Our Lady of Fatima University

College of Nursing

Family Nursing Care Plan

A Written Report Presented to the Faculty of

Our Lady of Fatima University
College of Nursing

In Partial Fulfillment of the Requirement

In Community Care Management
NCM 101

Presented by:
Group 62
BSN 3A2-D
Avelino, Erlinda
Dela Cruz, Dionisio
Delfin, Jody Ann D.
Diampoc, Aiza L.
Espino, Cecile S.
Fernando, Ronell G.
Gregorio, Erika
Gubalane, Jhonel A.
Hernandez, Ferdinand G.
Jimenez, Lenie G.
Legaspi, Lea Mariz S.

S.Y. 2009 – 2010

Presented to
Ms. Mary Ann Emeterio
 ACKNOWLEDGEMENT

First and foremost, we would like to thank God, above all for showing us the wisdom,
confidence and courage that we were able to finish this project and use it with a purpose that
could not profit only us but as well as our fellowmen, to whom our service is for.

Secondly, to our parents for it not for their unending support both financially and
morally, it certainly would not be possible for us to go this far.

To the Lopez family, for without your support and full cooperation, we won’t be able to
make this project possible.

To our friends, thanks for all the help you’ve shared for this project.

Lastly, to our professor, Ms. Mary Ann Emeterio, for giving us this kind of responsibility
that test our patience, determination and versatility. For giving us enough knowledge for us to
finish this project and for teaching us to have a lot of patience. Through this project, we were
able to rediscover a better person in ourselves. It molds us to be responsible students in present
and to be more responsible and good nurses in the near future.

Thank you.
 TABLE OF CONTENTS

I. Acknowledgement
II. Introduction
III. Objectives, Scope and Calendar of activities
IV. Initial Database for Nursing Care Practice
V. First level Assessment
VI. Second Level Assessment
VII. Prioritation of Problems
VIII. Family Nursing Care Plans
IX. Bibliography
X. Appendices
• Pictures
• Charts & Tables
 INTRODUCTION

“The Family is one of nature’s masterpieces” – George Santayana

We are all born the product of a union between a man and a woman, and we are all very
much shaped by those who raised us, our parents and/or caregivers. We are the product of human
relationships, and most of us spend our days within the context of relationships with other
people. We need other people to be close to us in our lives, or we tend to get sick. Who we are is
very much a function of where we have come from, and who we surround ourselves with.
Despite their vital importance in our lives, relationships can be very difficult to manage. We
expect our intimate partners to provide for many of our needs, but often find that differing
expectations, frustration, and a need to be right create conditions for conflict and erosion of
intimacy. Angels though they may be, our children test us for weaknesses and we don't always
pass. Our adult parents grow older and require care, placing a burden on our other
responsibilities. A diverse set of communication and relationship skills is required if one is to
successfully meet the challenges of family life.
An accurate physical assessment requires an organized and systematic approach using the
techniques of inspection, palpation, percussion, and auscultation. It also requires a trusting
relationship and rapport between the nurse and the patient to decrease the stress the patient may
have from being physically exposed and vulnerable. The patient will be much more relaxed and
cooperative if you explain what will be done and the reason for doing it. While the findings of a
nursing assessment do sometimes contribute to the identification of a medical diagnosis, the
unique focus of a nursing assessment is on the patient's responses to actual or potential problems.

Home visiting is a major strategy for delivering health, social support, and educational
services directly to individuals in their homes.

A nursing care plan outlines the nursing care to be provided to a patient. It is a set of
actions the nurse will implement to resolve nursing problems identified by assessment. The
creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing
provision of nursing care and assists in the evaluation of that care.
 OBJECTIVES, SCOPE AND CALENDAR OF ACTIVITIES

Objectives

• To establish a good working relationship.

• Efficiently conduct family health assessment.
• Accurately identify family health problems.
• Prepare family health care plans for the top five priority problem.
• Work out details of the family health care plan with the family.
• Assist client families in implementing family nursing care plan.
• Evaluate health care conducted on the client family.
• Develop family's ability and confidence in providing health care to its members.

Scope

This study is confined to the family of Mr. And Mrs. Rolando Lopez of #3911 Franville
4, Yakal St., Caloocan City. It is included in this study the observation and interview of the
family members.

