILY CASE ANALYSIS

SUBMITTED BY:

BALUYUT, LIEZEL ANN M.MENDOZA, CARISA G.

SUBMITTED TO:

MR. MARCO ANTONIO Y. TIQUIMRS. CARMELITA DJ. RAMOS

19TH DAY OF DECEMBER

TABLE OF CONTENTS:

I. INTRODUCTION

II. FAMILY CONSTELLATION

III. HEALTH ASSESSMENT

IV. SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENT ASSESSMENT

V. PROBLEM IDENTIFICATION

VI. FAMILY NURSING CARE PLAN

VII. LEARNING DERIVED

VIII. SOCIOGRAM

IX. SPOT MAP AND DOCUMENTATION

INTRODUCTION:

Nursing- includes a range of specialties and definitions that vary from country to country.

Community health nursing- a field of nursing that is a blend of primary health care and nursing practice with public health nursing.

Public health nursing- a field of nursing that is concerned with the health needs of the community as a whole. Public health

nurses may work with families in the home, in schools, at the workplace, in government agencies, and at major health facilities.

Family case analysis- is an instrument utilized by PHN nurses and student nurses a like in delineating all prevailing problems

of the community by centering on the families constituting it.

Why should you do family care analysis- is a tedious and painstaking requirement but it is rewarding enough as it is. It served

as a wakeup call for all student nurses, making them witnesses of the poverty and decreasing self-reliance when it comes to

health care’s which are becoming ubiquitous in the community at present.

A. OBJECTIVES

Short term objective:

1. Student-centered

At the end of the whole day home visits to the family. The student will have:

Introduced to one’s self the family and emphasized the purpose of the home visiting order to establish rapport.

Built a harmonious working relationship with the family members

Discussed the problems identified and pointed out solutions to prevent the problem.

Perform interventions associated with the diagnosis of the family to promote wellness.

Educate the family in the promotion of health and prevention of illness.

2. Client-centered

At the end of the whole day home visits to the family. The family will have:

They recognized specific problem present in the family and surroundings.

They gained awareness regards to the family health status and health problems.

Broaden their knowledge tin terms of the importance of having healthy lifestyle.

Prioritize the identified family health nursing problems with the assistance of their student nurse.

Cooperate with the student nurse.

Long-term objective:

1. Student-centered

At the end of four weeks of home visits. The student will have:

Improve nursing skill in terms of therapeutic communication, physical assessment and in rendering care and service.

Gained knowledge about family health nursing.

Perform health assessment to each family member (IPPA-Cephalocaudal).

Motivated the family to have healthy life style.

Gather and obtain pertinent data including demographic, socio-economic, cultural, and environmental data.

2. Client-centered

At the end of four weeks of home visits the family will have:

Evaluate changes in condition after giving interventions

Perform the health teachings taught by the student nurse

Participate actively during home visits and assessment interviews

Categorize the identified health problems as health threat, health deficit or foreseeable crisis through the assistance of their student- nurse.

Maintain an environment that is conducive to health and development.

Realize the importance of having and maintaining good health practices.

B. ENTRY AND CLIMATE ACCEPTANCE

NOVEMBER 25, 2011

A sunny Friday when the group first visited the Jao Ville. The group looked for family that is capable and

qualified in their family care plan. At first, they felt the fear and worry because the group doesn’t know the people there.

The entire groups expected about those places are collective of people taking drugs and abusive. Then, they finally

found their chosen family and they saw the mother combing the hair of their daughter, the father is repairing the parts of

the bike, one of their children was playing on the sand and the group respectfully gave greetings “magandang umaga po”

and then the family happily replied “magandang umaga din”.

C. NUMBER OF ACTUAL HOME VISITS:

NOVEMBER 25, 2011

The entire group arrived at 7am going to 9TH street Marisol. It was the first time that the group went to that place

. Its unfamiliar environment welcomed them. Mam Carmelita Ramos and Mr. Antonio Tiqui grouped them into two.

The group went to Jao Ville and the group saw a big population and a huge number of children playing laro ng lahi on

the street. The groups were very shy because all of the people there are staring to them and a group of mothers were

murmuring while on them, the group felt that they were the topic but they continued walking and looked for a family.

DECEMBER 02, 2011

In the group’s 2nd visit. They documented some information such as vital signs of the present members.

