Submitted by: Christine Karen Suarez BSN IV D D4

INTRODUCTION

The family is the nucleus of civilization. -Ariel Durant The family is the smallest unit of the society and the natural fundamental core of the community and consequently, it is considered as the primordial recipient of the nursing effort, which is contributory to the development, and progress of the community through active involvement and self responsibilities of each constituent. It is composed of persons, male and female, being molded to be as one, working hand in hand to maintain a good atmosphere among the family members. A nucleus controls the functions of the entire cell and can be thought as the command center of the cell. The nucleus as well has different components which are all needed in order for it and the cell to function well, same as with the commander or the head of the family and the members who has different functions within the family. The impression or status of each family will always affect the status of the community as a whole. Community health nursing is a response to the health needs of the people. It does not focus on a particular class or family. It is comprehensive and general in approach. Community health service is not episodic as it requires continuous observation and monitoring of the community as a whole. Promotion and preservation of the health of its different clients (individual, family, group or community) is the primary goal of community health nursing. and Will

The community is a group of people sharing geographic boundaries and/or values and interests. (Maglaya, 2004) No two communities are alike. A nurse exposed in the community learns how to interact and adapt to different kinds of people. The family is considered as the basic unit of care in the community health nursing. It is in the family where a member develops his health values, beliefs and practices. The family is a major influence in the health behaviors of an individual. With this, it is important that families in a community are aware of the things and practices pertaining to their health. It is apt to say that community health nursing has a big role in the nursing education. It is in the community where the student nurse learns nursing apart from the hospital setting as she was exposed to different level of orientation. It is in the community where the saying nursing is an art can be applied as a student nurse tries to give quality service using the available resources in the health center. Conducting a family case study is a means by which student nurse reaches and feels the community through its basic structure the family. It is a tool in determining the health status of a family through assessment and critical inspection. Through this, health related problems are identified, thus giving the student nurse a hint on where to act and how to intervene. It is also a means towards improving the health of the community people, making them more productive. To come up with a family case study gives a sense of fulfillment to a student nurse as he / she was given the opportunity to share their skills, knowledge and time to alleviate and uplift the living condition of a family.

I. INITIAL DATABASE A. FAMILY STRUCTURES, CHARACTERISTICS, AND DYNAMICS

NAME of FAMILY MEMBERS SEX DATE OF AGE BIRTH HT. WT. CIVIL RELIGION EDUCATIONA OCCUPATION RELATIONSHIP STATUS L TO THE HEAD ATTAINMENT OF THE FAMILY Married Roman Catholic Elementary Graduate Farmer Father

1. Fernando Tolinada Bautista 2. Arsely Gadia Bautista 3. Gary Gadia Bautista 4. Allan Gadia Bautista 5. Katerine Gadia Bautista

Oct. 3, 1961

48y/o

54

66 kgs.

Sep. 18, 49y/o 1961

54

59 kgs.

Married

Roman Catholic

Elementary Graduate

Housewife

Mother

Jul. 16, 24y/o 1986 Aug. 20, 20y/o 1990 Oct. 3, 1993 17y/o

56

60 kgs. 57 kgs. 48 kgs.

Single

Roman Catholic Roman Catholic Roman Catholic

Elementary Graduate

None

Eldest child

54

Single

Elementary Construction Second child Graduate worker Elementary Graduate None Youngest child

48

Single

The Bautista Family is considered as a nuclear type of family. They were currently residing in Purok 2, Baranggay Sto. Domingo, Tarlac City. Mr. and Mrs. Bautista go hand in hand in terms of decisionmaking. They consult each other in terms of planning and budgeting for their family. They discuss matters concerning their emotional problems or aspects within the rest of the family. When problem arises, they make sure that both of them will handle and solve the problem. But then, in terms of matter concerning health, Mrs. Bautista is the one who ascertains that the health needs of the family were taken cared of. She makes sure that she complies with the appropriate regimen when certain health issues arise. They usually come to the health center for check ups or consultations with the rural health doctors. She has awareness concerning health matters. These health matters include immunization, feeding the right food and caring for the sick member of the family. Norms: A nuclear type is a typical type of family composed of a

father, a mother and child/children. This type of family structure is found in almost all societies, although the length of time in which the family remains in this form varies even within the same society. The nuclear family can be a nurturing environment in which to raise children as long as there is love, time spent with children, emotional support, low stress, and a stable economic environment. In nuclear families, both adults are the biological or adoptive parents of their children (Jay C, 2004,).

Analysis: The Bautista Family still follows the nuclear type of family. In this, their father acts as the head of the family that has the responsibilities in providing their needs, whereas, their mother stays in the house and does household chores and takes care of them. They had a good communication that is important in providing a good and strong bonding within the family. The family also ascertains that they comply with the appropriate regimen when certain health issues arise. They usually come to the health center for check ups or consultations.

