Fca Group 8

ANG ELES UNIVERSITY FOUNDATION
Angeles City
College of Nursing
In partial fulfillment
of the requirements in
Related Learning Experience
A FAMILY CASE ANALYSIS
IN BARANGAY LOURDES NORTH WEST, ANGELES CITY, PAMPANGA
Submitted by:
Cruz, Hazel Irish B.
Dizon, Kenneth T.
Ingal, Krizane L.
Manalang, Ma. Clarelle S.
GROUP 8, B.S.N. III – B
Submitted to:
Ria Rose C. Celis, RN, MN
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I. INTRODUCTION
“To us, family means putting your arms around each other
and being there.”
-Barbara Bush
Family is an important unit of society. It holds great importance in social life. It

is the strongest unit of society. A society is made up of families. According to
sociology, a family is the foundation of society. It's where a member comes into
the world and is nurtured and given the tools to go out into the world, capable of
living.
A family is the first school in which a child receives the basic values of life.
He learns good manners in the family. The morals and values learn in our family
become a guide to make our character be good. They lay the foundation of our
thinking. While a family has the greatest potential for raising healthy individuals,
they can also wound their members in places that will never heal. When a family
breaks down and fail to provide the healthy nurturing the person needs, the
effects impact not only to their own lives but also in the community. As defined
by World Health Organization (WHO), health is a state of complete physical,
mental, and social well being, and not merely the absence of disease or infirmity.
This is in line with the task of a community health nurse which is to assist the
people in their health conditions which is to be healthy.
Community health nursing practice promotes and preserves the health of

populations by integrating the skills and knowledge relevant to both nursing and
public health. The practice is comprehensive and general, and is not limited
to a particular age or diagnostic group; it is continual, and is not limited to
episodic care. It is a specialized field of nursing practice. Its basic knowledge
and skills are anchored on nursing theories and important concepts from the
science of public health such as to emphasis on the importance of the
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"greatest good for the greatest number" , to assess health needs,
planning, implementing and evaluating the impact of health services on
population groups, to prioritized health-promotive and disease-preventive
strategies over curative interventions, the use of tools for measuring and
analyzing community health problems, application of principles of
management and organization in the delivery of health services to the
community.
A clinician is a health care provider, taking care of the sick people at home
or in the RHU. A health educator aims towards health promotion and illness
prevention through dissemination of correct information; education people. A
facilitator establishes multi-sectoral linkages by referral system. Lastly, a
supervisor monitors and supervises the performance of the health workers. This
group focuses on the promotion of a healthy lifestyle of one’s family. We, the
student nurses, are assigned in Barangay Lourdes North West to provide
knowledge, attitude and skills towards health to the society specifically the family.
The family case analysis is mainly directed on identifying and analyzing

the families’ past and present health status. The nursing process which includes
the assessment, diagnosis, planning implementation and evaluation are
important factors for the student nurses to accomplish the FCA’s goal which are
geared towards the family’s optimum level of functioning in order for them to be
productive and self-reliant members of the society in which they belong.
Cooperation of the family, maximizing use of resources and collaboration with the
health care team are essential parts in improving the health status of the family
as well as to alleviate the identified problems.
(familyimpactseminars.org/doc.asp?d=tfp_assign_familyimpactcsfia_kb.pdf)
The student nurses set the criteria for choosing their adopted family for the
family case analysis. The family to be adopted must be depressed/ deprived, with
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for or more children w/ at least one member belonging to 0-5 age bracket, with
visible poor environmental conditions and most of all, one which gives the
student nurses their consent for the FCA. The said criteria had been met
although the barangay health worker and not the student nurses were the one
who chose the family to be adopted.
The student nurses’ adopted the “Shapes” family and is composed of 7
members, a mother, a father and five daughters. The father lives in bataan
together with Sister Rectangle in Bataan. The mother is living together with her 4
children. The mother and children are living in a narrow, concrete house in
Barangay Lourdes North West, Angeles City, Pampanga, Philippines.
A. Objectives
The following objectives were formulated in order to guide

the student nurses in the accomplishment of the Family Case
Analysis:
SHORT TERM
Student-centered
After the first exposure to the community, the students will be able to:
 Set criteria for the family to be chosen;
 Familiarize themselves with the physical setup of the community;
 Collect data regarding the family’s demographic profile through

interview and other data that may be significant in identifying
problems;
 Identify the family’s problems and needs based on the analysis of

the data obtained;
 Establish a good working relationship with their adopted family;
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LONG TERM
At the end of the home visits, the student nurses will be able to:
 Accomplish thorough physical assessment of the whole family;
 Work with the family in solving identified health problems;
 Provide necessary health teachings and suggestions based on

each family member’s needs;
 Evaluate family’s response to health teachings given;
SHORT TERM
Client-centered
After the first home visit, the family members will be able to:
 Accept the student nurses in an accommodating manner;
 Familiarize and trust themselves with the student nurses;
 Provide the student nurses necessary information they need;
 Recognize the actual and potential problems in their family with the
help of the student nurses;
 Cooperate with the student nurses throughout the initial home visit;
LONG TERM
At the end of the home visits, the family members will be able to:
 Participate in the individual physical assessment;
 Work with the student nurses in solving identified health and health
related problems;
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 Cooperate to the health teachings provided by the student nurses;
 Become self-reliant in managing identified health problems;
 Utilize available resources in the community;
RESEARCH-CENTERED
At the end of the home visits, the students shall be able to identify:
 The family’s demographic profile described as to:
a. Age
b. Sex
c. Position in the family
d. Educational status
 The family described as to:

a. Structure
b. Composition
c. Socio-economic status
d. Cultural and religious beliefs
e. Relationship to the larger community
 The family’s home and environment as to:

a. Housing
b. Sanitation facilities
c. Kind of neighborhood
d. Availability of social health
e. Communication facilities
f. Transportation facilities
 The family’s health status as to:

a. Current and past illnesses
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b. Mother’s obstetrical history
c. Practices conducive to health and illnesses
d. Developmental status
e. Body mass index
f. Physical assessment findings
g. Immunization status
h. Growth and development
i. Activities of daily living
 Values, habits and practices of the family on health promotion,

maintenance and disease prevention including:
a. Preventive services
b. Rest and sleep adequacy
c. Exercise
d. Relaxation activities
e. Stress management
 How may the problems encountered by the family be identified, classified

and prioritized
 How may the problems experienced by the family be formulated as family
nursing care plan
 How may the family coping index be evaluated
A. Entry, Climate of acceptance, First few words and Number of Home

Visits
Our first day of exposure in the community of Barangay Lourdes North

West, Angeles City, Pampanga was on November 5, 2013, Tuesday. The Group
8 of BSN III – B was appointed to meet and choose that will suit their set criteria
wherein the chosen criteria should be underserved, deprived and depressed,
with at least seven family members, a family who needs improvement with
their health status and very willing to cooperate and accept
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changes especially in their health practices for the group’s requirement, the
Family Case Analysis. They divided themselves into two subgroups with 4 – 5
members of a group. The two groups together with their clinical instructor looked
for a family.
On the first day of home visit, the clinical instructor accompanied the
student nurses on their way to the families that are depressed/ deprived, with for
or more children w/ at least one member belonging to 0-5 age bracket, with
visible poor environmental conditions and most of all, one which gives the
student nurses their consent for the FCA.
The mother let us stayed outside their house since their house was small
and narrowed. The student nurses conversed with the mother while holding her
youngest child. “Magandang umaga po”, were the first few words that the student
nurses uttered to their chosen family. The mother greeted them back willingly
and without hesitation and said, “Magandang umaga din. Pasensya na
kung hindi ko kayo mapasok sa bahay namin. Maliit lang kasi.” The student
nurses introduced themselves as 3rd year nursing students from Angeles
University foundation and explained their purpose. The group asked the mother if
they could have a series of interaction with them which she gladly agreed.
First Week of Visit
First Home Visit (November 5, 2013, Tuesday)
It was a very sunny day around 12 noon and the student nurses with their
clinical instructor accompanied them on their way to their family. They saw Sister
Square playing with the other children in the street. They say hello and asked if
their mother was their and said yes. She called her and the student nurses
followed her. The mother, while holding her youngest child with a cigarette on her
hand, went outside. The student nurses greeted “Goodmorning”. The mother
greeted them too but she told them to have a talk outside than in their house.
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She apologized to them that she cannot let them stay in their house since it was
only small and narrowed house. They say it was okay for them to talk to her
outside. They established rapport to the mother and the children with the present
family members and were able to interview the mother regarding their socio-
economic status, environmental sanitation and the like. They were able to
acquire some information and even exchanged light-hearted conversations with
her. The vital signs of the present members were also assessed and recorded.
They have identified some of the problems of the family. After 30 – 45 minutes,
the student nurses bid the Shapes Family goodbye and told them that they will
be back next week.
Second Week of Visit
Second Home Visit (November 11, 2013, Monday)
The group arrived on their respective family at around 11: 00 am on a

sunny day. They saw Sister Square again outside the house and she entertained
them. They asked if Mother Circle is there but she said she and Sister Heart went
to her work. They asked them what time will Mother Circle be arriving and he
said before lunch she will arrived. While waiting for Mother Circle, they checked
the children’s vital signs and did the physical assessment. One of the student
nurses measured the area for the house, windows and walls. After they did their
task, they had identified their problems for this family. Mother Circle didn’t came
so after 30 minutes, they said their goodbyes and said they will come back the
next day.
Third Home Visit (November 12, 2013, Tuesday)
The group went to their respective family on a cloudy day around 11: 30
am to catch up with Mother Circle because she arrives before 12 noon. Mother
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Circle was there and one of the student nurses interviewed her about their
activities of daily living and their lifestyle, one of them measured the house and
two of them were assigned in physical assessment. After one hour, they left the
house and said they will come back next week.
Third Week of Visit
Fourth Home Visit (November 18, 2013, Monday)
It was slightly sunny day around 11:20 am and the group went to their
respective family. Gladly, they saw Mother Circle was inside their house. They
asked her what time she will go and she said later at around 1:00 pm after they
have lunch. They have talked about the family’s problems and they have
provided the Mother Circle some knowledge and skills about the family’s
problem. She said that she will try to comply those problems but they suggested
to her that their neighbor who is a grandmother can help her when she is not
around. After one hour, they have left the house and told them they will come
back the next day.
FAMILY CONSTELLATION:
In this part of the Family Case Analysis, the demographic profile of the members of the family
are presented such as their name, age, position in the family, gender, educational attainment
and present health status which describes the general appearance, mental status, physical
assessment, nutritional status, and vital signs.
PRESENT HEALTH STATUS