Calendar of Activities

• February 18, 2010 - 1st Home Visit and ocular inspection of the area.
• February 19, 2010 – Initial Interview and physical assessment of the family members.
• February 27, 2010 – Meeting for the First and second level assessment.
• March 6, 2010 – 2nd Home visit for health teachings and Nursing interventions.
• March 13, 20010 - Documentation of gathered data.
 INITIAL DATE BASE FOR NURSING CARE PRACTICE

A. Family Structure, Characteristics and Dynamics

• Members of the household and relationship to the head of the family

1. Rolando Lopez - Head of the family

2. Gleponia Lopez - Wife
3. Valentina Lopez - Daughter
4. Francis Jeffrey Lopez - Son
5. Frank Jude Lopez - Son
6. Pedro Cantos - Brother-in-law

1. Demographic Data
Family Member Age Sex Civil Position in the Family
Status
1.Rolando Lopez 60 M married Head of the family
2. Gleponia Lopez 32 F married Wife
3. Pedro Cantos 28 M single Brother in law
4. Valentina Lopez 12 F single Daughter
5. Francis Jeffrey Lopez 7 M single Son
6.Frank Jude Lopez 3½ M single Son

2. Place of residence of each member

• All members of the family are residing at #3911 Franville 4, Yakal St. Caloocan
City.

3. Type of Family Structure

• Patriarchal
• Nuclear

4. Dominant family members in terms of decision making (in terms of Health Care)
• Rolando and Gleponia Lopez

5. General family relationship/dynamics

• NO presence of any obvious and observable conflict between family members.
• Children can be heard using “po” and “opo” during conversations with their
elders.

B. Socio-economic and Cultural Characteristics

1. Income and Expenses
a. Occupation, place of work and income of each working member:
• Rolando Lopez – freelance all around technician (plumbing, carpentry,
construction)- ₱4000.00/month
• Gleponia Lopez – laundry woman- ₱2000.00/month
• Pedro Cantos – security guard- ₱ 6000.00/month

b. Adequacy to meet basic necessities

• The family spends at least ₱100/day for their needs. Income of the family is
adequate to meet the necessities of every member. The following are the
priority expenditure of the family ranked from the most prioritized to the least:
- Food
- Education
- Water
- Clothing
- Electricity
- Health care

c. Who makes decisions about money and how it is spent?

• Rolando and Gleponia Lopez are the ones making the decisions about the
finances of the whole family.

2. Educational Attainment of each member

• Rolando Lopez – 2nd year high school

• Gleponia Lopez – High school graduate
• Valentina Lopez – currently in gr. 4
• Francis Jeffrey Lopez – currently in gr.1
• Frank Jude Lopez
• Pedro Cantos – High school graduate

3. Ethnic Background and religious affiliation

• The family speaks Waray and Tagalog. They are also members of the Born
Again Christians.

4. Significant others
• The lot where the family currently resides is owned by another private citizen.

5. Relationship of the family to the larger community

 • The family actively participates in church activities. They also participate in
community activities like the women’s organization and their children also
participate in youth activities.

C. Home and Environment

1. Housing

a. Adequacy of living space

• Not crowded

b. Sleeping arrangement
• Mr. and Mrs. Lopez sleep with their children in one room. Mr. Cantos stay in
another room beside the family’s room.

c. Presence of breeding or resting sites of vectors of disease

• Open and unsanitary drainage system.
• Improper and open garbage disposal pit.

d. Presence of accident hazards

• Sharp objects
• Steep stairs
• Poor lighted place.

e. Food storage and cooking facilities

• The family sees to it that the food and water containers are always covered.
They also use wood and charcoal to cook food.

f. Water supply
• Water supply of the family comes from the water works system.

g. Toilet facility
• The toilet facility is owned but sanitation is quite poor.

h. Garbage disposal
• Garbage is usually collected on Mondays and Thursdays but they also burn
their garbage from time to time and sometimes just throw it in the garbage pit
near their house.

i. Drainage system
The house has its own septic tank and toilet. The drainage system is open and
sanitation is poor.
 2. Kind of Neighborhood

• slum

Social and Health Facilities available

• the family mentioned that they avail the following services from the
community: Immunizations, check up for both children and adults.

• The health center, government hospital (East Avenue Medical Center) is the
primary source of health care of the family. They sometimes visit Bernardino
General Hospital, which is a private hospital for consultations.

Communication and Transportation Facilities available

• The family's means of communication includes a cellphone and newspaper.

• Their means of transportation is by the public utility vehicles.