That time the father and their three children are not at home. The father is a tricycle driver that’s why the groups are

difficulties interviewing him. The three children wasn’t around, the mother explained that they were not staying at home.

the mother and her two children gladly cooperated to them.

DECEMBER 07, 2011

In our 3rd visit, the group asked the family if they are feeling well or is there something wrong about their body.

After several talks and playing with the two children, we ask permission to the parents if we can personally bath the

children and the mother said yes and we started bathing them. After that the group helped the mother in cleaning their

backyard and they also help getting water from water pump in their neighbour.

DECEMBER 09, 2011

It’s our final visit in the family. The group did what was intended to do that day. They had their final

documentation and they added some tips about health. At last, their children were complete. So, the groups perform

the assessment to them. That was the first time the group meet the three children. The group really spends time to

them because that day will be the last time that they will be seeing them. The group cherish the last moment because

they learned a lot from them.

NAME AGE BIRTHDAY POSITION IN THE FAMILY

GENDER CIVIL STATUS EDUCATIONAL ATTAINMENT

Papa x 61 y/o June 15, 1950 father male married High school graduate

Mama x 44 y/o March 01, 1967 mother female married High school graduate

Ate x 26 y/o May 05, 1985 Eldest female single High school graduate

Kuya x 22 y/o March 15, 1988 2nd eldest male single High school graduate

Ate xx 17y/o Feb 02, 1994 3rd to the eldest female single High school graduate

Baby 1 x 06 y/o August 03, 2006 2ndyoungest male single Still going to school

Baby 2 x 05 y/o Sep 23, 2005 youngest female single Never been to school

Health Assessment (IPPA-cephalocaudal)

A. GENERAL CONDITION/APPEARANCE

Papa x is the head of the family. During our first visit he was wearing white shirt and pants. He was dirty because his

job is vulcanizing. He was repairing the parts of the bicycle. His vital signs were taken on Nov 25, 2011 and as follows;

B. VITAL SIGNS:

(First home visit)

BP: 140/90 mmhg T: 37.1 ˚C/ axilla PR: 85 bpm RR: 19bpm

BMI: weight in kg/height in m2

58kg/5’4” = 57.73/3.25 = 18

(Due to his work, we only met the father once.)

C. PHYSICAL ASSESSMENT

HEAD: His scalp is dry

EARS: He has wet cerumen around the ear canal

MOUTH AND THROAT: Teeth are yellowish. Presence of caries on the upper and lower molars positive for halitosis.

D. HISTORY OF PAST AND PRESENT ILLNESS

Papa x was never been hospitalized. He previously had coughs, colds, fever and diarrhea. When feeling sick,

he usually gets enough rest and his wife gave him adequate water. And if illness does not subside in three days, he usually

goes to the health center to avail of medicines. Presently, he has no illness.

E. ACTIVITIES OF DAILY LIVING ( PAPA X )

5am - 5:30am Wake up and drink coffee.

5:30am - 10am Working hours.

10am - 11:30am Working in small town lottery.

11:30am - 12pm Eat lunch.

12pm - 5pm Working hours.

5pm - 7pm Going home and rest time.

7pm - 8pm Eat dinner.

8pm - 5am Time to sleep.



Mama x is the wife of the head of the family. She has brown skin. Her hair is shoulder level and not well combed.

Upon initial contact, the group observed that the mother is busy watching her child. She was so kind and hospitable.

She entertained the different questions that the group asked. She wears a white t-shirt, pajama and she wears footwear.

Her vital signs were taken on Nov 25, 2011 and as follows;

B. VITAL SIGNS:

(First home visit)

BP: 120/90 mmhg T: 36.1˚C/ axilla PR: 95 bpm RR: 17 bpm


56kg/59” = 123/3= 18.64

Dec. 02 2011 BP: 130/90 mmhg T: 37.1˚C/ axilla PR: 90 bpm RR: 20 bpm

Dec. 07 2011BP: 120/90 mmhg T: 37.1˚C/ axilla PR: 88 bpm RR: 17 bpm

Dec. 09 2011BP: 140/90 mmhg T: 36.4˚C/ axilla PR: 96 bpm RR: 20 bpm

MOUTH AND THROAT: She has tartar and presence of halitosis

NECK: She has small lumps.

GASTROINTESTINAL: She has allergy in some seafood.


Mama x had never been hospitalized or acquired any serious illness in the past. She had experienced simple cough and

colds some years ago but was resolved through home remedies such as taking more fluids and citrus fruits and sometimes over

the counter medicines. At present, she has no known disease.

