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INTRODUCTION

Community Health Nursing is to assist the individual, family and community in

attaining their highest level of holistic health. To provide and promote healthy lifestyle

choices through education, public awareness and community activities.

Community development seeks to empower individuals and groups of people by

providing these groups with the skills they need to effect change in their own

communities. Community development as defined by the Federation for Community

Development Learning (2007) is the process of developing active and sustainable

communities based on social justice and mutual respect.

Family, basic social group united through bonds of kinship or marriage, present in

all societies. Ideally, the family provides its members with protection, companionship,

security, and socialization. The structure of the family, and the needs that the family

fulfills vary from society to society. The nuclear familytwo adults and their children

is the main unit in some societies. In others, it is a subordinate part of an extended family,

which also consists of grandparents and other relatives. A third family unit is the single-

parent family, in which children live with an unmarried, divorced, or widowed mother or

father.(Microsoft Encarta 2007. 1993-2006 Microsoft Corporation.)

In line with the subject NCM 104, our group was exposed to the community. Our

study was rendered to Barangay 7 San Miguel, Ilocos Norte last February 5, 2011 as

recommended by the RHU of San Nicolas. In this activity we were able to understand

what community nursing is and we were able to focus on improving the overall health of

the family by educating the members about health care issues, nutrition, childcare, and


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disease prevention. We choose the family of Mrs. N as our case because compared to our

first assessed family they need more knowledge about their health conditions as well as

their family relationship. As we get in to their house we immediate saw and assessed that

they are problems that would harm the family members infact as the interview go on we

had come up with the health threat that are present in their household and some problem

that may arise later in life. They belong to a big family which makes them more unite,

indeed they all have a good relation to each one of them. They are cooperative during the

assessment they provide all the information that we need.

General objectives:

Thisstudy aimed to understand and improved the belief that care directed to the

individual, the family, and the group contributes to the health care of the population as a

whole as well as to provide quality of care, by identifying health problems which are

recognized by the people themselves for the promotion of healthy lifestyle choices

through education, public awareness and community activities.

Specific objectives:

1. For the family to become more practical in promoting health.2.

For the family to be able to recognize the importance of having a healthylifestyle.

3. For the family to be able to expand information of having a healthylifestyle.

4. For the family to understand the implications of their belief, values andpractices in health.

5. Propose priority interventions as being recognized by the family membersthrough a comprehensive health care plan.

6. Inorder for us student nurses, provide teaching in improving the ways andmeans of the family.

7. To improve our skills in helping the family by giving hints and teachingdeal with the problems that will be identified.

8. To help the family in attaining the goal of care of this study.


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INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICSNAME

RELATION TO

HEADAGE SEX

CIVIL

STATUS

POSITION IN

THE FAMILYOCCUPATION

RELIGIOUS

AFFILIATION

EDUCATIONAL

ATTAINMENTADDRESS

MRS. N 68y/o F Widow HEAD N/ARoman

Catholic

Elementary

Graduate Brgy.7 S.

Daughter M Daughter 44y/o F Single 5th child Housekeeper Born AgainElementary

Graduate

Nalbo, Lao

city

Daughter T Daughter 39y/o F Single 6th childDomestic

helperBorn Again

High School

LevelHongkon

Son F Son 36y/o M Single 7th child

Farmer and

Construction

worker

Roman

Catholic

Elementary

levelBrgy.7 S.

Son E Son 30y/o M Single 10th

child N/ARoman

CatholicCollege level Brgy.7 S.

Daughter A Daughter 27y/o F Single 11

th

child B.H.W Born Again

High school

level Brgy.7 S.

Son J Son 24y/0 Single 12 child SegregatorRoman

CatholicCollege level Brgy.7 S.

Apo SGrand

Daughter5y/o F Child

1st

grandchildNone Born Again KINDER Brgy.7 S.

Apo X Grandson 1y/o M Child2nd

grandchildNone

Born AgainN/A Brgy.7 S.

Apo Z Grandson 7mons. M Child3rd

grandchildNone

Born AgainN/A Brgy.7 S.

The family of Mrs. N is considered as an extended family The family is

composed of 8 members. They are currently residing at Barangay 7 San Miguel,

San Nicolas, Ilocos Norte.

Mrs. N, 68 years of age, the head of the family was born and raised in

Brgy.7 San Miguel, San Nicolas, Ilocos Norte. She had common law husband

when she was still 14 years old, and they live in Isabela at the family house of

common law husband. Before, they live with their 5 children namely son Ne

currently living at Pangil, Currimao, the second child is daughter Ma. who is also

currently living with her own family at the same barangay, their son Jo, the third


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child who is also currently living at the same barangay but different house.

Daughter Flo, the fourth child is now currently living at Leyte and daughter Mi.,

the last child is currently living at Nalbo, Laoag City who is a stay in housemaid.

Five years after Mrs. Ns first common law husband death she married his second

common law husband and they resided at # 7 San Nicolas at their family house.

