A Case Presentation of

The Family Case Study of the DSMC Family

Presented to the Faculty of College of Nursing

Northeastern College

Villasis, Santiago City Isabela

In Partial Fulfillment of the Requirements for Intensive Nursing Practicum

Submitted By:

CATAINA , ANGEL JOY

CONCEPCION , HENSON

ENCARNACION , MERRIN

JANDOC AILA TRICIA

OLIDAN , NOVELYN

ORPILLA ERICA

SALVADOR KAYLA ZHAINE

TASSIE RUTH

ARTURO G. GARCIA JR. RN, MSN

CLINICAL INSTRUCTOR
 CHAPTER 1
INTRODUCTION

We, the nursing students, play a vital part in putting our newly
acquired knowledge of community health nursing into practice. Individuals
and families are at the center of community health nursing. With the
various interventions provided for them. Health professionals want to
underline the need of offering their complete and entire commitment and
dedication to their coworkers in order for them to achieve good and precise
health.
In response to the people's health requirements, the school's
nursing department of Northeastern College chose Barangay Sinili for our
Community. Community health Nursing plays an essential characteristic
due to the fact it's miles wherein student nurses research nursing outdoor
of the health facility setting and are uncovered to diverse kinds of
orientation. We, the nursing students, want to maintain and improve
people's health by addressing the structures and systems that define a
community and assisting those who live and work there in making informed
decisions.

Aging is a natural process of gradual change that begins in early

adulthood. Every person, from conception to death, will undergo the
unavoidable process of aging. Several physical functions begin to diminish
progressively in early middle age. Humans do not grow old or elderly at a
predetermined age. Historically, the age of 65 has been considered as the
start of old age.It is a crucial component required to achieve physical
development and complete various developmental activities throughout
life. The procedure is ongoing and continuous with respect to time. An
individual goes through many life phases as they age in order to develop,
adapt, and grow in accordance with each stage's requirements. For some
people, aging is inevitable and must be accepted, while for others, it can
be delayed, and only those who realize they will age will actually feel and
experience it.

Elderly folks need care and comfort to live a healthy life free from
anxieties and anxiety because old age is a delicate stage. Abuse can occur
anywhere, whether it's in the elderly person's home, the home of a relative,
an assisted living facility, or a nursing home. Abuse of older people by
family members results from a lack of information concerning the changing
behavioral patterns or psychological characteristics in these individuals at
home. Older people frequently confront new obstacles, particularly when a
family is caring for another elderly person who is disabled. We chose
family DSMC as the subject of our study.

In this household resides three (3) elderly; Lolo D (81) considered

as the head of the household, Lola S (80) wife of lolo D and Lola M (78) a
person with disability due to poliovirus and sister of Lola S. We made the
decision to provide and extend in an effort to improve the family's health by
enabling them to be more self-sufficient and productive in preserving their
health in light of the family's environment and age.
 Chapter II

OBJECTIVES OF THE STUDY

General Objectives:

After the adoption relationship between the student nurse and family ended,
Through proper interventions in a predetermined amount of time, the family will be able
to improve their health status and become independent in sustaining it.

Specific Objectives:

After 3 days of home visits and student nurse-family interaction, the family should be
able to:
• Built a relationship of trust and rapport with the student nurse.
• Provide factual information during interview.
• Assess current and potential issues that may be impeding your ability to achieve optimal health.
• Actively

Cognitive Domain
Affective Domain
Psychomotor Domain
 Chapter III

INITIAL DATABASE

A. Family Structure, Characteristics, and Dynamics

FAMILY PROFILE A. Family Structure, Characteristics and Dynamics

The DSMC family Husband is an illustration of an extended family because the

children are nearby the household and the husband, wife, and sister of Lola S live in the
same house.