Father (Trapezoid) NEVER SEEN
Second Youngest (Rectangle)
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Name: Mommy Circle Mommy Circle was alert and oriented
Age: 27 years old during the interview and physical
Position in the family: Mother assessment. When we asked questions
Gender: Female regarding their status and some other
Educational Attainment: 2nd year High questions about her family, she was
School responsive and cooperative. She was
smoking a cigarette while making
conversation with her. The mother shows
poor personal hygiene. She has long
dirty fingernails. Her teeth shown
cavities.
NUTRITIONAL STATUS:
Height: 1.57m
Weight: 50.35 kg
BMI: 20.47-Normal
VITAL SIGNS:
Temperature per Axilla: 36.3 degree
Celsius
Pulse Rate: 63bpm/min
Respiratory Rate: 21 bpm/min
Blood Pressure: 90/60 mmHg
Name: Sister Triangle Sister Triangle was responsive and she
Age: 7 years old showed dominion over her siblings. Being
Position in the family: Eldest child the eldest she directs her siblings on what
Gender: Female her mother says her to do so, Like mother,
Educational Attainment: Not Going To she showed poor personal hygiene. She
School – Preparatory has long dirty long fingernails. Her teeth
shown cavities and Triangle had also
cough and colds. She is walking
barefooted.
NUTRITIONAL STATUS:
Height: 113 cm
Weight: 17.24 kg
BMI: Normal 14th percentile
VITAL SIGNS:
Celsius
Pulse Rate: 69 bpm/min
Respiratory Rate: 23 bpm/min
Name: Sister Heart Sister Heart has evenly distributed brown
Age: 6 years old short hair, fair complexion with good skin
Position in the family: Second eldest turgor. Coughs and colds were present,
child dirty finger nails and toes, cavities were
Gender: Female noted. Cough and colds were also
Educational Attainment: Not Going To present. She is walking barefooted
School – Preparatory Level
NUTRITIONAL STATUS:
Height: 104 cm
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Weight: 11.79 kg
BMI: 14.3 Normal
VITAL SIGNS:
Celsius
Pulse Rate:72 bpm/min
Respiratory Rate: 16bpm/min
Name: Sister Square Sister Square was responsive in terms of
Age: 5 years old answering our questions by merely saying
Position in the family: Third eldest child yes or no and she has fair complexion with
Gender: Female good skin turgor and she has a evenly
Educational Attainment: Never Been To distributed black that was very short hair.
School Noted the presence of cavities, she also
have long and dirty fingernails. She also
has coughs and colds. She is walking
barefooted
NUTRITIONAL STATUS:
Height: 96 cm
Weight: 11.34 kg
BMI: 14.3 Normal
VITAL SIGNS:
Celsius
Pulse Rate: 124 bpm/min
Respiratory Rate:14 bpm/min
Name: Sister Oval Sister Oval was crying while we had the
Age: 2 months old assessment on her. She has long dirty
Position in the family: Youngest children fingernails and cough and colds were
Gender: Female also present.
Educational Attainment: Never been to
school NUTRITIONAL STATUS:
Height: 9.53 kg
Weight: 65 cm
BMI: Above Normal
VITAL SIGNS:
Celsius
Pulse rate: 106
Respiratory rate: 14
III. HEALTH ASSESSMENT (IPPA-CEPHALOCAUDAL)
a. Physical Assessment (Starting from the head of the family)
First Week of Visit

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First Home Visit (November 5, 2013, Tuesday)
*Daddy Trapezoid and Sister Recatangle was not met and assessed
Mommy Circle
 SKIN, HAIR AND NAILS
She has a fair complexion with evenly distributed body hair consistent from
head, neck, arms down to the legs and with other parts of the body. She does not
have any edema. With a good skin turgor because when the skin was lifted at the
arm the skin goes back to its previous state.
She has an evenly distributed thin, brown hair, medium in length. Upon
palpation it can be noted that, a hint of dandruff and no infestations of lice were
noted. There are no areas of hair loss.
She has medium, dirty fingernails. Her nails are smooth and have good
curvature with an intact epidermis. The nail base is firm and adheres to the bed
capillary refill time of approximately 2 seconds upon performing Blanch test.
 HEAD AND NECK
Headaches were absent. Head is on the midline upon inspection and no

swelling or enlargement of lymph nodes. The trachea is in the midline of neck
and spaces are equal on both sides. The thyroid gland is not visible on inspection
and ascends during swallowing but not still visible. Lobes are small, smooth,
centrally located, painless, and rise freely with swallowing upon palpation. She
was able to flex, hyperextend, laterally flex and laterally rotate the head and can
move side to side, up and down.
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 EARS AND HEARING
No deformities or inflammation noted and auricles are smooth, firm and not
tender upon palpation. The pinna recoils after it is folded and normal voice tone
audible as evidenced by responding when called by her name. The client is
positive in Watch Tick Test because she was able to hear the ticking of the watch
in both ears. According to client, there was no experienced pain, ringing or any
difficulty in hearing.
 EYES AND VISION
The eyebrows and eyelashes are evenly distributed and are symmetrically
aligned with equal movements. Eyelids have intact skin with no discharges and
discoloration noted. They also close symmetrically. The bulbar conjunctivas are
transparent and capillaries are sometimes apparent but no presence of nodules
or lesions. The sclera also appears white. Her palpebral conjunctiva is pink, shiny
and smooth. No edema or lesions noted upon the inspection of lacrimal sac and
nasolacrimal duct. Cornea is transparent, shiny and smooth and details of iris are
visible. The client blinks when cornea is touched by cotton which means that she
has an intact cranial nerve 5 (trigeminal). Iris is round, brown in color and equal
in size. Illuminated and non-illuminated pupils are equally round and reactive to
light accommodation (PERRLA). The client can also see objects in the periphery
and when looking straight ahead and both eyes move in unison with parallel
alignment. She was also able to see objects clearly, identify different colours and
was able to see the pen up, down and from side to side.
 NOSE
Client’s nasal septum is intact and at the midline with no tenderness and
lesions noted upon inspection. Each nostril is not occluded by discharges and
there is no difficulty of breathing. She has a good sense of smell and was able to
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distinguish different scents like alcohol and soy sauce when asked to close eyes
and identify the different aromas which means that she has an intact cranial
nerve 1 (olfactory).
 MOUTH AND OROPHARYNX
The lips are slightly dry and pinkish in color with no lesions noted. The client
was able to purse her lips which mean that she has an intact cranial nerve 7
(facial). She has no gingivitis, no evidence of dehydration but with the presence
of tooth decay and dental carries. The tongue is white in color and moist and
clean. Both the hard and soft palates are pink in color and the uvula is positioned
in the midline of soft palate. Tonsils are pink and smooth with no discharges
noted and are normal in size. Twenty nine (29) teeth were present and some
cavities were noted.
 THORAX AND LUNGS
The spine is vertically aligned and straight. Chest is uniform in color and has
a cold temperature. It expands symmetrically and no tenderness or masses upon
palpation. There is no presence of abnormal breath sounds and with regular rate
and rhythm. Breathing is smooth. Upon auscultations there are no rales or
abnormal findings.
 BREAST AND LYMPHATICS
Upon the palpation of the client, she did not report any lumps, discharges or
any swollen lymph nodes. The client has erected nipples with positive milk let
down reflex. When asked about her breastfeeding, she did not report any pain or
discomfort.
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 HEART
She has normal heart rate with regular rhythm and no murmurs or wheezing
heard upon auscultation. There are no chest pains being experienced. She also
told us that she never experienced palpitations.
 ABDOMEN
Abdomen is uniform in color and no presence of lesions or rashes noted upon

inspection. It is flat and symmetric contour.
 UPPER AND LOWER EXTREMITIES
The skin is uniform in color with no contractures or deformities. Muscles on

both sides of the body are equal in size and has smooth coordinated movement.
There are no lesions, tenderness or swelling and no jaundice and cyanosis. Her
skin is in uniform temperature upon palpation. There are also normal and uniform
in the body size and built.
 ANUS AND RECTUM
According to client, she does not have any hemorrhoids. Her bowel habit is to defecate at
least once a day.
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ASSESSMENT NORMAL ACTUAL
CRANIAL NERVE
METHOD FINDINGS FINDINGS
I: Olfactory The student nurse Client will be able The client was
Type: Sensory asked the client to to identify the able to identify
Function: Smell close both of her different odors different aromas
eyes and asked to presented with that the student
identify different eyes closed nurse prepared
aromas such as such as alcohol
alcohol and soy and soy sauce.
sauce.
II: Optic The student nurse Client will be able The client was
Type: Sensory asked the client to to read words and able to read some
Function: Vision read some printed able to see words from a
words from a objects and paper and was
paper and identify identify the colors able to identify
some colors with a with a distance of different colors
distance of approximately 12- with a distance of
approximately 12- 14 inches. approximately 12-
14 inches. 14 inches.
III: Oculomotor The client was PERRLA The dilated pupil
Type: Motor asked to look gradually
Function: Extra- straight ahead. constricted upon
ocular movement Then with the use the introduction of
and constriction of of penlight, the light with the use
pupils light was focused of penlight and
on the right eye was able to open
and was moved to and close eyelids.
determine any Client can see
changes on the near and far
pupil size. Same objects.
assessment was
done with the left
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eye.
The client was
asked if she can
see the objects
both near and far.
IV: Trochlear The client was Eyes will be able Client was able to
Type: Motor asked to follow the to move on follow the
Function: Extra- direction of the oblique direction direction of the
ocular movement penlight in an without moving penlight with her
of eyes in oblique oblique movement her head. both eyes without
movement moving her head. moving her head
V: Trigeminal The student nurse The client will be The client was
Type: Motor also asked the able to move her able to move her
Type: Sensory client to move her jaw from side to jaw from side to
Function: jaw from side to side and can side and can
Sensation of side and chew. chew. chew.
cornea, skin of face The student nurse Client will be able Client responded
and jaw movement made use of a to elicit corneal to the cotton wisp
clean cotton wisp reflex and identify by blinking her
and gently stroked the sensation of eyes. She was
client’s eyelashes dull or sharp able to identify the
to elicit corneal objects. difference
reflex. Also, The between sharp
student nurse and dull objects.
asked the client to
close her eyes to
determine if the
object is sharp or
dull upon
introducing to arm.
VI: Abducens The student nurse Eyes will be able Client was able to
Type: Motor asked the client to to move in a follow the
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Function: Extra- follow the direction lateral movement direction of the
ocular movement of the penlight in a without moving penlight in a
of eyes in a lateral lateral movement the head. lateral movement
movement without moving without moving
the head. her head.
VII: Facial The student nurse Client will be able Client was able to
Type: Motor asked the client to to raise follow the
Type: Sensory raise her eyebrows, frown, directions given
Function: eyebrows, smile, and smile, show by the student
Movement of facial frown, show teeth, teeth, and puff out nurse; she was
muscles and sense and puff out her cheeks. able to raise
of taste on the cheeks. The client will be eyebrows, smile,
anterior two thirds The student nurse able to identify frown, show teeth
of the tongue asked the client to various tastes on and puffed out her
identify various the tip of tongue cheeks.
taste on the tip of like sweet and The client was
the tongue like salty. able to identified
sweet and salty. taste of sugar and
salt.
VIII: The student nurse The client will be The client was
Vestibulocochlear/ placed a second- able to hear the able to hear the
Acoustics hand watch near ticking watch and watch tick and
Type: Sensory the ears and will be able to was able to show
Function: Hearing asked the client if show balance balance when
and Equilibrium she could hear the when standing standing
watch tick. Then,
she was also to
stand by her own
for several
seconds with eyes
close.
IX: The student nurse The client will be The client was
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Glossopharyngeal asked the client to able to elicit able to say “Ah”
Type: Motor say “Ah” and upward and yawn; the
Type: Sensory yawn; pressed the movement of soft palate rose
Function: posterior tongue palate when symmetrically with
Swallowing, gag with a tongue mouth is opened, the uvula and in
reflex, pharyngeal depressor. elicit gag reflex. the in midline and
movement and The student nurse The client will be elicited gag reflex.
sense of taste of asked the client to able to identify The client was
the posterior one- taste vinegar and bitter and sour able to identify
third of the tongue coffee to the taste. different tastes
posterior tongue and was able to
with closed eyes. distinguish them.
X: Vagus The student nurse Client will be able The client has no
Type: Motor asked the client to to swallow and difficulty in
Function: swallow and speak without swallowing and
Swallowing and asked her to hoarseness thyroid glands
Speaking answer a moved upward
question. during
swallowing; there
was no
hoarseness of
voice noted
XI: Accessory The student nurse The client will be The client was
Type: Motor asked the client to able to shrug able to move her
Function: move her head shoulders and head from side to
Movement of from side to side move head from side and was able
shoulder muscles and asked him to side to side to elevate her
shrug her against applied shoulders against
shoulders against resistance resistance
the resistance
introduced by the
student nurse.
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XII: Hypoglossal The student nurse The client will be Client was able to
Type: Motor asked the client to able to protrude move her tongue
Function: move her tongue tongue and move from side to side
Movement and from side to side it from side to and in and out.
strength of tongue and in and out side.
Sister Triangle
She has a dark complexion with evenly distributed body hair consistent from
She has an evenly distributed thin, brown hair, short in length. No infestations
of lice were noted. There are no areas of hair loss.
She has short, dirty fingernails. Her nails are smooth and have good
 HEAD AND NECK