They were gifted with 7 children namely daughter T, first child, 39 years old,

female, a domestic helper in Hongkong, son F,36 years old, second child, male ,a

farmer and a construction worker, son S, thrid child who is a welder, son Y,

fourth son who is living with his family at the same barangay but different house,

son E, fifth son who is living with Mrs. N, the sixth child is daughter A, 28 years

old , a BHW in Brgy. 7 San Nicolas, Ilocos Norte and the last child is son J, 25

years old, and living also with Mrs. N. Her second law husband died last 2000

because of hypertension. At present Mrs. N is living with Son F, Son E, Daughter

A, Son J, the three kids of Daughter A (Apo S, Apo X, and Apo Z) and son S and

her family but not included in the above table because they have separated things

and income.

Daughter T, daughter A and her three children are born again because they

are influence by daughter M while Mrs. N, son F, E and J is Roman Catholic

The father of daughter As children is not living with them because the

father of her first and only daughter has his legitimate family as well as the father

of her two sons. They dont have communication with the first father of his child

while the father of her two sons is through texting. Daughter A relationship with

her first partner was not good they dont have communication and he never

support his daughter while her second partner sometimes visit but never stay for a


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long time. Since the relationship of daughter A is not legal, Mrs. N still support

and never got angry with daughter A Daughter A takes a role of a mother and a

father so she provides her full support to her children.

Their family is considered as an extended type of family. Also, their

family is considered as patrilocal since their family lives at the house of her

second law husband. Since they are oriented with both the mother and fathers

kin, they are considered to be bilateral descent type of family.

Mrs. N makes most of the decision about family matters but not regards to

the health problems, Mrs. N, daughter M and daughter A decides but most of the

time Mrs. N and daughter A since daughter M is working in Nalbo. Son F serves

as the head of the family since he is the primary person who provides the needs of

the family. Mrs. N do not have hard time in terms of decision making because

they tend to consider each others opinion first before coming up with the final

decision especially regarding health matters. Whenever problem arises within the

family such as conflicts and misunderstanding they would usually settle it right

away. As claimed, their family has a good relationship with each other, each one

of them knows how to understand someones situation thus conflict rarely occurs.

According to Mrs. N, they also have good relationship with their neighbors; they

share things when there are extras.

The family values connection to God. In fact, they have worship every

Tuesday on their house. Respect is also valued as evidenced by the egalitarian

form of authority. As to endearments, they head called nana by her children and

grandchildren. They also use manong , manang, ading, tito, and tita.


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B. Socio economicStatusThe educational attainment of the family seems to be an obstacle for them

since most of them was not able to graduate in college, but they still thankful

because even they dont have stable job still they can provide every member of

the families need. As verbalized by Mrs. N, uray jak napagturpos dagitoy anak

ko iti kolehiyo ket agyamanak ta makastrek da met lata ti trabaho ta dida met

napili. Mrs. N, an elementary graduate is a plain housekeeper and the one

helping her daughter A in taking care of her grandchildren. Her first daughter

namely daughter M is an elementary graduate, working as a housemaid at Laoag

City Ilocos Norte receiving Php 3,000 per month and contributing Php 1,500 per

month for the expenses of the family. Second is daughter T a high school

graduate, currently working at Hong Kong as domestic helper since year 2005 and

sending Php 3000 a month. Next is son F an elementary graduate, working as a

farmer receiving 8 cavans per crop rotation and selling 3 cavans for the expenses

use in farming such as abono and irrigation and use the 5 cavans for food. He

also work as a construction worker (per contract) as his part time job receiving

Php 2,700-5,400 a month and if unfortunately none and since he is the one who

stand as the father of the family he contributes all of his salary if there is.

Daughter A attained high school level and is presently serving as a BHW at Brgy.

7 San Nicolas receiving Php 1,440 quarterly. The father of her two sons is giving

money worth Php 4,000 a month for their daily expenses. The youngest child is

Son J, a college graduate, working at Coca Cola Plant and giving Php 500 per

month. Their combined monthly income as contributed by the family members is

approximately Php 8,000-15,000 per month. The monthly income of the family is


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enough if Son F and Son J have a job but if none they need to borrow money from

their neighborhood. They help each other in making decisions about money and

how they spent it.

Based on the pie graph above, the highest percentage is allotted for their

food which is 37.5 % or Php. 5000. About 4.17 % or Php 500 is spent for their

electricity and water bill, 33.33 % or Php. 4000 goes to the childrens expenses

such as vitamins (tiki-tiki, prophan and cherifer) diaper, milo, milk, toys, clothes

and educations. About 10.42 % or Php. 1,550 is allotted for their miscellaneous

such as load, transportation, vices and medication, and another 6.72 % or Php.

800 is spent for their home necessities such as gasoline and groceries the rest is

serve as payment for their debt and sometimes serve as their savings. They have

no relatives who are helping them and that they are striving on their own.

Family Monthly Budget Allotment

Food

Children expenses

Miscellaneous

Electricity

Home expenses

37.5%

4.17%

33.33%

10.42%

6.72%


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C. HomeandenvironmentThe family is living together at Barangay 7 San Miguel, San Nicolas,

Ilocos Norte. They live in a 2 storey house which is about approximately 7m x

7m.