NAME POSITION IN THE GENDER BIRTHDATE AGE CIVIL EDUCATIONAL MONTHLY PENSION
FAMILY STATUS ATTAINMENT

Lolo D Husband Male 01/2/1942 80 Married Vocational 1000 per month

Lola S Wife Female 03/8/1943 80 Married Elementary 1000 per month

Graduate

Lola M Sister of Lola Female 03/6/1945 78 Single No No Income or

S Educational Pension
Attainment Received

B. Socio-Economic and Cultural Characteristics

Due to financial constraints, Mr. D was unable to complete his vocational degree
since life back then was really hard, and his wife only has an elementary school diploma
and was not given the opportunity to attend high school or college and need to work at
young age for daily needs. Ms. M didn't have the chance to study at all due to her
condition and Lola S became the official guardian of Lola M when their parents died.
Since Lolo D and Lola S don’t have a stable financial source the family merely
has to wait for their pension, which is worth Php 1000 per member and paid monthly. The
pension given to them were not sufficient for their everyday expenses. Their children
overseas rarely send them money because they must also send money to their own family
or children so Mrs. S told us that their pension and the money given by their children were
insufficient to cover their expenses. Yet, they are only anticipating a small crop profit. Their
only expenses are for food and energy, and occasionally for over-the-counter medicine in
case of an emergency or for pain reliever.
In terms of drinking and bathing, water is drawn from a deep well pump and it is
owned by their youngest child. They did once have a deep well pump, but it was destroyed
long ago. Lola S. claims they don't have enough money to install a new deep well pump, so
they have decided to utilize her son's deep well pump instead.
 In their neighborhood, the family was very well and also the neighbors get along
well with the family. They have really no conflicts with them that every time they need
help their neighbor will gladly provide a helping hand. They are quite accommodating to
their visitors , every time a visitor arrives, they accommodate them enthusiastically by
providing coffee or appetizers like boiled sweet potato or corn.
C. Home and Environment
The house is made of hollow blocks, wood, and galvanized. Lola S did not know the
exact measurement of their house. Her husband, Lolo D knows only the
measurement of their property; he said that it is half hectare. The house only has 3 windows and
can sustain the ventilation that they need.
 The house has 2 rooms, the one is the sala/room of Lola S and Lola M, the other one is
the bedroom of Lolo D. Lola S and M sleep together in the living room. The reason behind why
lolo D and lola S did not sleep together is that lola M needed attention even when she sleeps,
because she pees on the bed and needs to get dressed immediately so that the urine does
not dry and itch.

The DSMC family has 4 appliances, television, radio, electric fan and rice cooker. In
terms of garbage disposal, they either bury or burn their garbage their son has their own
garbage disposal but the waste are not segregated properly.
 Lola S uses a wood and gas stove in cooking. She is the one who prepares
the food. She cooks inside the house at the back portion. The food that
they usually eat are vegetables and sometimes fish. They use plastic plates and stainless
spoons when eating. When it comes to storing food, they place it in their cabinet/dish
cabinet. In terms of cooking facilities, the family is equipped with kettle, “sandok” ,
knives and rice cooker but according to Lola S they seldomly

Manual jetmatic(poso) is their main source of water, 4 m away from their house.
The “poso” does not belong to them, it belongs to their son who is their neighbor. Lola S
stated that they do not sanitize their drinking water supply because they do not get sick
easily even if they drink water from the "poso," and she also stated that even if there are
water refilling stations, she will refuse to buy because it will increase their daily expenses
or cost them.
DSMC family has no comfort room and bathroom,so the DSMC family utilizes
the comfort room of their son. Lolo D defecates in their son’s house, Lola S used only an
improvised Arinola in urinating and defecating, then she will throw it in her son’s comfort
room. Lola M, was not able to go to the comfort room and she’s not able to speak, that’s
why she can't tell if she's pooping or peeing, so she will just peed and defecated on his
bed, then lola S will clean and will clothed her right away.

The drainage system of family DSMC is an open type wherein the drainage flows
anywhere and there are some stagnant water around them and also When they have a lot
of flies and mosquitoes around, Lolo D and Lola M mentioned that they use a mosquito
spray or mosquito repellant coil to ward them off. Lolo D also mentioned that he will
occasionally simply burn dried leaves to help deter mosquitoes.

The DSMC family has three dogs and 2 cats. There are fruit trees all around
them such as, mangoes, cashews, cotton fruit, rambutans, kamias ,guava and
tamarind they also have citrus and dragon fruit and they also own a corn fields.