B. SOCIO ECONOMICS AND CULTURAL CHARACTERISTICS

Monthly income: P800.00 Weekly budget: P200.00 EXPENDITURE Foods Bills (Electricity and Water) Transportation AMOUNT P450.00 P200.00 P150.00 Total: P800.00

PRIORITIZATION OF NEEDS RANK 1 2 3 PRIORITY Foods Bills Transportation

The Bautista Familys main source of income is coming from Mr. Bautistas farming. Mr. Bautista earns about Php 800.00 a month. Since Mrs. Bautista does not work, she is in charge of the house and in taking care of their children. Mrs. Bautista budgets the money in terms of food, billings and transportation, since their 3 children stopped going to school. They do not have any financial assets at hand in case of emergency. They typically borrow money from their relatives. Norms: Income is a determinant of health. A determinant of

standard of living and variations in ill-health and premature mortality reflect differences in levels in income and material deprivation. The population will had incomes below half the National Average after allowing for housing costs. The average daily income in Region III ranges from 159 to 250 pesos per day to meet the borderline of poverty while in Tarlac province, it ranges from 250 to 300 pesos per day. Those most likely in this category are unemployed, pensioners and lone parents, families with three or more children and the lowpaid. Poverty also reduces people choices of healthier lifestyles. Healthier food, for example, not only cost more but also when money is short, family buys food that is high in calories and filling rather than necessarily nutritious. (EPH staff: 2008 edition) Analysis:

The familys income is inadequate for their daily financial needs. The father needs to work hard to earn the money for their everyday finances. That was why they typically borrow money from their relatives.

C. HOME AND ENVIRONMENT

HOME Ownership of the House Construction Materials Used Space adequacy Lighting Facility Lighting Adequacy Ventilation Water Supply Drinking Water Food Storage WASTE DISPOSAL Garbage Container Owned Mixed Adequate Electricity Adequate Electric fan Water pump Covered Covered Covered

Method of Disposal Garbage collection Toilet Facility Pail system DRAINAGE SYSTEM Type of Drainage Open drainage DOMESTIC ANIMALS, INSECTS, BREEDING SITE Pets/Animals Pests/Insects Ways of Eradication Cow, Pig, Chicken, Dog Rodents, Cockroaches, Mosquitoes, Flies Insecticides

The Bautista familys house is made up of mixed materials (wood, and cement). The entry to the house is located near the terrace. It has 8 windows; four are located in the bedroom while two is found in the living room, one for the kitchen, and the other one was located in the dining area. One door for the entry way, three doors distributed to each bedroom, and one door for the kitchen. They cooked their foods using charcoals. They get their water through the water pump which was located near their neighborhood. There were observed animals in their surrounding such as cow, pig, chicken, and dogs.

Norms:

The concept of the housing is defined not only as a means

of physical shelter, but should also provide (1) an environment conducive to the physical and moral welfare of the individual (2) a high level of health and living standards through adequate and safe housing and related community facilities (3) formulation of the satisfactory community life and the means of equalizing access to the other services and opportunities which exists in the larger community (4) an environment where privacy is balanced with meaningful social interaction (5) a housing environment whose character and quality reduce environmental cause of family disintegrations and anti-social behavior. Adequate light and ventilation must also be present, as well as protection from excessive noise. Roofing must be impervious to water. Direct assess to the dwelling shall be provided by means of an abutting public street or pathway. Water supply, should be safe and sanitary and can accommodate the need for fire extinguishing on

demand. At least 1 sanitary toilet should exists in the house and should have a sewage disposal system either in the form of septic tank or a connection to the community sewerage system.(www.nha.gov)

Analysis: The environment near their house is balanced with meaningful social interaction with their neighbors, and was quiet within the area. The house has adequate ventilation, and the windows have sufficient sizes that air can pass through and circulate in the house. Presence of breeding sites for vectors and flies are evident in the surroundings near their house.

Floor Plan
607.06

609. 6 cm

683.26 cm

193.04 cm

D. HEALTH STATUS Name of the Patient: Gary Gadia Bautista Age: 23 years old MEASUREMENTS

RESULT

NORMAL VALUES

ANALYSIS

Height

56

Weight

60 kgs

A medium frame man with a height of 56 should have a weight range of

132 - 133 lbs.

Normal

Normal

VITAL SIGNS 1st visit Temperature Pulse rate Respiratory rate Blood pressure 110/80 mmHg 120/70 mmHg Normal 36.3 84 bpm 26 cpm 2nd visit 37.1 80 bpm 22 cpm Analysis Normal Normal Not normal

GENOGRAM OF BAUTISTA FAMILY Paternal Side

7 A&W 6 A&W
6 2 5 9 5 5

Maternal Side
7 HTN
5 2 7

7 0 A&W
5 3

8 A&W 4
4 5

4 HTN

5 4

4 9

4 0

A&W A&W

A&W

A&W

A&W

A&W A&W A&W A&W A&W A&W A&W A&W

A&W A&W

2 3 AST

2 A&W

1 7 A&W

LEGEND: LIVING MALE PATIENT AST Asthma Hypertension LIVING FEMALE A&W Alive and Well HTN