E. ACTIVITIES OF DAILY LIVING ( MAMA X )

5am - 5:30am Wake up and prepare the things that the father needs.

5:30am - 7am Sleep again.

7am - 8am Wake up and take her second youngest child to school.

8am – 11:30am Cleaning the house and cook for lunch.


12pm - 7pm Rest time while bonding with children.





Ate x is the eldest child in the family. She has fair skin, her hair is long. Upon initial contact, the group observed

that ate x is washing their clothes. She is kind and friendly person. She wears a white t-shirt and black shorts and she

wear footwear and has accessories. Her vital signs were taken on Dec 09, 2011 and as follows;

B. VITAL SIGNS:



45kg/5’4” = 100/3.25 = 14


SKIN: Her skin is dry .

CHEST AND LUNGS: Presence of cough and sputum noted. Presence of wheezing sound.


Ate x had not acquired any serious disease or illness in the past and had not been confined in a hospital.

At present, she is experiencing cough and colds which begun in the last week of October.

E. ACTIVITIES OF DAILY LIVING ( ATE X )

9am Wake up.

9am - 10:30am Cleaning and helping in the household chores.

10:30am - 11:30am Watching television.


12pm - 3pm Rest time.

3pm - 4pm Cleaning the house.

4pm - 7pm Hang-out with friends.


8pm - 9am Sleeping hours.



Kuya x is the second eldest child in the family. He has dark skin, his hair is shiny and in clean cut. He is kind.

He wears a blue t-shirt, black shorts and he wear footwear. His vital signs were taken on Dec. 09, 2011 and as follows;

B. VITAL SIGNS:

BP: 120/80 mmhg T: 37˚C/ axilla PR: 88 bpm RR: 16 bpm


47kg/5’5” = 105/3.30 = 14.46


SKIN: His skin is dry.

EARS: Presence of dirt and cerumen. He responses late when being called.

MOUTH AND THROAT: He has yellowish teeth and presence of halitosis.

GASTROINTESTINAL: He is constipated.


Kuya x was never been hospitalized. He has no allergies to any kind of foods. Presently, he has cough and colds

and it has been present since the first week of November.

E. ACTIVITIES OF DAILY LIVING ( KUYA X )

5am - 5:30am Wake up.

5:30am - 10am Working hours with his father.

10am - 11:30am Working in small town lottery with his father.


12pm - 5pm Working hours again with father.

5pm - 7pm Going home and rest time.





Ate xx is the third eldest child in the family. She has flawless skin, her hair is long. She is friendly person.

When we saw her, she’s holding her cell phone and texting. She wears a black t-shirt and black shorts. Her vital signs

were taken on Dec. 09, 2011 and as follows;

B. VITAL SIGNS



45kg/5’4” = 100/3.25 = 14


NOSE AND SINUSES: Presence of nasal discharge.

MOUTH AND THROAT: She has yellowish teeth, presence of tartar and presence of halitosis.


Ate xx verbalized that she had never been hospitalized. Sometimes due to weather changes, ate xx had fever,

cold and cough. At present, she’s well.

E. ACTIVITIES OF DAILY LIVING. ( ATE XX )

10am Wake up.

10am - 11:30am Clean their bedroom.


12pm - 4pm Rest while texting.

4pm - 7pm Hang out with friends.





Baby 1x is the second youngest child in the family. He has dark color skin, his hair is short. Upon initial contact,

the group observed that baby 1x is playing his baby sister. He is quite naughty child. He wears a white printed t-shirt and

chequered shorts and he wear footwear. His vital signs were taken on Nov 25, 2011 and as follows;

B. VITAL SIGNS:

T: 36.4˚C PR: 95 bpm RR: 20 bpm

Dec. 02 2011

T: 36.1˚C/ axilla PR: 90 bpm RR: 15 bpm

Dec. 07 2011T: 37.1˚C/ axilla PR: 88 bpm RR: 17 bpm

Dec. 09 2011T: 36.4˚C/ axilla PR: 96 bpm RR: 15 bpm

FNRI: age in years x 2 + 8 = 6 x 2 = 12 + 8 = 20 normal.


SKIN: He has dry skin.

HEAD: Hair is dry .

MOUTH AND THROAT: His teeth are yellowish.

E. ACTIVITIES OF DAILY LIVING ( BABY 1X )

5am Wake up.

5am -7am Eat breakfast, take a bath and dress up..

