Table of Contents

I. II. III.

Introduction Family Health History Nursing System Review Chart Integrated Management of Childs Illness

IV. V. VI. VII. VIII. IX. X. XI. XII. XIII.

Home and Environment Profile Family Coping Index Schematic Presentation of Family Health Problem Nursing Care Plan Drug Study Family Care Plan Actual Implementation/ Progress Notes Recommendation Bibliography Documentation

Introduction The family is the basic unit of a society. Hence, for a community to prosper, the change and improvement should primarily start within the family. Healthy families create a healthy community. Considering the family as the building blocks to creating a better community, community health nursing focuses on educating the people in the community to understand and develop their critical awareness about their existing conditions in order to develop the capability of responding to their identified needs. Though the community is well advancing to become more developed, some issues become overlooked specially in terms of health orientation, importance, and maintenance. Other factors that might have affected the current status of this community is low income due to incompetent educational attainment of the working members of the family which resulted to incomplete basic housing facilities, insufficient family support, inadequate supply of basic needs, and malnutrition of children. Other factors also include poor orientation about hygiene and environmental cleanliness.

Objective This study is well intended to suffice the learning of Medical-Surgical Nursing students about the current status of the community, identify specific problems that would require assistance, appreciate different manifestations of possible illness/disease present in each of the households in the community, and incorporate learned theories from Medical-Surgical Nursing into practice in terms of giving health teachings and applying related nursing interventions as necessary. Furthermore, it is aimed to observing and applying the nursing process in performing all related activities relevant to the success and completion of the study.

Scope and Limitation As 4th year nursing students, our study is limited according to the depth of knowledge and training that we have in our level. This study covers a background of the community and a thorough assessment of a group of selected clients for our family care plan. The information that we have gathered are vital yet limited in terms of completeness of information. Gathered data are solely based on a 4 day application of nursing process in accordance with subjective and objective information gathered from the client.

Spot Map Taking Liceo de Cagayan University as the point of reference, it takes about 3km to reach our CHN destination; Vietcong Zone 6 Lower Bulua. The B1 Jeepney, which is bound for Bulua passes at Persimmon outside Elipe Park, a walking distance from the university. The fare is 7.00php and it takes about 10minutes to reach the destination. The jeepney stops at ZONE 6 Bulua basketball court. From there, we walked down for about 100meters to reach Vietcong where our clients houses were situated.

SPOT MAP VIETCONG

Zone 6, Bulua, Cagayan de Oro City August 02, 2011

Family Health History Family Profile Head of the Family Note: Client not home during home visits, data gathered are subjective as verbalized by wife Name: Birth Date: Age: Address: Citizenship: Occupation: Income: Religion: Educational Attainment: JASON PASIA April 13, 1982 29 y/o Zone 6, Bulua, Cagayan de Oro City Filipino Packer (Nestle) P5, 000.00/month Roman Catholic College Level

Wife/Mother

Name: Birth Date: Age: Address: Citizenship: Income: Occupation: Religion: Educational Attainment: Assessment Data: Vital signs BP: PULSE: RR: TEMP: Allergies: Height: Weight:

MICHELLE CANUMON-PASIA March 26, 1983 28y/o Zone 6, Bulua, Cagayan de Oro City Filipino No income Housekeeper Roman Catholic High School Graduate

110/70 75 bpm 19 cpm 36.8 C None 48 43kg

Children Note: Client not home during home visits, data gathered are subjective as verbalized by mother

Name: Birth Date: Birth Place:

Jychelle Santander Canumon Pasia April 02, 2005 J.R. Borja General Hospital (Former City Hospital)

Type of Delivery: Age: Address: Citizenship: Religion: Educational Attainment: Bulua Health Center Date 1st seen: February 18, 2009 Birth weight: 2.8kg BCG: At birth

Normal Spontaneous Vaginal Delivery 6y/o Zone 6, Bulua, Cagayan de Oro City Filipino Roman Catholic Kindergarten (K2)

DPT: 1st (March 18, 2009 1 month old) 2nd (May 06, 2009) 3rd (June 10, 2009) OPV: 1st (March 18, 2009) 2nd (May 06, 2009) 3rd (June 10, 2009) HEPA B: 1st (March 18, 2009) 2nd (May 06, 2009) 3rd (June 10, 2009) MEASLES: November 04, 2009) Vit. A: November 04, 2009)

Name: Birth Date: Birth Place: Type of Delivery: Age: Address: Citizenship: Religion: Assessment Data: TEMP: Pulse: RR: Allergies: Height: Weight:

Janilla Mae Canumon Pasia January 20, 2009 Lying-in clinic Normal Spontaneous Vaginal Delivery 2 years and 6 months Zone 6, Bulua, Cagayan de Oro City Filipino Roman Catholic

36.7 C 72 bpm 46 cpm none 36cm 10 kg

IMMUNIZATION: Complete Bulua Health Center Date 1st seen: April 21, 2008 Birth weight: 6lbs BCG: 1st (April 21, 2011) DPT: 1st (May 19, 2005 6 weeks old) 2nd (June 23, 2005 10 weeks old) 3rd (July 28, 2005 14 weeks old) HEPA B: September 01, 2005 Measles: January 05, 2006 Vit. A: 10, 000 iu (January 05, 2006)

Janilla was noted to have productive cough during the whole duration of home visits. As verbalized by mother, Janilla was diagnosed of Pneumonia by a doctor at St. Ignatius Clinic last August 01, 2011.

Health History (All Members) Head of the Family: JASON PASIA Note: Client not home during home visits, data gathered are subjective as verbalized by wife Health History Mr. Pasia has neither previous hospitalization nor blood transfusion. He has no known heredo-familial disease, with no known food/drug allergies. He is an occasional drinker (drinks alcoholic beverages only in visited occasions for at least 1-2 small bottles per occasion), and smokes at least 2 sticks of cigarette per day making it his past time during his break. He started both smoking and drinking alcoholic beverages way back in high school. Previous illnesses experienced include cough and fever. He drinks paracetamol for fever (preferably BIOGESIC) every four hours until he feels relieved, which usually takes at least 2 days. Unfortunately, he disregards giving attention to cough since he considers it a normal condition that will just go away in a few days. Present Health Status Mr. Pasia is currently not subject to having any present illness. He still drinks alcoholic beverages on varied occasions where he is invited and maintains his personally established quota of cigarette, which are 2 sticks per day. Since the client is not home during our visits, basic information was subjectively relayed by his wife.

Wife/Mother: MICHELLE CANUMON-PASIA

Health History April 02, 2005 - Mrs. Pasia gave birth to her eldest child at JRBorja General Hospital (formerly City Hospital) through normal spontaneous vaginal delivery. January 20, 2009 - Mrs. Pasia gave birth to her second child was born at a lyingin clinic near February, 2011 She had a miscarriage; Basin nakuhaan ko kay gapadede man ko aning kinamanghuran kay wala ko kabalo nga mabdos ko. She has neither undergone blood transfusion nor has any known food/drug allergies. She reported hypertension as a common illness in their family. She used to be an occasional drinker but never tried smoking. She never had Pap smear even after miscarriage. She is not aware of the importance and how to do self-breast examination. Previous illnesses experienced include cough and fever. Considered as a family regimen, she takes paracetamol for fever (preferably BIOGESIC) every four hours until she feels relieved and usually lasts for 2 days. Same as her husband, she disregards giving attention to cough and considers it normal, which will eventually pass. Present Health Status Mrs. Ganade is presently not subject to any kind of illness. She has not resorted to drinking alcoholic beverages anymore and prefers to keep it that way. She is open to learning about health maintenance and related practices to protect self and her family.

Eldest Child: JYCHELL SANTANDER CANUMON PASIA Health History

Jychelle has neither previous hospitalization nor blood transfusion. She has no known food/drug allergies. According to her mother, she is a picky eater and prefers to skip meals and play instead. Her water intake is less than required and has not maintained any vitamins or food supplements for the past 5 years. Previous illnesses encountered include chicken pox, cough, and fever. Her mother normally gives her paracetamol (preferably BIOGESIC cut into half) for her fever once every four hours until fever subsides. She was never treated with any cough medicine since her parents does not give attention to cough and believes that it will pass after a couple of days even if left untreated. Present Health Status Gi-ubo na pod to siya, natakdan na sa iyang manghod, gasuka-suka unya green kayo ang plema. Dili man to tigkaon ug utan, kasagara prito2x man among sudan nga pinalit sa silingan as verbalized by Mrs. Pasia.