21
 EYES AND VISION
 NOSE
22
lesions noted upon inspection. There was presence of mucus discharge but the
client had no difficulty of breathing. She has a bad sense of smell because of
having colds but she was able to distinguish different scents like alcohol and soy
sauce when asked to close eyes and identify the different aromas which means
that she has an intact cranial nerve 1 (olfactory).
The lips are moist and pinkish in color with no lesions noted. The client was
able to purse her lips which mean that she has an intact cranial nerve 7 (facial).
She has no gingivitis, no evidence of dehydration but with the presence of tooth
decay and dental carries. The tongue is white in color and moist and clean. Both
the hard and soft palates are pink in color and the uvula is positioned in the
midline of soft palate. Tonsils are pink and smooth with no discharges noted and
are normal in size. Twenty (20) teeth were present and some cavities were
noted.
abnormal findings.
Upon palpation, there were no lumps, discharges or any swollen lymph

nodes.
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 HEART
 ABDOMEN


 ANUS AND RECTUM
According to the mother, she does not have any hemorrhoids.
24
CRANIAL NERVE
sauce.
assessment was
done with the left
25
eye.
The client was
asked if she can
see the objects
both near and far.
asked the client to
close her eyes to
determine if the
object is sharp or
dull upon
introducing to arm.
26
the head. her head.
of the tongue asked the client to various tastes on and puff out her
salt.
watch tick. Then,
she was also to
stand by her own
for several
seconds with eyes
close.
27
Swallowing and asked him to hoarseness thyroid glands
question. during
swallowing; there
was no
hoarseness of
voice noted
the resistance
introduced by the
student nurse.
28
Sister Heart
 HEAD AND NECK

29
 EYES AND VISION
 NOSE
lesions noted upon inspection. The left nostril is occluded by discharges, mouth
breathing was present. She has a bad sense of smell because of her colds but
30
was able to distinguish different scents like alcohol and soy sauce when asked to
close eyes and identify the different aromas which means that she has an intact
cranial nerve 1 (olfactory).
noted.
abnormal findings.

nodes.
 HEART
31
 ABDOMEN


 ANUS AND RECTUM
32
CRANIAL NERVE
sauce.
assessment was
done with the left
33
eye.
The client was
asked if she can
see the objects
both near and far.
asked the client to
close her eyes to
determine if the
object is sharp or
dull upon
introducing to arm.
34
the head. her head.
salt.
watch tick. Then,
she was also to
stand by her own
for several
seconds with eyes
close.
35
question. during
swallowing; there
was no
hoarseness of
voice noted
the resistance
introduced by the
student nurse.
36
Sister Square
 HEAD AND NECK

37
 EYES AND VISION
 NOSE
38
noted.
abnormal findings.

nodes.
39
 HEART
 ABDOMEN


 ANUS AND RECTUM
40
CRANIAL NERVE
sauce.
assessment was
done with the left
41
eye.
The client was
asked if she can
see the objects
both near and far.
asked the client to
close her eyes to
determine if the
object is sharp or
dull upon
introducing to arm.
42
the head. her head.
salt.
watch tick. Then,
she was also to
stand by her own
for several
seconds with eyes
close.
43
question. during
swallowing; there
was no
hoarseness of
voice noted
the resistance
introduced by the
student nurse.
44
Baby Oval
She has an evenly distributed thin, black hair, very short in length. No
infestations of lice were noted. There are no areas of hair loss.
 HEAD AND NECK

45
 EYES AND VISION
 NOSE
46
lesions noted upon inspection. There was presence of colds with cloudy-colored
discharge.
able to purse Her lips which mean that she has an intact cranial nerve 7 (facial).
are normal in size. Eight incisors (8) teeth were present and some cavities were
noted.
abnormal findings.

nodes.
47
 HEART
 ABDOMEN

inspection. It is distended and uniform and color. Upon palpation, it is soft and
non-tender.

There are no lesions, tenderness or swelling and no jaundice and cyanosis. her
 ANUS AND RECTUM
48
CRANIAL NERVE
sauce.
assessment was
done with the left
49
eye.
The client was
asked if she can
see the objects
both near and far.
ocular movement penlight in an without moving penlight with Her
movement moving Her head. moving Her head
Type: Motor also asked the able to move Her able to move Her
Type: Sensory client to move Her jaw from side to jaw from side to
clean cotton wisp reflex and identify by blinking Her
asked the client to
close Her eyes to
determine if the
object is sharp or
dull upon
introducing to arm.
50
the head. Her head.
Type: Sensory raise Her eyebrows, frown, directions given
of the tongue asked the client to various tastes on and puff out Her
salt.
watch tick. Then,
she was also to
stand by Her own
for several
seconds with eyes
close.
51
question. during
swallowing; there
was no
hoarseness of
voice noted
Type: Motor asked the client to able to shrug able to move Her
Function: move Her head shoulders and head from side to
shoulder muscles and asked him to side to side to elevate Her
shrug Her against applied shoulders against
the resistance
introduced by the
student nurse.
52
Type: Motor asked the client to able to protrude move Her tongue
Function: move Her tongue tongue and move from side to side
Second Week of Visit
Second Home Visit (November 11, 2013, Monday)
Mommy Circle
 HEAD AND NECK
53
 EYES AND VISION
54
 NOSE
55
abnormal findings.
discomfort.
 HEART
 ABDOMEN


56
 ANUS AND RECTUM
According to client, she does not have any hemorrhoids. Her bowel habit is to
defecate at least once a day.
Sister Triangle
 HEAD AND NECK

57
 EYES AND VISION
58
 NOSE
noted.
abnormal findings.
59

nodes.
 HEART
 ABDOMEN


 ANUS AND RECTUM
60
Sister Heart
 HEAD AND NECK

61
 EYES AND VISION
 NOSE
62
noted.
abnormal findings.

nodes.
 HEART
63
 ABDOMEN


 ANUS AND RECTUM
Sister Square
64
65
 HEAD AND NECK

 EYES AND VISION
66
 NOSE
noted.
67
abnormal findings.

nodes.
 HEART
 ABDOMEN


68
 ANUS AND RECTUM
69
Baby Oval
 HEAD AND NECK

70
 EYES AND VISION
 NOSE
discharge.
71
noted.
abnormal findings.

nodes.
 HEART
72
 ABDOMEN

non-tender.

 ANUS AND RECTUM
73
Third Home Visit (November 12, 2013, Tuesday)
Mommy Circle
 HEAD AND NECK

74
 EYES AND VISION
 NOSE
75
abnormal findings.
76
discomfort.
 HEART
 ABDOMEN


 ANUS AND RECTUM
Sister Triangle
77
 HEAD AND NECK

78
 EYES AND VISION
79
 NOSE
noted.
abnormal findings.
80

nodes.
 HEART
 ABDOMEN


 ANUS AND RECTUM
81
Sister Heart
 HEAD AND NECK

82
 EYES AND VISION
 NOSE
83
noted.
abnormal findings.

nodes.
 HEART
84
 ABDOMEN


 ANUS AND RECTUM
Sister Square
85
86
 HEAD AND NECK

 EYES AND VISION
87
 NOSE
noted.
88
abnormal findings.

nodes.
 HEART
 ABDOMEN


89
 ANUS AND RECTUM
90
Baby Oval
 HEAD AND NECK

91
 EYES AND VISION
 NOSE
discharge.
92
noted.
abnormal findings.

nodes.
 HEART
 ABDOMEN
93
non-tender.