7am - 11:30pm School hours.

11:30 - 12pm Eat lunch.

12pm - 3pm Rest and sleep.

3pm - 8pm Playing after that eat dinner




Baby 2x is the youngest child in the family. She has dark color skin, her hair is short. Upon initial contact,

the group observed that baby 2x is playing his brother. She is shy-type child. She wears a pink t-shirt and pajama and

she wear footwear. Her vital signs were taken on Nov 25, 2011 and as follows;

B. VITAL SIGNS

T- 36.7˚C PR- 98 bmp RR- 25bmp

IBW: age in years x 2 + 8 = 5 x 2 = 10 + 8 = 18 normal

Dec. 02 2011 T: 36.1˚C/ axilla PR: 85 bpm RR: 18 bpm

Dec. 07 2011


Dec. 09 2011



SKIN: She has dry skin.

HEAD: Her hair is dry. and presence of nodules.

EARS: Presence of wet cerumen.

NOSE AND SINUSES: She has colds.

MOUTH AND THROAT: Her teeth are yellowish and incomplete

CHEST/LUNGS: Presence of cough and sputum and wheezing sounds.


According to mama x like baby 1x, baby 2x had never been hospitalized. Sometimes due to weather changes,

baby 2x had fever, cold and coughs. At present, she has colds and cough.

E. ACTIVITIES OF DAILY LIVING ( BABY 2X )

5am Wake up.

5am -7am Eat breakfast.

7am - 11:30pm Watching television.

11:30 - 12pm Eat lunch.

12pm - 3pm Rest and sleep.

3pm - 8pm Playing after that eat dinner


F. IMMUNIZATION STATUS

Noted: this is based on mama x. She was unable to present the immunization record because it was misplaced.

According to mama x, all the vaccine of baby 2x were completed.

G. FOOD AND NUTRITION

The family have two younger children aged five and six, they don’t drink milk instead they like to drink

coffee (Nescafe). Their food source comes from their backyard. Their plants are eggplants, radish, okra, tomato and mustard.

BCG DPT OPV HEPA-V MEASLES

1 2 3 1 2 3 1 2 3

IV. SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT.

A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

The family X is nuclear family and they are currently living at lot #2 Jao Ville, Marisol. The head of the family is papa x,

61 years old and was born on June 15, 1950. Together with him his wife mama x, born on march 01, 1967 and she was 44

years old. They are married for 26 years. Their eldest child is 26 years old and was born on May 5, 1985. Now, she was

stopped schooling after she graduated high school but she’s helping her mother cleaning their house. The second eldest child

is 22 years old and was born on March 15, 1988. He also stopped schooling because they don’t enough money but he is

currently helping her father. Their third eldest child is 17 years old and was born on February 02, 1994. She also stopped

schooling because of financial problem.

Their second youngest is 6 years old and was born on august 03, 2006. He is studying in blist school as grade 1 and their

youngest is 5 years old and was born on September 23, 2005. She’s not yet attending school because the required age for

grade 1 is 7 years old. Mama x is the one who made decisions because she is the one whose taking care of the children

and manage daily expenses. Papa x is simply stay at home during free time and take a rest because he’s tired on his work.

B. Socio-economic and social characteristic.

Occupation and work of income

The family X primary source of income comes from the salary earned by papa x as a tricycle driver and a worker of small

town lottery. He usually starts working from 4 in the morning until 5 in the afternoon. He usually earns hundred to two

hundred per day in his tricycle and in the small town lottery he earns ten pesos in every hundred peso in stake.

Mode of expenditure

Nature and Extend of family participation in the community

The family x participates in the community’s activity. They have good relationship with their neighbours

because they get the chance to spend time with them if there is free time.

Ethnic background and Religious practices

All members of the family speak kapampangan and tagalog and they are Roman Catholic. Sometimes they

attend mass but the father doesn’t attend or hear masses due to lack of time.

FOOD

WATER

OTHER EXPENSES

TOTAL

160

10

30

200

Values, Beliefs, Tradition, Cultural aspects and Relation to their health practices .

The family x believes in usog, tawas and albularyo. When one of the family member get sick they first bring them

to quack doctor instead of going straight to the medical doctor because they could not afford the doctor’s fee due to financial

constraints or problems, if it is only minor illness like cough and colds they will only just drink calamansi juice. They usually

pray at night and they will just make gatherings when it’s Christmas and New Year’s Eve.