13 AREAS OF ASSESSMENT 1. SOCIAL STATUS Gary is a 23 year old man currently residing at Purok 2, Brgy. Sto. Domingo, Tarlac City. He is a Roman Catholic and eldest among the three children of Mr. and Mrs. Bautista. They have a good relationship within the family, and their neighbors. Alcohol use The patient stated that he drinks alcoholic beverages

and was able to consume 1 - 2 bottles of beer in one seating. Drug use He is not a drug user. He stated that he usually

smokes 1 stick per day. He self medicates and uses Over-theCounter drugs, whenever he experiences asthma. Coping ability condition. Education Hobbies chores. Food of choice He usually eat fruits and vegetables, and He was an elementary graduate (grade 6). He loves watching T.V., and does household He could cope up to his stressors as he accepts

his health condition and was hopeful to regain his good health

fish. He occasionally eats fatty and oily foods. Activity He does gardening and crop planting sometimes.

Norms:

The patient and his family have respect to other people,

believing that relationships with other people are based on mutual trust (Westershoff) and putting their faith in action and standing up for their beliefs (Kohlberg), (Med.& Surg. Nursing Lemone and Burk 2004) Analysis: The patient developed interpersonal relationship within the family and their neighbors with a certain degree of satisfaction. He developed a good coping ability as evidenced by being hopeful to regain his normal functioning or health condition. Preferences and interest exposed of his age were rather normal. His activities were mostly dynamic in nature.

2. MENTAL STATUS

Facial expression His expressions were appropriate according to the content of his dialogue and showed a smile during the entire interview. Consciousness He was well oriented with the time and

date, although he wasnt able to recall some of his past memories. Communication He has a good eye contact during the

interview. He was conversant, and he could understand and speak Ilocano as well as Tagalog language. Attention He was attentive during the interview and had

a good communication process. He was cooperative and answers the question appropriately. Memory his past memories. The patient wasnt able to remember some of

Norms: amount

The patient should appear relaxed with appropriate concern of the assessment; should be clean and well spontaneous, coherent

groomed; expressions should be appropriate to the content of the conversations; should be able to produce and physical speech; and should respond to questions properly.(health assessment assessment, Mary Elen zator Estes).

Analysis: The patient was oriented and conscious. He was energetic during the interview and was confident in expressing himself. The patient was also unable to recall some past events that happened in his life.

3. EMOTIONAL STATUS Gary remained participative during the interview. Norms: emotionally A persons emotional status depends much on is ability to stable of unfortunate incidents happened. (Nursing

cope up with the happenings in his life. He may or may not be CEU.com: The process of human development) Analysis: The client has a positive outlook in life and can handle his emotions well.

4. SENSORY PERCEPTION

Sense of Sight Visual acuity Visual acuity wasnt performed due to lack of resources. Symmetry shape. Color of Sclera Both scleras are whitish in color but the conjunctivas are pinkish in color. Norms: sclera should The patient should have a visual acuity of be white with some small blood vessels. (Health Patients eyes are symmetrical and round in

20/20; the eyes must be symmetrical during the six cardinal gazes; Assessment and physical assessment, Mary Elen Zator Estes). Analysis: The patients visual aciuty was not assessed due to lack of resources. His eyes were symmetrical in shape, the sclera is whitish in color, and he has pale conjunctiva. Sense of Taste Color Hydration saliva. Taste He verbalized the sweet taste when given INIPIT sandwich, indicating he could determine the taste the food served to him. The tongue is pinkish in color. It is moist and rough with a clear secretions or

Norms:

A person has no problem about his sense of taste if

he can identify the sweet, sour, salty, and bitter taste of foods he eats. (Estes, Third edition, Copyright 2006) Analysis: Revealed normal condition of the sense of taste based from the standards.

Sense of Smell External inspection Patency Nose is in the midline of the face.

Symmetrical, without lesions or pain There was no obstruction upon breathing. The student nurse asked him to smell the objects we held near his nose through blindfold. The patient responded and verbalized what he smelled and stated that he smelled alcohol and perfume. Norms: Nose must be symmetrical and along the midline of the

face. Each nostril must be patent. (Health assessment and Physical Assessment, Mary Elen Zator Estes) Analysis: Revealed normal findings upon assessment based on standards. There were no deviations observed.

Tactile Sensitivity Pain tolerance The student nurse pointed the sharp and

dull edges of the ballpen to the pt.s skin and asked him to tell the sensation. The patient responded and verbalized what he felt and stated that he felt sharp and dull object touched his skin.