 ANUS AND RECTUM
Third Week of Visit
Fourth Home Visit (November 18, 2013, Monday)
Mommy Circle
94
 HEAD AND NECK

 EYES AND VISION
95
 NOSE
96
abnormal findings.
discomfort.
 HEART
 ABDOMEN
97

 ANUS AND RECTUM
Sister Triangle
98
 HEAD AND NECK

99
 EYES AND VISION
100
 NOSE
noted.
abnormal findings.
101

nodes.
 HEART
 ABDOMEN


 ANUS AND RECTUM
102
Sister Heart
 HEAD AND NECK

103
 EYES AND VISION
 NOSE
104
noted.
abnormal findings.

nodes.
 HEART
105
 ABDOMEN


 ANUS AND RECTUM
Sister Square
106
107
 HEAD AND NECK

 EYES AND VISION
108
 NOSE
noted.
109
abnormal findings.

nodes.
 HEART
 ABDOMEN


110
 ANUS AND RECTUM
111
Baby Oval
She has a fair complexion with evenly distributed body hair consistent from head,
neck, arms down to the legs and with other parts of the body. She does not have any
edema. With a good skin turgor because when the skin was lifted at the arm the skin
goes back to its previous state.
She has an evenly distributed thin, black hair, very short in length. No infestations of
lice were noted. There are no areas of hair loss.
She has short, dirty fingernails. Her nails are smooth and have good curvature with
an intact epidermis. The nail base is firm and adheres to the bed capillary refill time of
approximately 2 seconds upon performing Blanch test.
 HEAD AND NECK
Headaches were absent. Head is on the midline upon inspection and no swelling or
enlargement of lymph nodes. The trachea is in the midline of neck and spaces are
equal on both sides. The thyroid gland is not visible on inspection and ascends during
swallowing but not still visible. Lobes are small, smooth, centrally located, painless, and
rise freely with swallowing upon palpation. She was able to flex, hyperextend, laterally
flex and laterally rotate the head and can move side to side, up and down.
No deformities or inflammation noted and auricles are smooth, firm and not tender
upon palpation. The pinna recoils after it is folded and normal voice tone audible as
evidenced by responding when called by her name. The client is positive in Watch Tick
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Test because she was able to hear the ticking of the watch in both ears. According to
client, there was no experienced pain, ringing or any difficulty in hearing.
 EYES AND VISION
The eyebrows and eyelashes are evenly distributed and are symmetrically aligned
with equal movements. Eyelids have intact skin with no discharges and discoloration
noted. They also close symmetrically. The bulbar conjunctivas are transparent and
capillaries are sometimes apparent but no presence of nodules or lesions. The sclera
also appears white. Her palpebral conjunctiva is pink, shiny and smooth. No edema or
lesions noted upon the inspection of lacrimal sac and nasolacrimal duct. Cornea is
transparent, shiny and smooth and details of iris are visible. The client blinks when
cornea is touched by cotton which means that she has an intact cranial nerve 5
(trigeminal). Iris is round, brown in color and equal in size. Illuminated and non-
illuminated pupils are equally round and reactive to light accommodation (PERRLA).
The client can also see objects in the periphery and when looking straight ahead and
both eyes move in unison with parallel alignment. She was also able to see objects
clearly, identify different colours and was able to see the pen up, down and from side to
side.
 NOSE
Client’s nasal septum is intact and at the midline with no tenderness and lesions
noted upon inspection. There was presence of colds with cloudy-colored discharge.
The lips are moist and pinkish in color with no lesions noted. The client was able to
purse her lips which mean that she has an intact cranial nerve 7 (facial). She has no
gingivitis, no evidence of dehydration but with the presence of tooth decay and dental
113
carries. The tongue is white in color and moist and clean. Both the hard and soft palates
are pink in color and the uvula is positioned in the midline of soft palate. Tonsils are pink
and smooth with no discharges noted and are normal in size. Eight incisors (8) teeth
were present and some cavities were noted.
The spine is vertically aligned and straight. Chest is uniform in color and has a cold
temperature. It expands symmetrically and no tenderness or masses upon palpation.
There is no presence of abnormal breath sounds and with regular rate and rhythm.
Breathing is smooth. Upon auscultations there are no rales or abnormal findings.
Upon palpation, there were no lumps, discharges or any swollen lymph nodes.
 HEART
She has normal heart rate with regular rhythm and no murmurs or wheezing heard
upon auscultation. There are no chest pains being experienced. She also told us that
she never experienced palpitations.
 ABDOMEN

inspection. It is distended and uniform and color. Upon palpation, it is soft and non-
tender.
The skin is uniform in color with no contractures or deformities. Muscles on both

sides of the body are equal in size and has smooth coordinated movement. There are
114
no lesions, tenderness or swelling and no jaundice and cyanosis. her skin is in uniform
temperature upon palpation. There are also normal and uniform in the body size and
built.
 ANUS AND RECTUM
b. Mother’s Obstetrical History
Mommy cirlce’s obstetrical history is G5 P5 T5 P0 A0 L5. According to Mommy

Circle, all her pregnancies had no complications. She had no particular cravings, or any
abnormal discomforts aside from the occasional nausea and vomiting in the morning,
frequent urination, lower back pain upon prolonged standing and she had no edema of
the upper extremities.
Her first birthing and second experience was at bataan, and she was admitted for 3
days, having a normal spontaneous delivery with episiotomy and episorrhapy done. She
had pain relievers and antibiotics for her take-home medications.
Her third to fifth birthing experience was only at home, facilitated by a “kumadrona”
as she would say. She stated that she had an episiotomy, but did not have an
episiorrhapy afterwards. She was only advised to take antibiotics and pain relievers.
She said she had bleeding for 2 weeks afterwards.
Her third childbearing experience was the most difficult, saying that when she was
giving birth
According to Mommy Red, she has completed her Tetanus Toxoid vaccinations.
115
c. Growth and Development
ERIKSON’S FREUD’S
PERSON PSYCHOSOCIAL PSYCHOSEXUAL
DEVELOPMENT DEVELOPMENT
Sister Heart Initiative-vs-Guilt Latency Stage
Initiative-vs-Guilt Phallic Stage

Sister Square
Baby Oval Trust-vs-Mistrust Oral Stage
Sister Heart
Erik Erikson’s Psychosocial Development
Stage: Initiative-vs-Guilt
In this stage, children’s desire to act independently conflicts with the guilt that
comes from the unintended and unexpected consequences of such behavior. Children
in this period come to understand that they are persons in their own right, and they
begin to make decisions about their behavior. If parents react positively to children’s
116
attempts at independence, they will help their resolve the initiative-vs-guilt crisis
positively.
Sister Heart is in this stage for her age, and in her progress, she is also in this
stage. The student nurses have observed that Sister Heart has started to exert
independence by dressing by herself after taking a bath. Also, she exerts independence
in the sense that she chooses which clothes to wear, which things to do and which
decisions she readily refuses if she is not in favor of it. She also learns to refuse if she
doesn’t desire the actions to be made, such as accepting vaccinations, even if she
knows it is for Her own good.
Sigmund Freud’s Psychosexual Development
Stage: Latency Stage
During this period, sexual interests become dormant, even in the unconscious.
Then, during adolescence, sexual feelings remerge, marking the stage of the final
period. This is the period when the child’s sexual concerns are temporarily put aside.
Sister Heart has exhibited interests in studying but she’s not going to school and
playing. She has not exhibited any interests in Her sexual aspect during the course of
interaction.
Sister Square
Stage: Initiative-vs-Guilt
In this stage, children’s desire to act independently conflicts with the guilt that
comes from the unintended and unexpected consequences of such behavior. Children
in this period come to understand that they are persons in their own right, and they
begin to make decisions about their behavior. If parents react positively to children’s
117
attempts at independence, they will help their resolve the initiative-vs-guilt crisis
positively.
Sister Square is in this stage for Her age, and in Her progress, she is also in this
stage. The student nurses have observed that Sister Heart also has started to exert
independence by dressing by herself after taking a bath. Also, she exerts independence
in the sense that she chooses which clothes to wear, which things to do and which
decisions she readily refuses if she is not in favor of it. She also learns to refuse if she
doesn’t desire the actions to be made, such as accepting vaccinations, even if she
knows it is for her own good.
Stage: Phallic
The third stage of psychosexual development is the phallic stage, spanning the
ages of three to six years, wherein the child's genitalia are his or her primary erogenous
zone. It is in this third infantile development stage that children become aware of their
bodies, the bodies of other children, and the bodies of their parents; they gratify physical
curiosity by undressing and exploring each other and their genitals.
Sister Square is in this stage, and in her progress, she is also in this stage. The
student nurses have observed that Sister heart has become aware of her genitalia.
Baby Oval
Stage: Trust-vs-Mistrust
The infant will develop a healthy balance between trust and mistrust if fed and
cared for and not over-indulged or over-protected. Abuse or neglect or cruelty will
destroy trust and foster mistrust. Mistrust increases a person's resistance to risk-
exposure and exploration. "Once bitten twice shy" is an apt analogy. On the other hand,
if the infant is insulated from all and any feelings of surprise and normality, or unfailingly
118
indulged, this will create a false sense of trust amounting to sensory distortion, in other
words a failure to appreciate reality. Infants who grow up to trust are more able to hope
and have faith that 'things will generally be okay'. This crisis stage incorporates Freud's
psychosexual Oral stage, in which the infant's crucial relationships and experiences are
defined by oral matters, notably feeding and relationship with mum .
Baby Oval exerts the stage trust-vs-mistrust stage, wherein she showed intimate
love to her mother.
Sigmund Freud’s Psychosexual Development
Stage: Oral Stage
The first stage of psychosexual development is the oral stage,

spanning from birth until the age of two years, wherein the infant's mouth is
the focus of libidinal gratification derived from the pleasure of feeding at the
mother's breast, and from the oral exploration of his or her environment, i.e.
the tendency to place objects in the mouth. The id dominates, because
neither the ego nor the super ego is yet fully developed, and, since the
infant has no personality (identity), every action is based upon the pleasure
principle.
Baby Oval exerts the Oral Stage, wherein she showed intimate
pleasure in thumb sucking and she stills practice breastfeeding.
d. Immunization Status
Baby Oval was only given BCG vaccine, no other else.
e. Nutrition Status by age, weight and height
MEMBER AGE WEIGHT HEIGHT BMI
119
Mommy
27 y/o 50.35kg 1.57m 20.47
Circle
Sister
7 y/o 17.24kg 1.13m 14.2
Triangle
Sister Heart 6 y/o 11.79kg 1.04m 15.1
Sister Square 5 y/o 11.34kg 0.96m 14.3
Baby Oval 10 months 9.53kg 0.64m 23.24
Computation for Body Mass Index (BMI)
BMI = Weight in kilograms (kg)
Height in meters2
FNRI TABLE WAS USED
WEIGHT
BMI RANGE
CLASSIFICATION
<18.5 Underweight
18.5-24.9 Normal
25-29.9 Overweight
30-39.9 Obese
Interpretation
Mommy Circle’s computed BMI which is 23.24 falls under the Normal weight
classification. This indicates that Mommy Circle is neither underweight, overweight nor
obese - thereby considering her as “healthy” in terms of her nutritional status.
Sister Triangle’s computed BMI which is 14.2 falls under the Healthy Weight
status category indicates that sister Triangle is neither underweight, overweight nor
obese - thereby considering her as “healthy” in terms of her nutritional status
120
Sister Heart computed BMI which is 15.1 falls under the Healthy Weight status
category indicates that sister Heart is neither underweight, overweight nor obese -
thereby considering her as “healthy” in terms of her nutritional status.
Sister Square’s computed BMI which is 14.3 falls under the Healthy Weight
status category indicates that sister square is neither underweight, overweight nor
Baby Oval’s BMI which is 23.24 falls under the above normal status category of
the FNRI table, this indicates that baby oval is neither underweight, overweight nor
f. History of Past and Present Illness
Mommy Circle
According to Mommy Circle, she had dengue when she was 14 y/o. She had no
other childhood illnesses. Only the common cough and colds, headache and body pains
due to her work.
Sister Triangle
According to Mommy Circle, sister Triangle had asthma (2 mos. - 1 y/o). Her
allergen was animal fur and smoke. She had once bronchopneumonia when she was 2
months and 1 week. She had no other childhood illnesses. Only the common cough and
colds, headache and fever.
Sister Heart
According to Mommy Circle, sister Heart had no other childhood illnesses. Only the
common cough and colds, headache and fever.
Sister Square
121
According to Mommy Circle, sister Square had no other childhood illnesses. Only
the common cough and colds, headache and fever.
Baby Oval
According to Mommy Circle, sister Oval had no other childhood illnesses. Only the
common cough and colds, and fever.
g. Activities of daily living
Mommy Circle
TIME ACTIVITY
6:00AM – 12:00NN WORK
RETURN FROM WORK

