Far Eastern University

Manila Institute of nursing

Brgy. Maytunas, San Juan

AUGUST 2, 2011

COMMUNICABLE DISEASE
Passed to:

PROF. TAGAPAN

Passed by: Group28

Pea, Elaine Joy J. Cabigting Clarisse Jane Patao, Cristian P. Ramos, Kaylle Marie R. Santos, Jear P. Santos, John Carlo B. Solis, Mikhail M. Tabago, Girlie Ann S. Toreja, Mark Joseph S. Ventura, Kevin Ace R.

Villamor, Katrine A. Villavicencio, Beverly L.

PRIMARY COMPLEX
An introduction

Primary complex
-

It is a type of tuberculosis infection that most often occurs in children. The focus of the initial infection is a small area in the lungs and lymph nodes. - Primary complex is acquired when someone inhales the tuberculosis germs of an infected person. The germs are breathed into the lungs and develop into an infection over a period of one or two months before spreading to the lymph node, according to Pediatric On Call. - People infected with primary complex often do not demonstrate any symptoms. However, they may have a cough or swollen lymph nodes. Primary complex is diagnosed with a skin test.
-

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

- Incidence rate of Primary Complex is 243/ 100,000 population/year. - Treatment for Primary Complex TB in children is the use Anti-TB medications and involves other treatment modalities for it not to be active. - Mode of transmission: Airborne/ Droplet - Incubation Period: 4-12 weeks, Average of 8 weeks - Causative Agent: Mycobacterium Tuberculae

Pathophysiology

Organism: M. Tuberculae

Hemoptysis

Upper Respiratory Tract

Consumption of lung tissue Cachexia Scarring of the Lungs

Weight Loss

Lower Respiratory Tract

Cavitation

Fat Loss

Phagocytosis

Caseous Necrosis

Increased Basal Metabolic Rate

Org. is resistant to phagocyte d/t lipid coat, which makes it survive

Inflammation

Recurrent Fever

Productive Cough

Decrease Immune Response

Active Infection occurs

II. BIOGRAPHIC DATA

NAME POSITION IN THE FAMILY
(relationship to client) 1. Mikhaella Dhayne Arongay Manuela Denise Arongay Maria Christina Arongay Marlon Arongay Lolita Francisco Danilo Francisco Dexter Francisco Christian Francisco

GENDER

AGE

BIRTHDAY

OCCUPATION

MARITAL STATUS
Single Single Married Married Married Single Single Single

Daughter (eldest) Daughter (youngest) Mother Father Grandmother Grandmother Uncle Uncle

Female Female Female Male Female Male Male Male

4 y/o 3 y/o 25 y/o 26 y/o 50 y/o 51 y/o 20 y/o 13 y/o

Feb. 17, 2007 April 16, 2008 October 10, 1986 Feb. 15, 1985 Jan. 8, 1958 March 3, 1957 Oct. 19, 1991 July 15, 1998

N/A N/A Housewife Janitor Housewife Company Driver N/A: student N/A: student

2.

3.

4.

5.

6. 7.

8.

FAMILY PRIMARY DATA:

HOME ADDRESS: RELIGION: ETHNIC GROUP: PRIMARY DIALECT: NATIONALITY: HEALTHCARE FINANCE: INCOME (monthly estimation)

Sr. Mariano St. Brgy. Maytunas, San Juan City

Roman Catholic None Tagalog Filipino None P 7, 000

II. NURSING HISTORY

A.PAST HEALT H HISTORY

The patients history of past health involved her hospitalization when she was 1 week old when she had a bacterial infection (specific disease not recognized); symptoms include appearance of a red mump-like presentation in the left chin. The said disease was identified by the clients mother as pigsa sa loob; in lay mans term. According to her, her husband also had the disease when he was a baby. An antibiotic (specific name of drug not identified) was use in treatment of disease. The client was confined for one month in hospital in Silang Cavite. (Hospital unspecified by the mother). Aside from this, client was not hospitalized due to any major diseases. Colds, fever and cough are her common experienced diseases; she had cough and colds last June 2011 and had just recovered 3 weeks ago, 1st week of July. According to the mother, the clients experiences common colds and cough every rainy season. She uses over the counter drug (Solmux kids syrup) in treatment of disease in every

occurrence. According to her, it is recurrent and the client easily got colds leading to cough. The client doesnt have a regular check up and was not brought for any medical assistance in times of coughs or colds. The clients mother recalled that the client had complete immunizations including BCG, DPT, OPV, HEPA B. and Measles. She was not been diagnosed of asthma and is non-diabetic. There had been no accidents or trauma, blood transfusions, medications or any allergy to foods or drugs. The client did not have any foreign travel but was able to go to Cavite and Batangas City.

