INTRODUCTION

This is the family health nursing care plan for the ARENOS family of Tublay
Central. Data was surveyed September 30, 2010, Thursday with the informant Rita
Arenos.

What is a family?

How well a family works together and how well it can organize itself against potential
threats depend on who its members are and the activities or roles the family members
carry out. Recognizing different family structures allows health care providers to focus
on family-centered care or provide a family-friendly environment for care.

A family is traditionally defined as a group of people related by blood, marriage,

or adoption. However, this definition is limited when assessing a family for its health
concerns or for its available support systems because some families are made up of
unrelated couples, and at certain points in life, not all family members may live together.
A broader definition of family is then formulated. A family is two or more people who
live in the same household, share a common emotional bond, and perform certain
interrelated social task. This definition advises the broad range of types of families that
health care providers often encounter.

By context, we define “family client” as group of people who live in the same
household, share a common emotional bond, and perform certain interrelated social tasks
to which health care is directed. With the aid of health care providers, the family client is
the co-facilitator of its own care.

Nevertheless, such care can only be achieved if health workers dedicate

themselves to mastering an organized and dynamic approach towards health. The Family
Health Care Process is a deliberate activity where the practice of a health worker is
performed in a systematic manner wherein the health worker utilizes comprehensive
knowledge as a base to assess family’s health status. The health worker involved in the
Family Care Plan should entail judicious statements of health problems and to plan,
implement and evaluate the plan of care.

To every successful activity, planning is an essential factor. It is expected of a

health worker to be always geared towards achieving optimum health care provision for
their clients. This can be carried out through having a properly prepared nursing health
care plan, where interventions are purposely made for a specific family client.
 Page | 71
I. FAMILY INITIAL DATA BASE

A. Family Structure, Characteristics and Dynamics

Name of the Family Relationship to Age Gender Civil Occupation

family member Position Head of the Status
Family
SaniyoArenos Grandfather Head 70 Male Married Farmer
Rita Arenos Grandmother Wife 66 Female Married Farmer
Julius Arenos Father Son 30 Male Married Farmer
Ana Arenos Mother Daughter in-law 23 Female Married Housewife
Joan Arenos Grand- Grand Daughter 1 Female Single N/A
daughter

Place of Residence
The Arenos family owns a house and lives at BenguetTublay Central.

Group Conclusion as to Types of Family and Family Relationship

The type of the family that they have is extended family. They owned the house and
lot. The type of the family structure is a democratic one since both the husband and wife
decides on what is best for the family. No one is always right and should be followed.
When it comes to matters regarding the house like cooking, cleaning, health of child and
family, maintaining orderliness Ara is responsible. On the other hand when it comes to
work related the three members of the family are responsible financially.

B. Socio-economicand Cultural Characteristics

The family income comes from the 3 members of the family, namely
SaniyoArenos(head of the family), Rita Arenos(wife of Saniyo), and Julius Arenos(their
first child). They are working mainly as a farmer. Since the three members of the family
are working, their salary is good enough for the allocation of the family’s needs as
confessed by Rita. According to the wife, income for a month is roughly P2, 000.00. The
income is distributed to the house expenses, food and farm equipments. The electric bill
has an amount of P100.00. The child’s milk is also one of the major expenses of the
family. A box of bonamil is P95.00 and is only good for 4 days while a can, P475.00 is
usually consumed in 2 weeks. Since the client’s water avail from community water
system, it is also added to the expenses of the family. The family is incapable of having
luxuries like clothes, and other machineries since their focus is on their necessities.

SaniyoArenos with an ethnic affiliation of Ibaloi, and his education attainment is

elementary graduate. His wife Rita Arenos, is also an Ibaloi, which has an education
attainment of elementary level. Since they stop studying they decided to work in the farm
instead, then they got married at the right age that they can handle the new family and
family member, wherein they can support the needs of each member, even though they
did not finish their study yet. They were originally an Ibaloi so that they landed here in
Central Tublay wherein most of the Ibaloislived.