Their house is basically made of woods, cement, metals, galvanized iron

and glass. The first floor is divided into a living room, a kitchen and a room which

is divided with a curtain under their stairs where son E sleeps. Their stairs have no

rails connected to the second floor made up of wood. They have 2 bedrooms at

the second floor which is consists of 1 foamed bed, and a caha de oro. One room

was occupied by Mrs. N, daughter A. and her 3 kids(Apo S, X and Z), and the

other room was occupied by son S and her family while Son F and son J sleeps in

their living room.

Their living room is found on the first floor at the right side of their house

upon entering. The living room has a two plastic long chairs and a center table.

The chairs available can be climbed by the children. There are toys and souvenir

items on the divider. The floor is cemented. They have appliances in the living

room like TV, flat iron, radio and 2 electric fans.

With regards to their kitchen, it is located in the left side of their first floor

upon entering on the front door. Their kitchen consist of a table with four plastic

chairs, a gas ranged stove, an LPG tank, a covered water jag and a dish shelf

covered with a clean cloth.

Scattered empty cans and a hammer were seen on the surrounding of the

house which could cause accident or injury.


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LPG, and sometimes charcoal, was used for cooking. Their clay stove is

located at their backyard. They prepare just enough food for the family members

like noodles most of the time combined rice and egg sometimes. Whenever there

are leftovers, it is covered with a plate and place in the kitchen table. Kitchen

utensils, especially knives, are kept away from children and are placed in an

organizer. They store their drinking water in a covered container.

Their water is from the deep well beside their old bathroom which is used

for bathing and flushing the toilet located at the front side of their house. The deep

well is owned by the family and it is chlorinated by the BHW of their barangays,

it is approximately 15 meters away to the toilet facility. The water that was

fetched is placed in a pail. They are also supplied by the Nawasa which they use

in cooking and washing dishes. Drinking water is bought from refilling stations.

They use pour flush in using their toilet facility, which is approximately 20 meters

away from their source of water.

They do not segregate garbage. Instead, they put it all together in a sack,

and are collected by garbage tracks ones a week.

There is a canal in front of the house, which should be ideally used as a

drainage system. However, the water remains stagnant which makes it a breading

site for mosquitoes. The family use mosquito repellants such as Bigon once a

week, usually on a Saturday afternoon as precaution to diseases caused by

mosquitoes.


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D. Health Status ofeach Family Membera) Medical and nursing history indicating current andpast significant

illnesses or beliefsandpracticesconduciveto health andillness.

According to Mrs. N they do believe in quack doctors but they still consult

medical doctors. The family members had experienced chicken pox, measles and

mumps. They manage mumps with the traditional akot akot mixed with

vinegar and applied during bed time while they manage measles by wearing black

t-shirt. As Mrs. N, claimed they dont usually manage chicken pox they just leave

it and wait until the vesicles disappears. They also avoid eating oily foods during

that time like fried eggs. She claimed also that they dont have any known

hereditary disease. They only experience cough, colds and fever. They take

Carboceistine 500mg once a day to manage cough and oregano one teaspoon for

the children, Paracetamol (biogesics) 500mg for fever and Neozep 500 mg twice a

day for common colds, with these 3 ailments, they increase their oral fluid level.

Mrs. N also told us that they dont usually visit the R.H.U. they onlyto the RHU if

their illnesses are not managed by taking the said medicine.

Last 2003, Mrs. N was diagnosed to have hypertension by Dr. S.N,

municipal doctor. He prescribed Metropololas her maintenance drug and if ever

she feels dizzy and aching of the nape, she ask her neighbor who is a BHW to

check her blood pressure and the result is always high which is not lower than

180/100mmHg. She was confined at Gertes Clinic by Dr. Ko due to the high

blood pressure. After three days of confinement, she was discharged and she

never had her check up again, instead, she prefer to rest and lay on bed when she

feels dizzy. She cant remember the management done. At this time her BP


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monitoring is already done by her daughter A, who is now a BHW in their

barangay. Since 2007, she never takes her nape ache up to now.

Mrs. N claimed that Son E, her 5th

child on her second husband, used

prohibited drugs (SHABU) when he was in 2nd

year college. When they first knew

that son E is using prohibited drugs, as a normal response of a parent they were

problematic and angry but then as time passed by, they continuously talk with son

E as an emotional support. Few years later, Son E never mingles with other

people since he stops to use drugs. He prefers to stay on his room than to go out

and have friends with their neighbors. During the interview, Mrs. N mentioned

that her Son E took a medicine for 6 months for cough and she cannot recall what

the name of the drug is was. They thought of consulting a specialist and a

Rehabilitation center but never try to go because they dont have enough money.

The medication was prescribed by Dr. Ka. Son E is suffering from arthritis and

taking Athro as a medication which is prescribed by the RHU doctor but he just

takes it if he feels joint pain. During our second home visit we saw son E, he is a

so skinny, long haired, long balbas and has a dark complexion compared to the

grooming of his other member of the family.