C. House and lot ownership

Family x lives in a made shift house. Their house serves all purposes for the family usage such as dining, living, kitchen and

bedroom. They have one window and one electric fan and their sources of light come from their neighbour. Their house is

within an area approximately adequacy of light. It has no vacant area and we pass through a narrow path way leading to

their house but they have front and side yard for the children to play.

Adequacy of living space

The house measured 4.36mx3.92m and the family is consisting of seven members five of them are adults and two are

children. Based on the computation for adequacy of living space the total floor area is 20.01sq.m and the TSR is 61sq.m making the

house crowded for the family of seven members since the total space requirement is greater than the total floor area.

The inadequacy of living space may result to easy transmission of communicable disease. All member of the family sleep together

one bedroom.

Breeding or resting sites of vectors of disease

It has been noted of the X house that there are sites for breeding vectors during interventions it is noticeable that

there are cockroaches and other insects. Since the backyard and front yard is the garbage disposal, the flies and mosquitoes

flew around outside and inside of the house.

D. ENVIRONMENTAL CONDITION

Water supply and water storage

Their source of water comes from a water pump located near their house. They use this for bath, laundry and

other household chores. They buy water in that comes from faucet (NAWASA) for them to drink they fall in level two and

three. They stored their water in a one gallon mineral water container. They stored the water coming from water pump in

the pail.

Toilet facility, garbage disposal and drainage system

The X family has their own toilet. They used the septic tank, pail system down through manual flushing as their

means of toilet of toilet facility. The toilet is beside their utility area and unclean. They made a cat hole in the sand as their

garbage container. The drainage system is beside house causing foul smell and favourable breeding site of insects. They

used mosquito nets and mosquito coil to avoid mosquitoes.

V. LIST OF PROBLEMS IDENTIFIED

1. Presence of cough and colds 5

2. Malnutrition 3.33

3. Poor Home and Environmental Sanitation 2.84

3. Poor Personal Hygiene 2.84

3. Inadequate Living Space 2.84

4. Goiter 2.5

Problem No 1. Presence of cough and colds

Criteria Computation Score Justification

Nature of the problem Modifiability of the problem Preventive Potential Salience

3/3 x 3 2/2 x 2 3/3 x 1 2/2 x 1

Total

1 2 1 1

5

It is a health deficit since this is an actual health condition being experienced by the two children baby (ex1 and baby ex 2). It is easily modifiable with proper knowledge and usage of community resources such as herbal medicine and some health teaching by the nursing students. The problem has moderate preventive potential considering facts that cough and colds is usually self limiting and easily managed. The family dully recognizes the presence of cough and colds as a problem needing immediate attention as verbalized by the mother in one of the home visit,

Problem No 2. Malnutrition


Nature of the problem Modifiability of the problem Preventive Potential Salience

3/3 x 3 1/2 x 2 1/3 x 1 2/2 x 1

Total

1 1 0.33 1

3.33

It is a health deficit because according to assessment made the weight of the children are below the ideal weight. It is partially modifiable the families are inadequate to address the problem although the student nurses could rendered health teachings to the family about the nutrient rich food which are inexpensive and could assist them in preparing meals properly to address the problem. This problem has a low preventive potential the mother tries her best to feed adequately their children but their financial problem is preventing her doing this. The problem recognize needing an immediate attention. In one of the interviews the mother stated that she is just so helpless regarding the problem.

Problem No 3. Poor Home and Environmental Sanitation


Nature of the Problem Modifiability PreventivePotential Salience

2/3 x 1 1/2 x 1 2/3 x 1 1/2 x 1

Total

0.67 1 0.67 0.5

2.84

It is a health threat because this type of condition predisposes the family to infection and spreading of the diseases. Contamination of the foods can cause disturbances to the growth of their children. It is partially or moderate modifiable, because proper health teaching came from the nurses can help them. They can also motivate and assist the family in cleaning their house and their surroundings. These such kind of problems requires the whole take drastic measures of fully eliminating the problem. Since the family X is used to this long time existing problem, health teaching may have an effect to their compliance of their problem. As well as the lack of necessary actions of the government decreases the potential of preventing this kind of problem. The family recognizes the condition as a problem, but they do not see it as something needs immediate attention. This situation cannot be charged immediately according to them and there are more important needs attention.

Systems Plus College Foundation

Documents

family health status

family members

chosen family

family constellation

community health nursing

public health nursing

health threat

health deficit