case data commu cont (repaired)

7/28/2019 Case Data Commu Cont (Repaired)

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Far Eastern UniversityManila

Institute of nursing

Brgy. Maytunas, San JuanAUGUST 2, 2011

Passed to:PROF. TAGAPAN

Passed by:

Group28Pea, Elaine Joy J.

Cabigting Clarisse Jane

Patao, Cristian P.

Ramos, Kaylle Marie R.

Santos, Jear P.

Santos, John Carlo B.

Solis, Mikhail M.

Tabago, Girlie Ann S.

Toreja, Mark Joseph S.

Ventura, Kevin Ace R.

COMMUNICABLE

DISEASE


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Villamor, Katrine A.

Villavicencio, Beverly L.

PRIMARY COMPLEXAn introduction

Primary complex

- It is a type of tuberculosis infection that most often occurs in children. The focus of the

initial infection is a small area in the lungs and lymph nodes.

- Primary complex is acquired when someone inhales the tuberculosis germs of an infected

person. The germs are breathed into the lungs and develop into an infection over a period of

one or two months before spreading to the lymph node, according to Pediatric On Call.

- People infected with primary complex often do not demonstrate any symptoms. However,

they may have a cough or swollen lymph nodes. Primary complex is diagnosed with a skin

test.- Ranks 6th in the leading cause of morbidity and mortality in 2002.

- Incidence rate of Primary Complex is 243/ 100,000 population/year.

- Treatment for Primary Complex TB in children is the use Anti-TB medications and

involves other treatment modalities for it not to be active.

- Mode of transmission: Airborne/ Droplet

- Incubation Period: 4-12 weeks, Average of 8 weeks

- Causative Agent: Mycobacterium Tuberculae


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Pathophysiology

Lower

Respiratory

Tract

CachexiaUpper

Respiratory

Tract

Weight Loss

Consumption

of lung tissue

Hemoptysis

Scarring of

the Lungs

Cavitation

Caseous

Necrosis

Fat

Loss

Increased Basal

Metabolic Rate

Recurrent

FeverInflammation

Productive

Cough

Org. is

resistant to

phagocyte d/t

lipid coat,

which makes it

survive

Phagocytosis

Organism: M.

Tuberculae


4/27

II. BIOGRAPHIC DATANAME POSITION IN

THE FAMILY

(relationship to

client)

GENDER AGE BIRTHDAY OCCUPATION MARITAL

STATUS

1. MikhaellaDhayneArongay

Daughter (eldest) Female 4 y/o Feb. 17, 2007 N/A Single

2. ManuelaDeniseArongay

Daughter

(youngest)

Female 3 y/o April 16, 2008 N/A Single

3. MariaChristinaArongay

Mother Female 25

y/o

October 10,

1986

Housewife Married

4. MarlonArongay

Father Male 26

y/o

Feb. 15, 1985 Janitor Married

5. LolitaFrancisco

Grandmother Female 50

y/o

Jan. 8, 1958 Housewife Married

6. DaniloFrancisco

Grandmother Male 51 y/o March 3, 1957 Company Driver Single

7. DexterFrancisco

Uncle Male 20

y/o

Oct. 19, 1991 N/A: studentSingle

8. ChristianFrancisco

Uncle Male 13 y/o July 15, 1998 N/A: student Single

FAMILY PRIMARY DATA:

Active

Infection

occurs

Decrease

Immune

Response


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HOME ADDRESS: Sr. Mariano St. Brgy. Maytunas,San Juan City

RELIGION: Roman CatholicETHNIC GROUP: None

PRIMARY DIALECT: TagalogNATIONALITY: FilipinoHEALTHCARE FINANCE: None

INCOME(monthly estimation) P 7, 000

II.NURSING HISTORY

A.PAST HEALT H HISTORY

The patients history of past health involved her hospitalization when she was 1

week old when she had a bacterial infection (specific disease not recognized);symptoms include appearance of a red mump-like presentation in the left chin. The

said disease was identified by the clients mother as pigsa sa loob; in lay mans term.

According to her, her husband also had the disease when he was a baby. An antibiotic

(specific name of drug not identified) was use in treatment of disease. The client was

confined for one month in hospital in Silang Cavite. (Hospital unspecified by the

mother).