Temperature house. Norms:

He could feel the humid temperature in their

The skin contains receptors for pain, touch, pressure

and temperature. Sensory signals that help determine precise locations on the skin are transmitted along rapid sensory pathways, and less distinct signals such as pressure or poorly localized touch are sent via slower or sensory pathways. (Health Assessment and Physical Examination, Mary Ellen Zator Estes 5th Edition) Analysis: The patients sensory transmission functions are

within the normal as manifested by the data presented. Auditory Acuity Watch tick test He could hear the sound of the watch

1inch away from him. Symmetry Ears were symmetrical with each other and were aligned on the level of his eyes. There was no pain complained felt upon inspection. Whisper test The patient was able to hear whispered words from 1-2 inches away and repeated the words accordingly. Norms: The patient should be able to hear whispered words to 2

inch away. The pt. should not complain of pain upon palpation. (Health assessment and physical assessment, Mary Elen Zator Estes)

Analysis: Upon assessment, there were no wounds, lesions or inflammation found. 5. MOTOR STABILITY The client has a good motor stability. Norms: Normal motor stability includes the ability to perform the

different steps in doing range of motion. It should be firm with smooth and coordinated movements (Estes, Third edition, Copyright 2006) Analysis: The clients walking gait was normal. 6. BODY TEMPERATURE 1st visit Temperature 36.3 2nd visit 37.1 Analysis Normal

Norms:

36.5 C to 37.5 C is the normal body temperature (Kozier,

Seventh edition, Copyright 2004) Analysis: range. 7. RESPIRATORY STATUS The body temperature of the patient was within normal

1st visit Respiratory rate Norms: 26 cpm

2nd visit 22 cpm

Analysis Not normal

Normal respiratory rate for adults is 12-20 cpm. Average is

18. In terms of pattern, normal respiration must be regular and even in rhythm. The normal depth of respirations must be effortless.(Health Assessment and Physical Examination 3rd Edition Mary Ellen Zator Estes). Analysis: The patient has an elevated respiration during the assessment due to his asthma. 8. CIRCULATORY STATUS 1st visit Blood pressure Pulse rate 84 bpm 80 bpm Normal 110/80 mmHg 2nd visit 120/70 mmHg Analysis Normal

Norms:

The average heart rate of an adult is 80 100 bpm, and

the average blood pressure of an adult is 120/80mmHg. (Kozier, Seventh edition, Copyright 2004). Analysis: With regards to Garys circulatory status, it shows that his pulse rate and blood pressure is in the normal range. 9. NUTRITIONAL STATUS

The clients weight is 60 kg and his height was 56. He usually eat fruits and vegetables, and fish. He occasionally eats fatty and oily foods. BMI Computation: Given: weight = 60 kg Height = 5 ft (6 inches) BMI BMI Norms: = weight in kg / height in (m) 2 = 60 / (1.6764)2 = 21.35 BMI is a measurement that indicates body composition.

The degree of overweight or obesity as well as the degree of underweight can be determined by making use of BMI.(Estes, Third edition, Copyright 2006)

Standard Body Mass Index for Adults (Estes, Third edition, Copyright 2006)

Underweight = <18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

Analysis: The patient has normal weight.

10. ELIMINATION STATUS

Gary stated that he usually defecates once a day; and he described his stool is brown in color, and solid - formed. He usually voids 3 4 times per day depending on the amount of fluid he ingests, and his urine color was yellow. Norms: Normal bowel movement is usually 1 2 times per day. It

should be solid - formed and brown in color. Normal urine output of an adult is usually 1200-1500mL per day, and voids 3 4 times a day.. (Kozier Seventh edition, Copyright 2004) Analysis: Garys elimination status is normal. No alterations found during assessment.

11. REPRODUCTIVE STATUS

Gary stated that he was circumcised when he was 10 years old. He started to be sexually active with the same sex when he is 9 years old. Norms: The reproductive status of a man is known by the ability to

be circumcised and does not experiencing any difficulty in his sexual life. (Estes, Third edition, Copyright 2006)

Analysis: The patient has normal reproductive status.

12. STATE OF PHYSICAL REST AND COMFORT

Gary usually sleeps at around 9:00 pm and wakes up at around 8:00 in the morning. He also takes a nap at around 1:00 pm if he is not doing anything at home. Norms: A normal sleep hour of an adult per day is 6-8 hours

without disturbance.(Kozier, Seventh edition, Copyright 2004) Analysis: The patient has adequate rest and sleep.

13. STATE OF SKIN APPENDAGES

Garys skin is fair and smooth. His hair is evenly and the scalp has no flakes and free from lesions. His hair is color black and does not have any infestations. Nails are pinkish and well groomed. No wounds, lesions, and masses are assessed in the other parts of the body. His capillary refill is within 3 seconds and returns back immediately. Norms: Skin varies from light to brown from ruddy pink to light

pink. Generally, the skin has uniform color except in areas exposed to the sun, in areas of lighter pigmentation in palms, nail beds, and lips. The hair should be evenly distributed, thick, shiny and free from infestation. Capillary refill must be within 2 3 seconds and should return immediately. (Kozier, Seventh edition, Copyright 2004)

Analysis: Revealed normal findings based on the standards given.