B. HISTORY OF PRESENT ILLNESS

The clients history of the present illness started seven days (July 19, 2011) prior to interview (July 25, 2011) when she was observed to have a poor appetite. According to the clients mother, its just this time when she start to observed the client to have a decreased food intake from approximately 3 servings of rice to 1 serving. The client also experience frequent mood swings, easily irritated and showed disinterest in food. The client sometimes skips food; specifically, (lunch) during the interview. The client was diagnosed skin test positive (primary complex) conducted in barangay Maytunas health center, San Juan City last July 19, 2011. This is free program of the barangay; the incident also served as way in client being diagnosed of the current disease. The client currently does not yet received any medical assistance in treatment of the disease. Clients mother do not bring client for any follow up hospital check-up.

C. FAMILY HISTORY Client belongs to a family with paternal history of cancer; N. Francisco (51, grandmother) and M. Francisco (51, grandmother) both died from ovarian cancer and maternal history of hypertension, and Clients mother side has a history of asthma, family members namely H. Francisco (56, grandmother), E. Francisco (49, grandmother) have asthma. Also, clients father Marlon (26) and uncle D. Francisco (28) experienced asthmatic symptoms when they were still infants. J.c Francisco (deceased, uncle) died from pneumonia at 8 month old. Aside from these, there are No other hereditary -familial diseases noted such as heart, lung or kidney diseases and diabetes mellitus.

D. DEVELOPMENTAL HISTORY

The patients developmental history compose of her being conceived as planned and wanted, with regular prenatal check-up, delivered through normal spontaneous delivery, in full term, experienced an infective disease when she was just 1 week old. The client was breast- fed until 5 months old but was bottle-fed after until today, 4 yrs. Old. The client started walking at one and a half of age. She had regular sleep and had good toilet training. There are No signs of strange and separation anxiety noted in her, there are also No signs of thumb sucking, head banging and nail biting though there are temper tantrums, fears noted at times during first encounter, usually to unknown people. The client is playful and is now attending school.

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

H.F 49 y/o

N.D 51 y/o

D. F

L.F 50 y/o

51 y/o

E.F 56

M.D 5I y/o

J. F 8mo. old

M.C. A

D.F
20 y/o

C. F
13 y/o

M.A
26 y/o

LEGEND: -Female -Male -Identified patient -married -siblings -deceased

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

III. PATTERNS OF FUNCTIONING

A. FAMILY HEALTH PERCEPTION AND MANAGEMENT

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

defines health as absence of any diseases, and being physically active and well. More so, according to the mother of the client, health means having proper body grooming, adequate clothing, proper and balanced nutrition, as well as good home sanitation and ventilation.

I. Socio-economic and cultural characteristics

Mr. A. (Father) are the only that has a permanent job in the family. He earns Php7 000.00/month. The familys expenditures composed of their food, electric bill, water bill, and schooling of the children, were the prioritized to the least prioritized. Mr. A. is the decision-maker of the family. According to Mrs. A, she admitted that her family has inadequacy to meet their basic necessities which includes food, clothing, shelter and health services due to insufficient income. When asked about the familys financial stability, she stated, Kulang talaga, depende talaga kung magkano lang ang meron sa isang araw. But she said, sina mama, kasi magkasama naman kami ditto, ang tumutulong sa amin kapag wala na kami makain. Binibigyan nila kami ng pagkain tulad ng ulam at bigas o share, sa gastos kasi karaniwan share na e. Di na maiwasan kasi parang isang pamilya na kami, sa desisyon na lang nagkakaiba tapos ayun oo sa kwarto nga hiwalay. The family does not belong in any ethnic group. Their religion is Roman Catholic. They do not engage themselves in any religious affiliation. Mrs. A is unaware when it comes to the activities of their community. She verbalized, Hindi kasi ako aktibo sa barangay kasi bago pa lang kami dito, noong febuary lang ganun. Kaya di ko pa masyadong alam, ke mama ako ngtatanong.

