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CHAPTER III Client Presentation This is the case of family DT., a nuclear, egalitarian type of family with 2 members. The family currently resides at #1 Purok Marikit Brgy. Bukal, Cavinti Laguna. The head of the family is Mr. V.DT., born on October 17, 1932, 79 years old, grade school undergraduate with his own store as the source of the income of the family. He is married to Mrs. M.DT., born on September 10, 1937, 74 years old and grade school undergraduate. The researchers had their first interaction to the family last July 3, 2012 at 1500H. The researchers were assigned to done home visit to family DT. The family greeted the researchers warmly and let them enter their terrace. The researchers introduced themselves and stated their purpose for the home visit to established rapport. The researchers reassure the family that the data to be gathered will be confidential and they also stated the contract of interaction. During the interview, the researchers asked Mrs. M.DT., about their family relationship, she characterized it as katamtamang kanais- nais and verbalizes hindi masasabing kung kanais- nais kasi minsan hindi kami nagkakasundo bihira lang dumalaw dito ang mga anak naming. Pag birthday naming mag- asawa o pag meron okasyon. Mrs. M. DT cannot describe her family as close but as resistant thus stress provoking factors specifically interpersonal conflicts between family members are identified. It is not recognized as a problem by the family because it is normal part of the family relationship. When the researcher asked Mrs. M.DT. other important person to her family she verbalizes ang asawa ko nagtitinda at nagluluto, yung iba ako naman na sa gawaing bahay. They stated that they attend barangay assembly seldom.

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The house of family DT is made of mixed structure, and it is owned by them. They use electricity and it is adequate for the family. They use charcoal in cooking their foods, the family has two kitchens, and the other one is inside their house while the other is at the place at the back of their house. The kitchen inside their house is unkempt and may be a breeding site of insects while the kitchen at the back of their house is well cleaned and organized. The family stored their food inside the refrigerator and the Mrs. M. DT., cooked their food in boiled, fried and apripaya (Afritada with papaya). They have 3 rooms and described by Mrs. M.DT., as maayos naman ang pagtulog naming. May kutson naman yung kama. The size of their house is adequate to the number of family members. The total number of windows of the family is 3. The type of toilet used by the family is level 1, which is de buhos system, it is private for the family and located inside their house and the sanitation is clean. The family has two sources of water facility, they used the water stored in tank as their source of water in their comfort room and they used the water fetch from the community tank as water for cooking. The researchers asked the family if the water is safe and clean, the client answered maayos naman ang tubig, pwede naming mainom as verbalized by Mrs. M. DT. The family admitted that they burned their garbage as their way of waste disposal. Mrs. M. DT. verbalizes that dinadala ko po sa taniman yung mga basura tapos doon ko sinusunog. Thus the researcher identified poor home/ environmental condition/ sanitation: improper garbage disposal. It is not considered as a problem because they are used to this lifestyle and due to lack of community resources. The family have 3 pets: dos, cat and pig, and all are unvaccinated. The yard of family DT have ornamental and fruits crops. The source of health information of the family is through television and student nurses. The means of transportation of the family is jeepney. The income of the family per month is estimated 1000-2999 php and

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adequate to the needs of the family. They consumed 2100 php for food and 900 php for the electricity. The family eat regularly three times a day. The home of family DT is near the Aglipay church, high school, senior citizens hall, Day care center, sports complex and health station. According to the family the leadership style in their community is participative. The researchers asked the family their concept about health and she answered pagkain ng gulay but their concept of sickness is panghihina ng katawan as verbalized by Mrs. M. DT. When asked about the ways of maintaining health, the couples agreed on kumain sa tamang oras. Kumain ng gulay at huwag pagurin ang sarili as verbalized by Mrs. M and Mr. V. DT. The family mostly consulted at a private clinic and traditional faith healer when they are sick. According to the family the condition in which the community have misunderstanding is Pag hindi naipaliwanag ang mga kautusan ni kapitan and it will resolve through Barangay Assembly as verbalized by Mrs. M. DT. According to Mrs. M. DT. her husband, Mr. V. DT. is still smoking three sticks per day. Hindi naman siya umiinom pero naninigarilyo talaga siya as verbalized by Mrs. M. DT. Nakakatatlong stick ako sa isang araw as verbalized by Mrs. V. DT. In line with this the researchers identified: Unhealthful lifestyle and personal habits specifically cigarette smoking. Since the family uses charcoal for cooking and disposed their garbage through burning. Uling ang pang gamit naming panluto as verbalized by Mrs. M. DT, the researchers identified poor home/ environmental condition/ sanitation specifically air pollution. For the last 6 months Mrs. M. DT. has been sick due to urinary tract infection and goiter. There is a visible swelling of the base of the client sabi ng duktor goiter daw. Kaya kailanganin dapat operahan. Dahil takot ako sa operasyon kay nagpapagamot ako sa albularyo. Tapos lumiit kaya hindi na ko nagpaopera as verbalized by Mrs. M. DT thus goiter as health