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION

MAINTENANCE AND DISEASE PREVENTION The children in the family has completed their immunization done in the health center in their Baranggay. The Bautista Family has adequate rest and sleep. They sleep early and wake up early, the usual time of sleeping is 9:00 pm and they wake up at around 8:00 in the morning. Mrs. Bautista stated that farming, doing the household chores, gardening, and walking are their ways of exercise. Mr. Bautista is in the farm planting crops and took care of their carabao, while Mrs. Bautista usually does the household works along with their children, and talks with the neighbors during free time. The mother recognizes the importance of health in the family, however, because of financial constraints made them ignores any major health problems that may arise.

Furthermore, they were not able to sustain sufficient supplies of medication which they would need related to their health care needs. They often use alternative medicines or herbal medicines for treating their illnesses and habitually self-medicate if OTC medications are available. They occasionally use herbal plants near the house in treating diseases or symptoms in the family. They usually come to the health center for check ups or consultations.

Norms:

Studies of practices among Filipino Americans suggests from rural areas in the Philippines are health remedies, traditional healing regarding

that people originally knowledgeable

techniques and supernatural ailments, whereas those from urban areas relay more on Western medical intervention and over the counter drugs. Newborn sleep 16 to 18 hours a day, usually divided into about seven sleep periods, while some infants sleep as long as 22 hours a day, other 12 to 14 a day. The sleep requirement of toddlers decrease to 10 to 12 hours per day. The preschool child usually requires 11 to 12 hours of sleep per night, particularly if the child is in preschool while the school age child sleeps between 8 and 12 hours a night with daytime days. Most adolescence requires 8 to 10 hours of sleep each night and the adult requires at least 6-8 hours of sleep per night. Eight hours undisturbed sleep at night with no daytime nap has become the assumed idea of pattern. Disturbed sleep pattern may result to sleep disorder and affect the immune system. Vaccination among infants and newborn (0-12 months) against the 7 vaccine preventable diseases. These include: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles and hepatitis. Every Wednesday is designated as immunization day and is adopted in all parts of the country. In a Barangay health station, immunization is done monthly while in far flung areas it is done quarterly. The standard routine immunizations schedule for infants is adopted to provide maximum immunity against the 7 vaccines preventable diseases before a child first birthday. A child is said to be Fully immunized child when a child receives 1 dose of BCG, 3 doses of OPD, 3 doses of DPT, 3 doses of HB, and 1 dose of Measles before a child 1st birthday. (http:/ www.livinginthephillipines.com/philculture/practices.html)

Analysis: The Bautista family has a good health practices as evidenced by seeking help from medical professionals in the Baranggay Health Center or Rural Health Unit, and also used herbal medicines, as well as over the counter drugs. The members of the family gets adequate sleep and they have completed their immunizations.

II. ORGANIZATIONAL DATA CUES / DATA NORMAL STANDARDS BASED ON REFERENCE Subjective: akong Nahihirapan A healthy person must be free from any lalo na diseases or illnesses.

huminga,

kapag madumi ang paligid at mainit sa lugar namin

Subjective: na nga eh.

Inuubo

at A healthy person

must be free from

sinisipon ako, dalawang araw any diseases or illnesses.

Subjective: umuulan.

Ang

daming A healthy home must be free from ventilate and free from threats.

lamok dito lalo na kapag rodents and pest, it is clean, well Minsan din malangaw kapag hindi nakukuha yung mga basura sa bawat bahay.

III. CLUSTERED DATA CUES / DATA Subjective: akong Nahihirapan lalo na FAMILY NURSING PROBLEMS Asthma as a Health Deficit 1. Inability to recognize a condition or a problem due to: a. Lack of knowledge on the nature and management of the health condition. 2. Inability to make decisions with respect in taking appropriate

huminga,

kapag madumi ang paligid at mainit sa lugar namin

health action due to: a. Low salience of the problem b. Negative attitude towards health problem c. Inaccessibility if appropriate resources for care specifically financial constraints

Subjective: na nga eh.

Inuubo

at Cough and Colds as a Health Threat 1. Inability to recognize a condition or a problem due to: a. Lack of knowledge on the nature and management of the health condition. 2. Inability to make decisions with respect in taking appropriate health action due to: a. Low salience of the problem b. Negative attitude towards health problem c. Inaccessibility if appropriate resources for care specifically financial constraints

sinisipon ako, dalawang araw

Subjective: umuulan. malangaw

Ang Minsan kapag

daming

Presence of Vectors, Mosquitoes,

lamok dito lalo na kapag Flies, and Rodents as Health Threat din 1. Inability to recognize a condition hindi or a problem due to: a. Lack of knowledge on the nature

nakukuha yung mga basura

sa bawat bahay.

and management of the health condition. 2. Inability to make decisions with regards to the management of the condition due to: a. Failure on identifying what measures are appropriate. 3. Inability to provide home conducive to health maintenance and personal development due to: a. Ignorance in preventive measures.

IV.

PRIORITIZATION OF THE PROBLEM

1. ASTHMA
Computatio n Actual Score

Criteria

Justification

1. Nature of the Problem.

3/3 x 1

It requires immediate attention since untreated asthma has a possibility to lead to other complication.