II. Home and Environment When asked about the condition of their living space, the mother uttered, mejo masikip, 8 kami dito, pero Ok lang naman Nakakagalaw naman kami ng maayos. But according to our observation, the land area is approximately 25 square meters which makes it inadequate for the familys living space. They have two bedrooms. They sleep separately as a family. They use bed for sleeping. There are presence of vectors in their home, specifically, mosquitoes and cockroaches. They do not spray pesticides. They only kill the vectors by means of

hitting. There are pets like, cat, dog and mini-mice. There is no presence of accident hazards except to ladder which can be risky for the children. They do not store food because the moment they buy their food, they immediately cook it. They usually cook their food by frying and they are fond of eating fish, fruits and vegetables. But they do drink liquors but only during occasion. The familys water supply is coming from Maynilad, also their drinking water. But the children take a mineral water (no brand, according to the mother) that is being bought to the nearby store. They do not use any method in sanitizing their drinking water but they see to it that it is covered. They use a flush-type excreta disposal and is placed inside the house, privately used by them. The family relies in the communitys garbage services by means of collecting garbage and they do not segregate the biodegradable from nonbiodegradable. They leave their garbage uncovered. They have a blind drainage and it is free lowing. The family lives in a slum neighbourhood near water bridge where there are narrow streets. There are social and health facilities available like basketball courts and health center in their community however the family seldom uses these facilities. Although there are also communication and transportation facilities available like jeepneys and side cars, the family utilize those services when needed.

III.

Health status of each family members

It was mentioned by the mother, that some past illnesses in the family includes asthma wherein it is mostly on the side of her mother. Cancer was also common on the relatives on the side of her father. As of now, the family does perceive indications that they acquired the said illnesses and disease specifically M.A, the client who is not diagnosed of primary complex.

The family does not have a regular or annual check-up, there is also no finances allotted for health. Only in times of disease when they get to see a physician or bring a family member in a hospital or health center for assistance.

Family experienced several hospitalizations, one major confinement happened 4 yrs. ago when a family member was confined due to a bacterial infection. Currently, the family asks assistance from the barangay health center in incidence of disease (children) like fever from cough/colds.

Family observed importance on hygiene, hand washing. Taking a bath daily, brushing teeth. None of the family has vices like cigarette smoking and alcohol intake. In terms of food intake, the family is not able to meet a planned diet. The family reasoned out that is enough that in a day they are able to eat three times a day. The amount of food intake depends on their financial capability to buy food for a day. The family is experiencing stress due to some workload, financial needs, responsibilities and roles, and misunderstandings, which contribute in some health risks.

IV.

Values, habits, practices on health promotion, maintenance and disease prevention

When asked about any practices concerning health issues, the mother mentioned that her family dont have any beliefs like going to albularyo when theres a sick member in the family, but she verbalized that, nagamit kami ng oregano ganun, kunyari may ubo, ok nman e wala naman gumagaling din. None in the family drink or smoke. According to her, it is because they already have history of asthma thats why they try to avoid. Hard drinks are only during occasions. The family sometimes experience difficulty in sleeping due to noise brought by pets of neighbourhood even their own; she also stated that in some instance it is because of occasional noise when there are party and celebration but stated that they are used to it. She and other family members, dont take a nap, she elaborated, it seldom happen, only when she is too tired or her brother and partner is too tired of work. The family usually prefer to be at home and chat, and have it as a form of family activity. When stressed due to too much work, she stated, itutulog na lang ganun. In general health view, the family, In the scale of 1-10, 10 being the highest and 1 being the lowest, she rated their family as 5, because according to her, her family is not that healthy for they sometimes acquire diseases and illnesses, particularly the children, she stated, mga kalahati lang ganun, kasi minsan talaga di naman kami ok, ayun
kapag ngkakasakit iyong mga bata, lalo na kapag tag-ulan.

She said she is not that active in barangay programs and is not aware of any health services that it offers; its just recently when she started to get involved.