D. Health

Assessment of Each Family Member

Lolo D - Completed his immunization as he said in the

interview. He has hypertension with a blood pressure of 150/100 and has a history of
Diabetes Mellitus in their family, he drinks occasionally or when someone will invite him
he will join and he consumes before a five to ten stick of cigarette per day, He stopped
smoking year ago for the reason that he doesn’t have money to buy for his vices. Every
time he eats chicken egg and sardines , he feels itchy and he cannot resist scratching his
skin. He uses an ointment to relieve the itchy part on his feet and scars are visible . His
height and weight are 150cm and 53.70kg, his body mass index is 23.87 within normal
range. He has an astrazenica vaccine for covid and get his flu vaccine last year.

Lola S - She had no degenerative, chronic or infectious diseases in the past and she rarely get sick.
Her family has a history of Poliovirus in her mother side. She also completed her immunization. In
2019 she had her check-up at Renmar hospital due to the weakness and pain on her right leg, her
physician said that it's caused by her age. And now she is using a bamboo stick as her cane when
she walks and she has a kyphosis posture. She is 4 feet and 7 inches (145cm) and weighs 37.45
kilograms. Her body mass index reveals underweight with a value of 17.83. At times of illness, she
would just drink paracetamol for fever and mefenamic acid for pain or treat wounds with guava
leaves coming from their backyard. She has an astrazeneca vaccine for covid but 1st dose only and
have her flu vaccine

Lola M - Because Lola M only speaks a few words, the student was unable to interview
her. Lola M, whose sister is caring for her, told the students that Lola M hasn't been able
to walk since the poliovirus she acquired as a baby caused the condition. When she was a
child, she spent a lot of time in the hospital getting her immunization. She was able to
crawl when she was younger, but as she got older, she was fully bedridden. Her legs and
arms were decorticate , and her body was thin and inflexible.
FAMILY ASSESSMENT BASED ON FUNCTIONAL HEALTH PATTERN

I. HEALTH PERCEPTION AND HEALTH MANAGEMENT

Lolo D and Lola S were active smokers before. Lolo D can smoke at least 10 stick of
cigarettes per day He just gave up smoking and now only rarely indulges in alcohol,
taking little amounts if he is invited or it is offered. Lola S also drinks alcohol, but not to
the point where she will be completely wasted, and she stops drinking alcohol when she
has children, but Lola S stopped smoking 20 years ago when they already had their grand
children.Lolo D and Lola S was able to recognize the importance of their health and to
value their healthy well-being. The family doesn’t use any herbal medicine to treat
their mild and common illness.

II.NUTRITION AND METABOLIC PATTERN

The DSMC Family stated that they eat meals thrice a day, plus snacks which
includes soft drinks but according to them it is occasionally only, Lola D and Lola S
claimed that back when they were younger, they absolutely loved eating junk food.
Since Lola S is Lola M's guardian, they also provided her with junk food as a snack
because it is less expensive than other options. If they don't have any money to spend,
they will instead eat boiled sweet potatoes or corn or climb guava trees to obtain
snacks. Their diet mainly consists of vegetables and rice since, since they have
planted vegetables in their yard, But, Lola S indicated that they consume meat when her son
from the other house, which was their neighbor, give them. Lolo D enjoys eating fish and
chicken meat despite having allergies He claims he can't stop himself and has no
choice because there are no other options.” Nu isut adda anya ngay garud
pagyamanan lattan ah”. Lola M's favorite food is biscuits, and it is the only snack she
could easily consume. Couple claim that they can consume 1- 2 liters of water a day
while Lola M can consume 2-3 glass of water. The DSMC family does not consume
any nutritional supplements or vitamins since, in their estimation, they do not have
adequate cash to do so even if they want to, however they take over the counter drugs
for their fever or for pain reliever (Paracetamol)

III. ELIMINATION PATTERN

Lolo D usually voids 10 times or more per day, Lola S usually voids
approximately 9 to 10 times per day while Lola M voids up to 3 to 5 times per
day, according to the couple they don’t feel any discomfort in voiding they also
claimed that they do not have history of difficulty in voiding or urinary retention
back when they are young and this past few months. Lola S defecates 2 times per
day morning and night time, and Lolo D defecates once per day in irregular time
while according to Lola S, Lola M defecates once every two days or occasionally
after three days and sometimes her feces have a firm, black texture mentioned by
Lola S.
.

