CHAPTER I

INTRODUCTION

A community is a small or large social unit (a group of living things) that has

something in common, such as norms, religion, values, or identity. Communities often

share a sense of place that is situated to a given geographical area (e.g. a country,

village, town, or neighborhood) or in virtual space through communication platforms. We,

the student nurses were able to display our skill, knowledge and ability in our community

health nursing rotation and to transfer our class room-acquired experience to our fellow

men in the community.

Community Health Nursing being the opportunity given to student nurses to

practice the act of care in the community is defined as the synthesis of nursing and

public health practice applied to promote and protect the health of population. It

combines all the basic elements of professional, clinical nursing with public health and

community practice. Community health nursing is essential particularly now because it

maximizes the health status of individuals, families, groups and the community through

direct approach with them. One of the important elements to be consider during

community health nursing is the family, irrespective of the type of family.

The family is the smallest unit of the society and the natural fundamental core of

the community and consequently, it is considered as the primordial recipient of the

nursing effort, which is contributory to the development, and progress of the community

through active involvement and self-responsibilities of each constituent. It is composed

of persons, male and female, being molded to be as one, working hand in hand to

maintain a good atmosphere among the family members. Among the different families in

the community are different health conditions present. For example, pneumonia

tuberculosis, diabetes, hypertension, asthma, malnutrition, and pregnancy complications

like preeclampsia. Malnutrition being the most common factor in the community was

chosen for the case study.

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of

energy and or nutrients. Malnutrition can be seen in ‘under nutrition’—which includes

stunting (low height for age), wasting (low weight for height), underweight (low weight for

age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and

1
minerals). The other is overweight, obesity and diet-related non-communicable diseases

(such as heart disease, stroke, diabetes and cancer). In the Philippines, according to the

National Nutrition Council (NNC) earlier this year, more than 3.8 million children in the

nation are stunted or short for their age, while about 807,057 are wasted or underweight.

This is equivalent to about 33.4 percent and 7.1 percent of children in the country. In

2017, globally, there were 151 million children under 5 year of age were stunted, 51

million wasted, and 38 million overweight.

OBJECTIVES

General Objective:

Student nurses will be able to put into practice the art and concepts of family-oriented

Nursing care and be competently able to deliver quality nursing services to the family

and community. Furthermore, the adopted family will also gain more knowledge about

the identified health problems in the family and maintain their health status by

accomplishing the following specific objectives;

Specific Objectives:

For the family:

 Be knowledgeable on the basic nursing care and prevention of family health

problems.

 Be able to properly manage and maintain a good nutritional routine in their

family.

 Utilize the health teachings on proper sanitation in the management of home and

environment.

For the community:

 Be able to gain more knowledge about basic nursing care through the health

teachings given.

 Utilize the health services and resources available in the community to promote

their health.

 Give importance on proper sanitation and maximize efforts on the management

of environment.

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For the student-nurse:

 Student nurse should be able to grasp the concept of community health nursing

through understanding the essence of family, community and its relationship.

 Should be competently relate the family problem in formulating nursing

interventions relevant to helping students have more skills in critical thinking and

planning nursing care.

 Should be able to utilize the concepts of Community Health Nursing and relevant

skills to be able to deliver health services as well as to be an instrument to raise

awareness to the community.

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 CHAPTER II

FAMILY PROFILE

Position Relationship
Family Civil Educational
Age Sex in the to the Family Occupation
Members Status Attainment
Family Head

E. G. 26 M Married Head Elementary Stock Clerk

C. A. G. 26 F Married Wife Wife Elementary Housewife

M. A. G. 9 M Single Child Son Grade 3 Student

E. A. G. 7 M Single Child Son Grade 1 Student

C. A. G. 5 F Single Child Daughter Kindergarten Student

C. A. G. F Single Child Daughter Newborn

The adopted family is composed of six members. The head of the family, Mr. E.

G. is 26 years of age and married to Mrs. C. G. His highest educational attainment is

Elementary level and is currently working as a Stock Clerk. His wife, Mrs. C.G. is 26

years old. Her highest educational attainment is Elementary level. She is currently

unemployed and is a housewife.