B. CLIENTS NUTRITIONAL-METABOLIC PATTERN According to the clients mother, her family eats are prepared by their mother, wherein, she usually bought it in San Juan public market market and do the sometimes just bought cooked food outside. The

preparation at home, they

client usually eats breakfast at 9:00 am, take merienda every 9:30 am during their recess time in school, have his lunch at 12:00-1:00 pm and dinner by 6-7pm.

Breads, biscuits like Fugee bar and other branded biscuits were her favorite foods. The mother stated that the client does love eating soupy foods like sinigang. She likes mango and banana. She oftentimes drinks water about 400ml. Of water a day plus her milk (Alaska) that is 5 oz. (bottled). Not picky in foods but do not eat much vegetable often. According to the mother, she has a good appetite and can acquire 3plates/servings of rice in one sitting. But currently, loses her appetite from three

servings to 1serving of rice, and skip some meals. She doesnt have any food allergy. The client has four tooth decays. 3-DAY DIET RECALL
FAMILY
MEMBER

SATURDAY [JULY 23, 2011]

Break fast
lunch snacks dinner

SUNDAY [JULY 24, 2011]

breakfast
lunch
snack

MONDAY [JULY 24, 2011]

breakfast
lunch

dinner

snack
Fugee bar biscuit (1 serving) water (200ml)

dinner

M.D.A

Bread
(1 pc.)

Rice
(1 serving)

none

Pancit canton
(1 serving)

Rice
(2 serving)

Rice
(1 serving) Chicken adobo (1 serving)

non e

Rice
(1 serving)

Rice
(1 serving)

Skip meal

Puto
(1 pc)

Fried egg
(1 pc)

Soup
(1cup)

Chicken adobo
(1 serving)

Dried fish
(1 serving)

Tokwa
(3 slices)

Ginisang toge
(1 serving)

Water
(1ml)

Water
(200ml)

Water (200ml)

water
(200ml)

water
(200ml)

water
(200ml)

water
(200ml)

Alska milk
(5oz)

C.

CLIENTS ELIMINATION PATTERN As verbalized by the mother, the client defecates once every other day, usually in the morning. According to the description of the mother, the color of the stool is brown, long oval; sometimes hard. At present the client does not experience any changes in her stool. The client also defecates by herself when there is an urge to eliminate. The client frequently urinate which ranges from 5 to 6 times a day. In the morning particularly after waking up, the color of the urine is somewhat yellowish but

becomes clear in the afternoon. The mother also told that the client stopped using diaper when she was 2 yrs. old. When there is an urge to urinate, the client immediately proceeds to the bathroom by herself.

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

D.

CLIENTS ACTIVITY EXERCISE PATTERN The mother described clients daily activity as routine, after she wakes up; she eats breakfast and prepares for school. Most of his time, starting from 10:00-12pm were spent for school where she usually does not interact with her classmates, the mother stated, tahimik yan si mika eh, tahimik tapos suplada talaga yan, minsan naglalaro naman yan sa school, malikot din. Most often, after waking up, the client eats her breakfast, and then takes a bath, after which she will walk for school, then lunch, play or watch TV again, and then eats her dinner and then sleep.

The client enjoys playing toys, watching television, sometimes, bahaybahayan, luto-lutuan and habul-habulan. As verbalized by the mother, the client spends her time mostly inside the house playing with her toys together with her sister. Moreover, the client often plays inside the house instead of playing outdoor games because she prefers playing alone, although she sometimes plays at school. She does not take nap during the afternoon. The mother stated, kasi, maaga yan matulog, kaya mahaba naman iyong nagiging tulog niya. The client does not have any difficulty with regards to body movement but is observed to be moody, and irritated with some discomfort in affect.