12:00NN – 1:00PM
LUNCH
1:00PM – 3:00PM SLEEPING
STAYS AT HOME TO WATCH OVER

3:00PM - 3:30PM
THE KIDS
BATHING OF KIDS
3:30PM – 4:30PM
PERSONAL NEEDS
4:30PM – 5:30PM PREPARING MATERIALS FOR WORK
PREPARING OF DINNER
5:30PM – 7:00PM
DINNER
7:00PM – 8:00PM PREPARING KIDS FOR SLEEP

5:00AM – 6:00PM GETTING READY FOR WORK
According to Mommy Orange, this usual schedule is applicable to the whole

week. At morning she prepares herself and her goods sell in the market. Early in the
morning at 5:00AM she prepares and cook the corns for her to sell. At 6:00 AM she will
122
sell her goods at the nearest market and she will stay there until 12 NN. At 1pm she will
have her nap and the rest of the day she will just watch over the kids and get ready for
work the next morning.
IV. SOCIO ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT
a. Type of Family
They are a blended family where in the home is consisted of the father, mother,
and five children. Mother Circle had a previous partner which she had three children,
Triangle who is seven years old, Heart 6 years old, and Square five years old. Mother
Circle and her previous got separated. Then on her second partner she had to more
children, Rectangle two years old and Oval ten months old.
b. Dominant family member(s) in terms of decision-making especially to health

care
Understanding the power structure in the family is essential in formulating

effective nursing interventions. When health actions/decisions need to be made by the
family in the health aspect, knowing who holds the power for this type of decision and
for overall decisions, coupled with knowledge of how decisions are made will guide the
family nurse to speak to the appropriate persons with sensitivity as to how decisions
take place (Friedman, 1996).
c. Source of income / expenditures
Economic status, a component of social class, refers to income level of the

family. An assessment of the economic resources of the family provides the nurse with
data relevant to the ability of the family to allocate resources appropriately to meet
family needs such as adequate clothing, food, shelter, and health care. By gaining an
understanding of how the family distributes its resources, the family-centered nurse can
also obtain a clearer perspective on the value system of the family (Friedman, 1996).
Both Father Hexagon and Mother Circle are working. Father Hexagon is working
in Bataan and sends money to his family every month amounting to Php 4000. Mother
Circle works as a corn vendor in the Pampang Market and earns Php 600 per day
(600x30 =18000). Mother Circle’s previous husband ( Father Octagon ) also sends
money every month to support his children amounting to Php 5000.
123
Though Mother Circle is earning Php 18000 only half of it serves as their income.
She earns Php 6oo per day but the Php 300 of it is being used as the capital for the
next day. So in a month her total family income is only Php 9000.
Monthly income:
4000 + 9000 + 5000 = 18000
Breakdown of expenses:
Electricity = 200/day (6000/month)
Water = 1500/month
Food = 300/day (9000/month)
Oval’s milk = 50/day (1500/month)
d. Working hours
Father Trapezoid works in Bataan and stays there for several weeks or months
before going home. Mother Circle sells corn from 6:30 AM to 12:00 PM. After selling
corn she goes home to cook lunch and take care of her children.
e. Ethnic background and religious affiliation
A cultural orientation or background of the family may be by far the most

pertinent variable in understanding the behavior of the family, value system, and
functions. Because culture permeates and circumscribes our individual, familial, and
social actions, its consequences are pervasive and its implications for practice broad.
Thus, to understand and be able to work efficaciously with families from cultures
different from one’s own, one must be aware of that the unique, distinctive qualities of a
culture and the variety of lifestyles, values, and structures found within that group
(Friedman, 1996).
Since cultural differences are often at the root of poor communication,
interpersonal tensions, avoidance in working effectively with others and poor
assessment of health problems and their remedies, successful nursing care of clients of
various ethnic backgrounds is dependent on the knowledge of and sensitivity to the
clients’ culture that nurses have.
The family is originally from Bataan. They are living in Lourdes North West since 2010.
They are under the religion “Sagrado Corazon Senior”. Mother Circle said that their
124
religion is somewhat similar with the Catholic religion but the only difference is that they
are not allowed to eat pork every Friday and they are also not allowed to eat dog meat.
f. Significant other’s role(s) in the family life
In cases of emergencies like accidents and unexpected occurrence of illnesses,

Mother Circle asks help to her relatives which are also their neighbors.
g. Health habits / beliefs
In order to establish with the family realistic goals, health beliefs, habits and
values of the family need to be addressed, understood and accepted. In addition,
understanding the health values of the family will aid the student nurses suggest more
value-appropriate community resources to refer to. Assessment of this aspect is also
very helpful in motivating the family to take preventive or restorative health action or to
be responsible for health decisions. Tracing the health habits and beliefs of the family
would be an indicator of how knowledgeable the family is in treating their illnesses and
diseases. This could also be a good pointer in knowing the appropriate interventions
that can be applied to the problems.
The family doesn’t believe in herbolarios, tawas, hilot, etc. Instead they directly
go to the hospital for check-ups whenever they get sick.
h. Family’s involvement in community activities
The involvement of the family in community activities is important to know in

order to see how well the family interacts within the community. Based from the
interview, the only community activities attended by the family are the free check-ups
and immunizations.
i. Family’s utilization of community resources
A determination of the actual use of the family of community health resources

inclusive of an interpretation of whether this use is appropriate are important factors to
consider in the assessment of the health care function of the family. According to Otto,
the author of Family Strength Approach, the appropriate use of community resources is
strength, while their inappropriate use is a weakness. The utilization of the family with
the present community resources was assessed in order to find out if they avail the
government or non-government programs that are in line with their present situation.
The family utilized their community resources well by having free check-ups and
immunizations in the health center.
125
j. Housing condition
A home reflects the influence of the life style, culture, interests, values and
economic status of a family. In a healthy state, a family will attempt to create a
sheltered, protective, and satisfying environment for its members. Such assessment of
the home environment provides a most valuable aid in understanding the family and its
life cycle.
Provision of a healthy environment in the form of adequate shelter is an aspect of
family functioning, which is of special concern to the family-centered community nurse.
A family’s home is extraordinarily significant for its members because it becomes part of
their family identity. “Home is that place where things are familiar and unchanging and
where people maintain some sense of autonomy and control” (Rauckhorst, Stokes and
Mezey, 1992).
The family’s house floor area is 24x20 square meters, it has one door and no
window. It has some poor conditions like the walls are only made up of broken ply
woods and their roof has holes. They do not have their own comfort room. They have a
joint comfort room together with their neighbors. There is an open drainage of dirty
water in front of their house. There is no proper lighting and ventilation and there are
presence of cockroaches and flies.
k. Food sources, storage and cooking facilities
Mother Circle buys food for her family in the market. Then they do not use gas
but instead they use wood in cooking. They use utensil bowls and plates made of plastic
and aluminium pots for cooking. They do not have a refrigerator or a food cabinet as
food storage but instead they just place their left-overs on their table and cover it with
plates.
l. Water supply
The Source of their water supply is Angeles Water District Station. They only
share the source of water from their neighborhood who are actually their relatives. And
with regards to their drinking water, they do not buy purified water but instead they just
get from the faucet.
m. Toilet facility
126
Their toilet has no water carriage. Based from the observation, there were
presence of cockroaches and spiders in the comfort room. And the comfort room appear
to be messy because they use a joint comfort room with their neighbors so it is not
privately cleaned.
n. Drainage system
The drainage system that the family have is the “posonegro” but they are joint
with the house around them which are their relatives’ houses.
o. Social and health facilities available
Social and health facilities are one of the vital resources within a community.
These would determine the utilization and frequency of usage of resources of the family.
As the family stated, the facilities available in their area was the health center which
they can have immunizations and free check-ups. They don’t go out for recreational
activities because they don’t have money to go to parks, amusement places, etc.
Mother Circle also considers that she cannot handle her kids alone.
p. Communication and transportation facilities
The assessment of communication and transportation facilities allows the

community health nurse to determine the availability of information transfer services
with the aid of innovation in the society such as the telephone or cellular phones, postal
services, and also of mobility through transportation vehicle. The family’s modes of
transportation are tricycles and jeepneys. But Mother Circle only walks going to the
market since it is just near. They can communicate through the use of cellphone.
Chapter V
Problem Identification
A. List of Problems Identified
Problems Identified Score

1 Presence of Runny and Cough as 4.17
Health Deficit
2 Unhealthy lifestyle and personal 3.84

habits r/t Walking Barefooted as
127
Health Threat
3 Poor Sanitation r/t Improper 3.34
Garbage Disposal as Health
Threat
4.1 Poor Personal Hygiene as Health 2
Threat
4.2 Presence of Environmental 2
Condition r/t Presence of Breeding
Sites of Vectors of Diseases
(Rodents, Pests, Mosquitoes &
Cockroaches) as Health Threat
5.1 Poor Home Condition r/t 1
Inadequate Living Space as