Aside from this, client was not hospitalized due to any major diseases. Colds,

fever and cough are her common experienced diseases; she had cough and colds last

June 2011 and had just recovered 3 weeks ago, 1st week of July. According to the

mother, the clients experiences common colds and cough every rainy season. She uses

over the counter drug (Solmux kids syrup) in treatment of disease in every


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occurrence. According to her, it is recurrent and the client easily got colds leading to

cough. The client doesnt have a regular check up and was not brought for any

medical assistance in times of coughs or colds.

The clients mother recalled that the client had complete immunizations

including BCG, DPT, OPV, HEPA B. and Measles. She was not been diagnosed of

asthma and is non-diabetic. There had been no accidents or trauma, blood

transfusions, medications or any allergy to foods or drugs. The client did not have any

foreign travel but was able to go to Cavite and Batangas City.

B. HISTORY OF PRESENT ILLNESS

The clients history of the present illness started seven days (July 19, 2011)

prior to interview (July 25, 2011) when she was observed to have a poor appetite.

According to the clients mother, its just this time when she start to observed the

client to have a decreased food intake from approximately 3 servings of rice to 1

serving. The client also experience frequent mood swings, easily irritated and showed

disinterest in food. The client sometimes skips food; specifically, (lunch) during the

interview.

The client was diagnosed skin test positive (primary complex) conducted in

barangay Maytunas health center, San Juan City last July 19, 2011. This is free program

of the barangay; the incident also served as way in client being diagnosed of the

current disease.

The client currently does not yet received any medical assistance in

treatment of the disease. Clients mother do not bring client for any follow up hospital

check-up.


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C. FAMILY HISTORY

Client belongs to a family with paternal history of cancer; N. Francisco (51,

grandmother) and M. Francisco (51, grandmother) both died from ovarian cancer and

maternal history of hypertension, and Clients mother side has a history of asthma,

family members namely H. Francisco (56, grandmother), E. Francisco (49,

grandmother) have asthma. Also, clients father Marlon (26) and uncle D. Francisco

(28) experienced asthmatic symptoms when they were still infants. J.c Francisco

(deceased, uncle) died from pneumonia at 8 month old.

Aside from these, there are No other hereditary -familial diseases noted

such as heart, lung or kidney diseases and diabetes mellitus.

D. DEVELOPMENTAL HISTORY

The patients developmental history compose of her being conceived as

planned and wanted, with regular prenatal check-up, delivered through normal

spontaneous delivery, in full term, experienced an infective disease when she was just

1 week old. The client was breast- fed until 5 months old but was bottle-fed after until

today, 4 yrs. Old. The client started walking at one and a half of age. She had regular

sleep and had good toilet training. There are No signs of strange and separation

anxiety noted in her, there are also No signs of thumb sucking, head banging and nail

biting though there are temper tantrums, fears noted at times during first encounter,

usually to unknown people. The client is playful and is now attending school.


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FAMILY GENOGRAM

(Family members living with the client/with history of disease)

M.C.

A

L.F

50 y/o

D. F

51 y/o

M.A

26 y/o

D.F

20 y/o

C. F

13 y/o

E.F

56

H.F

49

J. F 8mo.

old

N.D

51 y/o

M.D

5I y/o


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LEGEND:

-Female

-Male

-Identified patient

-married

-siblings

-deceased

*NOTE: there are two families living in common house.

III.PATTERNS OF FUNCTIONINGA. FAMILY HEALTH PERCEPTION AND MANAGEMENT

Regarding health, the family consider health important; the mother of the client

defines health as absence of any diseases, and being physically active and well. More

so, according to the mother of the client, health means having proper body grooming,

adequate clothing, proper and balanced nutrition, as well as good home sanitation

and ventilation.

I. Socio-economic and cultural characteristics


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Mr. A. (Father) are the only that has a permanent job in the family. He

earns Php7 000.00/month. The familys expenditures composed of their food, electric

bill, water bill, and schooling of the children, were the prioritized to the least

prioritized.

Mr. A. is the decision-maker of the family. According to Mrs. A, she admitted that her

family has inadequacy to meet their basic necessities which includes food, clothing,

shelter and health services due to insufficient income. When asked about the familys

financial stability, she stated, Kulang talaga, depende talaga kung magkano lang ang

meron sa isang araw. But she said, sina mama, kasi magkasama naman kami ditto,

ang tumutulong sa amin kapag wala na kami makain. Binibigyan nila kami ng pagkain

tulad ng ulam at bigas o share, sa gastos kasi karaniwan share na e. Di na maiwasan

kasi parang isang pamilya na kami, sa desisyon na lang nagkakaiba tapos ayun oo sa

kwarto nga hiwalay.