2. Modifiabil ity of the Problem.

2/2 x 2

The family has resources such as medicines; they have also knowledge on how to manage the problem such as resting

and whenever he feels that his respiration is elevated. Nurse has time to conduct health teaching to the patient.

3. Preventiv e Potential.

3/3 x 1

Possible complication can be minimized or controlled if the problem is managed well.

4. Salience of the Problem

3/3 x 1

The family considers the problem and gives immediate action.

TOTAL:

2. COUGH AND COLDS

Computatio n Actual Score

Criteria

Justification

1. Nature of the Problem.

2/3 x 1

0.67

It requires immediate attention since untreated cough and colds has a possibility to lead to other complication.

2. Modifiability of the Problem.

2/2 x 2

The family has resources such as medicines; they have also knowledge on how to manage the problem such as taking a rest.

3. Preventive Potential.

2/3 x 1

0.67

Possible complication can be minimized or controlled if the problem is managed well.

4.Salience of the Problem

2/2 x 1

The family considers the problem and gives immediate action.

TOTAL:

4.34

3. PRESENCE RODENTS

OF

VECTORS,

MOSQUITOWA,

FLIES,

AND

Criteria

Computatio n

Actual Score

Justification

1. Nature of the Problem.

2/3 x 1

0.67

It is a health threat that needs an immediate attention.

2. Modifiability of the Problem.

1/2 x 2

The family has the necessary resources but does not utilize them properly.

3. Preventive

Potential. 2/3 x 1 0.67

The susceptibility in acquiring other infections can be prevented if the problem will be solved.

4.Salience of the Problem

2/2 x 1

The problem was recognized by the family but they do not think it needs an immediate attention.

TOTAL:

3.34

Problem Prioritization Family Problems According to Priority 1

Asthma

Cough and Colds

4.34

Presence of Vectors, Mosquitoes, Flies, and Rodents

3.34

V. FAMILY NURSING CARE PLAN

Health Problem

Family Nursing Diagnosis

Goal of Care

Objectives of Care

Nursing Intervention s

Method of Researcher Family Contact

Resources Required

Asthma as a Health Deficit

Inability to After manage the nursing condition due to intervention the lack of , the family knowledge must be regarding its equipped management. with the necessary knowledge they need in dealing with the situation.

After nursing intervention, the family:

-Establish rapport.

Home Visit

Material Resources: Visual Aids on Asthma Human Resources: Time and effort of both the Researchers and the family.

-Prepare the necessary -will be able equipments identify the needed. cause and effect of the -Inform the disease. family about the visit. -know the appropriate -Health intervention to education make. about the disease and its management.

What to teach?..... ASTHMA What is Asthma? Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. What are the signs and symptoms of Asthma? Common symptoms of asthma include wheezing, shortness of breath, chest tightness and coughing. Symptoms are often worse at night or in the early morning, or in response to exercise or cold air. Some people with asthma only rarely experience symptoms, usually in response to triggers, where as other may have marked persistent airflow obstruction. What causes Asthma? Asthma is caused by environmental and genetic factors. Environmental Factors Many environmental risk factors have been associated with asthma development and morbidity in children. Environmental tobacco smoke, especially maternal cigarette smoking, is associated with high risk of asthma prevalence and asthma morbidity, wheeze, and respiratory infections. Low air quality, from traffic pollution or high ozone levels, has been repeatedly associated with increased asthma morbidity and

has a suggested association with asthma development that needs further research. Recent studies show a relationship between exposure to air pollutants (e.g. from traffic) and childhood asthma. This research finds that both the occurrence of the disease and exacerbation of childhood asthma are affected by outdoor air pollutants. Viral respiratory infections are not only one of the leading triggers of an exacerbation but may increase one's risk of developing asthma. Genetic Factors Many of these genes are related to the immune system or to modulating inflammation. However, even among this list of highly replicated genes associated with asthma, the results have not been consistent among all of the populations that have been tested. This indicates that these genes are not associated with asthma under every condition, and that researchers need to do further investigation to figure out the complex interactions that cause asthma. How does Asthma can be treated? Treatment goes on for a very long time. Some people have to stay on treatment for the rest of their lives. The best way to improve your condition and live your life on your terms is to learn all you can about your asthma and what you can do to make it better.

Become a partner with your health-care provider and his or her support staff. Use the resources they can offer -- information, education, and expertise -- to help you.

Become aware of your asthma triggers and do what you can to avoid them.

Follow the treatment recommendations of your health-care provider. Understand your treatment. Know what each drug does and how it is used.

See your health-care provider as scheduled. Report any changes or worsening of your symptoms promptly. Report any side effects you are having with your medications.