Youngest Child: JANILLA MAE CANUMON PASIA Health History Janilla does not have any previous hospitalization or blood transfusion and has completed her immunization according to schedule. She has no reported food or drug allergies as of the moment. Her water intake is less than required and has not maintained any vitamins or food supplements for the past 5 years. Previous illnesses encountered include chicken pox, cough, and fever. Her mother normally gives her Paracetamol (preferably BIOGESIC cut into half) for her fever once every four hours until fever subsides. Like her sister, she was never treated with any cough medicine since her parents does not give attention to cough and believes that it will pass after a couple of days even if left untreated. May 05, 2011 Janilla was diagnosed of Pneumonia for the first time; medications were not complied due to financial restraints. Present Health Status Isa na ka semana iyang ubo, unya ngsunggo naman siya, gidala na lang nako sa doctor. August 01, 2011 Janilla had epistaxis, an incident that alarmed her mother and decided to visit the doctor at St. Ignatius Clinic even without money for consultation. Janilla was ordered to have a CBC since her condition was suspected as Dengue. After the CBC result was checked, Pneumonia was the final diagnosis of the physician and prescribed medications. (See Appendix)

NURSING SYSTEM REVIEW CHART (PHYSICAL ASSESSMENT)

Name: Janilla Canumo Pasia Pulse: 72bpm Temp: 36.7C EENT:
[ ] Impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teeth Asses eyes, ears, nose Throat for abnormality [x ] no problem

Date: August 02, 2011 Height: cm Weight: 10 kg RR: 46cpm

RESPI:
[ ] asymmetric [ ] tachypnea [ ] apnea [ ]rales[ x] cough[ ]barrel chest [ ]bradypnea[ ] shallow [x ] rhonchi [x] Sputum [ ] diminished [x ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic Asses resp. rate, rhythm, depth, pattern Breath sounds, comfort [ ] no problem

Dyspnea, Rhonchi Productive cough with whitish phlegm

Skin warm to touch, Underweight

CARDIO VASCULAR
[ ] arrhythmia [ ] tachycardia [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ]bradycardia[ ] murmur [] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate, rhythm, pulse, blood Pressure, etc., fluid retention, comfort [X]no problem

Dirty and long nails

GASTRO INTESTINAL TRACT

[ ] obese [ ] distention [ ] mass [ ] dysphagia [ ] rigidity [ ] pain Asses abdomen, bowel habits, swallowing, Bowel sounds, comfort [x]no problem

GENITO-URINARY and GYNE

[ ] pain [ ] urine color [ ] vaginal bleeding [ ]hematuria [ ] discharge[ ]nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge [x ]no problem

Back pain/ Discomfort

NEURO
[] paralysis [ ]stuporous[ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip Assess motor function, sensation, LOC, strength, Grip, galt, coordination, orientation, speech. [X]no problem

Skin warm to touch

MUSCULOSKELETAL and SKIN

[ ] appliance [ ] stiffness [ ] itching [ ]petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity [x] no problem

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Date: August 2, 2011 Childs Name: Janilla Mae C. Pasia Age: 2 years old Ht: 30 cm Wt: 10kg. Temp: 36.8 C ASK: What are the childs problems? Productive cough Initial visit: CHECK FOR GENERAL DANGER SIGNS YES___NO__ NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES ___NO__ For how long? 1 week PNEUMONIA Count the breaths in one minute. 46 breaths per minute. Fast breathing? Yes Look for chest indrawing. Look and listen for stridor. None DOES THE CHILD HAVE DIARRHEA? YES_NO___ For how long? __days Look at the young infants general condition. Is the infant: Abnormally sleepy or difficult to awaken Restless or irritable? Look for sunken eyes. Pinch the skin of the abdomen. Does it go back : Very slowly (longer than 2 seconds)? Slowly? DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37C YES__NO___ Decide malaria risk Does the child live in malaria area? Has the child visited/traveled or stayed overnight in a malaria area in the past 4 weeks? If malaria risk, obtain a blood smear. LOOK AND FEEL Look or feel for stiff neck Look for runny nose THEN ASK : For how long has the child had a fever? days. If more than 7 days. Has fever been present almost everyday? Has the child had measles within the last 3 months? Look for signs of MEASLES Generalized rash and One of these, cough, runny nose, or red eyes.

-----------------------------------------------------------------------------------If the child has measles now or within the last 3 months: Look for mouth ulcers If yes, are they deep and extensive? Look for pus draining from the eye. Look for clouding of the cornea. -----------------------------------------------------------------------------------ASSESS DENGUE HEMORRHAGIC FEVER THEN ASK: Has the child had any bleeding from the nose or gums or in the vomitus or stool? Nose, Yes Has the child had black vomitus or black stool? No Has the child had persistent abdominal pain? No Has the child had persistent vomiting? No LOOK AND FEEL: Look for bleeding from nose or gums Look for skin petachiae Feel for cold and clammy extremities Check for capillary refill._2_ seconds. Perform tourniquet test if child is 6 months or older AND has no other signs AND has fever for more than 3 days. DOES THE CHILD HAVE AN EAR PROBLEM? YES__NO__ Is there ear pain? Is there ear discharge? If yes, for how long ___days Look for pus draining from the ear Feel for tender swelling behind the ear. THEN CHECK FOR MALNUTRITION and ANEMIA Look for visible severe wasting. Look for edema of both feet. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? Determine weight for age. Very low? CHECK THE CHILDS IMMUNIZATION STATUS Circle immunizations needed today. ___ ___ ___ ___ BCG DPT1 OPV1 HEP B1 ___ ___ ___ ____ DPT2 OPV2 HEP B2 MEASLES ___ ___ ___ DPT3 OPV3 HEP B3 CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older.