Son F is the third child of Mrs. N to her 2nd

husband. He hasnt suffered

from any serious illnesses as well as son J. As a farmer and carpenter, he

experienced to have wound and he manage it by taking Mefenamic acid 250mg

twice a day for pain and cleansing with betadine and dressing it with a clean cloth

to cover the wound.

Mrs. N. delivered her 12 children through normal delivery at home

assisted by a partera and to prefer to breastfeed her child.


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According to daughter A she was able to obtain the 5 shots of tetanus

toxoid vaccines. She delivered her 3 kids through normal delivery at GRBASMH.

As she claimed the she feed Son Z through mixed feeding but mostly

breastfeeding as well as to Son X when he still a baby but he is now using bottle

feeding. Son X was also confined August last year because of non healing cough.

He was admitted at Gertes Clinic and was confined for 5 days but due to mot

improving condition they decided to take him home. The following day they

consulted a mang-ngilot, for a few hours after the ilot session the fever

subsides while his cough was relieved few days after, by taking oregano extract.

Since then they first consult quack doctors than medical doctors.

b. Nutritional Assessment

NamesWeightin

kgHeightin m BMI

Category

Apo S 15 kg(33lbs) 0.94m BMI = 16.98 kg/m2

At risk of overweight

normal BMI range: 13.5 - 16.8kg/m

2

normal weight range for theheight: 11.9 - 14.8 kgs

Apo X12 kg

(26.5lbs)0.82m

BMI = 17.85

kg/m2

Healthy weightnormal BMI range: 14.7 - 18.2

kg/m2

normal weight range for the

height: 9.9 - 12.2 kgs

Apo Z7 kg

(17.3lbs)0.57m BMI = 25 kg/m

2

BMI = 24.62 kg/m2(Overweight)

normal BMI range: 13.8 - 16.8

kg/m2

normal weight range for the

height: 4.5 - 5.5 kgs

The family eats 3 times a day and sometimes they eat their snack in the

afternoon. They cook at least ganta of rice every meal. During Sunday, they


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cook at least 1 ganta of rice because some of the family members are going home.

In the morning they usually cook 2 packs of noodles as their breakfast and

sometimes they buy pandesal as an alternative to noodles at around 7:00 in the

morning. They claimed that most of the time they cook noodles the morning and

sometimes it is combined with egg. As stated by Daughter A, toy anakko nga

ina-una ti umuna nga mangan ti pamigat ta mapan agbasa ket no anaman ti tedda

na isunto lang ti kanen mi kidetoy anakko nga maikadwa. Mrs. N and son F

mostly eat 2 pieces of pandesal and a cup of coffee while son E and J dont

usually eat their breakfast. At around 12 noon they take their lunch and they

usually cook vegetables and sometimes meat and fish. And at around 7 in the

evening they take their dinner and they cook vegetables and the leftover food are

all consumed. But they mostly eat vegetables and fish since they are not eating in

eating meat. Ms. A stated that, if there is a leftover food from their dinner they put

it in the covered in the kitchen table and reheat it in the following day. Their

merienda are usually consisting biscuits and 1 liter of juice at around 3-4 pm and

for the children they are found in eating junk foods. Ms. A claims that her 3

children are taking vitamins everyday Tiki-tiki(5 cc) for Apo Z, Prophan(1 table

spoon) for Apo X, and Cherifer (1table spoon) for Apo S.

As practiced by the farmers son F usually rise to bed early in the morning

at exactly 5 oclock as his daily routine. But when he has a construction work, he

only go to the farm after work. According to Mrs. N, her son F can consume 3-4

sticks of cigarette per day. Mrs. N stated that son F smoked cigarette after meals

and sometimes the remaining one stick he smoke it during at night before bed


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time. Mrs. N also claimed that even at that age, she still drinks liquor with their

neighbors every afternoon 2 times per week.

MMDST (METRO MANILA DEVELOPEMENTAL SCREENING TEST)

8 months

(Year) (Month) (Day)2011 02 4

2010 6 11

0 7 mos 23 days

Task Result Interpretation

Personal (social)

Main:

Back:

Wave bye-bye F

The client was not able to

do this task matched to his

age. He is delayed to

accomplish this task

though he has still time to

do this in his later life

Indicate wants P

The client passed this task

that is appropriate to 8

months 9 months old

children, and can improve

and master this task as he

goes older.

Play pat a cake RThe client refused to do

this task.

Feed self P



months 9 months old



goes older.

Work for toy F


do this task. He is delayed

to do this thus; he has still

the chance to do this in his

later life.

Fine motor (adaptive)

Main:

Bang 2 cubes held in hands P



months 9 months old



goes older.


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Advance:

Thumb-finger grasp P



months 9 months old



goes older.

Put block in cup P

The client passed this taskthat is appropriate to 8

months 9 months old



goes older.

Scribbles F

The client failed to do this

task which is matched to

his age. Even though he is

delayed to do the task, he

has still to accomplish and

master using scribbles.

Language

Main:

Advance:

Dad/Mama specific P



months 9 months old



goes older.