September 11, 2010

(Saturday)

Dear Diary,

Hello! This day will be our 1st day of Immersion at Baranggay Sto. Domingo, Tarlac City. I prepare all my personal things, clothes, snacks, and sleeping materials to bring in the immersion. Our group decided to go to TSU Main at 1:00pm, so we can buy our foods and needed things for our activities during our Immersion. At 4:30pm, our service arrived. We started putting our things inside the jeep. When were done, we took funny pictures of ourselves while waiting for Sir Catap. At 5:30pm, Sir Catap arrived, and then, we left for our journey at Brgy. Sto. Domingo and the rain started to fall. At exactly 6:00pm, we arrived Baranggay Sto. Domingo, Tarlac City.

We fixed our things and foods out of the vehicle, and placed it inside the kitchen and at the Day Care Center. After that, we prepared our dinner (Pinakbet), me and ate Jelyn as the cooks. Michael and Ademar helped us in lighting the charcoals we will use for cooking. Ate Dana, Eejie, Marjorie, Neptune, Jovie, and Jelly finished placing the other foods in the dining area. After we finished cooking, we prepared the tables and chairs, and then Sir Catap led the prayer, and we had our dinner.

After eating, the group 2 (jovie, me, jelly, and ate jelyn) was assigned to wash the dishes, while the others cleaned the dining area and kitchen. Some of us get their water for bathing at the water pump near the Botika ng Brgy.

Each of us waited for our turn at the comfort room. When all of us were done, 9:30pm, Sir Catap had a short discussion about our routine for our 5days Immersion, and also he designated us per group for cooking, cleaning, and dishwashing representing each Puroks at Brgy. Sto. Domingo. The Group 1 members were Ademar, Neptune, and Marjorie for the Purok 1; Group 2 members Jovie, Me, Jelly, and ate Jelyn for the Purok 2; while the last group that will handle the Purok 3 were ate Dana, Eejie, and Michael. After that, we fixed our beddings in the floor, and resume our rest.

At 10:00pm, lights off.. Cell phones off.. Good night!!

Christine Karen Ang Suarez Group D4

September 12, 2010

(Sunday)

Dear Diary,

Good morning! .. This is our 2nd day of Immersion here at Baranggay Sto. Domingo, Tarlac City. At 4:30am, Neptune, Ademar,

and Marjorie waked up early to prepare for our breakfast, because they were the assigned cooks for the day. They cooked egg with onions, hotdogs, and dilis. At 5:30am, some of us prepared the tables and chairs, so that we can eat already. Ademar was the prayer leader, and we ate our breakfast with Sir Catap. After breakfast, Me, Jovie, Jelly, and ate Jelyn cleaned the kitchen, and dining area. Eejie, ate Dana and Michael washed the dishes. We waited at the room for our group mates, and at 6:45am, we had our discussion about the activities for this day.

The girls will do the gardening and will find rocks that will be placed in the flowing in the rice fields, while the boys began digging the soil that will serve as a compost pit. At the garden, we were taken pictures by Sir Catap while were doing gardening. He also took pictures for the boys. Then, after we finished the gardening and finding rocks, we had our break. We returned to our room, and take a rest while we waited for the boys to finished their task. After the boys were finished to their tasks, Sir Catap introduced us to Auntie Maritess (mother of Rommel).

Auntie Maritess said that if we want to go to the river and catch snails, she will gladly accompany us. Sir Catap agreed to her suggestions and we decided to go there at 2pm. At 10:30am, the group 3 was the assigned cooks for lunch, group 2 for dishwashers, and group 1 for the cleaners. Our lunch was Tinolang Manok!!! So yummy! After lunch, we took a nap. At 2pm, we met Sir Catap and Auntie Maritess, and began a long walk for the river. At 1st, we cannot find snails, and tulya. As time passed by, we were enjoying our time in the river catching snails and tulya. We were the SURVIVORS! Lols.. :D At 4:30pm, we finished our River Snail - Tulya Treasure Hunting and returned back to the Brgy. Hall.

Some of our group mates took a bath along the flowing and some in the comfort room. We, the Group 2 cooked Tortang Talong and fried fish. While Jovie and Jelly remained to cook, Me and ate Jelyn takes a bath. Then, Jovie and Jellys turn. We prepared the tables and chairs, and properly divide the rice and dish for 11 persons. After dinner, group 1 washed the dishes and group 3 cleaned the area. The rest of the group goes back to the room, and finished making diary. At 10:00pm, lights off.. Cell phones off.. Good night!!

Christine Karen Ang Suarez Group D4

September 13, 2010

(Monday)

Dear Diary,

Hello again! Today is our 3rd day of Immersion and 1st day of our house visits. A new day full of works, leisure, and interaction with people of Brgy. Sto. Domingo. At 5am, we took turns in taking our baths in the comfort room. The cooks for this day was the Group 3. The menu was Pancit Bihon with Sardines. The whole group were chatting during the entire breakfast. After breakfast, group 2 washed the dishes and group 1 cleaned the area. Once were done, Sir Catap discussed the activities for the day and how we will conduct our home visit among each families per Purok.

At 9:10am, Sir Catap toured

us in the house of the Brgy.