The family has a good relationship with the community since they do not have enemies
or conflicts with other person but they are active in any community organization. Saniyo,
Rita, and Julius spend more time in the farm. Ana, the wife of Julius is a plain housewife;
she spends her time at home and to watch her one and only child.

They have pets like dogs, chickens, and carabao. The house of the client is prone to many
accident hazards, because the house is located in an unsafe area. It is noticeable that place
become muddy and slippery when it comes the rain. Risk for falls or injury therefore it is
considered as foreseeable crisis or it can be also a health threat for the whole family.

Page | 72
C. Home and Environment

The family owns a house made up of light materials such as wood, hallow blocks and
galvanized iron sheets. They have two bed rooms, a living room and a kitchen. All things
found in their house are fixed. Their house is neat and clean. There are four windows,
which keep the entire house well lighted and ventilated and they have also a connection
of electricity. However, cob webs are seen on the ceiling, fire woods are not properly
piled up and garbage are not properly placed on a sealed container so as with the drums
containing rain water and they are just burning their garbage’s. These areas could be a
breeding site for mosquitoes, flies and cockroaches.

Outside the house water is stagnant on the backyard for there was no proper and
good drainage system. And the grasses are evidently tall and not well trimmed. This
could serve as a site for mosquitoes, cockroaches, rodents and snakes.

The family utilizes “saleng” in cooking their food, woods are located near the area for
cooking, and one window is located in the kitchen for ventilation. Pots and pans are
properly at one corner together with their plates, bowls, glasses and eating utensils. Food
supplies are stored in a basket or in the small built-in cabinet. Excess food were placed in
a container and left on the table. The table on the other hand is clean and flies are absent.
The only problem is the garbage is not properly sealed and there garbage is not properly
disposed.

The family utilizes a level two water supply facilities or a communal faucet system.
Abundant and continues water supply came from a spring, which were stored in a
reservoir and distributed through pipeline. The family boils their water intended for
drinking purposes for 30 minutes and stores it in plastic containers.The family is
defecating in an open pit style.

The collection of garbage is not practiced in the community. Waste segregation is

practiced and composting is not done. Usual practice is placing the trash in an old sack or
plastic bags and burning the garbage when the rain stopped or if the land is already dry.

There is no drainage system utilized by the family. Waste water from the kitchen, laundry
and the water used for bathing flows directly on the background and it had already
formed a pool of stagnant water, which serves as a breeding site for vectors.

The compound where the family lives is free from noise disturbance. Houses are 5 to 10
meters away from each other. The people within the compound know each other and they
have an open communication with one another.

The road is quite difficult to reach because of landslides, slippery and rocky terrain which
is about two to three kilometers away. No public unity vehicle can reach the area so
people need to walk. At the highway, trucks, jeepneys, buses, motorcycles and private
vehicles can passé through and the road is well developed aside from some cases of
landslides due to the previous typhoon.

Page | 73
D. Family Development Stages and Health Status of Each Family Member

Health statuses of each family member are as follows:

Saniyo- grandfather
Since the client is not always around during the assessment because of his work, he was
not physically assessed. Saniyo is monitored to be hypertensive according to her wife. No
hypertensive drugs taken for maintenance. Never been hospitalized and had her last
check up at the Rural Health Unit at Acop, Tubay few years ago (Not remembered).

Rita – grandmother

Rita is currently 66 years old. She is anemic. She sometimes feels body weakness and
headache when she is stressed. Pain relievers like paracetamol are taken to alleviate
condition and she also taking Vitamins. The diet of the client consists mainly of rice,
vegetables and some meat and fruits. She eats three times a day with snacks in between
meals.

Rita is alert and coherent. She responds well to verbal stimuli and responds appropriately
to noise, touch, and painful stimuli. In addition, she is well oriented to time, place and
person. She is able to understand and responds appropriately to stimuli. She is well
oriented to her environment and she is not using any restraints devices for
morbidity.Cough and colds are the common illnesses occur in the family.

Julius – Son

During the visit the mother of Julius said to us that Julius is suffering from cough and
colds. According to Rita it is because of the weather and maybe of their neighbors who
just suffer from colds. They have not consulted physicians because they believe it is
normal to get cough and cold. In cases of serious medical problems the family usually
visits RHU Acop and Benguet General Hospital.