IV. ACTIVITY AND EXERCISE PATTERN

Due to their ages , the couple can’t do light exercise but Lolo D usually walks to their
garden 50 meters away from their house or do some sweeping of dried leaves in the yard
serve as his exercise , While Lola S stays at home to care for Lola M and handle
household duties .Lola S stated that because it takes a lot of energy to care for her sister,
which is why she is unable to perform even modest exercise, caring for her sister counts
as exercise.

V. SLEEP AND REST PATTERN

Lolo D usually sleeps at 7 p.m. and wakes up at 5 a.m., whereas Lola S sleeps at 10
p.m. because she needs to keep an eye on her sister and wakes up at 3 a.m., and usually
woke up in the middle of the night because Lola M voids and wets her clothes, so she
needs to change her clothes, whereas Lola M sleeps inconsistently, sometimes she stays
awake throughout the night . Afternoon naps are not possible for Lolo D and Lola S since
they have to keep an eye to Lola M.

VI. COGNITIVE AND PERCEPTUAL PATTERN

Lola S and Lolo D is both aware to the time and date, and can still remember some of
the important events in their lives, but due to their ages they can’t clearly remember some
events that is already happened in the past like specific dates time and place., Lolo D and
Lola S already have a blurry vision that’s why they use specs/reading glasses when they
read the bible but they seldom use their glasses Lola M., who has already lost her vision
and has poor hearing, could previously only pronounce a few words, such as "nanang,"
"tatang," and "manang," but she is now confined to moaning in responding.

VII. SELF PERCEPTION AND SELF CONCEPT PATTERN

According to the couple they still see themselves as normal and healthy individuals.
Lolo D and Lola S bathe three to four times every day because they become chilly or
shiver easily, and Lola S bathes Lola M twice a week or whenever needed since Lola M
will just poo or pee in her bed, moreover the DSMC family doesn’t pay too much
attention on their personal hygiene because they have long and dirty fingernails and
toenails, they don’t also have alcohol or any hand sanitizer/ hand soap they just use barely
water to wash their hands. They rarely use cosmetics and personal care items since they
don't fit into their budget, or they rely only on gifts from their children or other family
members.
 VIII.ROLE AND RELATIONSHIP PATTERN

According to Lola S, their family is doing well, they have no issues with how they interact
with one another,

IX. SEXUALITY AND REPRODUCTIVE PATTERN

Lolo D was circumcised at the age of 16, and Lola S experienced menopause at the age of
40; as a result of their ages, they have already stopped indulging in sexual activities.
X. COPING STRESS PATTERN
According to the couple, when they are having a difficult time or encountering
problems, they simply try to solve them without enlisting the assistance of their
children, and when they are stressed, they simply divert their attention by watching
television or listening to their radio. They find strength in the assurance provided by
their family members.

XI. VALUES AND BELIEFS PATTERN

Their religion before was Roman Catholic but now they don’t have the strength to go
to the church since it is far from their house and don’t have the strength to walk because
of their ages and they decided to adapt Born Again since a Pastor visits them every
Sunday morning and held a Devotion to their house for about 30 minutes, The Family
doesn’t use any herbal medicine, But Lolo D uses some herbal oil (methyl salicylate
camphor+menthol) to treat his allergies, the DSMC family is likewise superstitious and
believes in ghosts. Lola S. hangs bunches of garlic at the rear door of their home.

E. VALUES ,HABITS ,PRACTICES ON HEALTH

PROMOTION ,MAINTENANCE AND DISEASE PREVENTION

Lolo D received 2 shots of Covid vaccination (Astrazeneca) while Lola S had only
received her 1st dose. On the contrary, Lola M haven’t had any shots of covid vaccine yet.
Flu vaccine was given to D and S while Lola M haven’t received any.
Apart for Ms. mRNA, who has an irregular sleeping schedule because she is not fully aware of the time and only
sleeps when she feels exhausted due to her condition, the family gets enough rest and sleep. Mr. XY often goes to bed
at 7 p.m. and gets up at 5 a.m. Mrs. XX typically goes to bed at 10 p.m. while watching television and wakes up
around 3 a.m. with a regular urination urge, which is occasionally brought on by her sister peeing in bed and keeping
her from falling back to sleep.