The family does not belong in any ethnic group. Their religion is Roman

Catholic. They do not engage themselves in any religious affiliation. Mrs. A is unaware

when it comes to the activities of their community. She verbalized, Hindi kasi ako

aktibo sa barangay kasi bago pa lang kami dito, noong febuary lang ganun. Kaya di ko

pa masyadong alam, ke mama ako ngtatanong.

II. Home and Environment

When asked about the condition of their living space, the mother uttered,

mejo masikip, 8 kami dito, pero Ok lang naman Nakakagalaw naman kami ng

maayos. But according to our observation, the land area is approximately 25 square

meters which makes it inadequate for the familys living space. They have two

bedrooms. They sleep separately as a family. They use bed for sleeping.

There are presence of vectors in their home, specifically, mosquitoes and

cockroaches. They do not spray pesticides. They only kill the vectors by means of


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hitting. There are pets like, cat, dog and mini-mice. There is no presence of accident

hazards except to ladder which can be risky for the children.

They do not store food because the moment they buy their food, they

immediately cook it. They usually cook their food by frying and they are fond of eating

fish, fruits and vegetables. But they do drink liquors but only during occasion.

The familys water supply is coming from Maynilad, also their drinking

water. But the children take a mineral water (no brand, according to the mother) that

is being bought to the nearby store. They do not use any method in sanitizing their

drinking water but they see to it that it is covered.

They use a flush-type excreta disposal and is placed inside the house,

privately used by them.

The family relies in the communitys garbage services by means of

collecting garbage and they do not segregate the biodegradable from non-

biodegradable. They leave their garbage uncovered.

They have a blind drainage and it is free lowing.

The family lives in a slum neighbourhood near water bridge where there are

narrow streets.

There are social and health facilities available like basketball courts and

health center in their community however the family seldom uses these facilities.

Although there are also communication and transportation facilities available like

jeepneys and side cars, the family utilize those services when needed.

III. Health status of each family members


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It was mentioned by the mother, that some past illnesses in the family

includes asthma wherein it is mostly on the side of her mother. Cancer was also

common on the relatives on the side of her father.

As of now, the family does perceive indications that they acquired the said

illnesses and disease specifically M.A, the client who is not diagnosed of primary

complex.

The family does not have a regular or annual check-up, there is also no

finances allotted for health. Only in times of disease when they get to see a physician or

bring a family member in a hospital or health center for assistance.

Family experienced several hospitalizations, one major confinement

happened 4 yrs. ago when a family member was confined due to a bacterial infection.

Currently, the family asks assistance from the barangay health center in incidence of

disease (children) like fever from cough/colds.

Family observed importance on hygiene, hand washing. Taking a bath daily,

brushing teeth. None of the family has vices like cigarette smoking and alcohol intake.

In terms of food intake, the family is not able to meet a planned diet. The

family reasoned out that is enough that in a day they are able to eat three times a day.

The amount of food intake depends on their financial capability to buy food for a day.

The family is experiencing stress due to some workload, financial needs,

responsibilities and roles, and misunderstandings, which contribute in some health

risks.

IV. Values, habits, practices on health promotion, maintenance and disease

prevention


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When asked about any practices concerning health issues, the mother

mentioned that her family dont have any beliefs like going to albularyo when theres a

sick member in the family, but she verbalized that, nagamit kami ng oregano ganun,

kunyari may ubo, ok nman e wala naman gumagaling din.

None in the family drink or smoke. According to her, it is because they

already have history of asthma thats why they try to avoid. Hard drinks are only

during occasions. The family sometimes experience difficulty in sleeping due to noise

brought by pets of neighbourhood even their own; she also stated that in some

instance it is because of occasional noise when there are party and celebration but

stated that they are used to it. She and other family members, dont take a nap, she

elaborated, it seldom happen, only when she is too tired or her brother and partner is

too tired of work.

The family usually prefer to be at home and chat, and have it as a form of

family activity. When stressed due to too much work, she stated, itutulog na lang

ganun.

In general health view, the family, In the scale of 1-10, 10 being the highest

and 1 being the lowest, she rated their family as 5, because according to her, her family

is not that healthy for they sometimes acquire diseases and illnesses, particularly the

children, she stated, mga kalahati lang ganun, kasi minsan talaga di naman kami ok, ayun

kapag ngkakasakit iyong mga bata, lalo na kapag tag-ulan.