Captain Gadia. The captain was their with his wife and chidren. Mr. and Mrs. Gadia welcomed us as the new batch in thei Brgy. And thanked us for our stay at their Brgy. for 5 days. We introduced ourselves individually to them. After that, we go to our respected puroks and Rommel accompanied us in Purok 2. Me and ate Jelyn goes back to the house of Brgy. Captain to checked the status of their sick child. After we assessed the children, we impart some health teaching to Kapitana, and then, we leave.

We proceeded to the houses located at the back of the Brgy. Hall, while our partners, Jovie and Jelly were accompanied by Rommel

and Sir Catap in their home visits at the Sentro of purok 2. We finished visiting all houses there and we returned back to Brgy. Hall because we were the assigned cooks for lunch. I prepared the seasonings and ingredients for the menu Adobong Manok while chatting with Sir Catap about my experiences in life and my race. Ate Jelyn cooked the rice, then we noticed that were lacking of onions and cooking oil. So, we asked permission to Sir Catap to buy those items in the Sari Sari Store and he permitted us. Jovie and Jelly came after 15 minutes and helped us in cooking.

Ademar and Rommel cooked the snails and tulya that we caught yesterday for our additional dish. At 12:30pm,we had our lunch. After eating, some of us took a rest, while on the other hand, me, jelly, jovie, ate dana,ate jelyn, and Rommel were laughing about our activities this morning, and reading the diaries of other groups. We fixed ourselves and continued our home visits! Whoa! Its so hot outside, so we decided to wear our jackets for protection against the sun. We finished visiting the houses near the boundaryof purok 1 and 2, and sentro of purok 2.

The last house that we visited were Kagawad Abayans house. He entertained us with a smile on his lips, with his wife and daughter in law. They were so kind that they told us we were doing the right thing helping the community people in their Brgy. even we sacrificed our comfort zones in our homes and live with the community people. They gave us 6 kilos of rice as a sign of gratitude and we thanked them also.

Then, we graciously and happily leave them. Its past 6pm when we get back to brgy. hall. While some of our group mates cooked for our dinner, we had fun in making the CONTAGIOUS PAGEANT in Brgy. Sto. Domingo. Jovie as Ms. Venus Raas, and ate Jelyn as Ms. Pluto Maslam. We had it on the spot as past time while waiting for dinner. They had long gown, and swimsuit competition wherein they used the bedsheets as their gowns and swimsuits.

We laughed to our hearts content. Jeez! I cant forget it! Our food was great and we are all satisfied about the dish they cooked. After taking a shower, we finished our diaries, passed it to Sir Catap and he checked it. My group mates and me prepared our beddings and resume our rest. Good night! Lights off, and cell phones off

Christine Karen Ang Suarez Group D4

September 14, 2010 (Tuesday)

Dear Diary,

Good morning! Such a beautiful day! I woke up in the morning thinking this day was our 4th day of Immersion, and our 2nd day of house to house visits each families per puroks. Im having enjoyment upon staying here at Brgy. Sto. Domingo and it is as a part of my life as a 4th year Nursing Student. Our supposed to be meal was omelet, and hotdogs. Instead, we cooked pancit canton and hotdog, because we dont have any stocks of egg left.

We had our evaluation exam this morning, instead of tomorrow morning because Ademar and Michael will leave for their practice in baseball. Our group finished interviewing the families we have chosen for the family case study. After lunch, Marjorie was sad because Ademar left for their practice in baseball for the upcoming Intramurals. Then, at 3:30pm, we finished visiting all the houses at Purok 2. And

Rommel gladly said that our group were the 1st of all group finished in doing home visits at Purok 2.

At 5:30pm, we returned back to the brgy. hall and took a rest. We had our dinner at past 7pm, and we enjoyed our meal. After eating, we took a bath and prepared our bedding. At 10pm, Sir Catap let us watch a movie in his laptop. Then, at 11:30pm, we had our rest. Lights and cell phones off. Good night!

Christine Karen Ang Suarez Group D4

September 15, 2010 (Wednesday)

Dear Diary,

Well, hello! This is our last day of Immersion! Today, after having breakfast and preparation of our things, we go to Purok 3 and visit the houses that are usually limitedly visited by the health workers. We interviewed them and take pictures within the family. Then, we returned to the brgy. Hall. We packed our things. Rommel and Auntie Maritess got a banana leaves in their house and we prepared it clean and presentable. We called it as boodle fight. We were all happy and enjoyed eating together with our clinical instructor and Rommel. After we eat, we help each other in cleaning the area very well. Then, we waited for our service. But before we leave, we go to the Brgy. Hall and gave our thanks to Brgy. Captain Gadia. He also thanked us for our efforts and works in their Brgy. then, we say goodbye to him, and to other officials. We give our thanks Haist! HOME SWEET HOME! to the Ilac family especially Rommel for their help and companythen we leave Brgy. Sto. Domingo.

Christine Karen Ang Suarez Group D4