---------------------

No ear infection

No anemia and not very low weight

Return for next immunization on: Completed (date) Vitamin A given

Is the child six months of age or older? Yes__No___ Has the child received Vitamin A in the past six months? Yes__No___ ASSESS CHILDS FEEDING If child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old. Do you breastfeed your child? Yes__No__ If Yes, how many times in 24 hours? ___ Times. Do you breastfeed during the night? Yes__No__ Does the child take any other food or fluids? Yes__No__ If Yes, what food or fluids? __rice, vegetables, fish and meat______________________________________________ How many times per day? _3__times. What do you use to feed the child? _____spoon________ If very low weight for age: How large are servings? ______________________________ Does the child receive his/her own serving? ____Who feeds the child and how? _______ During the illness, has the childs feeding change? Yes___No___ If Yes, how? ASSESS CARE FOR DEVELOPMENT: Ask question about how the mother cares for her child. Compare the mothers answers to the Recommendations for Care and Development for childs age. How do you play with your child? How do you communicate with your child? ASSESS OTHER PROBLEMS

Yes __No __

Feeding Problems: Child has no feeding problems

No anemia and not in very low weigh

Care and development problems

None

NURSING SYSTEM REVIEW CHART (PHYSICAL ASSESSMENT)

Name: Michelle Canumo Pasia Pulse: 75 bpm BP: 130/80 Temp: 36.8C EENT:
[ ] Impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teeth Asses eyes, ears, nose Throat for abnormality [x] no problem

Date: August 02, 2011 Height: 48 Weight: kg RR: 19cpm

RESPI:
[ ] asymmetric [ ] tachypnea [ ] apnea [ ]rales[ ] cough[ ]barrel chest [ ]bradypnea[ ] shallow [ ] rhonchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic Asses resp. rate, rhythm, depth, pattern Breath sounds, comfort [x]no problem

Warm and dry skin

CARDIO VASCULAR
[ ] arrhythmia [ ] tachycardia [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ]bradycardia[ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate, rhythm, pulse, blood Pressure, etc., fluid retention, comfort [X]no problem

Dirty nails

GASTRO INTESTINAL TRACT

[ ] obese [ ] distention [ ] mass [ ] dysphagia [ ] rigidity [ ] pain Asses abdomen, bowel habits, swallowing, Bowel sounds, comfort [x]no problem

GENITO-URINARY and GYNE

[ ] pain [ ] urine color [ ] vaginal bleeding [ ]hematuria [ ] discharge[ ]nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge [x]no problem

NEURO
[] paralysis [ ]stuporous[ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip Assess motor function, sensation, LOC, strength, Grip, galt, coordination, orientation, speech. [x]no problem

Poor skin turgor, Fatigue

MUSCULOSKELETAL and SKIN

[ ] appliance [ ] stiffness [ ] itching [ ]petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [x] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity [ ] no problem

NURSING ASSESSMENT II

SUBJECTIVE

OBJECTIVE

COMMUNICATION: [ ]hearing loss [ ]visual changes [X] denied

Comments: wala man ko problema sa akong pandungog ug mata

[ ] glasses [ ] contact lenses Pupil size: 3mm

[ ] languages [ ] hearing aide

[ ] speech difficulties Reaction: Pupil equally round and reactive to light accommodation

OXYGENATION: [ ] dyspnea [ ]smoking history [ ] cough [ ] sputum [ ] denied

Comments: Ok raman akong ginhawa, wala man pod koy ubo .

Resp.

[x ] regular

[] irregular

Describe: The patient has regular respiratory rate of 20cpm (Normal RR: 15- 25 cpm).

R: Right lung expansion symmetrical to left lung L: Left lung expansion symmetrical to right lung

Comments: CIRCULATION: [ ] chest pain [ ] leg pain [ ] numbness of extremities [ ] denied Dili man magsakit akong dughan ug ala pod koy lain sakit na gibati karon

Heart Rhythm [x] regular [ ] irregular Ankle Edema Pulse R L Car + + Rad. DP Fem* not assessed not assessed

80bpm + 80bpm +

Comments: The pulse are palpable and steady

NUTRITION Diet:DAT []N[]V Character [ ]recent change in weight and appetite [ ] swallowing Difficulty [ ] denied ELIMINATION: Usual bowel pattern 1-2 a day [ ] constipation remedy Date of last BM Cannot recall [ ] diarrhea character Soft Stools .