1 word P

The client was able to do

this task appropriate to theage bracket being able to

say the word mama.

2 words F

The client failed this task

since this task is not

appropriate to her age.

Gross Motor:

Main:

Advance:

Get to sitting P


this task since this task is

appropriate to 8 months 9

months old old children.

Pull to stand P


this task but with a few

seconds only with assist to

her mother.

Stand 2 seconds FThe client failed to do this

task since this is not


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appropriate to her age. She

can still do this task as he

reaches the right age.

Analysis:

The child was not able to pass all screen test. He was behaved during the

assessment. His developmental milestone was partially achieved because come of the

task are not yet able to carry out by Apo Z so the result is still NORMAL.

21 months(Year) (Month) (Day)

2011 02 4

2009 4 22

1year 9 mos 12 days


Personal (Social)

Main:

Advance:

Wash and dry hands P

The client was able to pass

this task and can still

further improve and master

this task as he goes older.

Brush teeth P


this task but with an

assistance to his mother.

Put on clothing P





Name friends F


task which is matched tohis age. Even though he is

delayed to the task, he has

still time to accomplish and

master in naming his

friend.

Fine motor (Adaptive)

Main:

Advance:

Tower of 4 cubes P





Tower of 6 cubes R The client refuses this task.

Imitate vertical line F


task since this is not

appropriate to her age. She

can still do this task as he

reaches the right age.


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3. Language

Main:

Back:

Speech half understandable P



month old children, and

can improve and master


Name 1 picture P

The client passes this task

since this task isappropriate to 21 month

old, especially in naming

picture of animals.

Point 2 pictures P

The client passes this task

since this task is

appropriate to 21 month

old, especially in pointing

the named picture of

animals.

Combine Words P




old children, and can still



Point 2 pictures P



month old children, as she

was able to point a picturelike the picture of his

mother and father.

Name 6 body parts F


do this task matched to age,

but he can improve when is

life goes on.

6 words P


this skill which we had

manifested by saying:

mama, lola, tito, popo,

wen, tita and many more.

Gross Motor

Main:

Throw ball overhead P






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Advance:



Jump up P





further improve and masterthis task as he goes older.

Kick ball forward P







Broad Jump P







Balance each foot 1 secondP







Balance each foot 2 second F







Analysis

Apo X does not able to pass the entire main task but he was cooperative and able

to perform more main task assigned to his age group. The result is NORMAL because

most of the sectors are achieved.

5 years old

(Year) (Month) (Day)

2011 2 4

2005 9 8

5 4 mos 26 days


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Fine Motor (Adaptive)

Main:

Copy square P



appropriate to 5 month old

children, and can still



Draw person 6 parts P







Copy square demonstrate P







Language

Main:

Define 7 words P







Opposite 2 P

The client was able to passthis task since this task is





Count 5 Blocks P







Gross Motor

Main:

Balance each foot 6 seconds P






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Heel to toe walk P





further improve and masterthis task as she goes older.

Balance each foot 5 seconds P




children, and she can

master this task as she goes

older.

Analysis

Apo S was a shy type kid but able to perform correctly the task requested to carry

out during the assessment since she is a pre-schooler. She passed all the task under her

age so as a result it is NORMAL.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention

Mrs. N said that she doesnt know if she received immunizations also with

her children if they were given vaccines because she is not aware of such program

of the government. Daughter A claimed that her 2 older children has completed

their vaccination proven that she showed us the yellow card of her children. The

youngest among her children received BCG, HEPA A&B, DPT and polio vaccine

1, 2&3. He does not yet receive an anti measles vaccine since he is still 8 months

old. She also claimed that she received five TT (Tetanus Toxoid) vaccines

throughout her pregnancies.

Their meals consist of rice, vegetable meal, fish and instant noodles since

they are not fond of eating meat. They would only have a meal of meat if they feel

like to eat.


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The family member usually takes a bath once a day and the children

usually have half bath before going to bed. They use shampoo and soap in

bathing. They brush their teeth twice a day during morning and evening.

The family has three bedrooms in their house. The first room located at the

second floor is being used by Mrs. N, daughter A and daughter As 3 children

while the other bedroom is used by her son S and his family. There is also a room

located in the first floor which is divided by a curtain from their living room, is

being used by Son J and Son F. They usually sleeps together at around 9-10pm

after they have done all the household chores and wake up around 6 in the

morning while the children of daughter A usually wakes up around 7-8 in the

morning. When they sleep, they used mosquito net, electric fan and mosquito coil.

Mrs. N claimed that doing their household chores is their form of exercise.

They sometimes go walking with daughter A in the afternoon but just around near

their house.

Mrs. N sees to it that sharps objects, and matches are place in their proper

place for the children not to reach and play on it.

The family has a good relationship with their neighbors. Every Tuesday

night, there is a worship service in their house together with their neighbors. On

their free time, daughter A usually goes to their neighbors to have some chitchat.

The children also play inside their house with the supervision of daughter A and

sometimes Mrs. N.


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The family is active in the barangay activities. Daughter A performs her

role as a BHW and involved themselves in community activities like Oplan dalus.