D. Health Status of each family member

1. Medical and nursing history indicating current or past significant illnesses.

▪ Rolando Lopez y Pilande

- Family History

*Father side: rheumatism

*Mother side: none

-Past History

*Childhood illnesses: fever, cough and colds, chicken pox,

mumps

*Injuries: none

*Hospitalization: none

-Present Health Status

*colds for 2 weeks

• Glepionia Lopez y Quitorio

- Family History
 *Father side: Diabetes Mellitus

*Mother side: Breast cancer, hypertension

*Childhood sickness: fever, cough&colds

• Valentina Lopez y Quitorio

- Family History

* Father side: rheumatism

* Mother side: Diabetes Mellitus, breast cancer, hypertension

* Childhood sickness: cough&colds, chicken pox, measles

• Francis Jeffrey Lopez y Quitorio

- Family History

* Father side: rheumatism

* Mother side: Diabetes Mellitus, breast cancer, hypertension

• Frank Jude Lopez y Quitorio

- Family History

*Father side: Rheumatism

*Mother side: Diabetes Mellitus, breast cancer, hypertension

- Childhood sickness: fever, cough&colds,

• Pedro Cantos

- Family History:

* Father side: Rheumatism

* Mother side: Diabetes Mellitus, breast cancer, hypertension

2. Beliefs and practices conducive to one's illness

- Gleponia Lopez agrees to the following statements:

• Food rich protein such as meat, fish & eggs are needed.
 • Headache, nausea, and vomiting are common signs of pregnancy.

• Umbilical cord of the newborn baby that remained fresh may only be cleaned by wiping.

• Breastfed infants are healthier than bottle fed infants.

• Illness such as measles, polio, diptheria and tetanus can be avoided through
immunization.

• Thick clothing should be removed when babies have fever.

• Oresol are given to babies who have diarrhea.

• Family planning is good for maternal health.

• Herbal meds are safe and causes no side-effects when taken in excessive amounts.

• Blood streaked sputum from coughing is a symptom of TB.

• Small cuts and contusions may be cleansed using soap and tap water.

• Not taking a bath during menstruation.

• Don't cut fingernails during Tuesday & Wednesday.

• Do not sleep when hair is wet.

• Do not wash hands after ironing.

• Do not eat too much at night before sleeping.

• Do not eat sour foods during menstruation

• Consults faith healers.

• Do not allow family members to take a bath when they are sick.

• Feed “am” as an alternative to milk.

• Believes in “paglilihi”

- Mrs. Lopez disagrees to the following statement:

• Common illness such as measles can be prevented.

• Putting first menstruation on the face to prevent pimples.

 3. Nutritional assessment

- Eating/feeding habits/practices

• The family's food preferences are: meat, poultry, fish, fruits, vegetables and instant food.

• The family usually eats three times a day but there are instances that they eat two times a
day only.

Physical Assessment indicating Presence of Illness State

(Undiagnosed by a Medical Practitioner)

• Rolando Lopez - colds for 2 weeks

• Gleponia Lopez - cough for 2 days

• Valentina Lopez - cough & colds for 5 days

• Francis Jeffrey Lopez - fever and colds for 4 days

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

Disease Prevention

1. Immunization Status of the Family Members

▪ All members of the family have a complete immunization

2. Health Lifestyle Practices

• Trimming of fingernails

• Hand washing

• Bathing

• Use of slippers

• Medical check-up

• Dental check-up

• De-worming of children (2x a year)

3. Adequacy of:

a. Rest & sleep

-The family sleeps at night and usually have an average of 7-8hrs of sleep.

b. Exercise / Activities

- Mr. Lopez has a regular exercise of walking every morning.

c. Use of Protective Measures

- The family uses mosquito nets when sleeping at night.

d. Relaxation and Stress management activities

- The family usually participates in church/worship activities. Their children also

play with other children in the neighborhood.
 FIRST LEVEL ASSESSMENT

1. Fire hazard as a health threat + use of candles at night due to lack of electricity inside the
house.

2. Threat of cross infection from a communicable disease case +

3. Unsanitary food handling and preparation

4. Unhealthful lifestyle and personal habits/practices – self medication

5. Unhealthful lifestyle and personal habits/practices – walking barefooted or inadequate

footwear.

6. Poor home environment condition/sanitation – improper garbage disposal

7. Poor home environment condition/sanitation – unsanitary waste disposal

8. Poor home environment condition/sanitation – lack of food storage facilities

9. Presence of foreseeable crisis situations – hospitalization of a family member

10. Presence of foreseeable crisis situations – loss of job

11. Presence of health deficit - asthma

 SECOND LEVEL ASSESSMENT

1. Fire hazard as a health threat + inability to recognize the presence of the condition or
problem due to the lack of or inadequate knowledge.