They have a strong faith to health care professionals because they expect them to provide
them the quality care they need for a good health status.

Julius is under the developmental task vs. isolation. He is already coped up with this task
since he is already. The only thing to do is to maintain the marriage working and setting
problems or issues to avoid conflicts.

Ana- Daughter in-law

Ana is currently 23 years old. She is also under the developmental task of intimacy vs.
isolation. Ana is also suffering from cough and colds. According to Rita it is because of
the weather and maybe of their neighbors who just suffer from colds. They have not
consulted physicians because they believe it is normal to get cough and cold. Her child
was delivered in the hospital when she labored. Further assessment reveals that the client
didn’t have any difficulties with her pregnancies. She is well oriented to her
environment. She is able to read and write. She relates to other family members well.
 Page | 74
Joan- Grand-daughter

Joan is a 1-year-old baby girl. She is under the developmental task of trust vs. mistrust.
Since she is on this stage, the parents must be able to provide the child with a loving and
caring environment. It was observed that the mother carries and talks with child and the
child felt safe with mother as manifested by hugging her when the student nurse is
around.

The client was exclusively breastfed for the first five months of life. From then on, water
was incorporated. At 5 months, formula milk was introduced but still mixed breastfeed.
Complementary feedings like mashed potatoes, am with milk porridge, biscuits and
breads were also given. The mother noticed that the child was choosy with foods.The
mother doesn’t do any home remedies to deal with client’s illnesses since she believe that
the medications will do.

The baby sleeps most of the time during the day about 1-2 hours interval. During the
night the baby sometimes wake up but most of the time asleep. The client is already able
to crawl, stand with assistance and hold objects. The baby can also utter words such as
mama or papa and other short words.

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

Prevention

The family goes to the RHU they only utilize such services when someone in the family
gets too ill because of its distal proximity and lack of financial resources. The family does
not have beliefs on food and nutrition. They just considerfoods as a source of strength
and energy that keeps them alive.

The family goes to bed at 8 o’clock. They usually wake up at 4 to 5 o’ clock in the
morning. During the afternoon when they do not to go to the farm they usually have an
hour of nap at noontime. Gardening and farming, as verbalized is one of the recreational
and at the same time relaxation technique utilized by the clients.

The clients are non-smoker and non-alcohol drinker. Gambling for them is just a waste of
money so they do not practice any. The family does not utilize the barangay health
services due to its distant location; medical check-up was seldom done due to financial
inadequacy.

The family believes on “atang practices” and super natural being such as fairies and
dwarfs. Many beliefs are also present regarding supernatural phenomena such as “kulam”
and ”buyon”. The family is conscious, coherent, and conversant. They are oriented
toperson, place, and time. They can speak in Ilocano and Tagalog.

There were no reported infectious diseases present neither in the family nor in the
neighborhood except for cough and colds. As observed, hand washing is not given
attention; health education regarding infection control is best required. They claimed that
they get irritable in too much noise. There are four windows, which keep the entire house
well lighted and ventilated. However, cod webs are seen on the ceiling, fire woods are not
properly piled up and garbage are not properly placed on a sealed container so as with the
drums containing rain water. These areas could be breeding sites for mosquitoes, flies,
and cockroaches.

Outside the house wastewater is stagnant on the backyard for there was no proper and
good drainage system. The yard also serves as a place where they urinate, and the grasses
are evidently tall and not trimmed; this could serve as a site tor mosquitoes, rodents and
snakes.