On their free time they usually stay on their living room watching their

favorite TV shows and sometimes listening to their radio.

They family dont usually seeks health of the RHU, whenever a member

of the family is sick. The family also believed in a mangngilot and quack

doctors and sometime they have more belief on it than with the health care given

by RHU. They also used alternative medicines such as oregano for cough. They

also use OTC drugs such as Biogesic 500mg tablet once a day for fever and

Neozep 500mg tablet twice a day for colds as well as Carboceistine 500mg once a

day for cough.


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TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

1. Presence of wellness conditionHealthy Lifestyle

y The family eats 3 times a day and sometimes they eat their snacksin the afternoon. They cook at least ganta of rice every meal.

And if Sundays they cooked at least 1 ganta of rice that is because

some of the family members are going home. D-b, P1, S3

y Their meals consist of rice, vegetable meal, fish and pancit mamisince they are not fond of eating meat. They would only have a

meal of meat if they feel like to eat. E, P2, S1-2

y The family member usually takes a bath once a day and thechildren usually have half bath before going to bed. They use

shampoo and soap in bathing. They brush their teeth twice a day

during morning and evening. E, P3, S1-3

y Mrs. N claimed that doing their household chores is their form ofexercise. They sometimes go walking with Miss A in the afternoon

but just around near their house. E, P5, S1-2

Health Maintenance/Health Management

y They only experience cough, colds and fever. They takeCarboceistine 500mg once a day to manage cough while oregano

one teaspoon for the children, Paracetamol (biogesics) 500mg for

fever and Neozep 500 mg twice a day for common colds, with

these 3 ailments, they increase their oral fluid level. D-a, P1, S7-8


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y Son E is suffering from arthritis and taking Athro as a medicationwhich is prescribed by the RHU doctor but he just takes it if he

feels joint pain. D-a, P3, S8

y Ms. A claims that her 3 children are taking vitamins everyday Tiki-tiki(5 cc) for Apo Z, Prophan(1 table spoon) for Apo X, and

Cherifer (1 table spoon) for Apo S. D-b, P1, S12

y Daughter A claimed that her 2 older children has completed theirvaccination proven that she showed us the yellow card of her

children. The youngest among her children received BCG, HEPA

A&B, DPT and polio vaccine 1, 2&3. He does not yet receive an

anti measles vaccine since he is still 8 months old. She also

claimed that she received five TT (Tetanus Toxoid) vaccines

throughout her pregnancies. E, P1, S2-5

Parenting

y Since the relationship of daughter A is not legal, Mrs. N stillsupport and never got angry with daughter A. A, P4, S4

y When they first knew that son E is using prohibited drugs, as anormal response of a parent they were problematic and angry but

then as time passed by, they continuously talk with son E as an

emotional support. D-a, P3, S2

y The children also play inside their house with the supervision ofdaughter A and sometimes Mrs. N. E, P7, S4


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Spiritual well-being

y The family values connection to God. In fact, they have worshipevery Tuesday on their house. A, P7, S1

y Daughter T, daughter A and her three children are born againbecause they are influence by daughter M while Mrs. N, son F, E

and J is Roman Catholic. A, P3, S1

2. Presence of health threata. Presence of risk factors of specific diseasey Since 2007, she never takes her nape ache up to now. D-a, P2, S7

b. Accident hazardsb.1 sharps objects

y Scattered empty cans and a hammer were seen on thesurrounding of the house. C, P5, S1

b.2 Fall hazards

y Their stairs have no rail which is connected to the secondfloor made up of wood. C, P2, S3

y The living room has a two plastic long chairs and a centertable. The chairs available can be climbed by the children.

C, P3, S2

c. Poor home/environmental condition/sanitationc.1 Lack of food storage

y Whenever there are leftovers, it is covered with a plate andplace in the kitchen table. C, P6, S4


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c.2 Presence of breeding or resting sites of vectors of disease

y There is a canal in front of the house where the waterremain stagnant sine there are plastic and dry leaves.

However, the water remains stagnant which makes it a

breading site of mosquitoes. C, P9, S1-2

c.3 Improper drainage system

y There is a canal in front of the house where the waterremain stagnant sine there are plastic and dry leaves.

However, the water remains stagnant which makes it a

breading site of mosquitoes. C, P9, S1-2

d. Unhealthy lifestyle and personal habits/practicesd.1 cigarette/tobacco smoking

y According to Mrs. N, her son F can consume 3-4 sticks ofcigarette per day. Mrs. N stated that son F smoked cigarette

after meals and sometimes the remaining one stick he

smoke it during at night before bed time. D-b, P2, S3-4

d.2 self medication

y They also use OTC drugs such as Biogesic 500mg tabletonce a day for fever and Neozep 500mg tablet twice a day

for colds as well as Carboceistine 500mg once a day for

cough. E, P10, S4


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3. Presence of health deficitsa. Illness state

y Last 2003, Mrs. N was diagnosed to have hypertension by Dr. S.N,municipal doctor. D-a, P2, S1

