PINES CITY COLLEGES

Magsaysay Avenue, Baguio City

College of Nursing

FAMILY CASE STUDY IN

COMMUNITY HEALTH NURSING

Submitted by:
LAGMAY, Jaclyn G.
BSN IV – 1

Submitted to:
, BSN, RN
Clinical Instructor

December, 2009
 ACKNOWLEDGEMENT

This study will not be possible without the help, motivation and encouragement of
these people who are very close to my heart.

First, I would like to thanks my parents, my brothers and sisters for their love and
care they have given me, their sacrifices and constant guidance especially in my financial
needs.

To my friends, who are always there to share their ideas.

To the Barangay Health Nurse, Mrs. Dionisia Andres, Barangay Health Midwife,
Mrs. Marlene Garcia, to the Barangay Health Workers and especially to the Barangay
Captain, Mr. Robert Cruz for their full support and warmest welcome in accommodating
us in their Barangay and providing us the materials we could use in making this study
possible.

Special thanks to my Clinical Instructor, Mrs. Geronima Patalinghug for

imparting her knowledge, patience and considerations in guiding and checking my work.

Above all, our Heavenly Father, for His countless blessings and infinite love.

Jaclyn G. Lagmay
I. Introduction
A. Source of Referral

B. Reason of choice of study

I would like to inform the body why I choosed this study because of the
following reasons:

1. The family belongs to a low income

2. The disease is hereditary and find out how it is also a lifestyle disease.

3. How is the disease being cured.

4. How the family accepts the presence of illness/disease.

C. Expected benefits to be derived from study (Student and Family)

The benefits that I will acquire from this study, is that I will gain
knowledge about the disease they have, the proper interventions, medications and
care that I will render to my future patients with the same disease or illness. This
study will enlighten my mind, on how to deal with my future patients. It will also
serve as my guide and source in my nursing practice, nursing education and
nursing profession. In doing this study, it serves as a practice for me on how to
deal with the individual, group, family or in the community. It also serves as a
practice for me on how to assess different family in the community, this study
really gives or provides me so many benefits that would help and enhance my
capability as a nursing student and as a nurse in the future. And the benefit that I
will gain from this study is that I will also impart it to the different family in the
community. And I learned from this study on how the family appreciate little
things and this could make them happy, and I also learned that do not take for
granted anything that you have, because not all people are lucky.

The benefits that the family will acquire in this study, is that they will also
gain knowledge about the disease they have, the proper medication, interventions
and care that they will render to the member of the family having an illness. And
they will become more aware or conscious on their health, they will be actively
participating to the different activities of the barangay like health education about
the different illness or disease. They will also learn what is the importance of
having healthy body and a healthy lifestyle. And they will also learn the
importance of going to the health centers for regular check-up, proper
immunization of their children and proper hygiene, the importance of eating
nutritious food. The family will also learn on how to utilize available resources in
their community and proper use of herbal medicines.
Having community health services to the different community and
conducting family case study would not only benefit the student and the family
but also the community. This case study would serve as a guide for us in our daily
living and a healthy life.

II. Family Profile

A. Family structure and characteristics
Members of the household of Pilila family are Mr. Bagano he is
the head of the family, 49 years old and he is happily married with Mrs.
Semiona Pilila, 50 years old. They have three (5) children namely, Myra,
she is 23 years old, female, single and she is the eldest, second child is
Bernabe, he is 21 years old, third child is Jomari he is 16 years old, fourth
 child is Rachelle she is 9 years old and the youngest child, female, she is 5
years old namely Mabeline. The place of their residence is at KM8 ,Tuba
Benguet. The type of their family structure is nuclear and patriarchal. In
terms of decision making the dominant family member is the head of the
family Mr. Bagano Pilila. The family relationship is they talk or
communicate to each other respectfully, no observable conflict between
members. They respect and love each other especially their children.