Comments: wala man ko problema sa pagkaon,.

[]dentures

[x]none

Full

Partial

Upper

[]

[]

Lower

[]

[]

[ ]urinary frequency 3-6 times a day [ ] urgency [ ] dysuria [ ] hematuria [ ] incontinence [ ] polyuria [ ] foley in place [ ] denied

Comment: wala man ko problema sa pagkalibang ug pagpangihi.

Bowel sound: normoactive Abdominal Distention Present [ ] yes [x] no Urine* (pale yellow, cloudy) Yellowish and aromatic

MGT. OF HEALTH & ILLNESS: [X]alcohol[ ] denied (amount & frequency) 2 bottle per session . [ ] SBE Last Pap Smear: none LMP: not applicable Skin Integrity [ x] dry [ ] itching [x] denied Comment: Wala man koy katol2 ug kagid sa akong panit

Briefly describe the patients ability to follow treatments (diet, meds, etc.) for chronic health problems (if present): Client is able to follow treatment regimen for family and understand health teachings

[ x] dry [ ] flushed [] moist

[ ] cold [ ] warm [ ] cyanotic

[ ] pale

Rashes, ulcers, decubitus (describe size, location, drainage) Patient has no rashes ,ulcers, decubitis.

Activity Safety [ ] convulsion [ ] dizziness [ ] limited motion of joints Limitation in ability to [x ] ambulate [x ] bathe self [ ] denied Comfort/Sleep/Awake [] pain (location frequency remedies) [ ] nocturia [ ] sleep difficulties [x] denied COPING: Occupation none

Comments: dili kayo ko ka lihok, dili nako kaya maka tindug nah

LOC and orientation: Patient is conscious and oriented to time, place and people around him Gait: [ ] walker [ ] cane [ ] other .

[x] Steady

[ ] unsteady

[x] sensory and motor losses in face or extremities: motor losses in lower and upper extremities. [x] ROM limitations: Patient

Comments: Wala man problema sa pagkatulog nako.

[ ] facial grimaces [ ] guarding [] other signs of pain: none [] side rail release formed signed: N/A

Members of household: 4 Most supportive person: Husband

Observed non-verbal behavior: None because the patient has tentative upon answering the question. Contact Person: No cellphone number

Home and Environment HOME

A. B. C. D. E.

General Sanitary Condition: Danger Ownership: ( ) Owned ( ) Rented ( ) Rent-Free Construction Materials Used: ( ) Light ( ) Mixed ( ) Strong Number of Rooms Used for Sleeping: one room for the whole family Lighting Facilities: ( ) Electricity ( ) Kerosene ( ) Others____________

WATER SUPPLY

A. Drinking Water Source: ( ) Private () Public Distance from the house: inside house Storage: ( ) None, direct from the faucet ( ) Container with cover () Container without cover ( ) Others__________________________________________

KITCHEN

A. Cooking Facility: ( ) Electric Stove ( ) Gas Stove ( ) Firewood/Charcoal DRAINAGE SYSTEM

A. Drainage Facility: ( ) None ( ) Open Drainage ( ) Blind/close Drainage WASTE DISPOSAL A. Garbage Disposal 1. Container: ( ) Covered ( ) Open ( ) None 2. Method of Disposal: ( ) Opening Dumping ( ) Open Burning ( ) Compost Pit

B. Toilet

1. Type: ( ) Pit Privy ( ) Pail System ( ) Flush Type ( ) Antipolo System ( ) Water-sealed ( ) none C. General Sanitary Condition: Danger

DOMESTIC ANIMALS (None) COMMUNITY IN GENERAL A. Housing Congestion: Not congested with other houses B. Recreational Facilities: None C. Type of Health Care Facility: Accessible/Only provides primary health care D. Distance of House from the nearest Health Care Facility: Far E. General Sanitary Condition: Danger

1. Housing The family owns the house and lot The house is a single story constructed out of wood and nipa The space of the house is just sufficient for the four members, the living room is also the familys shared bedroom, the kitchen is small with no proper compartments for storage, while their comfort room is located outside the house

2. Kitchen They use firewood in cooking since they find it more affordable

Kitchen is untidy with the presence of unwashed dishes and cluttered utensils Food is left uncovered and is feasted with flies

3. Presence of Health Hazards No drainage system No proper waste disposal Prominent number of mosquitoes because of stagnant water surrounding the house