y Since 2007, she never takes her nape ache up to now. D-a, P2, S74. Presence of stress points/foreseeable crisis situations

a. Parenthoody Daughter A take a role of a mother and a father so she provides her

full support to her children. A, P4, S5

y The father of daughter As children is not living with them becausethe father of her first and only daughter has his legitimate family as

well as the father of her two sons. A, P4, S1

b. Illegitimacyy The father of daughter As children is not living with them because

the father of her first and only daughter has his legitimate family as

well as the father of her two sons. They dont have communication

with the first father of his child while the father of her two sons is

through texting. Daughter A relationship with her first partner was

not good they dont have communication and he never support his

daughter while her second partner sometimes visit but never stay

for a long time. A, P4 S1-3


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Second Level Assessment

Health Threat

1. Presence of risk factors of specific diseasea. Presence of risk factors of specific disease

Inability to make decisions with respect to taking

appropriate health action due to negative attitude towards the

health condition or problem as manifested by not complying

maintenance drug for her hypertension.

2. Accident hazardsa. Sharp objects

Inability to provide home environment conducive to health

maintenance and personal development due to lack of

knowledge in carrying out measures to provide home

environment as manifested by presence of scattered cans in

front of their house.

b. Fall hazardInability to provide home environment conducive to health

maintenance and personal development due to inadequate

knowledge of preventive measures as manifested by no rails of

stairs.

3. Poor home/environmental condition/sanitationa. Lack of food storage

Inability to make decisions with respect to taking

appropriate health action due to low salience of the


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problem or condition as manifested by placing left over

foods at kitchen table.

b. Presence of breeding or resting sites of vectors of diseaseInability to provide home environment conducive to

health maintenance and personal development due to lack

of skills in carrying out measures to improve home

environment as manifested by presence of stagnant water in

their drainage system.

c. Improper drainage systemInability to provide home environment conducive to

health maintenance and personal development due to

inadequate knowledge of importance of hygiene and

sanitation as manifested by presence of stagnant water in

their drainage system.

5. Unhealthy lifestyle and personal habits/practicesa. Cigarette smoking

Inability to recognize the presence of the health condition or problem

due to inadequate knowledge as manifested by smoking.

b. Self medicationInability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable at risk member of the family due to inadequate

knowledge in carrying out necessary treatment as manifested by taking

unprescribed medications.


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Health deficits

1. Illness stateInability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable at risk member of the family due to inadequate

knowledge about the health condition and its severity as manifested by not

complying with the prescribed maintenance medication.

Foreseeable crisis

1. ParenthoodInability to provide adequate nursing care to the dependent

member of the family due to altered role performance as manifested by

the father of her child is not living with the family

2. IllegitimacyInability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable at risk member of the family due to absence of

responsible member as manifested by the father is not married with

daughter A.


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Scale for Ranking Health Problems According to Priorities

Criteria Weight

Nature of the Problem

Scale: Health Threat 3Health Deficit 2 1

Foreseeable Crisis 1

Modifiability of the Problems

Scale: Easily Modifiable 2

Partially Modifiable 1 2

Not Modifiable 0

Preventive Potential

Scale: High 3

Moderate 2 1

Low 1

Salience

Scale:

A serious problem that needs immediate attention 2A problem but not needed immediate attention 1 1

Not a felt need problem

SCORING

Decided a score for each criteria

Dive the score by the highest possible score and multiply by the weight

SCORE

Score/Highest Score x Weight


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Presence of risk factors of specific disease

COMPUTATION SCORE JUSTIFICATION

Nature of the problem

3/3x1 1

It is a health threat because the

condition of the family may

aggravate and may lead to

more serious complication

Modifiability of theproblem

1/2x2 1

It is partially modifiablebecause educating the family

will give them knowledge

about the problem

Preventive potential

3/3x1 1

It is highly preventive because

teaching and educating the

family will prevent the

occurrence of serious

complication as well as the

aggravation of the disease.

Salience

2/2x1 1

Problem needs immediate

attention because they may put

the health of the family at risk.

TOTAL SCORE 4.00

Sharp Object Hazards



2/3x1 0.67

It is classified under health

threat because scattered cans

and hammer may cause injurywhen any of the family

members accidentally step on

it.

Modifiability of the

problem

2/2x2 2

It is easily modifiable because

it can be done by simply

gathering the empty cans and

put it only one place, having a

garbage pit/sack where they

can compile /collect the cans

and putting the hammer in safe

and proper place.


3/3x1 1

The preventive potential is

high because educating the

family about the possible

threats which maybe brought


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about by leaving empty cans

and hammer scattered.

Salience

1/2x1 0.5

The family recognize it as a

problem but it does not need

immediate attention in order

for them to keep themselves

safe from accident or injury.

TOTAL SCORE 4.17

Fall Hazards



2/3x1 0.67

It is classified a health threat

because the stair without rails

is conducive for accidents

especially to their children

wherein they tend to bewillfully assertive.


problem

1/2x2 1

It is partially modifiable

because railings can be easily

constructed especially there is

a carpenter in the family but no

resources available.