B. Socio – Economic and Cultural Factors

The source of monthly income of the family is Mr. Bagano Pilila
the head of the family, he is working as a driver. His income is exact for
their basic necessities like foods and clothing, sometimes they cannot even
buy some extra clothing because of insufficient income for his family, not
intended for hospitalization or for regular check-up. The income of the
family ranges from P200 – 300.00 per day. He is the one who make
decisions on how the money is spent. The educational attainment of Mr.
Juan Dela Cruz is a high school level, and his wife Josefina Dele Cruz is
also a high school graduate and she is a housewife. Their child, Juan Jr., is
a Grade 1 student at Alonzo Elementary School, Joana is a nursery student
she is also studying at Alonzo Elementary School and Janine is not yet
studying. The place of origin of Mr. Juan is in Cebu and Mrs. Josefina is
from Manila, they both migrated at Tuba, Benguet and they met each other
and now they have a happy family. The families are not aware of any
activities or projects in their community. They are not involved in its
activities, and not a member of any organizations. But the family is aware
that there are existing organizations in the community.

C. Environmental Factors
As what I have observed and gathered information, there are
different environmental factors that could affect the health of the family.
According to the information given by the family, it is their owned
house but it is their owned lot. Their house is made up wood. They said that
the living space is adequate for them. They have their owned appliances like
radio as a source of news and also their diversional activities, television and
iron. There are presence of breeding or resting site of vectors of disease like
mosquitoes and flies, and there is a presence of accident hazards wherein
they are risk for falls and vehicular accidents. The type of their garbage
disposal is burning. Their waste disposal is flush, but their drainage system
is open. The source of their water supply is from spring, they cover their
drinking water storage wherein it is placed in the plastic bottles. For their
food storage they just cover it. As I observed there are common household
pests found on their house like dogs and cats. They are far from their
neighborhood, it is poor rural. But there are many resources that they can
utilize as a health resource like herbal medicines which is available to their
environment. They also have health centers in their Barangay but it is far
from their house.

D. Health and Medical History

Past and Present:
a. Immunization and Nutritional Status of 0-6 children
b. Family Planning
In a high populated community, knowing family planning method
is important. Most of the adults or those families in the community do not
know about the family planning method and how it will help to minimize
the population in their family. There are lots of methods to prevent
 pregnancy like for example condom which is very popular, pills, injection,
IUD (intrauterine device) and there are also what we call natural method
like withdrawal, calendar method or abstinence.
Pilila family used pills as a family planning method, they are
buying at the health center. The mother said that she is using family
planning method because she doesn’t want to have a child for now,
because she wanted to minimize the number of their family. And she also
said, that it’s good that there are family planning method that every family
can use.

c. Health Practices
For the health practice of the family is that they consult their health
related problems to “manghihilot” or to the Barangay Health Center.
Sometimes they do not go to the hospital for check-up due to insufficient
financial resources. Their lifestyle is, sometimes due to insufficient
financial status they can’t eat nutritious food, their source of exercise is
walking. They have an adequacy of rest and sleep and they also have
activities for relaxation or any stress management activities. In preventing
diseases, they used some protective measures like bed nets or protective
clothing in dengue. They use promotive-preventive health services like
utilizing resources and herbal medicines available to their community for
their health related problems. They also go to the health center if they have
time and if their children got sick.

E. Word portrait of case/cases

The perception of the family about the case (UTI) is that it needs a
long term medication. And they also said that if they do not take care of
their selves this may cause further complications on their health problem.
They also want to know some preventive measures to avoid having the
disease though the family are not familiar with the disease you will see to
them that they are really interested to learn about the disease because of
their fear that the disease might become worst.
III. Problem Identified

The Assessment Process

The available data gathered during the first-level assessment reflected the
following possible health condition or problems.

1. Congestive Heart Failure

Supporting Cues: 26 years old, father of three with a BP of 150/80 and he feels
difficulty of breathing and dizzy, he was diagnosed having CHF.

2. Cough and Colds

Supporting Cues: Joana, 4 years old, nursery student has a cough and colds started
two weeks ago.