4. Water Supply Water is from the Cagayan de Oro Water District (COWD), with faucet, also the source of drinking water

5. Sanitary Condition Garbage is not properly disposed and is kept inside the house Comfort room is left open Water containers left open outside the house

7. Garbage System They do not practice proper segregation of garbage

8. Drainage System Open drainage

9. Kinds of Neighborhood Low income Incompetent educational attainment Prominent problem of the community is scabies and cough

10. Presence of Health Hazards Poor sanitary condition No drainage system Unhealthful nutritional eating practices Poor lighting ventilation Presence of breeding sites of vectors(mosquitoes, flies, etc.) FAMILYs OVERALL DATA: FAMILY PLANNING: Condom SMOKING: Head of the family smokes but not inside the house or near the children as verbalized by wife ALLERGY: None INTAKE OF ALCOHOLIC BEVERAGES: Head of the family is a light drinker of alcoholic beverages on occasions FOOD USUALLY INCLUDED IN DIET: Rice, Fried Dishes Family does not regularly eat nutritious food and does not practice incorporating vegetables in their daily diet.

Family Coping Index AREAS 1.)Physical Independence - Family providing partially the needs of the members or care for some members but not for the other 2.)Therapeutic Independence - Includes procedure or treatment prescribed to any disease condition. 3.) Knowledge of the Health Condition SCALE 1 2 3 JUSTIFICATION The children is currently having productive cough, which affects their activities of daily living The family carried out some but not all of the treatment or procedures taught The mother does not go to the health center to seek for medical consultations They used to see the health condition of the child as natural and need not be addressed by medical attention They do not have any knowledge on the possible effects of disregarding minor illnesses of children such as cough. There were no appropriate measures to ensure the growth and development of the children Poor physical hygiene, imbalanced nutrition, faulty eating habits Garbage is not properly disposed; they are not practicing segregation of garbage. Accepts health care advice in some degree but with reservation. The mother does not consult the health center. The family considers minor illness such as cough to be natural. The family takes each day at a time and is completely satisfied in what they have now Parents currently disturbed about how to complete the prescribed medication of their youngest, who was diagnosed of pneumonia The family gets along with each other well

4.) Application of Principles of General Hygiene - Familys views on sanitation and proper personal hygiene and adequate rest and relaxation.

5.) Health Attitude - This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures. 6.) Emotional Competence - This category has to do with the maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life, and to plan for happiness. 7.) Family Living - This category is concerned

with the interpersonal or group aspects of family life.

Couple do not have misunderstandings Siblings do not have misunderstandings and are getting along well Does not practice the proper disposal of garbage. Most areas in the house are conducive for reproduction of insects and mosquitoes. Unclean house The mother does not go to the health center to seek for medical advice ( reasons include: lack of orientation about the presence of health care facilities, consider minor ailments as natural and need not medical attention, lack of financial resources, does not trust the personnel in the health center).

8.) Physical Environment - Is concerned with family home and community, or work environment as it affects family health.

9.) Use of the community facility - Is concerned with the degree to which the family members know about the wisdom with which they use available community resources for health education and welfare. Use of hospitals, clinic, welfare organization, churches, etc. Legend: 3 - Complete competence 2 - Moderate competence 1 - Incompetent

SCHEMATIC PRESENTATION OF FAMILY HEALTH PROBLEM

ENVIRONMENT

SOCIAL

BIOLOGICAL

Housing -House is not completely covered -Inadequate living space -Poor lighting ventilation -Windows are unscreened

Surroundings

Drainage System - No Drainage System; waste goes directly to the water below their house - Presence of breeding sites of vector diseases (mosquitoe s, flies, etc.)

Toilet - Left open - Dirty -Water containers uncovered

Economic - Father earns minimum wage of P5,000.00 per month on a contractual basis - Family size is beyond what family can adequately support

Social -The family is inactive in barangay organizations and community activities -Failure to perceive the benefits of health care

Genetic
-

Physical
-

-Absence of MACKS-P and herbal plants -Prominent number of mosquitoes because of stagnant water

-Family hereditary condition/ disease (HYPERTEN SION) on mothers side

-Illness state (Productive cough, Pneumonia)

Health Threats

Stress Points

Health Threat

Health Deficit

NURSING CARE PLAN Name of Patient: Janelle Mae Canumo Pasia NURSING CUES OBJECTIVES DIAGNOSIS Subjective: Ineffective At the end of Isa na cya ka airway clearance 30minutes, the semana ga-ubo related to client will be unya galuwa accumulation of able to maintain ug plema secretions in the airway patency tracheobronchial and expectorate Objective: tree and inability secretions Productive cough to expectorate readily Ronchi properly Back pain/ discomfort Dyspnea RR = 46cpm Restlessness

INTERVENTIONS Independent: Teach mother and child deep breathing exercise Encourage mother to increase childs fluid intake Instruct mother to feed child with aspiration precaution Dependent: Cefaclor 3ml TID PO Salbutamol 2.5ml TID PO Hisdec 2.5ml

RATIONALE To maximize effort of effective coughing To help liquefy viscous secretions

EVALUATION After 30minutes, the client was able to expectorate cough effectively and maintained airway patency by practicing deep breathing exercise.