She said she is not that active in barangay programs and is not aware of any

health services that it offers; its just recently when she started to get involved.

B. CLIENTSNUTRITIONAL-METABOLIC PATTERNAccording to the clients mother, her family eats are prepared by their

mother, wherein, she usually bought it in San Juan public market market and do the

preparation at home, they sometimes just bought cooked food outside. The


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client usually eats breakfast at 9:00 am, take merienda every 9:30 am during their

recess time in school, have his lunch at 12:00-1:00 pm and dinner by 6-7pm.

Breads, biscuits like Fugee bar and other branded biscuits were her favorite

foods. The mother stated that the client does love eating soupy foods like sinigang. She

likes mango and banana. She oftentimes drinks water about 400ml. Of water a day plus

her milk (Alaska) that is 5 oz. (bottled). Not picky in foods but do not eat much

vegetable often. According to the mother, she has a good appetite and can acquire 3-

plates/servings of rice in one sitting. But currently, loses her appetite from three

servings to 1serving of rice, and skip some meals. She doesnt have any food allergy.

The client has four tooth decays.

3-DAY DIET RECALL

C. CLIENTSELIMINATION PATTERNAs verbalized by the mother, the client defecates once every other day,

usually in the morning. According to the description of the mother, the color of the

stool is brown, long oval; sometimes hard. At present the client does not experience

any changes in her stool. The client also defecates by herself when there is an urge to

eliminate.

The client frequently urinate which ranges from 5 to 6 times a day. In the

morning particularly after waking up, the color of the urine is somewhat yellowish but

FAMILY

MEMBER

SATURDAY [JULY

23, 2011]

SUNDAY [JULY 24,

2011]

MONDAY [JULY 24, 2011]

Break

fast

lunch snacks dinner breakfast lunch snack dinner breakfast lunch snack dinner

M.D.A Bread(1 pc.)

Fried

egg(1 pc)

Water(1ml)

Rice(1

serving)

Soup

(1cup)

Water(200ml)

none Pancitcanton

(1

serving)

Water

(200ml)

Rice(2 serving)

Chicken

adobo(1 serving)

water(200ml)

Rice(1

serving)

Chicken

adobo(1

serving)

water(200ml)

non

e

Rice(1

serving)

Dried

fish(1

serving)

water(200ml)

Rice(1 serving)

Ginisang

toge(1 serving)

water(200ml)

Skip

meal

Fugee bar

biscuit(1serving)

water

(200ml)

Puto(1 pc)

Tokwa(3 slices)

Alska

milk(5oz)


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becomes clear in the afternoon. The mother also told that the client stopped using

diaper when she was 2 yrs. old. When there is an urge to urinate, the client

immediately proceeds to the bathroom by herself.

The mother told that the client do expires excessively or too much when

she plays too much.

D. CLIENTSACTIVITY EXERCISE PATTERNThe mother described clients daily activity as routine, after she wakes up;

she eats breakfast and prepares for school. Most of his time, starting from 10:00-12pm

were spent for school where she usually does not interact with her classmates, the

mother stated, tahimik yan si mika eh, tahimik tapos suplada talaga yan, minsan

naglalaro naman yan sa school, malikot din. Most often, after waking up, the client

eats her breakfast, and then takes a bath, after which she will walk for school, then

lunch, play or watch TV again, and then eats her dinner and then sleep.

The client enjoys playing toys, watching television, sometimes, bahay-

bahayan, luto-lutuan and habul-habulan. As verbalized by the mother, the client

spends her time mostly inside the house playing with her toys together with her sister.

Moreover, the client often plays inside the house instead of playing outdoor games

because she prefers playing alone, although she sometimes plays at school.

She does not take nap during the afternoon. The mother stated, kasi, maaga

yan matulog, kaya mahaba naman iyong nagiging tulog niya. The client does not have

any difficulty with regards to body movement but is observed to be moody, and

irritated with some discomfort in affect.


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There are no significant changes in regards with her past and present activity

even though she is encourage for rest at present for she just recovered from flue weeks

ago.