There are no significant changes in regards with her past and present activity even though she is encourage for rest at present for she just recovered from flue weeks ago. 7 DAY ACTIVITY DIARY
FAMILY MEMBERS TIME IN A DAY Eat breakfast, 9:00-10:00 noon take a bath, prepare for school Eat breakfast, take a bath, prepare for school Eat breakfast, take a bath, prepare for school Eat breakfast, take a bath, take a bath, prepare for school prepare for school In school (activity depend on school activity) Eat lunch, brush teeth watch TV, play with sibling Eat dinner, watch TV, brush teeth, drink milk Rest/sleep prepare for school prepare for school Eat breakfast, Eat breakfast, take a bath, Eat breakfast, take a bath, MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

M.D.A

In school 10:0012:00pm (activity depend on school activity) Eat lunch, brush teeth watch TV, play with sibling Eat dinner, watch TV, brush teeth, drink milk

In school (activity depend on school activity) Eat lunch, brush teeth watch TV, play with sibling Eat dinner, watch TV, brush teeth, drink milk

In school (activity depend on school activity)

In school (activity depend on school activity)

In school (activity depend on school activity) Eat lunch, brush teeth watch TV, play with sibling

In school (activity depend on school activity)

12:006:00pm

Eat lunch, brush teeth watch TV, play with sibling

Eat lunch, brush teeth watch TV, play with sibling

Eat lunch, brush teeth watch TV, play with sibling

6:007:00pm

Eat dinner, watch TV, brush teeth, drink milk

Eat dinner, watch TV, brush teeth, drink milk

Eat dinner, watch TV, brush teeth, drink milk

Eat dinner, watch TV, brush teeth, drink milk

7:009:00am

Rest/sleep

Rest/sleep

Rest/sleep

Rest/sleep

Rest/sleep

Rest/sleep

E.

CLIENTS SLEEP AND REST PATTERN According to the mother, the client usually has an average sleep 6 to 7 hours a day, from 7:00 or sometimes 8:00pm up to 9:00 in the morning. The client usually wakes up at 9:00 for school. She does not take nap in the afternoon. The client sleeps early at night because she does not have any nap in the afternoon. Before going to sleep, the client drinks a bottle of milk 5 oz. According to the mother, the client is

usually satisfied with sleep she has. The client has no problem with the sleeping environment. The client has no significant or notable changes between her past and present activities prior to her sleeping pattern.

F.

CLIENTS HYGIENE With regards to personal cleanliness and hygiene, the client takes a bath once a day every morning at 9:00am before going to school, She sometimes have her mother to assists him but she can do the activity alone. Aside from it, she washes his face before going to sleep; Brushes her teeth after eating meals. The client has no noted itching, scratching, unfix hair and clothing.
Client functional pattern (Disease-focused) Adl Before Seldom Eats vegetables and fruits, but like protein rich like egg and sea food like fish. With good appetite, approximately 3 servings of rice per meal. Voids urine 5-6 times a day with an estimation of 250-300cc per void of clear yellow urine. Defecates once every other day a day and describes it as bulky with aroma and from color light brown to yellowish brown. Her stool is many sometimes few depending on what she ate. Exercises done through play, usually around the house with her sibling. Takes a bath daily and brushes her teeth thrice daily. Sleeps for 10-12hrs. Do not take nap during noontime. Sleeping time is from 7pm to 9am. During Poor appetite with decreased interest, (from 3-1 serving of rice). Skip meals, not consistent in attending meals in meal times. No change in bladder and bowel pattern.

1.nutrition

2.elimination

3.exercise 4.hygiene 6.sleep & rest

With the same play pattern but is in Need of rest due to recent recovery from a disease condition. (Flue) The same practice is maintained. No observed change in the usual sleep and rest pattern.

IV.

PHYSICAL ASSESSMENT
VITAL SIGNS NORMS ACTUAL FINDINGS ANALYSIS

Body Temparature

Oral- 36.5 degrees Celsius- 37.5 degrees Celsius- normal range * Kozier and Erbs, Fundamentals of Nursing, page 529

Axillary temperature36.60 C

Normal

Pulse Rate

Pulse Average( and ranges) Adults- 75(60-100 bpm) Children -100 (70-130) *Kozier and Erbs, Fundamentals of Nursing, page 538

110bpm

Above Normal

Respiratory Rate

Respirations Average( and ranges) Children(15-30cpm) *kozier and Erbs, Fundamentals Of Nursing, Page 538

23cpm

Above Normal

Blood Pressure

Classification of blood pressure Normal- systolic BP MM HG <120 and Diastolic BP MM HG <80 *Kozier and Erbs, Fundamentals of Nursing, Page 552