The couple has four children, namely M.A. G., E.A. G., Older C.A. G. and the

youngest, and an additional member of the family, C.A. G. The eldest child, M.A. G., is

nine (9) years old, male and is currently a grade three (3) student at San Agustin

Elementary School. The second child, E.A.G. is seven (7) years old, male and a grade

one (1) student of San Agustin Elementary School.The third child, C. A. G. is five (5)

years of age, female and is currently a Kindergarten student at San Agustin Elementary

School. The couple had an additional member of the family, who is named C.A. G. as

well and is a healthy, baby girl.

4
 CHAPTER III

INITIAL DATA

A. Family Structure

The G. family is classified as nuclear family. It is composed of six family

members. The head of the family is E.G., 26 years old and his loving wife is C. A. G, 26

years old. The couple has four children; two of them are boys and the other two are girls.

The eldest son is nine years of age named M. A. G. The second son, aged seven is E.

A. G. The third child is a five-year old girl named C. A. G. The family recently had an

additional member of the family, named C. A. G. The mother was raised in Barangay

San Agustin, City of San Fernando La Union. She got married to Mr. E. G. who is

originally from Palugsi, Limasangan, Bauang La Union. Thus, it is a matrilocal type of

family according to residence.

B. Socio Economic and Cultural Background

Both parents are elementary graduate. The father earns 287 pesos a day for six

days in a week (6,888 pesos a month) at IQC Trading Company as man power (Stock

Clerk). He has been working there since 2010 without benefits. The wife is unemployed

so she stays at home to look after the children, especially now that they have a newborn.

Family income is not enough to sustain their daily needs. According to the mother, “Nu

awan iti paggatang mi, urayin mi pay ni lakay ko nga agsweldo sa ka min to gumatang ti

masapol.” Children skip classes due to financial problems. The eldest son verbalized,

“Awan balon mi” when he was asked why they do not come to class.

The adopted family's religious affiliation is Roman Catholic. As much as the

family would like to go to the church often, they are financially constrained.

C. Home and Environment

The adopted family is currently living in a congested area in Purok 2A, San Agustin,

City of San Fernando. San Agustin is around 5 kilometers away from Lorma Colleges.

The house is made of concrete and wood, with two bedrooms and a joint living room

and kitchen. The rest room is located near the house and is shared with the other

residents. The source of water used for their household chores comes from the

5
 communal water pump and the mother expressed her concern for her newborn,

“Mabutengak ta baka agsakit isuna gapo jay danom nga ususaren mi ket haan nga

nadalos.” They use clay pot and firewood for cooking, and refrigerator for food

storage. Presence of breeding sites of vectors of diseases such as the open drainage

near and beside their house is seen as well. In addition, the father claimed that “Nu

aglab-laba da jay bangir idta nga maururnong jay danum”. Despite the fact that they

own the house, the land is considered as a government-owned property.

D. Family Health Status

The only known familial disease is high blood pressure and anemia according to

the father. The head of the family has never been diagnosed or hospitalized with their

known familial disease. The father is well, has no previous hospitalization and has no

known food and drug allergy. The mother has no previous hospitalization other than

delivering her three (3) children via Normal Spontaneous Delivery. She recently gave

birth to a healthy baby girl through Normal Spontaneous Delivery as well. She has no

known food and drug allergy. The eldest son, M. A. G. has no known past hospitalization

but had previous intestinal worm infestation. His initial weight is 15kg and height 1.1m,

having a BMI of 12.39 and is considered as underweight. He has no known food and

drug allergy. The second son, E. A. G. has no known past hospitalization but had

previous intestinal worm infestation. His initial weight is 13kg and height is 0.90m having

a BMI of 16.04 and is also considered underweight. The third child, C.A.G., female, has

no past hospitalization as well. Her initial weight is 14kg and height 0.86m, having a BMI

of 18.92 that is normal for her age. When the mother was asked regarding the eating

habits of her children, the response was “napigsa da met amin nga mangan ma’am.”