3. Scabies
Supporting Cues: Juan Jr. and Janine brought to the health center for scabies, 2
weeks ago.

4. Lack of Immunization
Supporting Cues: Janine doesn’t receive any immunization.

5. Inadequate Living Space

Supporting Cues: A family with three children sleeping in a single room.

The results of the in-depth second level of assessment on the identified

health condition or problems are presented in the following tables.

Cues/Data Family Nursing Problems

• Mr. Juan Dela Cruz, 26 years old, A. Hypertension

father of three with a BP of 150/80 1. . Inability to manage the condition due to
and he feels dizzy and had difficulty the lack of knowledge regarding its
of breathing (dyspnea) management.

• Mr. Juan Dela Cruz verbalized “I
feel alright with the previous
months and when I fell difficulty of
breathing and dizzy I passed by at
the hospital for check-up and it was
diagnosed that I have Congestive
Heart Failure (CHF)
2. Inability to provide home care or in-
tervention that will help in maintain-
ning the health maintenance and per-
sonal development due to:
a. Inadequate family resources like
financial resources

• I am a driver and I am too busy b. Lack of information/knowledge

with my work that’s why I don’t regarding preventive
have enough time to go to the clinic measures/interventions
for regular check-up
c. Lack of knowledge in the nature of the
• The clinic or health center is 3km health condition
away from their house.
3. Failure to utilize community resources
• Family income is ranged from for health care due to:
P200.00-300.00 a day
a. Lack of appropriate information
 Cues/Data
• Joana, 4 years old, weighs 25 kgs., B. Cough and Colds as a Health Deficit
she has cough and colds
• Mother verbalized “Joana is having
cough and colds a week ago”
• Joana is a nursery student, her appropriate interventions/management to
eldest brother Juan Jr., is also
studying and her youngest sister
Janine is not yet studying and she is
left in their house with her mother.
• Mother is very busy working in
their house and she cannot properly
take care and give proper attention
to her children.
• Family income is ranged from
P200.00-300.00 a day
• Juan Jr. and Janine have scabies
• Mother verbalized “I have such a
lot of things to attend when Im
working in our house, and I
couldn’t even see or attend to the
health needs of my children due to
lack or insufficient financial needs.
My husband was able to buy a
medicine for them, but due to
insufficient financial resources he
cannot buy another one when it is
already consumed. This scabies
must be due to the children they are
playing with”.
• Family income is ranged from
P200.00-300.00 a day
• Water supply is from a public deep
well or “nakiki-igib” .
• Family sleep in only one room.
Family Nursing Problems
b. Busy on work
c. Physical inaccessibility of health services
due to far from the health centers
1. Inability to recognize the existence of the
problem due to lack of knowledge
regarding the illness.
2. Inability to make decisions in taking
health problem due to:
a. Failure to utilize different available
resources in the community like
herbal medicines.
b. Lack of knowledge regarding health
condition
c. Lack of knowledge as to alternative
courses of action open to them.
3. Inability to provide appropriate
conducive environment for the
development of the health problem.
C. Urinary Tract Infection
1. Inability to provide home remedies or
interventions to the scabies of Juan Jr. and
Janine due to:
a. Lack of knowledge regarding the
condition
b. Inadequate family resources
c. Lack of information regarding
preventive measures.
2. Failure to utilize community
resources for health care due to:
a. Financial resources
b. Physical resources like water supply
facilities
 Cues/Data Family Nursing Problems

• Janine the youngest child did not D. Lack of Immunization as a health threat
yet received any immunization. 1. Inability to recognize the existence of the
problem due to ignorance of facts.
• Mother verbalized “I didn’t bring
my child to the health center for 2. Inability to make decisions with respect
immunization because it is too far to taking appropriate actions due to:
from our house. My husband is
always busy that he cannot a. Lack of knowledge regarding
accompany me to go to the health proper immunization
center”.
b. Responsible family member

3. Failure to utilize community

resources for health care due to:

a. Inadequate family resources

b. Inadequate physical resources

Cues/Data Family Nursing Problems

• 5 members of the family stay in one F. Inadequate living space as a health threat
room.