7

DAY ACTIVITY DIARY

FAMILY

MEMBERS

TIME IN

A DAY

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

M.D.A

9:00-10:00

noon

Eat breakfast,

take a bath,

prepare for

school

Eat breakfast,

take a bath,

prepare for

school

Eat breakfast,

take a bath,

prepare for

school

Eat breakfast,

take a bath,

prepare for

school

Eat

breakfast,

take a bath,

prepare

for school

Eat breakfast,

take a bath,

prepare for

school

Eat breakfast,

take a bath,

prepare for

school

10:00-

12:00pm

In school

(activity

depend on

school

activity)

In school

(activity

depend on

school

activity)

In school

(activity depend

on school activity)

In school

(activity depend

on school

activity)

In school

(activity

depend on

school

activity)

In school

(activity

depend on

school

activity)

In school

(activity

depend on

school activity)

12:00-

6:00pm

Eat lunch,

brush teeth

watch TV,

play with

sibling

Eat lunch,

brush teeth

watch TV,

play with

sibling

Eat lunch, brush

teeth watch TV,

play with sibling

Eat lunch, brush

teeth watch

TV, play with

sibling

Eat lunch,

brush teeth

watch TV,

play with

sibling

Eat lunch,

brush teeth

watch TV, play

with sibling

Eat lunch,

brush teeth

watch TV, play

with sibling

6:00-

7:00pm

Eat dinner,

watch TV,brush teeth,

drink milk

Eat dinner,


drink milk

Eat dinner, watch

TV, brush teeth,drink milk

Eat dinner,

watch TV, brushteeth, drink

milk

Eat dinner,

watch TV,brush

teeth, drink

milk

Eat dinner,


drink milk

Eat dinner,


drink milk

7:00-

9:00am

Rest/sleep Rest/sleep Rest/sleep Rest/sleep Rest/sleep Rest/sleep Rest/sleep

E. CLIENTSSLEEP AND REST PATTERNAccording to the mother, the client usually has an average sleep 6 to 7

hours a day, from 7:00 or sometimes 8:00pm up to 9:00 in the morning. The client

usually wakes up at 9:00 for school. She does not take nap in the afternoon. The client

sleeps early at night because she does not have any nap in the afternoon. Before going

to sleep, the client drinks a bottle of milk 5 oz. According to the mother, the client is


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usually satisfied with sleep she has. The client has no problem with the sleeping

environment.

The client has no significant or notable changes between her past and

present activities prior to her sleeping pattern.

F. CLIENTSHYGIENEWith regards to personal cleanliness and hygiene, the client takes a bath

once a day every morning at 9:00am before going to school, She sometimes have her

mother to assists him but she can do the activity alone. Aside from it, she washes his

face before going to sleep; Brushes her teeth after eating meals. The client has no noted

itching, scratching, unfix hair and clothing.

IV. PHYSICAL ASSESSMENTVITAL SIGNS NORMS ACTUAL

FINDINGS

ANALYSIS

Client functional pattern(Disease-focused)

Adl Before During1.nutrition Seldom Eats vegetables and fruits, but like

protein rich like egg and sea food like fish.With good appetite, approximately 3servings of rice per meal.

Poor appetite with decreased interest, (from3-1 serving of rice). Skip meals, notconsistent in attending meals in mealtimes.

2.elimination Voids urine 5-6 times a day with anestimation of 250-300cc per void of clearyellow urine.

Defecates once every other day a day anddescribes it as bulky with aroma and fromcolor light brown to yellowish brown. Herstool is many sometimes few depending onwhat she ate.

No change in bladder and bowel pattern.

3.exercise Exercises done through play, usually aroundthe house with her sibling.

With the same play pattern but is in Needof rest due to recent recovery from a diseasecondition. (Flue)

4.hygiene Takes a bath daily and brushes her teeththrice daily.

The same practice is maintained.

6.sleep & rest Sleeps for 10-12hrs. Do not take nap duringnoontime. Sleeping time is from 7pm to9am.

No observed change in the usual sleep andrest pattern.


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Body Temparature Oral- 36.5 degrees

Celsius- 37.5 degrees

Celsius- normal range

* Kozier and Erbs,

Fundamentals of

Nursing, page 529

Axillary

temperature-

36.60 C

Normal

Pulse Rate Pulse Average( and

ranges)

Adults- 75(60-100 bpm)

Children -100 (70-130)

*Kozier and Erbs,Fundamentals of

Nursing, page 538

110bpm Above Normal

Respiratory Rate Respirations Average(

and ranges)

Children-

(15-30cpm)