To prevent vomiting with aspiration into lungs

Anti-infective Bronchodilator Antitussive

DRUG STUDY
Name of Patient:
Generic Name of Ordered Drug Brand Name Date Ordered Classification Dose / Frequency / Route Mechanism of Action Specific Indication Contraindication Side Effects/ Toxic Effects Nursing Precaution

Cefaclor

Ceclor

August 01, 2011

Anti-infective

3ml TID PO

Bactericidal, inhibits activity of bacterial cell wall causing cell death Causes vasoconstriction in skin, mucus membranes, and mucosa Causes bronchodilation and vasodilation

Treatment of respiratory tract infections including pneumonia Relief of nasal congestion and hypersecretion

Hypersensitivity to drug

Headache Dizziness Nausea Vomiting Abdominal pain

Complete full course of drug even if you feel Better

Hisdec

August 01, 2011

Nasal Decongestant

2.5ml TID PO

Hypersensitivity to drug, HPN

Restless Dizziness Palpitation Dry mouth

Take drug as prescribed Do not increase dosage Do not exceed recommended dosage

Salbutamol

August 01, 2011

Bronchodilator

2.5ml TID PO

Relief and prevention of bronchospasm

Hypersensitivity to albuterol

Palpitation Dizziness Headache Nausea vomiting

Family Care Plan Priority #1 CUES HEALTH PROBLEM FAMILY NURSING PROBLEMS GOAL OF CARE OBJECTIVES OF CARE INTERVENTION MEASURES METHODS EVALUATION OF NURSEFAMILY CONTACT Home Visit 1. The family was able to identify breeding sites of insects, rodents and vectors. 2. Identified ways of eliminating breeding sites of insects, rodents and other vectors.

Subjective: daghan lamok labi na pagkagabii as verbalized by the mother Objective: -stagnant water

Presence of breeding or resting sites of insects, rodents, and other vectors

Inability to provide a home/ Environment which is conducive to health maintenance and personal development due to -inadequate knowledge of importance of hygiene and sanitation, -lack of skill in carrying out measures to improve sanitary condition

After nursing intervention the family will be able to improve environmental condition to eliminate risk of vectorborne and carrier diseases.

After nursing intervention the family will be able to: a. identify possible breeding sites of insects, rodents and vectors. a. take measures in maintaining sanitary surroundings. b. identify and demonstrate ways of eliminating breeding sites of insects, rodents, and other vectors.

1. Discuss with the family the importance of maintaining clean surroundings. 2. Educate the family about possible breeding sites of insects, rodents and other vectors. 3. Provide sufficient information about diseases brought about by insects and other vectors. 4. Demonstrate methods in eliminating breeding sites.

Priority #2 CUES HEALTH PROBLEM FAMILY NURSING GOAL PROBLEM OBJECTIVES OF CARE INTERVENTION METHODS MEASURES OF NURSEFAMILY CONTACT 1. Provide teachings about Home visit the correct ways in garbage segregation 2. Educate the family about the risks and effects of improper garbage disposal to promote better compliance. 3. Encourage the family to maintain environmental sanitation by utilizing proper garbage containers. EVALUATION

Subjective: Diretso na ibutang sa basurahan as verbalized by the mother. Objective: - Scattered garbage outside their house - No garbage can

Improper garbage disposal as a health threat.

1. Inability to properly segregate and dispose due to lack of awareness on proper waste disposal. 2. Inability to appreciate the importance of garbage disposal.

After nursing intervention the family will be able to demonstrate correct ways of garbage disposal.

After nursing intervention the family will be able to: a. Identify and classify types of waste as biodegradable and nonbiodegradable. b. Practice proper method of waste management.

At the end of nursing intervention, the mother started to clean the home environment and sorroundings atleast once a day and place a sack for their garbage to be placed.