N/A

N/A

Height

110-120cm

100cm

Below Normal

* Kozier and Erbs, Fundamentals of Nursing, page 529 Weight N: 15-35kg 12kg Below Normal

* Kozier and Erbs, Fundamentals of Nursing, page 529 VITAL SIGNS NORMS ACTUAL FINDINGS ANALYSIS

General Survey A. Body built, height, and weight in relation to the clients age, lifestyle and health Proportionate, varies with lifestyle * Kozier and Erbs, Fundamentals of Nursing, page 572 Relaxed, erect posture: coordinated movement *Kozier and Erbs, Fundamentals of Nursing, page 572 The client is lying on bed, conscious and coherent Normal Ectomorph. Normal

B. Posture and gait, sitting, and walking

C. Overall hygiene and grooming

clean, neat *Kozier and Erbs, Fundamentals of Nursing, page 572

Her clothes and she appears neat and clean.

Normal

D. Body and Breath odor

No body odor or minor odor relative to work or exercise: no breath odor No distress *Kozier and Erbs, Fundamentals of Nursing, page 572

No body odor and breath odor

Normal

E. Signs of distress( in posture or facial expression)

Client is irritable and less cooperative due to anxiety at first, and cooperates later when rapport is done. The client is healthy in appearance. Though in BST, she have positive outlook towards her condition. She is uncooperative and unable to follow instructions and resists to be examined at first due to anxiety.

Normal

F. Obvious signs of health or illness

Healthy appearance *Kozier and Erbs, Fundamentals of Nursing, page 572

Normal

G. Attitude

Cooperative, able to follow instructions *Kozier and Erbs, Fundamentals of Nursing, page 572

Not Normal

H.Affect/mood(appropri ateness of the clients response

Appropriate to situation *Kozier and Erbs, Fundamentals of Nursing, page 572 Understandable, moderate pace. *Kozier and Erbs,

The Clients mood is not appropriate to situation.

Not Normal

I. Quantity and quality of speech

She has a clear voice, understandable, and moderate

Normal

Fundamentals of Nursing, page 572 J. Relevance and organization of thought Logical sequence: makes sense: has sense of reality Thought association *Kozier and Erbs, Fundamentals of Nursing, page 572

pace.

N/A.

N/A

V.

ECOLOGIC MODEL

Ecologic Model

Host

Age: 4y/o, Nationality: Filipino, Sex: Female -History of Primary Complex Tuberculosis

Agent
-Mycobacterium Tuberculosis

Environment
Primary Complex TB Exposure to PTB either in either community or at home.

Hypothesis

The occurrence of Primary Complex TB is attributed to clients exposure to PTB carriers and pathogen and immunosuppression due to the environment of the client at her home.

A. Predisposing Factors 1. Host Age: 4 y/o Sex: Female Nationality: Filipino 2. Agent Mechanical: Mycobacterium is passed and acquired through respiratory secretions/droplets which transmit during sneezing, coughing, and talking. Chemical: Substance Abuse, Smoking, and Alcohol Biologic: Mycobacterium Tuberculosis is a rod shaped, aerobic bacteria that is resistant to destruction and can persist necrotic and calcified lesions for prolonged periods and remain capable of reinstating growth. 3. Environment Physical: Possible contact to person with PTB Socio-Economic: Exposure with persons with PTB either in community or at home.

Analysis: Occurrence of Pulmonary Tuberculosis is caused by contact to carriers of pathogen, confined living condition. Past Health History of PTB may affect the development of the condition. Conclusion and Recommendation: We therefore conclude Tuberculosis is a chronic granulomatous infection that usually affects the pulmonary system but may also invade other organs and tissues. The incidence is highest in crowded, poverty-stricken settings. It spreads from one person to another by airborne transmission. An infected person releases droplet nuclei through

talking, coughing, sneezing, laughing or singing. Larger droplet nuclei; smaller droplets remain suspended in the air and are inhaled by susceptible persons. Risk factors for TB are close contact with someone who has active TB, immune compromised status, substance abuse, inadequate health care, pre-existing medical condition, institutionalization, living in crowded, substandard housing and caring for TB patients. In the case of the patient, the substandard / crowded housing, contact with active TB and immune compromised status are the factors that have contributed to the development of the disease. As a Student Nurse we recommend a vital role in caring for patients with TB and family, which includes Assessment of the patients ability to continue therapy at home. The nurse instructs the patient and family about infection control procedures, such as proper disposal of tissues, covering the mouth during coughing and hand hygiene. Assessment of the patients adherence to the medication regimen is imperative because of the risk of developing resistant strains of TB if treatment is not followed faithfully. (Smetltzer and Bare. Brunner and suddharts Textbook of Medical -Surgical Nursing 10th Edition. p.532-53, 539)

VI.