*kozier and Erbs,Fundamentals Of

Nursing, Page 538

23cpm Above Normal

Blood Pressure Classification of blood

pressure

Normal- systolic BP MM

HG


19/27

* Kozier and Erbs,

Fundamentals of

Nursing, page 529

Weight N: 15-35kg

* Kozier and Erbs,

Fundamentals of

Nursing, page 529

12kg Below Normal

VITAL SIGNS NORMS ACTUAL

FINDINGS

ANALYSIS

General Survey

A. Body built, height,

and weight in relation to

the clients age, lifestyle

and health

Proportionate, varies

with lifestyle

* Kozier and Erbs,

Fundamentals of

Nursing, page 572

Ectomorph. Normal

B. Posture and gait,

sitting, and walking

Relaxed, erect posture:

coordinated movement

*Kozier and Erbs,

Fundamentals of

Nursing, page 572

The client is lying

on bed, conscious

and coherent

Normal

C. Overall hygiene and

grooming

clean, neat

*Kozier and Erbs,

Fundamentals of

Nursing, page 572

Her clothes and

she appears neatand clean.

Normal


20/27

D. Body and Breath odor No body odor or minor

odor relative to work or

exercise: no breath odor

No body odor and

breath odor

Normal

E. Signs of distress( in

posture or facial

expression)

No distress

*Kozier and Erbs,

Fundamentals of

Nursing, page 572

Client is irritable

and less

cooperative due to

anxiety at first,

and cooperates

later when

rapport is done.

Normal

F. Obvious signs of

health or illness

Healthy appearance

*Kozier and Erbs,

Fundamentals of

Nursing, page 572

The client is

healthy in

appearance.Though in BST,

she have positive

outlook towards

her condition.

Normal

G. Attitude Cooperative, able to

follow instructions

*Kozier and Erbs,

Fundamentals ofNursing, page 572

She is

uncooperative

and unable to

follow

instructions and

resists to be

examined at first

due to anxiety.

Not Normal

H.Affect/mood(appropri

ateness of the clients

response

Appropriate to situation

*Kozier and Erbs,

Fundamentals ofNursing, page 572

The Clients mood

is not appropriate

to situation.

Not Normal

I. Quantity and quality

of speech

Understandable,

moderate pace.

*Kozier and Erbs,

She has a clear

voice,

understandable,

and moderate

Normal


21/27

Fundamentals of

Nursing, page 572

pace.

J. Relevance and

organization of thought

Logical sequence: makes

sense: has sense of

reality

Thought association

*Kozier and Erbs,

Fundamentals of

Nursing, page 572

N/A. N/A


22/27

V. ECOLOGIC MODEL

Ecologic Model

Hypothesis

- Primary Complex TB

- Exposure to PTB either in

either community or at

home.

Age: 4y/o, Nationality: Filipino,

Sex: Female

-History of Primary Complex

Tuberculosis

-Mycobacterium

Tuberculosis

Agent Environment

Host


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The occurrence of Primary Complex TB is attributed to clients exposure to PTB

carriers and pathogen and immunosuppression due to the environment of the client at

her home.

A. Predisposing Factors

1. Host

Age: 4 y/o Sex: Female Nationality: Filipino

2. Agent

Mechanical: Mycobacterium is passed and acquired throughrespiratory secretions/droplets which transmit during sneezing,coughing, and talking.

Chemical: Substance Abuse, Smoking, and Alcohol Biologic: Mycobacterium Tuberculosis is a rod shaped, aerobic

bacteria that is resistant to destruction and can persist necrotic and

calcified lesions for prolonged periods and remain capable of

reinstating growth.

3. Environment

Physical: Possible contact to person with PTB

Socio-Economic: Exposure with persons with PTB either incommunity or at home.

Analysis:

Occurrence of Pulmonary Tuberculosis is caused by contact to carriers of

pathogen, confined living condition. Past Health History of PTB may affect the

development of the condition.

Conclusion and Recommendation:

We therefore conclude Tuberculosis is a chronic granulomatous infection that

usually affects the pulmonary system but may also invade other organs and tissues. The

incidence is highest in crowded, poverty-stricken settings. It spreads from one person to

another by airborne transmission. An infected person releases droplet nuclei through


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talking, coughing, sneezing, laughing or singing. Larger droplet nuclei; smaller droplets

remain suspended in the air and are inhaled by susceptible persons. Risk factors for TB

are close contact with someone who has active TB, immune compromised status,

substance abuse, inadequate health care, pre-existing medical condition,

institutionalization, living in crowded, substandard housing and caring for TB patients. Inthe case of the patient, the substandard / crowded housing, contact with active TB and

immune compromised status are the factors that have contributed to the development of

the disease.