• Mother verbalized “we are all

sleeping together in one room”
SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES

CRITERIA WEIGHT

1. Nature of the condition or problem 1

presented

Scale **: wellness state 3

health deficit 3
health threat 2
foreseeable crisis 1

2. Modifiability of the condition or 2

problem

Scale **: easily modifiable 2

partially modifiable 1
not modifiable 0

3. Preventive potential 1

Scale **: high 3

moderate 2
low 1

4. Salience 1

Scale **: a condition or problem needing 2

immediate attention

a condition or problem not 1

needing immediate attention

not perceived as a problem or 0

condition needing change
Scoring:
1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply by the weight:
(Score / Highest Score) x weight
3. Sum up the scores for all the criteria. The highest score is 5, equivalent to
the total weight.
Problem: Congestive Heart Failure (CHF)

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 3/3 x 1 1 The problem is

problem health deficit and it
requires more
immediate
interventions and
medications for
maintenance of the
health problem.

2. Modifiability of 2/2 x 2 2 The resources and

the problem interventions for the
maintenance of the
health of the father
and healthy lifestyle
is available to the
family like help
them or encourage
them to do some
exercise, eat
nutritious food and a
healthy lifestyle.

3. Preventive 3/3 x 1 1 The possibility of

Potential any complication of
congestive heart
failure in the father
will be decreased or
may be eliminated if
he does exercise, has
a healthy lifestyle
and a maintenance
of medication. The
chance of acquiring
the children of the
disease or illness of
the father will be
reduced by eating
nutritious food and
healthy lifestyle.

The family
4. Salience of the 2/2 x 1 1 recognize the
problem existence of the
problem. This
condition needs a
close attention or
immediate proper
care.

TOTAL SCORE 5
Problem: Cough and Colds

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 3/3 x 1 1 The nature of the

problem problem is health
deficit. It is a failure
to maintain a healthy
body. There is the
presence of the
disease or illness
due to unable to take
care of our health.

It is easily
2. Modifiability of 2/2 x 2 2 modifiable, wherein
the problem the family can
utilize and know
how to use
available resources
and interventions to
their community,
like utilizing or
using herbal
medicines like for
example drinking
lagundi juice or
fruits like kalamansi
juice.

The preventive
3. Preventive 2/3 x 1 2/3 potential is
Potential moderate, wherein
the family doesn’t
have enough
resources for the
health problem and
the lack knowledge
about the different
resources.

The family
4. Salience of the 2/2 x 1 1 recognize it as a
problem problem and it also
needs immediate
attention to decrease
the chance of
spreading the virus
or infection to other
family member.
TOTAL SCORE 4 2/3
Problem: Scabies

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 3/3 x 1 1 It is a health deficit

problem that requires
immediate care and
proper treatment and
to reduce the chance
of spreading the
disease to other
family member.

The problem is
2. Modifiability of 1/2 x 1 1 partially modifiable
the problem because the family
does not have
adequate resources
for the health
problem and they
have inadequate
living space. Their
water supply is from
public deep well or
“nakiki-igib”.
Which sometimes its
hard for them to get
water .

3. Preventive 3/3 x 1 1 The preventive

Potential potential is high if
they treat
immediately and
manage the health
problem
appropriately the
chance of
transferring and
spreading the
disease to the other
family member will
be reduced.

4. Salience of the 2/2 x 1 1 The family does

problem recognize the
existence of the
problem and it needs
immediate
treatment/attention.
To prevent the
chance of spreading
the disease to other
family members
TOTAL SCORE 4
Problem: Lack of Immunization

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 2/3 x 1 2/3 It is a health threat

problem because the child
has a high
susceptibility to
infection due to lack
of immunization
which will lead to
some diseases that
may affect their
health.