Mr. XY claimed that he performs the chores in their front yard and that walking is their way of exercise, but they
barely clean inside their house because of their limitation on performing or doing a considerable number of chores are
limited by old age.

Although the family is aware of the importance of health in the family, they have been compelled to ignore any
potential major health issues because of financial constraints. Also, they were unable to have a sufficient stock of the
supplies they would need for their medical requirements, such as clothing or medications.
To cure their illnesses, they typically self-medicate using over-the-counter (OTC) medications, complementary therapies, or
herbal remedies. Yet, if the family member's symptoms get worse, they rush them to a hospital or clinic.
 Chapter IV

FAMILY BACKGROUND

THE DND FAMILY

There are 3 members in the household namely Lolo XY (80), Lola XX (79), Lola
mRNA (77). Family type is extended family because the husband, wife and sister of Lola
XX are living in the same household and the children living nearby the household.

They are part of the Ilocono cultural group thus speaks Ilocano at home and in the
community of Sinili, Santiago City. Her children’s house is 4-5 meters away from them.
Lola XX was originally from Villasis Pangasinan, she was a farmer back then.

They migrated to Batal Santiago City in 1957 and remained there till 1983, when
they moved to Barangay Sinili Santiago City and have remained there ever since. Originally
from Pangasinan, Lolo XY was also a farmer and a mechanic. Nevertheless, he has no
previous experience as a mechanic and has only finished his vocational training. Since she
was a little kid, Lola mRNA has had a condition that prevents her from moving her feet. She
used to be able to crawl, but as she grew older, her legs and arms became stiff and
deformed.
When it came to making decisions, Lola XX was the one in charge, and Lolo XY
always had her back. They don't frequently discuss or share one other's concerns..
 Chapter V

FAMILY COPING INDEX

In contrast to the ideal family attitude and behavior, this chapter illustrates the actual observation of family
practices and behavior. It comprises an evaluation and measurement of the family's coping mechanisms for
issues related to medical care.
The scaling values used in this assessment: 1 -
or no competence
3 - moderately competent 5
- fairly competent

Criteria Ideal Actual Rating Justification

1. Physical is concerned with The polio client Lola M is 3 Incomplete
Independence one's ability to immobile and unable to care for Independence-
move, including herself. With a kyphotic posture Family providing partially
getting out of bed, and difficulty walking due to the needs of its members or
walking, taking care issues with her right leg and providing care for some
of daily grooming, hip, Lola S utilizes a members but not for others
and other activities. handcrafted walking bamboo
stick. Lolo D is mobile yet
reports easily becoming
fatigued under stress.

2. Therapeutic Includes all Lolo D uses herbal oil that 3 Moderate Competence-
Competence procedures or cures for his skin 'allergies', he Family carrying out some
treatments does not use any maintenance but not all of the treatments
suggested for the medicines because of financial
care of the sick, considerations. For fevers, the
such as medication, family also uses over-the-
dressings, exercise counter medications such as
and relaxation, and paracetamol.Lola S also
specific diets, are continue to put some ointment
included.

3. Knowledge of concerned with the The DND family also does not 3 Satisfactory Knowledge-
Health specific medical recognize Lolo D hypertension Has some knowledge of
Condition condition for which during exertion as a health the disease or condition
care is being priority. Lola S initially but has not grasped the
provided diagnosed the developing underlying principles
pressure ulcers on Lola M back
as scabies (gaddil).
4. Application of concerned with The DND's diet is primarily 1 No Application-
Principles of family action in composed of veggies and rice. Family diet is
General regard to family When their child shares meals insufficient or
Hygiene nutrition, ensuring with them, they rarely get to eat imbalanced, required
enough rest and meat. They just prepare enough immunizations not
relaxation for family food for each meal, and any followed by boosters,
members, and leftovers are fed to their dogs. filthy house, unsterile
carrying out They get their water from a water.
established pump and do not sterilize their
preventive measures water. mRNA has no self-care
such as abilities and poor hygiene; XY
immunization. has been noted with long,
unclean nails and resistance to
cleanliness advice. Lolo D
completed his Covid
Vaccination while Lola S had
only received her 1st dose.