As a Student Nurse we recommend a vital role in caring for patients with TB and

family, which includes Assessment of the patients ability to continue therapy at home.

The nurse instructs the patient and family about infection control procedures, such as

proper disposal of tissues, covering the mouth during coughing and hand hygiene.

Assessment of the patients adherence to the medication regimen is imperative because of

the risk of developing resistant strains of TB if treatment is not followed faithfully.(Smetltzer and Bare. Brunner and suddharts Textbook of Medical-Surgical

Nursing 10th Edition. p.532-53, 539)

VI. PROBLEM IDENTIFICATION/PRIORITIZATIONA. CLIENT FOCUSED

PROBLEM RANK JUSTIFICATION

Imbalanced nutrition:

less than body

requirements

1 According to Maslows Hierarchy of need, nourishment is under

the physiologic need. This is the first and primary need of an

individual. Since the patient is a child with communicable disease

nutrition is a very important factor in order to enhance immune

system to fight for infections.

Susceptibility to other diseases or infections can be prevented if

malnutrition is eliminated.

Risk for infection

related to

compromised immune

2 According to Maslows Hierarchy of needs, this will fall under

physiological needs for it will affect the health of the client thus

addressing would prevent further infection. Physiological needs


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system are the most basic needs that are vital to survival.

Patients susceptibility to infection because of compromised

immune system can lead to more disturbing situation thus giving

importance to this and giving proper intervention will contribute

to improved recovery and well being.

Anxiety 3 According to Maslows Hierarchy of needs, this will fall under

esteem needs which include anxiety for it is considered as

deviation of personal worth. Anxiety arises to children when they

seem that something is wrong with them.

A. FAMILY FOCUS

Threat of cross infection from a communicable disease

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

Nature of the Problem 2/3 x 1 2/3 It is a health threat that neededimmediate attention andmanagement to eliminate possible

worsening of the problem.

Modifiability of theproblem

2/2 x 2 2 The problem is modifiable becausethe resources are available to thenurses to increase familysperception and knowledge of theexisting problem and also nursescan help the family in hygiene andsanitation and management of thefamily member withcommunicable disease.

Preventive Potential 3/3 x 1 1 Prevention of the cross infectionfrom a communicable disease will:

a. Reduces chances thatother family member willbe susceptible to thedisease

b. Decreases the likelihoodof the family in acquiringother diseases

Salience of the Problem 0/2 x 1 0 It is not felt as a problem

TOTAL SCORE: 3 2/3


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Primary Complex


Nature of the Problem 3/3 x 1 1 It is a health deficit that requiresimmediate attention and adequatemanagement to reduce theincidence of transmission of thedisease to the rest of the family.

Modifiability of the

problem

1/2 x 2 1 The problem is partiallymodifiable because the family doesnot have adequate resources tosolve the problem. Limitedfinancial resources and lack of

knowledge which is important inpreventing or managing theproblem but nurses can providehealth teaching about the propermanagement and prevention ofthe disease.

Preventive Potential 3/3 x 1 1 Transmission of infection to otherfamily can be prevented oreliminated if the problem ismanaged adequately.

Salience of the Problem 2/2 x 1 1 The family recognizes it as aproblem. They consulted the

problem to the health center. Andfrequently ask questions of what isthe proper health action to do.

TOTAL SCORE: 4

Inadequate living space


Nature of the Problem 2/3 x 1 2/3 It is a health threat that neededattention because it may increasespread or transferability ofinfection or diseases


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Modifiability of the

problem

0 0 The familys resources arepresently not adequateconsidering that they have otherproblems that for them should bethe priority of finances.

Preventive Potential 3/3 x 1 1 Increasing the living space will:a. Reduces possibility of

transferability ofcommunicable disease.

b. Provide for privacy tomembers.

Salience of the

Problem

0/2 x 1 0 It is not felt as a problem

TOTAL SCORE: 1 2/3

The Prioritized Health ProblemsThe list of health condition or problems ranked according to priorities is presented:

1. Primary Complex 42. Threat of cross infection from communicable disease 3 2/33. Inadequate living space 1 2/3

VII. NURSING CARE PLANA. CLIENT FOCUSEDB. FAMILY FOCUSED

VIII. FAMILY HEALTH TEACHING PLAN*(See tables below)

case data commu cont (repaired)

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