The following are the immunizations of Ana and Joan: BCG; DPT1, DPT2, DPT3;
OPV1, OPV2, OPV3; HEPB1, HEPB2, HEPB3 and AMV. Joan is fully immunized.
Ana, on the other hand already had 5 doses of Tetanus Toxoid

Page | 75
II. FIRST AND SECOND LEVEL OF ASSESSMENT

A. Health Strengths

HEALTH STRENGTHS SUPPORTING CUES

Health Maintenance and Management This can be seen whenever the mother would take her child
to the rural health unit whenever the child is sick. The
complete immunizations also reflect that she is aware of the
need to protect the child from the diseases.
Breastfeeding The mother breastfeed Joan for 5 months exclusively. She
also reported that she is now bottle feeding and giving
supplementary foods to her baby.
Healthy Lifestyle The boiling of the baby’s water is a good health practice.
Cleaning of surroundings and house also is observable.
Eating of vegetables and fruits are evident. Not doing self-
prescription also shows that she is afraid of the possible
effects of not consulting the doctor

B. Health Problems

Health Problem (First Level Supporting Cues/ Strengths Second Level Assessment (Family
Assessment) and Weaknesses Nursing Diagnosis)
A. Health Deficit
 Illness states: Cough and Crackles noted upon
colds auscultation on lower lobes of
the lungs. Occasional coughing
episodes noted. Mother
reported that client has
secretions with vomitus whitish
in color and thick consistency.
No use of accessory muscles
noted. Since the family has
inadequate resources of money,
the mother tends to delay
check-up of child until the
funds are available.
B. Heath Threat
Improper garbage disposal The collection of garbage is not
practiced in the community.
Waste segregation is practiced
and composting is not done.
Usual practice is placing the
trash in an old sack or plastic
bags and burning the garbage.
Presence of mosquitoes as Outside the house wasted water
health threats is stagnant on the backyard for
there was no proper and good
drainage system. The yard also
serves as a place where they
urinate, And the grasses are
evidently tall and not trimmed;
This could serve as a site tor
mosquitoes, rodents and snakes.
III.PRIORITIZATION TABLES & JUSTIFICATION OF ALL HEALTH
PROBLEMS IDENTIFIED
Problem #1: Cough & colds
Criteria Computation Actual score
1.) Nature of the problem 3/3 x 1 1 - It is a health deficit &
2.) Modifiable of the 2/2 x 2 2 - The problem is easily
problem
1. Inability to make decisions with
respect to taking appropriate health
action due to:
a.) fear of consequences of
actions, specifically: economic
consequences
2. inability to provide adequate
nursing care to sick member of the
family due to:
a.) lack of inadequate knowledge
about the disease/health condition
(nature, severity, complications,
prognosis and management)
3. inadequate family resources for
care,
- Inability to make decisions with
respect to taking appropriate health
action due to:
a. Fear of consequences of action,
specifically economicconsequences.
Inability to make decisions with
respect to taking appropriate health
action due to lack of knowledge
with the presence of problem.
Page | 76
Justification
requires an immediate
intervention
modifiable because the
resources and interventions
needed to solve the problem
and available
 3.) Preventive potential
4.) Salience of the problem
Total score
3/3 x 1 1 - The problem has a high
preventive potential because
it can be easily prevented
with proper lifestyle
2/2 x 1 1 - The problem is recognize by
the family
5

Problem #2: Presence of breeding sites of mosquitoes

Criteria Computation Actual score Justification
1.) Nature of the problem 2/3 x 1 0.7 - It is a health threat &
requires an immediate action
2.) Modifiability of the 2/2 x 2 2 - The problem easily
problem modifiability the resources
and interventions needed to
solve the problem is readily
available to the family
3.)Preventive potential 3/3 x 1 1 - The problem can be easily
presented
4.)Salience of the problem 0/2 x 1 0 - The family doesn’t
recognize it as a health-threat
Total score 3.7

Problem #3: Improper Garbage Disposal

Criteria Computation Actual score Justification
1.) Nature of the problem 2/3 x 1 0.7 - It is a health threat &
requires an immediate action
2.) Modifiability of the 1/2 x 2 0.5 - The problem easily
problem modifiability the resources
and interventions needed to
solve the problem is readily
available to the family
3.) Preventive potential 3/3 x 1 1 - The problem can be easily
presented
4.) Salience of the problem 0/2 x 1 0 - The family doesn’t
recognize it as a health-threat
Total score 2.2

Page | 77
List of prioritized Health Problem

Health Problem Rank Total Score

Illness of state:Cough and colds
1st 5

Presence of breeding sites of

mosquitoes 2nd 3.7

Improper garbage disposal

3rd 2.2