PROBLEM IDENTIFICATION/PRIORITIZATION
A. CLIENT FOCUSED

PROBLEM Imbalanced nutrition: less than body requirements

RANK 1

JUSTIFICATION According to Maslows Hierarchy of need, nourishment is under the physiologic need. This is the first and primary need of an individual. Since the patient is a child with communicable disease nutrition is a very important factor in order to enhance immune system to fight for infections. Susceptibility to other diseases or infections can be prevented if malnutrition is eliminated.

Risk for infection related to compromised immune

According to Maslows Hierarchy of needs, this will fall under physiological needs for it will affect the health of the client thus addressing would prevent further infection. Physiological needs

system

are the most basic needs that are vital to survival. Patients susceptibility to infection because of compromised immune system can lead to more disturbing situation thus giving importance to this and giving proper intervention will contribute to improved recovery and well being.

Anxiety

According to Maslows Hierarchy of needs, this will fall under esteem needs which include anxiety for it is considered as deviation of personal worth. Anxiety arises to children when they seem that something is wrong with them.

A. FAMILY FOCUS Threat of cross infection from a communicable disease

CRITERIA Nature of the Problem COMPUTATION 2/3 x 1 ACTUAL SCORE 2/3 JUSTIFICATION
It is a health threat that needed immediate attention and management to eliminate possible worsening of the problem. The problem is modifiable because the resources are available to the nurses to increase familys perception and knowledge of the existing problem and also nurses can help the family in hygiene and sanitation and management of the family member with communicable disease. Prevention of the cross infection from a communicable disease will: a. Reduces chances that other family member will be susceptible to the disease b. Decreases the likelihood of the family in acquiring other diseases It is not felt as a problem

Modifiability of the problem

2/2 x 2

Preventive Potential

3/3 x 1

Salience of the Problem TOTAL SCORE:

0/2 x 1

0 3 2/3

Primary Complex
CRITERIA Nature of the Problem COMPUTATION 3/3 x 1 ACTUAL SCORE 1 JUSTIFICATION
It is a health deficit that requires immediate attention and adequate management to reduce the incidence of transmission of the disease to the rest of the family. The problem is partially modifiable because the family does not have adequate resources to solve the problem. Limited financial resources and lack of knowledge which is important in preventing or managing the problem but nurses can provide health teaching about the proper management and prevention of the disease. Transmission of infection to other family can be prevented or eliminated if the problem is managed adequately. The family recognizes it as a problem. They consulted the problem to the health center. And frequently ask questions of what is the proper health action to do.

Modifiability of the problem

1/2 x 2

Preventive Potential

3/3 x 1

Salience of the Problem

2/2 x 1

TOTAL SCORE:

Inadequate living space

CRITERIA Nature of the Problem COMPUTATION 2/3 x 1 ACTUAL SCORE 2/3 JUSTIFICATION
It is a health threat that needed attention because it may increase spread or transferability of infection or diseases

Modifiability of the problem

The familys resources are presently not adequate considering that they have other problems that for them should be the priority of finances. Increasing the living space will: a. Reduces possibility of transferability of communicable disease. b. Provide for privacy to members. It is not felt as a problem

Preventive Potential

3/3 x 1

Salience of the Problem TOTAL SCORE:

0/2 x 1

0 1 2/3

The Prioritized Health Problems The list of health condition or problems ranked according to priorities is presented: 1. Primary Complex 2. Threat of cross infection from communicable disease 3. Inadequate living space 4 3 2/3 1 2/3

VII.

NURSING CARE PLAN

A. B. CLIENT FOCUSED FAMILY FOCUSED

VIII.

FAMILY HEALTH TEACHING PLAN

*(See tables below)