Health Threat
5.2 Poor condition r/t Poor Lighting & 1

Ventilation as Health Threat
A. Prioritizing
Problem # 1: Presence of Runny nose and Cough as Health Deficit
CRITERIA COMPUTATION SCORE JUSTIFICATION
128
Nature of the Problem 3/3x1 1 The problems are health
deficit.
Runny nose and Cough has
seen to the children. They
are experiencing dry cough.
This can lead to a more
serious respiratory condition
like pneumonia if it is not
managed properly.
Modifiability 2/2X2 2 The problem is easily

modifiable as supported by
Current 
knowledge , the following factors:
technology
and
intervention Current knowledge,
of the family
Technology and
Intervention
Resource of  >Mother Circle does have
the family
knowledge about her
Resource of  children’s illness but she
the Nurse
does not have any time to
Resource of  take care of them due to her
the
Community work. Cough can lead to
improper hygiene to the
children because no one is
teaching them of that. That
is why improper hygiene is
associated with this problem
like when they eat and there
is an increased susceptible
of taking in microorganisms.
129
Also, she cannot buy any
medicines for the children’s
runny nose and cough
because she does not have
any financial resources to
buy them.
Resources of the Family
>The family has resources

since the mother does have
knowledge to do in order to
keep her children health like
to eat nutritious foods and
increase fluid intake but due
to work, she does not have
time to provide them care
since working is more
important than to take care
of her children. Also, they
lack financial resources to
buy medicines and also they
only go to the health center
if the symptoms are severe.
Resources of the Student
Nurse
>The student nurses are
well-equipped with
knowledge and skills. They
reminded the mother for the
children to increase fluid
intake, increase citrus foods
130
like oranges and increase in
nutritious foods. They can
also teach the children for
proper breathing,
Resources of the
Community
>The Barangay Health
Center is open for the
population. It offers free
check-up and some
medications needed for the
children.
The problem has a moderat
Preventive Potential 2/3x1 0.67
e preventive potential as
Severity  supported by the following
factors:
Duration 
Severity
>It is considered as severe
Current  since the children’s immune
Management
systems are still weak; they
Exposure of 
are prone to develop severe
any high risk
group respiratory illness like
pneumonia.
Duration
>They have been
experiencing cough for ever
since the 1st week of the
student nurses visit.
Current Management
131
>Mother Circle is not doing
anything for the children
since she does not give
enough care to provide
them teachings about their
condition and they don’t
have enough financial
resources to buy medicines
to a drugstore.
Exposure of any High

Risk Group
> 6 the members are have
runny nose and cough since
their immune systems are
still weak and the mother
does not care enough to
provide them health
teachings.
1/2x1 0.5 The mother has knowledge
Salience
about her children’s
A condition not needing condition but she does not
immediate attention
care enough to take care of
her children .
Total 4.17
Score
132
Problem # 2: Unhealthy lifestyle and personal habits r/t Walking Barefooted as Health
Threat

Nature of the 2/3x1 0.67 Walking barefooted is a
Problem
health threat to the children
because it can damage
one’s foot by stepping on
dirt that can have a
numerous of
microorganisms and in
worst case; it can lead to
stepping of a rusty nail that
can cause tetanus and
parasitism.
Modifiability 2/2x2 2 The problem is easily
modifiable as supported
Resource of  by the following factors:
the Nurse
Resource of  Current knowledge,

the Technology and
Community
Intervention
>The family has sufficient
knowledge about the
problem. They know that
133
wearing slippers help in
promoting safety to their
feet and preventing them to
have microorganisms which
can lead to a serious
problem like tetanus and
parasitism
>The family has sufficient

knowledge and
skills in carrying
out effective
interventions to the
problem. They have
slippers to wear on
whenever they walk and
play.

Nurse
>The student nurses is
reminding the mother to
always put on slippers
when walking and playing
to avoid tetanus and
parasitism.
Resources of the
Community
>The Barangay Health
Center offers health
134
teachings and providing
tetanus toxoid medicine
related to stepping on
pieces of wood with nails.
Preventive Potential 1/3x1 0.33 The problem has a low pre
ventive potential as
Severity 
supported by the following
factors:
Duration 
Severity
Current  >It is almost considered
Management severe on their case
Exposure of  because it is still
any high risk
manageable by the family
group
specifically the Shapes
children because they wear
their slippers whenever
they walk and play but
sometimes they forget to
wear them and no one is
guiding and telling them
that it is bad not to wear
slippers since there are
microorganisms will be
going to their feet if they
don’t wear their
slippers. The
family knows what to do to
prevent the problem by just
wearing footwear.
135
Duration
>The children sometimes
does not wear slippers and
as we observed, they
sometimes wear their
slippers and sometimes
don’t.
Current Management
>Mother Circle sometimes
teaches them to wear their
slippers whenever they will
do activities such as
walking but during her work
sometimes, she forgets to
remind them to wear their
slippers.

Risk Group
>Only the children are at
risk of having this problem
since their mother knows
that wearing slippers are
important.
Salience 1/2x1 0.5 It is almost felt problem by
A problem not
the family but they still lack
needing immediate
attention of motivation to make
change
Total 3.84
Score
136
Problem #3: Poor Sanitation r/t Improper Garbage Disposal as Health Threat

Nature of the 2/3x1 0.67 Improper garbage disposal is a
Problem
health threat to the family as
it predisposes a good breeding
and resting ground for vectors of
disease such as rodents and
insects which could bring
about diseases such as
leptospirosis, dengue and the
like.
Modifiability 2/2x2 2 The problem is easily
modifiable as supported by the
following factors:
Current 
knowledge ,
technology Current Knowledge,
and
Technology and Intervention
intervention
of the family >The family is aware of this
problem; they know that
Resource of  improper garbage disposal may
the family
have a good breeding and
Resource of  resting
the Nurse
ground for vectors of diseases.
Resource of 
the
Community
137
>The family has physical
resources such as brooms and
dustpans; Mother Circle has also
the capability to clean their
house and environment.

Nurse
>The student nurses could give
the family health teachings
regarding proper garbage
disposal such as segregating
their trash to biodegradable and
non- biodegradable.
Resources of the Community

>The barangay has a garbage
truck which collects the garbage
of the barangay.
Preventive Potential 2/3x1 0.67 The problem has a moderate
preventive potential as
Severity 
factors:
Duration 
Severity
>The problem is not yet severe
Current 
Management since the mother cleans the
Exposure of  house and some of the part

any high risk outside of their house.
group
Duration
138
>The problem has existed for 2
weeks since the barangay
doesn’t collect their garbage yet.
Current Management
>The family continues to clean
their house and outside of their
house.
Exposure of any High Risk

Group
>All of the family members are
exposed to this problem
since all of them live on the sam
e house and are susceptible to
diseases that rodents and
insects may bring.
Salience 0/2x1 0 The family doesn’t recognize this

as a problem.
Not perceived as a
condition needing
change
Total 3.34
Score
139
Problem #4.1: Poor Personal Hygiene as Health Threat
Nature of the 2/3x1 0.67 Poor personal hygiene

Problem
is a health threat to the
Health Threat family as this problem
predisposes to health
deficits such as dental
caries, not washing
their hands after they
eat and does not take
a bath 2 times a day
because the next day
we would interview
them, they have the
same clothes on.
Modifiability 1/2x2 1 The problem is
partially modifiable
as supported by the
following factors:
Current Knowledge,
Technology and
Intervention
>Mother Circle does
not have any
140
knowledge about
Current X
proper hygiene as
knowledge ,
technology evidenced by the
and
children. They are not
intervention
of the family well-groomed. Mother
Circle is also busy
Resource of X working that is why she
the family
does not have time to
Resource of  groom her children.
the Nurse
Resource of  Resources of the

the Family
Community
>The family has
physical resources
such as shampoo,
soap, toothbrush, tooth
paste and the like
which can be used for
hygienic purposes but
the resources are not
enough.
Resources of the
Nurse
>The student nurses
are well-equipped with
knowledge and
skills so they are capa
ble of imparting
additional health
teachings regarding
141
the problem such as
proper hand washing
and microorganisms
that those can affect
the children’s immune
system.
Resources of the
Community
>The community offers
health teachings
regarding good
personal hygiene like
proper handwashing.
Preventive Potential 1/3x1 0.33 The problem has a low
preventive potential a
Severity 
s supported by the
following factors:
Duration 
Severity
>The problem is
Current 
Management severe because the
Exposure of  members are risk to

any high risk have different kinds of
group
disease since they are
not washing their
hands before and after
eating and brushing
their teeth after eating
and when getting up in
the morning and before
sleeping.
142
Duration
>The problem has
been existing since we
first visited.
Current Management
>Mother Circle has no
time to provide proper
hygiene to the children
since she is busy
working.

Risk Group
>All of the members of
the Shapes Family are
at risk of having bad
personal hygiene and
grooming since Mother
Circle prioritizing her
work more than the
children’s hygiene.
Salience The family does not
0/2x1 0
recognize this as a
Not perceived as a
condition needing problem since she
change
prioritizes her work
more than the
children’s hygiene.
Total 2
Score
143
144
Problem #4.2: Presence of Environmental Condition r/t Presence of Breeding and Resting Sites of Vectors
of Diseases (Rodents, Pests, Mosquitoes & Cockroaches) as Health Threat

Nature of the Problem 2/3x1 0.67 Presence of Vectors is a
health threat because these
Health Threat
can cause diseases such as
dengue, leptospirosis and
Chagas disease
Modifiability 1/2x2 1 The problem is partially mo
difiable as supported by the
following factors:
Current X
knowledge ,
technology Current Knowledge, Tech
and
nology and Intervention
intervention
of the family >The family does not know
that these vectors can
Resource of X cause them diseases such
the family
as dengue, leptospirosis
Resource of  and Chagas disease.
the Nurse
Resource of  Resources of the Family

the >The family does not
Community
eradicate these vectors by
keeping the environment
145
clean and disposing trash
properly. They don’t
segregate their trashes by
biodegradable, non-
biodegradable and recycled.

Nurse
>The student
nurses knowledge and
initiative will enable the
student nurses to provide
health education for the
family on how to minimize
if not to eradicate their
problem regarding vectors
such as always cleaning the
surroundings.
Resources of the
Community
>The community offers
health
teaching regarding Clean
and Green environmental
program where the family
could learn about it.
146
Severity  supported by the following

factors:
Duration  Severity
>This condition is definitely
Current  severe because the children
Management
experience mosquito bites
Exposure of  resulted from scratches.
any high risk
group Duration
>The problem has existed
for since the family has an
open drainage and improper
waste disposal that can
cause the vectors breeding
and resting site.
Current Management
> The family still assures
that they clean the house
and outside the house at
least once a day as
a management for the
problem.

Risk Group
>All of the family members
are at risk and are
susceptible to health
147
problems.
Salience 0/2x1 0 It is not felt a problem by the
family since they have an
Not perceived as a
condition needing open drainage and improper
change
garbage disposal which the
vectors can make them as
their breeding and resting
site.
Total 2
Score
148
Problem # 5.1: Poor Home Condition r/t Inadequate Living Space as Health Threat

Nature of the 2/3x1 0.67 The problem is considered to be
Problem
a health threat to the family,
inadequacy on the living space
denotes a crowd home
environment, which is a very
favorable environment for easy
transfer of infections.
Modifiability 0/2x2 0 The problem is low modifiable
as supported by the following
factors:
Current X Current Knowledge, Technolo

knowledge ,
gy and Intervention
technology
and >The family is not aware of the
intervention
problem; they don’t know that
of the family
their environment can
contribute to the transfer of
Resource of X
the family diseases.
Resource of 
the Nurse Resources of the Family
>There are 5 members in the
Resource of X
the family and the house is only
Community enough for 3 people since the
149
house is only 236 cm x 3 m.

Nurse
>The student nurses skills and
knowledge can help the family
by planning on how to
rearrange their furniture and
throw out old things that are not
needed to be kept in the house
anymore so that they may
increase their living space
somehow, at least to minimize
the problem.