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deficit is identified. It is recognized as a problem but does not need immediate intervention due to the size of her thyroid gland decreases. After the interview the researchers conducted the assessment and physical examination of the family. First is Mrs. M. DT, 74 years old. She can speak tagalong language and part of the civic organization: senior citizen. She has a chief complaint of masakit ang aking balikat pag nagppahinga at hindi masyadong maitaas as verbalized by Mrs. M. DT. The initial vital signs of the client are: temperatire of 36 C; pulse rate of 60 bpm; respiratory rate of 22 cpm; and blood pressure of 120/ 80 mmHg. The pain is located at the upper extremities, it is localized and throbbing with a pain scale of 1/ 10 which is mild. The onset is gradual and intermittent, the pain is aggravated by rest and when taking bath and the treatment used is hilot and ointment. The client has a past health history of urinary tract infection and others are unrecalled. She had laboratory examination like complete blood count with a result of normal, and urinalysis with a result of positive infection. Sabi ng duktor may impeksyon daw ang ihi ko nagpabalik balik ako wala naman akong nararamdaman, pero sabi ng duktor meron pa. Pero ayaw ko na bumalik sa duktor as verbalized by Mrs. M. DT. In line with this urinary tract infection as health deficit is identified. It is not recognized as a problem because the client thought the infection is totally eliminated although it is not. The client has no medication currently taking and no known allergy. The client had her cessation of menstrual period when she was 45 years old. The client asked about her family health history but she cannot be able to recall it. She perceived herself as middle but believe in saying po or opo and pagmamano. The client can feed and do self hygiene by herself but her mobility is limited due to easily fatigue. The client cannot perform exercise because of the pain she felt in her upper extremity and feels easily fatigue and verbalization of dahil matanda na ngayon hindi na nakakapag ehersisyo. Hindi

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katulad nung bata pa nakakatakbo sa plaza thus unhealthful and personal habits/ practices specifically lack of exercise identified. It is not recognized as a problem because part of aging which is non modifiable variable. The client can sleep without difficulty but have irregular pattern of elimination. She prefers to eat fish, meat and vegetables and she dont want eggs. The hobby of the client is watching the television. She perceived her health status as malakas naman at medyo payat as verbalized by Mrs. M. DT. The left eye of the client has some impairment and feels pain at the right shoulder but no apparent significant problem in the skin, head, pulmonary, cardiovascular, gastrointestinal, genitor- urinary tract, hematologic, and neurologic. Upon the assessment of Mr. V.DT, 79 years old, with initial vital signs of: temperature of 36; pulse rate of 70 bpm; respiratory rate of 18 cpm; and blood pressure of 120/80 mmHg. He has a chief complaint of masakit ang aking tuhod. Arthritis ito as verbalized by Mr. V. DT., the pain is described as localized, throbbing and has a pain scale of 7/10 which is severe and associated with joint pains. The onset of pain is sudden and recurrent and lasts for 6 hours. It is aggravated by walking and relieved by medication. Mr. V. DT., verbalizes that nagpaduktor ako at arthritis daw. Pag sumasakit umiinom ako ng mefenamic acid. The client is currently taking mefenamic acid 500 mg twice a day. The client also complained of difficulty in walking and limited range of motion. Thus arthritis as health deficit is identified. According to the past medical history, the client had rubella, rubeola, mumps, chickenpox, and urinary problem. He has been hospitalized for 2 days due to fever. The client had undergone urinalysis before and found out he had urinary tract infection. The client has no known allergy and unable to recalled his family health history. He prefers to eat fish, meat and vegetables. He likes to watch television and he is also part of the civic organization of senior citizen.

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The researchers visited the family lasts July 9, 2012 at 1500H, to gather more information, and to do health teaching to the family. The researchers greeted the family and they are invited inside the house of the family. The researchers stated their purpose for doing the home visit and explained the procedure to be done. They explained how the researchers identified the actual and potential problems and how it will be resolved. The researchers assessed the perception of the family regarding exercise by questioning them and they verbalized that pampalakas ng katawan. The researchers educated the family regarding the benefits of exercise and explained how important doing regular exercise. The researchers provided pamphlets for the family to follow the procedures in doing passive range of motion which is demonstrated by the researchers. The family is being encouraged by the researchers to continuously participate in doing the exercise. The family listened very carefully and joined the researchers in doing the exercise. After the health teaching the family has been asked about the benefits of the exercise, pampalakas ng katawan as verbalized by Mrs. M.DT., this has been done to assess if the client understood the health teaching. The researchers also health teach about goiter, they assessed first the knowledge of the family about goiter and answered basta lumaki na lang siya. Inaagapan naman siya eh as verbalized by Mrs.M.DT. The researchers provided information such as the causes, severity, complication, prognosis and management of goiter. The researcher also explained the benefits of regular check-up, early elimination of the disease, and change of lifestyle. The family asked ano ba yung iodized salt? Eto ba yung pinong asin? the researchers answered Opo tay, yun nga po yung iodized salt. Pwede rin po kumain si nanay ng mga tahong po pwede rin pong panggalingan yun ng iodine as verbalized by the researchers.Lumiit na nga siya eh nung nagpaduktor ako malaki na kaya pumunta ako sa hilot kaysa magpaopera ako as verbalized by

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Mrs. M.DT. The last health teaching is about the improper garbage disposal. Since the family used burning in waste disposal the researchers provide information regarding the benefits of proper waste disposal, the disadvantages of burning waste and possible diseased may occur and the ways to properly dispose the waste. akala kasi namin may mangongolekta ng basura ditto. Pinaghihiwalay namin ang nabubulok at di nabubulok kaso ang kinukuha lan ay yung mga di nabubulok kaya sinisiga na lang naming yung mga nabubulok sige susundin namin yang pagbabaon ng basura as verbalized by Mr. V. DT. After health teaching, the researchers asked for permission to the family to do ocular inspection. Near the door, at the side of the wall, cases of bottles were located and may cause fall accident. The table in the living room is unclean as well as the kitchen inside their house. The room upstairs is unorganized and not sanitised. After the survey, the researchers end their nurse- patient interaction and ask for permission to come back for further assessment. July 11, 2012, at 1000H the researchers conducted home visit and greeted the family and state the purpose for the home visit. The family accepted the researchers and let them sit at their terrace. The researchers asked the family regarding their family lineage and the family cooperated well and try their best to remember the needed information but the researchers. After the interview, the researchers terminated their contract for the week and ask again for permission to conduct home visit the following week. The researchers show gratitude to the family and left with a smile on the clients face.