5. Health concerned with The family is not concerned 3 Accepts the need for
Attitudes how the family with their illnesses and physical medical care for illness
perceives health problems, they have gotten used but not for preventative
care in general, to it and consider it as a part of measures- Accepts health
including their life. care to some extent but
preventative with reservations due to
services, illness budgetary constraints.
treatment, and
public health
measures.
6. Emotional with the maturity The family members are 5 Complete competence-
Competence and integrity with emotionally capable. XX is Each member of the family
which the concerned about who will must be able to handle
members of the care for her sister after she illness with reality and a
family are able to dies. decent level of emotional
face the usual calm.
difficulties and
problems of life,
and to plan for
happy and fruitful
existence.
7. Family Living concerned on the XX and XY are not involved 1 Unsatisfactory-
interpersonal or in their spouses' difficulties, Family consists of a group
group aspects of and they manage their of individuals indifferent to
family life, finances (pension) one another
including how well independently. mRNA is
family members get believed to be XX's sole
along with one responsibility, her husband
another and how XY does not cooperate in
they make decisions taking care of her.
that influence the
family as a whole.
8. Physical Concerned about the The family's home had 1 Unsatisfactory
Environment home, community, sufficient space for the three of environment-
and work them. On one side of the home, House in poor condition
environment as they there are only three windows and unscreened.
relate to family with no screens. Fruit flies are
health. The house's attracted to their backyard's
condition, such as ripe/rotting fallen fruits, and
the pressure of flies occasionally arrive from
accident hazards, the neighborhood fowl. Their
drainage system, yard is always littered with the
kitchen facilities, excrement of their neighbors'
privacy, and dogs and poultry.
community level
(presence of social
hazards and pests).

9. Use of The family's The family is unaware of and 1 No usage-

Community utilization and does not use community health The family has evident and
Facilities understanding of resources; it is also urgent social needs, but has
accessible inconvenient for them because not sought or gotten
community it is distant from their home. assistance.
facilities for
education and
welfare.
 Chapter VI

TYPOLOGY OF NURSING PROBLEM

TYPOLOGY OF NURSING PROBLEM

This chapter discusses the problems that were identified during assessment and interview with the
family. It includes the cues/data, the family nursing problem and the nursing diagnosis. The
problems identified are categorized into the presence of health deficits, health threats, foreseeable
crisis and stress points.

I. FIRST LEVEL OF ASSESSMENT

This determines existing potential health conditions or problems of the family. These health
conditions are categorized as:

A. Presence of health threats

A.1 inadequate food intake both in quality and quantity
A.2 unsanitary food handling and preparation
A.3 polluted/unhealthy water supply
A.4 poor personal hygiene
A.5 lack of food storage
A.6 poor water drainage system
A.7 poor waste disposal

B. Presence of health deficit

B.1 hypertension as diagnosed illness state

II. SECOND LEVEL OF ASSESSMENT

This identifies the nature or type of nursing problems the family experiences in the performance
of their health tasks with respect to a certain health condition or health problem.

A. Inability to recognize the presence of the condition or problem due to:

- scarcity of information and resources

B. Inability to make decisions with respect to taking appropriate health action

due to:
- lack of knowledge of community resources for care
- Varying views on the most appropriate action to take among family members
- unable to choose from a variety of options what to do.