E. Values Placed on Health

The outlook of the family with regards to health and its promotion is not deemed

as necessary because it is not one of their top priorities due to financial constraints.

This is reflected by their awareness of the availability of the services offered by the

Barangay but they do not make utmost use of the resources. They have insufficient

knowledge on when to consider having checked by a health worker as well as not

6
being aware of the schedule for free check-ups conducted at the Barangay.

7
 Physical Assessment

First Physical Assessment

E. G., the head of the family, has normal body build and has no deformities. He

has a tiring looking face but is an oriented man. He is able to respond to the given

questions well during our assessment. He has an even brown skin tone with a smooth

black hair. He is well-groomed, wearing clean and comfortable shirt and shorts.

His hair is black and smooth in texture and scalp has no presence of scaling and

lesions observed. His ears do not have any lesions but there is a presence of earwax.

For the eye assessment, patient's pupils are constricting, conjunctiva is clear and sclera

is white in color. His eyelashes are free of infestation as well. Furthermore, his mouth is

moist and has no lesions. His lips are pinkish in color and has clean and good dentition.

He has even brown skin tone but his arms and hands are dry in texture with no presence

of lesions. He has a good skin turgor and normal capillary refill. His nails and palms are

pinkish in color. His nails are well-trimmed and has no clubbing observed. His lungs do

not have adventitious sounds and accessory muscle is not used for breathing. His

abdomen is of normal contour, skin tone is even and free of lesions. The legs and feet of

the father’s skin tone are even and is free of lesions.

C. A. G., the wife, is currently at her ninth (9th) month of pregnancy. She is well-

groomed, wearing clean and comfortable sleeveless and shorts during the assessment.

She is an alert and oriented woman. However, there are times that she answers

questions that she is not sure of. She has complaints of mild headache and uses an

ointment for relief. She has even brown skin tone and has normal body build and no

deformities. However, her feet have presence of edema.

Her hair is black in color and dry in texture. Her scalp has no scaling and no

lesions present. Her ears do not have any lesions but there is a presence of earwax. For

the eye assessment, the pupils are constricting, conjunctiva is clear and sclera is white

in color. Her eyelashes are free of infestation as well. Her mouth is dry and lips are

blackish. She has good dentition but teeth are tarnished. Her arms and hands are dry in

texture with no lesions and no clubbing in the nails. However, her nails are dirty and

untrimmed. She has good skin turgor and capillary refill. Lungs have no adventitious

8
sounds and patient is not using any accessory muscles for breathing. Her abdomen has

a presence of linea nigra and striae. Her legs and feet do not have lesions but there is a

presence of edema.

M. A. G., the eldest son, is a weak-looking but oriented young boy. He has even

brown skin tone and his chest and abdomen are bulging. He is wearing a comfortable

shirt and shorts during our assessment.

M. A. G. has a black hair but dry in texture and scalp has no scaling and lesions

observed. His ears do not have any lesions but has presence of earwax. For the eye

assessment, his pupils are constricting, conjunctiva is clear and sclera is white. His

eyelashes are free of infestation. His mouth is moist, tongue free of lesions but has

whitish, milky-like patches. He has poor dentition and tarnished teeth is present. He has

good skin turgor but arms and hands are dry in texture. He has good capillary refill, no

clubbing but has dirty and untrimmed nails. His abdomen and chest are bulging but has

no lesions. Legs and feet do not have lesions but has dirty, untrimmed nails with

presence of hematoma on the left big toe.

E. A. G., the second child, is an attentive and oriented young boy. He has poor

grooming because his clothes are unclean and torn. He is short for his age, has no

deformities and shoulders are prominent.