2/3x1 0.67

It is a moderately preventive

because it can be avoided by

constructing the rails to

minimized the risk of injury

Salience

1/2x1 0.5

It is identified as a problem but

does not need immediate

attention because they always

supervise their children and

always reminding them not to

climb the stairs.

TOTAL SCORE 2.84

Lack of food storage



2/3x1 0.67


threat because lack of food

storage can result to poor

home physical condition since


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left over food will be easily

spoil and it can be a good site

of microorganism which may

cause disease.


problem

1/2x2 1

It is partially modifiable by

educating the advantage and

disadvantages of having aproper storage but resources

are not yet available.


3/3x1 1


high because if there is a

proper storage, GI disease

would be minimized.

Salience

0/2x1 0

The family does not recognize

it as a problem and does not

needs immediate attention

because the leftover food are

usually eaten on the following

meal.

TOTAL SCORE 2.67

Presence of breeding or resting sites of vectors of disease



2/3x1 0.67


threat because presence of

breeding sites of vectorincreases the possibility of

acquiring vector-borne diseases

and may result to poor

environmental sanitation


problem

2/2x2 2


because it can be done by

improving the drainage system

in order to let the water free

flow.


3/3x1 1


high to prevent the occurrence

of dengue or it can be a good

breeding site of insects.

Salience0/2x1 0


it as a problem because they


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does not yet experience to have

dengue in and there is no need

for change because they are not

only the family who is using

the canal.

TOTAL SCORE 3.67

Improper drainage system



2/3x1 0.67

It is a health threat because the

problem can cause pollution

and it is very unsanitary.


problem 2/2x2 2


digging deeper drainage can be

easily done.


3/3x1 1

It is highly preventive because

they are willing to cooperate

and improve their drainage.

Salience

2/2x1 1

Problem is not recognized as a

serious one because they didnt

yet experience to have dengue

and the risk for lots of diseases

are wide spread.

TOTAL SCORE 4.67

SmokingCOMPUTATION SCORE JUSTIFICATION


2/3x1 0.67

It is considered as health threat

because the patient may

develop a disease because it

may cause various type of

respiratory disease.


problem1/2x2 1


because the client is still

willing to minimize the number

of stick he use a day.


3/3x1 1

It is highly preventable because

from the start of smoking he

already lessen the number of

stick he use a day

Salience 0/2x1 0 The problem does not need


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immediate attention because

the client is trying to control

his self.

TOTAL SCORE 2.67

Self Medication

COMPUTATION SCORE JUSTIFICATIONNature of the problem

2/3x1 0.67

It is a health threat because it

may lead to danger towards the

family such as over dosage.


problem

2/2x2 2


educating and teaching with

regards the effect of the used

OTC drugs will give them

better idea on how to use the

drug immediately.


2/3x1 0.67

It is moderately preventable

because collaborating the

effect of OTC to the family

will prevent the possible threat

brought about by taking OTC

drug.

Salience

0/2x1 0

The family is not perceived as

a problem because they stated

that there is no side effect felt

by the family.TOTAL SCORE 3.34

Illness state



3/3x1 1


deficit because not taking

maintenance drug for

hypertension that may

aggravate the condition and it

may result to failure in

maintaining health condition


problem1/2x2 1


because it can be done by

educating her about the

advantage and disadvantages


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of taking maintenance for her

hypertension and encouraging

her take it religiously but the

attitude and the belief of the

patient must be consider in

order to do so.


3/3x1 1

The preventive potential ishigh because if she will

comply to the treatment it may

prevent the aggravation of

diseases.

Salience

0/2x1 0

The family did not recognize it

as a problem because the

patient doesnt feel any

symptoms of her disease and

she believes that not taking the

medication is just fine.

TOTAL SCORE 3.00

Parenthood



1/3x1 0.33

It is a foreseeable crisis

because it causes a negative

effect to the development of

the children.Modifiability of the

problem 0/2x2 0

It is not modified because the

father of the children has their

own family


1/3x1 0.33

It is low preventive because

daughter A can still do her part

being a mother and a father.

Salience

0/2x1 0


it as a problem but not needing

immediate attention because

they cannot do otherwise

because the fathers of

Daughter As children have

different family.

TOTAL SCORE 0.66


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Illegitimacy



1/3x1 0.33

The problem is foreseeable

because it may affect the

perception and development of

young children.

Modifiability of theproblem 0/2x2 0

The problem is not modifiablesince the father of her children

are married.


1/3x1 0.33

The problem is low because

the children do not yet know

the importance of having a

father.

Salience

0/2x1 0

The problem is not perceived

as a problem because they are

not married.

TOTAL SCORE 0.66

RANK PROBLEM SCORE

1 Improper drainage system 4.67

2 Sharp Object Hazards 4.17

3 Presence of risk factors of specific disease 4.00

4 Presence of breeding or resting sites of vectors of disease 3.67

5 Self Medication 3.34

6 Illness state 3.00

7 Fall Hazards 2.84

8 Lack of food storage 2.67

9 Smoking 2.67

10 Parenthood 0.66

11 Illegitimacy 0.66

initial data base1

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