C. Inability to provide adequate nursing care to the sick, dependent or at risk

member of the family due to:
- inadequate understanding of the illness or condition
- inability to provide the appropriate intervention or treatments due to a lack of
knowledge
 D. Inability to provide a home environment conducive to health maintenance
and personal development due to:
-inadequate family resources specifically limited financial support and
resources
- ignorance of the significance of cleanliness and hygiene
- ignorance of preventative actions
- lack of skills in carrying out measures to improve home environment

E. failure to utilize community resources for health care due to:

- failure to perceive the benefits of health care
-fear of negative outcomes, particularly negative financial outcomes
-a lack of family resources, particularly financial ones and the price of prescribed medications

Table 1. Typology of Nursing Problems identified in DSMC Family

Cues or Data Family Nursing Problem

Subjective data: Unhealthy lifestyle/personal habits

(hygiene, wound care)
Madi nak unay agkukkuko ,ken maliplipatak nu
dadduma nga agkukuko ” as verbalized by Lolo D 1. Inability to provide proper care due to
(I don't usually clip my nails, and occasionally I inadequate knowledge about the health
forget to do so) threat
2. Lack of knowledge on importance of
“Manmano ak agbuggo ti ima sakbay a mangan hygiene and sanitation
“ as verbalized by Lolo D 3. Inadequate knowledge in carrying out the
necessary intervention or treatment of
(I often forget to wash my hands before eating) care
4. Lack of knowledge of preventive measures
Objective data:

-long unclipped dirty nails

Subjective data: Unsanitary water supply as health threat
“madi min ipabpaburek tay ininumen mi a
danom ,madi met agsakit buksit mi uray saan a 1. inability to identify a health concern
naipaburek nasanayen siguro” because of a lack of understanding of the
issue
(We don't boil our drinking water since we don't get
2. The water supply is located close to the
stomach trouble, or perhaps because we are
accustomed to it restroom.
3.Lack of knowledge regarding the possible
Objective data: problems that a poor water supply may
Water pump source 5 meters away from the toilet. create

4.Inability to implement efforts to enhance

the home environment

Subjective data: Poor environmental sanitation as health

threat
” Madik masangon aglinis balay sipud ta baketakon
ni lakay ko agwalis met kitde dita sango nu 1. Ignorance of the significance of
makalagip” as verbalized by Lola S environmental sanitation
(Since I'm old enough, I don't have time to clean the 2.Lack of knowledge of preventive
house ; but, my husband will sweep the yard if he has
measures
time)
3.inability to execute efforts to enhance the
Objective data: home environment
-Dusty walls
-presence of cobwebs
-grimy bed lines
-small pooling of water beside the house
 Chapter VII

PRIORITIZING PROBLEMS

This chapter shows the setting of priorities of family health problems that have been
identified. It includes a computation on how priorities were shown with their corresponding
justification

● Nature of the Problem is categorized into health deficit, health threat and
foreseeable crisis.
● Modifiability of the Problem refers to the probability of success in minimizing,
alleviating, or totally eradicating the problem through intervention.
● Preventive Potential refers to the nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on the problem under
consideration.
● Salience of the Problem refers to the family’s perception and evaluation of the
problem in terms of seriousness and urgency of attention needed

● Health Threat - Poor Personal Hygiene

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 2/2 x 2 2 This problem is easily modifiable with

Problem better hygiene management such as nail
clipping and bathing.

3. Preventive 2/3 x 1 0.66 This problem has moderate preventive

Potential potential, nail trimming and care can
prevent wound formation and wound
infection.

4. Salience of the 1/2 x 1 0.5 The family partially understands the

Problem importance of hygiene and its function.
 Total Score 3.83

Health Threat - Unsanitary Food Handling and Preparation

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 1/2 x 2 2 The family can easily modify this

Problem problem with boiling their drinking
water from the well.

3. Preventive 2/3 x 1 .66 This problem has moderate preventive

Potential potential-the family can prevent
transmission of water based
communicable diseases.

4. Salience of the 0/2 x 1 0 The family doesn’t view this as a

Problem problem since they have never gotten
sick from the water

Total Score 3.33

Health Deficit - Hypertension, as Diagnosed Illness State

Criteria Computation Actual Score Justification

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

Problem

2. Modifiability of the 1/2 x 2 1 This problem is partially modifiable. This

Problem might be a chronic disease however, there
are many steps the family can take to
manage and prevent worsening of the
illness such as lifestyle management and
use of community resources.

3. Preventive 2/3 x 1 0.66 This problem has moderate preventive

Potential potential can prevent hypertension
complications such as stroke, CHF, kidney
diseases, dialysis, etc.

4. Salience of the 1/2 x 1 0.5 The family does not fully understand
Problem the importance of managing
hypertension in its current stage.