E. A. G. has a black with shades of brown hair and is dry in texture. His scalp is

free of lesions and scaling. His ears do not have lesions but there is a presence of

earwax. For the eye assessment, pupils are constricting, conjunctiva is clear and sclera

is white. His eyelashes are free of any infestation as well. Mouth is moist and lips are

pinkish in color. His tongue is free of lesions but has white, milky-like patches. He has

poor dentition because the lower teeth is incomplete. He has good skin turgor and good

capillary refill. His arms and hands are even in skin tone, dry in texture and has no

presence of lesions. His nails are dirty and untrimmed but has no clubbing nails. Lungs

do not have adventitious sounds and no accessory muscles used for breathing. His

abdomen is enlarged or bulging and navel is dirty. Legs and feet do not have any lesions

and nails on the feet are dirty and untrimmed.

9
 C. A. G., the third child, is a well-groomed young girl, wearing a matched

sleeveless and shorts and clean slippers. She is responsive during the interview and

cooperative during the assessment. She has normal body build and no deformities.

C. G.'s hair is black and smooth in texture. Her scalp is free of scaling and any

lesions. Her ears are aligned to the eye and has no lesions present. However, there is a

presence of earwax. For the eye assessment, pupils are constricting, conjunctiva is clear

and sclera is white. Her eyelashes are free of infestation. Mouth is moist and lips are

pinkish in color. She has good dentition because upper and lower set of teeth is

complete but has presence of cavities. She has even brown skin tone and good skin

turgor. Her arms and hands have dry skin but has no lesions. Her nails are dirty and

untrimmed and no clubbing nails observed. She also has a good capillary refill. Lungs

have no adventitious sounds and no use of accessory muscles used for breathing. C. A.

G.’s abdomen is normal in contour and is free of lesions. Legs and feet do not have

lesions but nails are untrimmed and unclean.

Second Physical Assessment

E. G., the head of the family, is well-groomed wearing comfortable shirt and

shorts. He is alert and responsive during the interview and assessment. He is sitting on

the chair during the assessment with slouched back.

His hair is black and smooth in texture and scalp has no presence of scaling and

lesions observed. His ears do not have any lesions and there is no presence of earwax.

For the eye assessment, patient's pupils are constricting, conjunctiva is clear and sclera

is white in color. His eyelashes are free of infestation as well. Furthermore, his mouth is

moist and has no lesions. His lips are pinkish in color and has clean and good dentition.

He has even brown skin tone but his arms and hands are dry in texture with no presence

of lesions. He has a good skin turgor and normal capillary refill. His nails and palms are

pinkish in color. His nails are well-trimmed and has no clubbing observed. His lungs do

not have adventitious sounds and accessory muscle is not used for breathing. His

10
abdomen is of normal contour, skin tone is even and free of lesions. The legs and feet of

the father’s skin tone are even and is free of lesions.

C. A. G., the wife, is well-groomed wearing clean and comfortable shirt and

shorts during the assessment. She has a tired-looking face and waddling gait.

Her hair is black in color and dry in texture. Her scalp has no scaling and no

lesions present. Her ears do not have any lesions but there is a presence of earwax. For

the eye assessment, the pupils are constricting, conjunctiva is clear and sclera is white

in color. Her eyelashes are free of infestation as well. Her mouth is dry and lips are

blackish. She has good dentition but teeth are tarnished. Her arms and hands are dry in

texture with no lesions and no clubbing in the nails. However, her nails are dirty and

untrimmed. She has good skin turgor and capillary refill. Lungs have no adventitious

sounds and patient is not using any accessory muscles for breathing. Her abdomen has

a presence of linea nigra and striae. Her legs and feet do not have lesions but there is a

presence of edema.

M. A. G., the eldest son, is wearing a t-shirt and torn shorts. He has more energy

because he is looking livelier than the initial assessment.

M. A. G. has a black hair but dry in texture and scalp has no scaling and lesions

observed. His ears do not have any lesions and has no presence of earwax. For the eye

assessment, his pupils are constricting, conjunctiva is clear and sclera is white. His

eyelashes are free of infestation. His mouth is moist, tongue free of lesions but has

whitish, milky-like patches. He has poor dentition and tarnished teeth is present. He has

good skin turgor but arms and hands are dry in texture. He has good capillary refill, no

clubbing, clean and trimmed nails. His abdomen and chest wall are bulging but has no

lesions. Legs and feet do not have lesions and has clean, trimmed nails with presence of

hematoma on the left big toe.