2. Threat of cross infection from a communicable disease case + Inability to provide

adequate nursing care to the sick, disabled, dependent, or vulnerable/at-risk member
of the family due to lack of or inadequate knowledge and skill in carrying out the
necessary interventions/treatment/procedure/care

3. Unsanitary food handling and preparation + Inability to provide a home environment

conducive to health maintenance and personal development due lack of/inadequate
knowledge of importance of hygiene and sanitation

4. Unhealthful lifestyle and personal habits/practices – self medication+ inability to

make decisions with respect to taking appropriate health action due to misconceptions
or erroneous information about proposed course(s) of action

5. Unhealthful lifestyle and personal habits/practices – walking barefoot or inadequate

footwear.+ Inability to provide a home environment conducive to health maintenance
and personal development due to inadequate family resources, specifically financial
constraints/limited financial resources.

6. Poor home environment condition/sanitation – improper garbage disposal + Inability

to provide a home environment conducive to health maintenance and personal
development due to lack of skill in carrying out measures to improve home
environment

7. Poor home environment condition/sanitation – unsanitary waste disposal + Inability

to provide a home environment conducive to health maintenance and personal
development due to lack of/inadequate knowledge of importance of hygiene and
sanitation.

8. Poor home environment condition/sanitation – lack of food storage facilities+

Inability to provide a home environment conducive to health maintenance and
personal development due to inadequate family resources, specifically financial
constraints/limited financial resources
9. Presence of crisis situations – hospitalization of a family member +inability to make
decisions with respect to taking appropriate health action due to inaccessibility of
appropriate resources for care, specifically cost constraints or economic/financial
inaccessibility.

10. Presence of health deficit – asthma + Inability to provide adequate nursing care to the
sick, disabled, dependent, or vulnerable/at-risk member of the family due to Lack
of/inadequate knowledge about the disease/health condition (nature, severity,
complications, prognosis and management)
 PRIORITATION OF HEALTH PROBLEMS

1. Cough and colds

Criteria Computation Actual Score Justification

Nature of the problem 3/3x1 1

Modifiability of the 1/2x2 1

problem

Preventive potential
2/3x1 .67 Possibility of
transferring infection
to other members of
the family is moderate
and should be given
immediate attention.
Salience of the problem
1/2x1 .50 The family recognize
it as a problem,
3.17
however it does not
see the problem as
needing immediate
action.

2. Poor environmental sanitation: Improper garbage disposal

Nature of the problem 2/3x1 .67 It is a health threat.

Modifiability of the
problem
2/2x2 2 Resources are
available and
intervention are
feasible.
Preventive potential Communicable
3/3x1 1
 disease transferred by
insects and rodents
can be prevented.
Salience of the problem 2/2x1 1

The family perceives

it as a serious problem
needing attention.
4.67

3. Presence of accident hazards

Nature of the problem 2/3x1 .67 It is a health threat

Modifiability of the 2/2x2 2 The resources and

problem intervention are
available to the
family.
Preventive Potential Accidents can be
3/3x1 1
prevented if sharp and
pointed objects are
properly kept and
cannot be reached by
children.
Salience of the problem
2/2x1 1 The family recognizes
the problem as a
condition needing
immediate attention.

4.67
 4. Malnutrition

Nature of the problem 3/3x1 1 It is a health deficit

that requires
immediate
management to
eliminate untoward
consequences.

Modifiability of the 2/2x2 2 The problem is easily

problem modifiable since the
nurse’s resources are
available; she can
develop the skill of
other members to
achieve good nutrition
and proper food
selection and
preparation.

Preventive potential Susceptibility of other

3/3x1 1 diseases and infections
can be prevented if
malnutrition is
eliminated.

It is not felt as a
Salience of the problem problem.
0/2x1 0

4
 5. Asthma

Nature of the problem 3/3x1 1 It is a health deficit

that requires
immediate attention.

Modifiability of the 1/2x2 1 The family does not

problem have adequate
resources to solve the
problem.
Preventive potential
3/3x1 1 Occurrence of asthma
can be minimized

Salience of the problem

1/2x1 .50
The family recognizes
it as a problem but it
does not see the
problem as needing
immediate action.
3.50

6. Fire hazard as a health threat

Nature of the problem 2/3x1 .67 It is a health threat that

does not demand
immediate action.
Modifiability of the 1/2x2 1 The family does not
problem have adequate
resources to solve the
 problem.

Preventive potential 3/3x1 1 Fires can be prevented

through the practice of
safety precaution.

Salience of the problem No data available

2.67

7. Cross infection as a health threat

Nature of the problem 2/3x1 .67 It is a health threat that

does not demand
immediate action.
Modifiability of the 1/2x2 1 The family does not
problem have adequate
resources to solve the
problem.
Preventive potential
2/3x1 .67 Possibility of
transferring infection
to other members,
therefore it needs to be
given immediate
attention.
Salience of the problem
1/2x1 .50 The family recognizes
it as a problem,
however it does not
see the problem as
needing immediate
action.