>The community can monitor the
housing conditions through
survey and inspection; However,
the barangay is lacking with
programs to be implemented
due to lacking of funds.
factors:
Severity
>The problem is severe since
there is already presence of
runny nose and cough in
150
family members, lack of living
space may contribute to the
Severity 
transfer of runny nose and
cough between family members.
Duration 
Current  Duration
Management >The problem existed for almost
Exposure of  3 years due to the growing
any high risk
family.
group
Current Management
>The family does not have
any current management on
their problem regarding
Inadequate living space.

Group
>All of the family members are
exposed to the problem as they
all live on that house.
Salience 0/2x1 0 It is not felt a problem
Not perceived as a
condition needing
change
Total 1
Score
151
Problem # 5.2: Poor condition r/t Poor Lighting & Ventilation as Health Threat

Nature of the 2/3x1 0.67 The problem is considered a
Problem
health threat because the family
members are prone to injuries
due to difficulty to see objects
along their way, especially at
night. They can also develop
eye problems in the future
brought about by poor lighting.
Inadequate ventilation will

impede the proper circulation of
air so as to freshen and purify,
the circulation of air will be
inadequate that may lead to
inadequate exchange of gases
in the respiratory system for
normal breathing pattern. Thus
the organism that can cause
Upper Respiratory Tract
Infection is easily transferred to
another member of the family.
152
Modifiability 0/2*2 0 The problem is not modifiable a
s supported by the following
factors:
Current Knowledge, Technolo

gy and Intervention
>The family is not aware of the
existence of the problem and the
complications that can be
brought about by the inadequacy
Current X
knowledge , of lighting. There are no
technology
interventions made by the family
and
intervention to reduce the problem
of the family
This could also fall with their
problem in financial constraints
Resource of X
their income is only sufficient for
the family
their basic needs that’s why they
Resource of  could not allocate for the
the Nurse
maintenance of their house.
Resource of X
the
Community Resources of the Family
>There is electrical supply in
the community and the house
has an electric line. The family
can make use of the light bulb
as source of light especially at
night. The family lack material
resources to improve the
ventilation of their house due to
lack of financial resources. They
don’t have any windows and
153
their door measures 72 cm x
190 cm

Nurse
>The student nurses can help
the family in improving their
lighting by suggesting
alternatives and teaching them
ways to prevent accidents or eye
problems that may result from
poor lighting. The student nurse
can inform the family about the
importance of adequate
ventilation. The student nurses
can also provide alternative
ways or suggestions in
improving the problem.

>There is electrical supply in the
community and the house has
an electric line. The family can
make use of light bulbs as
source of light especially at
night. The community can
monitor the housing conditions
through survey and inspection;
However, the barangay is
lacking with programs to be
implemented due to lacking of
154
funds.
Preventive Potential 1/3*1 0.33 The problem has a low

factors:
Severity 
Duration 
Severity
Current  >The severity is high since there
Manage have been an accident that
ment
resulted from poor lighting. The
Exposure  family also still manages to do
to high
risk their activities of daily living and
some of the family members
already acquired airborne
diseases such as runny nose
and cough.
Duration
>The problem existed for almost
3 years due to low income and
lack of supplies.
Current Management
>The family does not have
enough financial and material
resources to improve the lighting
and ventilation in their house.
155
Group
>The whole family, especially
the children are prone to injuries
since objects in the house may
not be very visible at night. All of
the family is at high risk of
acquiring the disease such as
runny nose and cough. These
diseases are easily transmitted
because the family is having
inadequate ventilation.
Salience 0/2*1 0 It is not felt a problem.
Not perceived as a
condition needing
change
Total 1
Score
156
Problem # 1: Presence of Runny Nose and Cough
Health
Date Date
Conditions and Nursing Problems Supporting Data Cues
Identified Resolved
Problems
Presence of  Inability to make  “Sinisipon at inu-ubo yung November 05, November 12,
Health Deficits: Runny decisions with mga bata.” as verbalized by 2013 2013
Nose and Cough respect to taking the mother.
appropriate health
action due to:  Presence of greenish nasal
- Lack of trust and discharge was observed
confidence in the during the assessment.
health
personnel/agency.
 Failure to utilize
community resources
for health care due
to:
- Failure to perceive
the benefits of health
care/services.
157
Goal & Intervention Plans Evaluation
Objectives
Short- Nursing Intervention Method & Standards Methods &
term: Resources Tools
158
 Discuss to the family the  Student Nurse-  Student nurses  Observation
After two presence of the problem. Family interaction knowledge, and Interview
hours of student  Assess for vital signs.  Student Nurse- time, and effort
nurse-family  Perform a Family interaction about possible
interaction, the comprehensive  Student Nurse- consequences
family will assessment. Family interaction of the problem.  Observation
demonstrate  Assess for abnormal  Student Nurse-  The family will and Health
compliance to breath sounds like rales, Family interaction be willing and teachings
management and wheezes or crackles. open in
prevention of the  Provide information  Health Teachings following proper
problem. about modes of  Health Teachings interventions.
transmission of cough  The family will  Observation
and colds  Health Teachings cooperate by
Long-term:  Encourage to increase doing the health
fluid intake teachings given.
After two  Encourage the family to  Health Teachings  The family and  Observation
home visits, the increase intake of foods the student- and Return
family will be able rich in Vitamin C. nurses Demonstratio
to maintain  Provide health teachings  Health Teachings willingness and n
appropriate about prevention of such positive view in
measures in conditions. attaining the
managing the  Instruct the family to use  Health Teachings objectives.
occurrence of the herbal medicines such as  The Barangay  Observation
problem and lagundi as an alternative. Health Workers’
prevent  Encourage the mother to ability and
occurrence of keep her children’s back willingness to
transfer of disease. dry. assist or help.
Problem # 2: Unhealthy Lifestyle and Personal Habits r/t Walking Barefooted
159
Health
Date Date
Identified Resolved
Problems
Presence of  Inability to recognize  The children are walking Novem Novemb
Health Threat: the presence of the barefooted. ber 05, 2013 er 12, 2013
Unhealthy Lifestyle and condition or problem
Personal Habits r/t due to:  The children are not washing
Walking Barefooted - Lack of adequate their feet though they are
knowledge dirty.
- Attitude in life
which hinders
recognition and
acceptance of the
problem
160
Objectives
Short-term: Nursing Method & Standards Methods &
Intervention Resources Tools
After two hours  Discuss to the  Student Nurse-  The family  Observation
of nursing interventions, family the Family interaction members will
the family will be able to presence of the gradually
verbalize the problem. improve their
understanding the hygiene until
different health  Assess for vital  Student Nurse- they reach the
teachings given signs. Family interaction level of a very
regarding the good hygiene.
importance of using  Perform a  Student Nurse-
slippers. comprehensive Family interaction
assessment.
 Encourage family  Health teachings

Long-term: members to
wash their feet
After two home and use slippers.
visits, the family will be
able to demonstrate the  Inform family  Health teachings
use of slippers. member that
wearing slippers
keeps them away
from illnesses
161
Problem # 3: Poor Sanitation r/t Improper Garbage Disposal
Health
Date Date
Identified Resolved
Problems
162
Presence of  Inability to recognize  The garbage is put along the Novem Novemb
Health Threat: Poor the presence of the walkway. ber 05, 2013 er 12, 2013
Sanitation r/t Improper condition or problem
Garbage Disposal due to:  Wrappers are not being
- Lack of adequate thrown on the trash bag
knowledge instead the children throw
- Attitude in life which their trash on the ground.
hinders recognition
and acceptance of
the problem

Objectives
163
verbalize the problem. improve in the
understanding that way they
proper garbage disposal  Perform a  Student Nurse- dispose
can help prevent comprehensive Family interaction garbage.
acquiring diseases. assessment.
 Encourage family  Health teaching

Long-term: members to
throw their
After two home garbage on the
visits, the family will be trash bag.
able o demonstrate
proper garbage disposal.  Inform family  Health teachings
member that
proper garbage
disposal keeps
them away from
illnesses
164
Problem # 4: Poor Personal Hygiene
Health
Date Date
Identified Resolved
Problems
Presence of  Inability to recognize  The children are dirty and Novem Novemb
Health Threat: Poor the presence of the smelly. ber 05, 2013 er 12, 2013
Personal Hygiene condition or problem
due to:  The children are not
- Lack of adequate presentable and also the
knowledge mother.
- Attitude in life which
hinders recognition
and acceptance of
the problem
165
Objectives
verbalize the problem. improve their
understanding the hygiene until
different health  Assess for vital  Student Nurse- they reach the
teachings given signs. Family interaction level of a very
regarding good hygiene. good hygiene.
 Perform a  Student Nurse-
Long-term: comprehensive Family interaction
assessment.
After two hoe
visits, the family will be  Encourage family  Health teachings
able to demonstrate members to take
improvement on their a bath regularly.
personal hygiene.
 Inform family  Health teachings
member that
good hygiene
keeps them away
from illnesses
166
Problem # 5: Presence of Environmental Condition r/t Presence of Breeding Sites of Vectors of Diseases (Rodents, Pests, Mosquitoes,
and Cockroaches)
Health Conditions Date Date

Nursing Problems Supporting Data Cues
and Problems Identified Resolved
167
Presence of Health  Inability to provide a  House is observed to be Novem Novem
Threat: Poor home environment unclean and not organized. ber 05, 2013 ber 18, 2013
home/environment/ conducive to health
sanitation – maintenance and  The door is not screened.
presence of breeding places personal development
or resting sites of vectors of due to:  Presence of stagnant water.
diseases (cockroaches and - Inadequate family
rats) resources, specifically  Presence of animal fecal
limited financial matter around the house.
resources.
- Inadequate  Presence of mosquitoes, flies,
knowledge of rats, and cockroaches around
importance of hygiene the house.
and sanitation.
- Inadequate  Presence of unsanitary
knowledge of drainage system.
preventive measures.