E. A. G., the second child, is sitting in the chair with slouched back. He is well-

groomed, with clean shirt and shorts. He has no deformities and shoulders are

prominent.

11
 E. A. G. has a black with shades of brown hair and is dry in texture. His scalp is

free of lesions and scaling. His ears do not have lesions and there is no presence of

earwax. For the eye assessment, pupils are constricting, conjunctiva is clear and sclera

is white. His eyelashes are free of any infestation as well. Mouth is moist and lips are

pinkish in color. His tongue is free of lesions but has white, milky-like patches. He has

poor dentition because the lower teeth are incomplete. He has good skin turgor and

good capillary refill. His arms and hands are even in skin tone, dry in texture and have

no presence of lesions. His nails are clean and well-trimmed. Lungs do not have

adventitious sounds and no accessory muscles used for breathing. His abdomen is

enlarged or bulging and navel is clean. Legs and feet do not have any lesions and nails

on the feet are clean and well-trimmed.

C. A. G., the third child, is a well-groomed young girl, wearing a loose shirt and

pink shorts. She has proper hair grooming as well but her hands are unclean because of

the dirt she played before the physical assessment.

C. G.'s hair is black and smooth in texture. Her scalp is free of scaling and any

lesions. Her ears are aligned to the eye, has no lesions present and free of earwax. For

the eye assessment, pupils are constricting, conjunctiva is clear and sclera is white. Her

eyelashes are free of infestation. Mouth is moist and lips are pinkish in color. She has

good dentition because upper and lower sets of teeth are complete but has presence of

cavities. She has even brown skin tone and good skin turgor. Her arms and hands have

dry skin but have no lesions. Her nails are dirty and untrimmed and no clubbing nails

observed. She also has a good capillary refill. Lungs have no adventitious sounds and

no use of accessory muscles used for breathing. C. A. G.’s abdomen is normal in

contour and is free of lesions. Legs and feet do not have lesions but nails are untrimmed

and unclean.

Baby C. A. G., is a healthy-looking baby girl. She is asleep, lying in supine

position. She is wearing a white with shades of pink baby clothes that is conducive for

her comfort. An amulet like beads of black and red is clipped on her clothes and another

on her right wrist. She has no deformities, has a normal head circumference of 35 cm.

12
 Baby C. G.'s head is of normal contour with a measurement of 35 cm and has

few hair. Her ears are aligned to her brows and free of any lesions. For the eye

assessment, the cornea is transparent, iris gray in color. Her lips are pinkish in color and

mouth is moist. Her arms and hands are smooth in texture. Lungs do not have

adventitious sounds and no use of accessory muscles for breathing. Contour of

abdomen is protuberant and clamped umbilical cord is still present. Extremities tend to

flex towards the chest, fingernails are soft to touch and palmar crease is more than one.

Legs and feet are sensitive to touch and nails are pinkish in color.

Third Physical Assessment

E. G., the head of the family, is sleepy from taking a nap but is attentive during

the physical assessment. He is wearing a clean, white shirt, comfortable clothes but has

no slippers on.

His hair is black and smooth in texture and scalp has no presence of scaling and

lesions observed. His ears do not have any lesions and there is no presence of earwax.

For the eye assessment, patient's pupils are constricting, conjunctiva is clear and sclera

is white in color. His eyelashes are free of infestation as well. Furthermore, his mouth is

moist and has no lesions. His lips are pinkish in color and has clean and good dentition.

He has even brown skin tone but his arms and hands are dry in texture with no presence

of lesions. He has a good skin turgor and normal capillary refill. His nails and palms are

pinkish in color. His nails are well-trimmed and has no clubbing observed. His lungs do

not have adventitious sounds and accessory muscle is not used for breathing. His

abdomen is of normal contour, skin tone is even and free of lesions. The legs and feet of

the father’s skin tone are even and is free of lesions.

C. A. G., the wife, is sitting with slouched back during the physical assessment.

She is tired and is feeling hot as manifested by excessive sweating.