2. Modifiability of 2/2 x 2 1
the problem It is easily
modifiable because
immunizations are
available at the
Barangay Health
Centers, which they
can get it for free.
3. Preventive 3/3 x 1 1
Potential The preventive
potential for
immunization is
high wherein they
can immunize their
children at Barangay
Health Centers for
free.
4. Salience of the 2/2 x 1 1
problem The family does not
recognize it as a
serious problem or
they does not
recognize the
existence of the
problem due to lack
of knowledge. But
this needs
immediate attention
to prevent the child
acquiring diseases.

TOTAL SCORE 3 2/3

Problem: Inadequate Living Space

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 2/3 x 1 2/3 The nature of the

problem problem is health
threat because
inadequate living
space may lead to
conditions that are
conducive to
accidents or illness.

2. Modifiability of 1/2 x 2 1 The problem is

the problem partially modifiable
because they need
financial
expenditure for
increasing the
adequacy of living
space considering
that they do not
have sufficient
income to increase
the living space.
However they can
allow more space if
they will arrange
their furniture or
removed things that
they do not use.

3. Preventive 3/3 x 1 1 If the living space is

Potential adequate for the
family there will be,
privacy for each
family member,
adequate living
space will allow
them to do their
work appropriately
and reduce the
chance of
transferring
diseases.

4. Salience of the 0/2 x 1 0 The family does not

problem recognize it as a
serious problem.

TOTAL SCORE 2 2/3

The prioritized health problems

The list of health condition or problem ranked according to priorities is presented

Congestive Heart Failure (CHF) ----------------------------------- 5

Cough and Colds------------------------------------------------------ 4 2/3

Scabies ----------------------------------------------------------------- 4

Lack of immunization ------------------------------------------------ 3 2/3

Inadequate Living Space --------------------------------------------- 2 2/3

The priority health condition or problems are going to be addressed in the Family
Nursing Care Plan (FNCP) which will be developed and illustrated.

1. Congestive Heart Failure (CHF)

V. PATHOPHYSIOLOGY

VII. Recommendations for further family care

 The family needs further care and follow up check-up for the maintenance
of the health of the family. Especially the health problem of the father which is
Congestive Heart Failure which needs close attention and proper care and treatment and
also a regular check-up. Also their children needs further care due to their illness which is
scabies and cough and colds. They need closed attention so that it will not lead to any
further complications.