Priority #3 HEALTH PROBLE M Poor Drainage System as a health threat. FAMILY NURSING PROBLEM Inability to provide a home environment conducive to health maintenance and personal development due to: a. Inadequate knowledge about the importance of sanitation and preventive measures. b. Lack of skills to improve home environment GOAL OF CARE At the end of 20 minutes, the client will be able to acknowle dge the importan ce of having a clean drainage effectivel y. INTERVENTION PLAN METHOD NURSING RESOURCES NURSEINTERVENTI NEEDED / FAMILY ON REQUIRED CONTACT Health Home Visit -Expenses for teachings transportation of about the ff.: the student a. Benefits nurses that will of having go to the family. a clean drainage -Time and effort system. of the student b. Disadvan nurse and family tages of members. unclean drainage. -Broomstick, c. Importan ce of keeping the drainage clean.

CUES/ DATA Subjective: Sa makita ninyo ang kanal namo walay tabon ug usahay ra malimpyoha n as verbalized by Mrs. Pasia Objective: -Open Drainage made out of soil -Presence of scattered barbecue sticks,cellophanes -Pungent odor

OBJECTIVES OF CARE At the end of 20 minutes, the family will be able to: a. Identify the benefits of having a clean and close drainage system. b. Enumerate the disadvantag es of unclean drainage c. Emphasize the importance of keeping the drainage clean.

Actual Implementation
Day 1 Date: august 2, 2011 During our first exposure in the area, we were tasked to assess three families in each pair. Ocular survey and spot mapping was done. We were able to survey the area and assess and interviewed six families, and we noticed that some families are not open to give data about their families. We also chose a family for our care study considering given criteria. Since day one was the first meeting with the family, we focused more on establishing trust and rapport with the family members. We introduced ourselves and explained the purpose of our visit and succeeding visits. We were able to collect data needed stated in the assessment sheet. We also observed the environment, identified potential problems in their area, and made a specific plan of intervention to identified problems. During the visit, only the mother and youngest child were around. At first, the mother is shy and is hesitant to open up with. The husband and eldest childs data were provided by the mother alone. A thorough physical assessment was done. We were able to note that their youngest child was diagnosed of pneumonia a day before our visit. We taught mother and child deep breathing exercises to expectorate effectively Health teachings were imparted emphasizing on keeping child from cold environment and keeping back dry. Strict compliance of medication was repeatedly stressed out.

Day 2 Date: August 3, 2011 The second day of visit was a Wednesday. The mother was expecting our visit. Unlike the first day, she was more open and readily answered our questions. The youngest child was better than the 1st day of our visit. However, her mother reported that her eldest child was also having a productive cough with phlegm. We gave our health teachings reinforcing the care of her youngest child by keeping her from cold environment and keeping back dry.

We also encouraged the mother to visit the barangay health center and avail of the services and facilities for the maintenance of her familys health. Strict compliance of medication especially on antibiotics was reinforced. We also invited the mother to join the scheduled microteaching the following week.

Day 3 Date: August 8, 2011 The third day was the last day of visit. Unfortunately, the mother was not able to join the microteaching for some personal matter. We visited them after the microteaching and made a thorough assessment to check improvement of childs health. The interventions done and health teachings were indeed effective. The mother was able to verbalize understanding of the imparted health teachings and promised to visit the heath center to avail the services. We were also able to note that the mother had a tendency to self-medicate, we stressed the importance of seeking medical advice and give only prescribed medication to her children.

Recommendation MEDICATIONS Instructed the clients to: Continue drinking prescribed medication Never do self-medication, take only medications prescribed by physician with its corresponding dose and frequency as ordered

EXERCISE Instructed clients to: Include exercise such as brisk walking, and stretching as part of their daily activity to promote wellness, proper blood circulation, and revive energy TREATMENT Taught client about: How to make homemade boiled lagundi as a treatment for cough Closely monitor BP since hypertension is a heredo-familial disease Visit the health center to be able to avail of the services rendered

DIET Instructed the clients to Eat food rich in protein, vitamins and minerals (meat, soya, vegetables, and fruits) for a stronger immune system Plant MACKS-P outside their house to make vegetables accessible and can be surely included in their diet Increase fluid intake by drinking 8-10 glasses per day Refrain from drinking soft drinks and eating junk foods

Bibliography BOOKS:
Smeltzer et al. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 12th edition. Doenges et al. Nurses Pocket Guide. 11th edition. Maglaya, Araceli S. Community Health Nursing in the Philippines.

IMCI Flipchart

WEBSITE:
www.nursingcrib.com www.answers.com

www.scribd.com

COMMUNITY HEALTH NURSING FAMILY CASE STUDY Submitted by: NCM501204 A15 Brown, Jackylou Tejada, Ellyza Grace Tecson, Lloyd Rusell B. Tan, George M. Yap, Christine P. Leonor H. Zaportiza

Submitted to: Ms. Chua, RN Clinical Instructor