Her hair is black in color and dry in texture. Her scalp has no scaling and no

lesions present. Her ears do not have any lesions and there is no presence of earwax.

For the eye assessment, the pupils are constricting, conjunctiva is clear and sclera is

white in color. Her eyelashes are free of infestation as well. Her mouth is dry and lips are

13
blackish. She has good dentition but teeth are tarnished. Her arms and hands are dry in

texture with no lesions and no clubbing in the nails. However, her nails are clean and

trimmed. She has good skin turgor and capillary refill. Lungs have no adventitious

sounds and patient is not using any accessory muscles for breathing. Her abdomen has

a presence of linea nigra and striae. Her legs and feet do not have lesions but there is a

presence of edema.

M. A. G., the eldest son, is wearing a clean shirt and shorts with slippers on. He

has unclean nose and sweaty as he is playing with a neighbor prior to the interview.

M. A. G. has a black hair but dry in texture and scalp has no scaling and lesions

observed. His ears do not have any lesions and has no presence of earwax. For the eye

assessment, his pupils are constricting, conjunctiva is clear and sclera is white. His

eyelashes are free of infestation. His mouth is moist, tongue free of lesions but has

whitish, milky-like patches. He has poor dentition and tarnished teeth are present. He

has good skin turgor but arms and hands are dry in texture. He has good capillary refill,

no clubbing but has unclean and untrimmed nails. His abdomen and chest wall are

bulging but has no lesions. Legs and feet do not have lesions and but unclean and

untrimmed nails with presence of hematoma on the left big toe.

E. A. G., the second child, is tired and grasping for breath because he is playing

prior to our assessment. He has unclean shirt and shorts with hands that are unclean as

well.

E. A. G. has a black with shades of brown hair and is dry in texture. His scalp is

free of lesions and scaling. His ears do not have lesions and there is no presence of

earwax. For the eye assessment, pupils are constricting, conjunctiva is clear and sclera

is white. His eyelashes are free of any infestation as well. Mouth is moist and lips are

pinkish in color. His tongue is free of lesions but has white, milky-like patches. He has

poor dentition because the lower teeth are incomplete. He has good skin turgor and

good capillary refill. His arms and hands are even in skin tone, dry in texture and have

no presence of lesions. His nails are unclean and untrimmed. Lungs do not have

adventitious sounds and no accessory muscles used for breathing. His abdomen is

14
enlarged or bulging and navel is clean. Legs and feet do not have any lesions and nails

on the feet are unclean and untrimmed.

C. A. G., the third child, is a well-groomed young girl wearing her school uniform.

She has proper hair grooming as well and her face is sweaty.

C. G.'s hair is black and smooth in texture. Her scalp is free of scaling and any

lesions. Her ears are aligned to the eye, has no lesions present and free of earwax. For

the eye assessment, pupils are constricting, conjunctiva is clear and sclera is white. Her

eyelashes are free of infestation. Mouth is moist and lips are pinkish in color. She has

good dentition because upper and lower sets of teeth are complete but has presence of

cavities. She has even brown skin tone and good skin turgor. Her arms and hands have

dry skin but has no lesions. Her nails are clean and well-trimmed and no clubbing nails

observed. She also has a good capillary refill. Lungs have no adventitious sounds and

no use of accessory muscles used for breathing. C. A. G.’s abdomen is normal in

contour, free of lesions and skin tone is even with the body. Legs and feet do not have

lesions and nails are trimmed and clean.

Baby C. A. G., is wearing an amulet like beads of black and red on her right

wrist. She is crying with no tears present. She has no deformities, has a normal head

circumference of 35 cm and has few hairs.

Her ears are aligned to her eyes and free of any lesions. For the eye

assessment, the cornea is transparent, iris gray in color. Her lips are pinkish in color and

mouth is moist. Her arms and hands are smooth in texture. Lungs do not have

adventitious sounds and no use of accessory muscles for breathing. Contour of

abdomen is normal and clamped umbilical cord is still present. Legs and feet are

sensitive to touch and nails are pinkish in color.

15