VIII. References

Nursing Practice in the Community, 4th Edition by Araceli S. Maglaya

Community Health Management Manual For Nursing Students by Lydia C. Viet

RN, MAN

www.google.com
LAGMAY, Jaclyn G. July 20, 2009
BSN IV-I

Journal Reaction

SUMMARY:
A 14-year old Marian Jose (not her real name) was brought to hospital with a
complained of headache, stabbing pain in her left leg and unusually thirty. And the doctor
find out that she has a high fever, he placed her for under careful observation. The
following morning, Marian’s manifested shuddering gasps, saliva filled her mouth and
when she tried to swallow, violent spasms tore at her throat muscles. And when the
doctor ask question it was find out that Marian was bitten by a dog two months ago. The
doctor cleaned the wound and gives an anti-tetanus shot. Until they find out that the dog
died few days after Marian had bitten by that dog. They done an autopsy and the result
confirmed the doctor’s worst fear: no hope for Marian now, for rabies once it was
permitted to take hold cannot be checked.
Six out of every million Filipinos get afflicted with rabies, a fatal and incurable
virus. According to the Rabies Control of the Department of Health, rabies are caused by
stray dogs and cats. In 1984, World Health Organization that Philippines had the 4th
highest human death rate for rabies. The rabies is an old problem of mankind. The term
“rabies” came from the Sanskrit word “rabhas” which means “to do violence”. Back to
20th century there was an ordinance form in the Eshnunna Code of Mesopotamia, until it
is translated as Rabies in dog was described by Democritus (500 B.C) and Aristotle (322
B.C) they said that once a person is bitten by a dog became mad. Galen (A.D 200)
recommended excising wounds to prevent development of the disease. Rabies was
proven infectious by Zinke in 1804, he done a test wherein he transmitted rabies from a
normal dog by inoculating it with saliva from the infected animal. Medical experts said
that rabies is caused by an ultra-microscopic organism that attacks through any break in
the skin, multiplies in salivary glands of infected animals and it is usually spread in
biting. The virus pauses for a while to gather force, then creeps into nearby nerves to
make a fatal, shattering rendezvous with the brain. It can strike for six days, and it can
also takes a month or more. The first sign of the disease in man is a hot pain in the area of
exposure, headache, nausea, accompanied by irrational irritability and strange
forebodings of doom. Although thirst may be agonizing, they will experience
hydrophobia (“fear of water”), eventually sounds, lights and even gentle puffs of air can
cause convulsions. After a week of torture, the body becomes paralyzed and death
follows, usually caused by stoppage of breathing and blood circulation. They said that
rabies is the beast that unexpectedly bites a person should be confined and watched
closely by a veterinarian for ten days to see if it has a disease. The best prevention
according to medical expert is avoid strange animals and those known to be rabid. The
main carriers of the rabies are the vampire bats, the primary affected by the rabies are
dogs and cats. According to Dr. Fatima N. Macavinta, there are three principal methods
available in our country for laboratory diagnosis of rabies. The first is fluorescent
antibody test, sensitive test, it is almost 100% accuracy and highly specific but requires
sophisticated equipment and expensive reagents. Second, mouse inoculation, highly
sensitive but requires several days for positive diagnosis and the last, direct microscopic
examination, a rapid and cheap test but less sensitive. For many years, treatment of rabies
was a fearful disease itself. In 1885, a nine-year-old boy bitten by a rabid dog was
inoculated with a vaccine made by Pasteur from a powdered spinal cord tissue of rabies
infected rabbits, it was a success for the boy and did not develop rabies.
The DOH issued first aid measures should be done when a person bitten by a dog
or animal assumed to be rabid:
• Scrub the wound or bitten area with soap under running water for at least
five minutes.
• Remove foreign material from the site
• Rinse with plain water
• Irrigate with a viricidal agent such as alcohol or povidone iodine and
consult a physician immediately for appropriate preventive measures.

Bad news for dog eater, medical expert said that cooking does not kill a virus,
rabies is a nerve lover and is concentrated in the brain so don’t eat the dogs brain.

REACTION:
This journal talks about rabies, which is one of the common problem in the
community due to many stray animals like dogs and cats which are not immunize for
anti-rabies. When you hear the word rabies, the first thing that comes into your mind is
that, it is fatal and incurable virus. Yes it’s true, but we can prevent thru getting away
from stray animals and having enough knowledge and information about rabies and
proper immunization for our pets like dogs and cats. The one way also is to control stray
dogs and quarantine other domestic dogs would eliminate the disease. There is a certain
topic in the journal that I have read that talks about an individual namely Marian Jose
(not her real name) who had bitten by a dog, the lesson there is they should not wait that
the child would manifest some signs and symptoms of having a rabies, they should bring
her immediately to the hospital for proper immunization and treatment. Once a person is
bitten by a dog they should also observe for the dog for ten days, if the dog died with ten
days this means that the dog has rabies. It is also discuss in this journal the different
studies they conducted about rabies. It’s nice to know that there are many people who
worked about rabies that helps us today how to manage rabies. Medical expert said that
rabies is caused by ultramicroscopic organism that attacks through any break skin,
multiplies the salivary glands of infected animals and it is usually spread in biting. They
also said that cooking does not kill the virus, because rabies is a nerve lover and is
concentrated in the brain so don’t eat the dogs brain. There are some basic first aid
measures to do if bitten by a dog like wash the wound with soap in running water,
remove foreign materials and rinse with plain water.
This journal I have read gives me more knowledge and idea about rabies and
proper measures to do when you are bitten by a dog. I will also be able to deal without
any confusion to the procedures and treatment to be done. I can also avoid errors in case
of future management of similar case. This study will be a supplemental for me as a
student nurse for any related research and will be utilized as my basic reference or source.
And it will be a helpful guide for me in dealing with my future patients.