Objectives
Short-term: Nursing Intervention Method & Standards Methods &
Resources Tools
168
After two hours  Assess the family’s level of  Student Nurse-  The student-  Observation and
of student nurse-family knowledge and Family nurses’ Interview
interaction, the family understanding of the interaction and assessment of the
will be able to recognize problem. observation family’s home
and understand the during the last
health consequences of  Provide teachings regarding  Health teachings home visit.
the presence of the different diseases that
breeding grounds of can be acquired from insects  The student-  Observation and
rodents and insects. and rodents. nurses’ inspection Inspection
of the drainage
 Assist the family in cleaning  Student Nurse- system and of
Long-term: their house and the Family garbage bins,
surrounding area. interaction comparing the
After three home family’s current
visits, the family will be  Teach the children on how to  Demonstration state from their
able to clean the properly dispose their waste, and health previous state
surrounding area, to especially their food teachings during the initial
include the cleaning of wrappers. home visit.
the drainage system and
the practice of proper  Instruct the parents to set up  Health teachings;
garbage disposal. traps for rodents and the use Student Nurse-
of affordable insect Family
repellants. interaction
 Health teachings
 Encourage the parents to
dispose things that could
serve as breeding sites of
insects such as can and tires.
169
Problem # 6: Poor Home Condition r/t Inadequate Living Space
Health
Date Date
Identified Resolved
Problems
Presence of  Inability to provide a  One bedroom for the whole Novem Novemb
Health Threat: Poor home environment family. ber 05, 2013 er 12, 2013
home/environment which is conducive to
condition/sanitation health maintenance due  With seven family members
(Inadequate living to: (including Father Hexagon
space) - Limited financial and Rectangle)
resources and limited
physical resources.  Has a floor area of 20x24
- Lack of/inadequate sq.m
knowledge of
preventive measures.
170
Objectives
Short-term: Nursing Method & Standards Methods & Tools
Intervention Resources
171
After two hours  Inform on the  Student Nurse-Family  The student-nurses’  Observation and
of student nurse-family importance of interaction and knowledge about Health Teachings
interaction, the family having an adequate Observation the causes,
will be able to verbalize living space. possible
the importance of complications, and
providing enough space  Discuss the possible  Student Nurse-Family management of
to allow variety of complications of interaction inadequate living
movements. having an space.
inadequate living  The student-nurses’  Observation and
Long-term: space such as easy giving of safety Return
spread of disease measures. demonstration
After two home among the family
visits, the will be able to members.  The family’s  Observation
demonstrate cooperation in
compliance of  Encourage proper  Student Nurse-Family doing the
techniques in providing arrangement of interaction appropriate
enough space to allow furniture within the interventions.
variety of movements as house.
evidenced by proper  The family’s  Interview
arrangement of the  Instruct to dispose  Student Nurse-Family alternative and
furniture. or removal of interaction availability of
useless materials. resources.
Problem # 7: Poor Home Condition r/t Poor Lighting and Ventilation
Health Nursing Problems Supporting Data Cues Date Date

Conditions and Identified Resolved
172
Problems
Presence of  Inability to make decisions  It was dark inside their house Novem Novemb
Health Threat: Poor with respect to taking because it has no windows ber 05, 2013 er 18, 2013
Home Condition r/t Poor appropriate health action here light can enter.
Lighting and Ventilation due to:
- Low salience of the  The house has no windows so
problem/condition. not much air is coming inside
- Inability to decide the house.
which action to take
from among a list of
alternatives.

Objectives
173
Short-term: Nursing Method & Standards Methods & Tools
Intervention Resources
After two hours  Discuss to the  Student Nurse-  The family and  Observation and
of student nurse-family family the Family the student- Interview
interaction, the family presence of the interaction nurses’ time and
will verbalize problem. effort in doing
understanding of the ways on how to
health teachings given  Assess for the  Student Nurse- improve their
regarding the family’s ability to Family lighting and
importance of proper care for the interaction ventilation.
lighting and ventilation. presence of the
problem.  The family and  Observation and
the student- Interview
Long-term:  Discuss and  Student Nurse- nurses’
identify with the Family willingness to
After three home family the interaction attain the
visits, the family will potential objectives.
demonstrate some ways complications
to improve their lighting that may arise
and ventilation such as and how to
creating even just as initiate in relation
small window to allow to the problem.
light and air to enter the
house.
174
Family Coping Index
Initial Final
Category Justification
1 3 5 1 3 5
Physical Independence.  Initial Visit:
Mother Circle is providing needs of

its family size. She goes to the
market at morning and goes home
before lunch to cook for her children.
Final Visit
No changes regarding financial

support because it’s only mother
Circle who’s working, but the others
especially Triangle can help by
taking care of baby Oval.
175
Initial Final
1 3 5 1 3 5
Therapeutic Competence  Initial Visit:
The mother told the nursing student

that they don’t believe in herbolario
and they go directly to the hospital
for a check-up.
176
Final Visit
After the health teachings and

interventions done by the group, they
noticed the willingness of the family
to learn. It has been observed that
they want to become more

knowledgeable and responsible for
their health. They are more opened
to choices that can bring a healthy
life to the family.
Initial Final
1 3 5 1 3 5
Knowledge of Health  Initial Visit:

Conduction.
The family doesn’t always take a
bath. Since they don’t have a
personal restroom, they take a bath
outside without privacy. They are not
177
aware of the microorganisms that
can get into their body.

Final Visit
After the health teachings done by

the group, the family acquired some
knowledge regarding certain
common illness like how can it be
transmitted and how it can be
prevented.
178
Initial Final
1 3 5 1 3 5
Application of Principle  Initial Visit:

Personal and General
In the first home visit the house was
Hygiene.
clean since it is small, it easy for
them to clean their house. They also
have a poor ventilation because they
don’t have a window and they only
have a door that is always open.
179
Final Visit
The family's household was much

cleaner than before. They always
clean since their house is only small.
Initial Final
1 3 5 1 3 5
Health Care Attitudes  Initial Visit:
The whole family are not aware on

the possible disease condition or
conditions that may worsen on the
health of each member. Their
knowledge about health was limited
and all they do in order to maintain a
good health was only based on their
own understanding of health.
Final Visit
180
The family was able to show their
understanding the need for medical
assistance and the need to comply
on the health teachings given by the
Student Nurses.
Initial Final
Justification
Category 1 3 5 1 3 5
Emotional Competence  Initial Visit:
The family has no plans for

foreseeable emergencies.
Final Visit
181
The family had talked about the
foreseeable crisis and is ready to
take their responsibility for the family.
Initial Final
1 3 5 1 3 5
Family Living Patterns  Initial Visit:
The family gets along well with their

neighbors. The children always play
outside.
Final Visit
182
The last home visit, we certainly see
a lot of chemistry with the family.

Triangle watches baby Oval when
the mother is not around.
Initial Final
1 3 5 1 3 5
Physical  Initial Visit:
Environment In the initial visit of the group, they

noticed that the place is small. They
have inadequate ventilation and no
restroom inside their house.
Final Visit
In the final home visit, some changes

were observed in the environment.
They clean their house everyday not
leaving any dust or dirt.
183
Initial Final
1 3 5 1 3 5
Physical  Initial Visit:
Environment The family is aware of the services

provided by the community like the
health center. They always visit a
doctor for check-up.
Final Visit
184
The mother shows understanding of
the importance of utilizing community
resources such as health center.
185
VI. SOCIOGRAM
This chapter illustrates graphic representation of the several home visits made,
including the interactions of the student nurses with the families, the assessment,
planning, interventions done.
Legend:
186
NURSE FAMILY HOUSE
HEALTH CENTER
RAPPORT
ASSESSMENT
HEALTH TEACHINGS
NURSING INTERVENTIONS
WELLNESS
187
During the initial visit (November 05, 2013), the student nurses feel comfortable with the
adopted family because of the warm welcome and showing of willingness of the family. Upon
meeting them, they started to establish rapport and told the family about the purpose of their
study and immediately interviewed. At the same time, they take the vital signs of the family
members that are present.
At the second visit (November 11, 2013), the student nurses continue the interview to
have enough data. During the interview, they did the health assessment of the family members
that are present. Mother Circle was not around because she is at the market. The student
nurses weren’t able to give health teachings because Mother Circle is not around. The student
nurses took the height and weight of the family members that are present.
At the third visit (November 12, 2013), Mother Circle was already present. The student
nurses get her height and weight to complete their data. During the assessment, the student
nurses gave health teachings to Mother Circle for them to be aware about their problems that
are affecting their health.
During this time, the family shows satisfaction and appreciation for what the student
nurses are doing. The group as well gave them a positive feedback and thanks them for
allowing the group to conduct the study with their participation.
At the final visit (November 18, 2013), the student nurses continue to assess and
interview the family members to have complete data. The student nurses gave the children
some foods and bathe them. Health teachings were given in order for the family to deliver
proper interventions to their problems effectively and independently without the student nurses’
help.
Documentation
November 11, 2011
188
189
November 12, 2013
190
191
192
November 18, 2013
193
194
195
196
197
198
199

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ANG ELES UNIVERSITY FOUNDATION

A FAMILY CASE ANALYSIS

IN BARANGAY LOURDES NORTH WEST, ANGELES CITY, PAMPANGA

Cruz, Hazel Irish B.

Manalang, Ma. Clarelle S.

GROUP 8, B.S.N. III – B

Ria Rose C. Celis, RN, MN

Family is an important unit of society. It holds great importance in social life. It

Community health nursing practice promotes and preserves the health of

The family case analysis is mainly directed on identifying and analyzing

The following objectives were formulated in order to guide

 Set criteria for the family to be chosen;

 Familiarize themselves with the physical setup of the community;

 Collect data regarding the family’s demographic profile through

 Identify the family’s problems and needs based on the analysis of

 Establish a good working relationship with their adopted family;

 Accomplish thorough physical assessment of the whole family;

 Work with the family in solving identified health problems;

 Provide necessary health teachings and suggestions based on

 Evaluate family’s response to health teachings given;

 Accept the student nurses in an accommodating manner;

 Familiarize and trust themselves with the student nurses;

 Provide the student nurses necessary information they need;

 Participate in the individual physical assessment;

 Become self-reliant in managing identified health problems;

 Utilize available resources in the community;

 The family described as to:

 The family’s home and environment as to:

 The family’s health status as to:

 Values, habits and practices of the family on health promotion,

 How may the problems encountered by the family be identified, classified

A. Entry, Climate of acceptance, First few words and Number of Home

Our first day of exposure in the community of Barangay Lourdes North

First Week of Visit

First Home Visit (November 5, 2013, Tuesday)

Second Week of Visit

Second Home Visit (November 11, 2013, Monday)

The group arrived on their respective family at around 11: 00 am on a

Third Home Visit (November 12, 2013, Tuesday)

Third Week of Visit

Fourth Home Visit (November 18, 2013, Monday)

PRESENT HEALTH STATUS

a. Physical Assessment (Starting from the head of the family)

First Week of Visit

 SKIN, HAIR AND NAILS

 HEAD AND NECK

Headaches were absent. Head is on the midline upon inspection and no

 EYES AND VISION

 MOUTH AND OROPHARYNX

 THORAX AND LUNGS

 BREAST AND LYMPHATICS

Abdomen is uniform in color and no presence of lesions or rashes noted upon

 UPPER AND LOWER EXTREMITIES

The skin is uniform in color with no contractures or deformities. Muscles on

 ANUS AND RECTUM

 SKIN, HAIR AND NAILS

 HEAD AND NECK

Headaches were absent. Head is on the midline upon inspection and no

 EYES AND VISION

 MOUTH AND OROPHARYNX

 THORAX AND LUNGS

 BREAST AND LYMPHATICS

Upon palpation, there were no lumps, discharges or any swollen lymph