Total Score 3.16

Health Threat - Inadequate Food Intake Both in Quality and Quantity

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 1/2 x 2 1 The family cannot easily modify this

Problem problem due to financial constraints.

3. Preventive 2/3 x 1 0.66 The problem has moderate preventive

Potential potential, it can deal with better wound
healing and malnutrition.

4. Salience of the 1/2 x 1 0.5 The family partially understands the

Problem importance of nutrition and effects of
 increased food intake.

Total Score 2.82

Health Threat - Presence of Breeding or Resting Sited of Vectors of Diseases

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 1/2 x 2 1 The family can partially modify this

Problem problem with cleaning their yard more
often, however this might be difficult due
to their old age.

3. Preventive 2/3 x 1 0.66 This problem has moderate preventive

Potential potential-the family can prevent
transmission of vector based diseases.

4. Salience of the 0/2 x 1 0 The family doesn’t view this as a

Problem problem

Total Score 2.33

Health Threat - Unsanitary Water Supply

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 1/2 x 2 1 The family cannot easily modify this

Problem problem due to financial constraints.
The water supply and toilet do not
belong to them but to their son.

3. Preventive 2/3 x 1 0.66 This problem has moderate preventive

Potential potential-the family can prevent
transmission of oral-fecal diseases.

4. Salience of the 0/2 x 1 0 The family doesn’t view this as a

Problem problem since they have never gotten
sick from the water
 Total Score 2.33

Health Threat – Poor Water Drainage

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 1/2 x 2 1 This problem is partially modifiable

Problem however modifying the behavior of a
person is difficult

3. Preventive 2/3 x 1 0.66 The problem has moderate preventive

Potential potential, D can help S in taking care of M
and prevent pressure ulcer formation.

4. Salience of the 0/2 x 1 0 The couple does not view self-oriented

Problem behavior as a problem.

Total Score 2.33

Health Threat – Poor Waste Disposal

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 This problem is a health threat.

Problem

2. Modifiability of the 1/2 x 2 1 This problem is partially modifiable

Problem however modifying the behavior of a
person is difficult

3. Preventive 2/3 x 1 0.66 The problem has moderate preventive

Potential potential, D can help S in taking care of M
and prevent pressure ulcer formation.

4. Salience of the 0/2 x 1 0 The couple does not view self oriented
Problem behavior as a problem.

Total Score 2.33

Chapter VIII
 FAMILY NURSING CARE PLAN

This chapter shows the identified and prioritized problems in a ranking order. This
chapter also presents the family care plan formulated by the student nurses together with the
family.

Problem List

Poor Personal Hygiene 3.83

Unsanitary Food Handling and Preparation 3.33

Hypertension, as Diagnosed Illness State 3.16

Inadequate Food Intake Both in Quality and Quantity 2.82

Presence of Breeding of Resting Sites of Vectors of Diseases 2.33

Unsanitary Water Supply 2.33

Poor water drainage system 2.33

Poor waste disposal 2.33
 HEALTH PROBLEM 1. HEALTH DEFICIT - Inadequate food intake both quality and quantity
ASSESSMENT: Family Nursing Goal of Care Objectives of Care Interventions Measures Method of Resources Evaluation
Problem Nursing-Cli required
ent
Interaction

S:“Adda gaddil na ma’am Inability to practice SHORT TERM: After 1-2 hours of 1. Discuss with the clients the -Home visit Human After 1-2 hours of
dita bukot ken dita patong proper hygienic care after 30 mins of student nurse-client nature, cause and even the lectures resources: student-nurse client
nan” due to: student interaction, the family signs and symptoms of interaction, Goal
(Meron siyang sugat sa nurse-client will be able to: possible complications that -health -time and effort partially met as
likod at balakang niya) as -lack of knowledge in Interaction, the he/she may acquire with poor teaching of both the evidence by:
verbalized by Lola XX hygienic care and client will be -patient teaching hygiene and wound care regarding student nurses
failure to see benefits able to about personal proper and the client -the client following
O: of performing proper demonstrate hygiene and proper 2. Explore with them the hygiene and themselves our health teaching
-presence of pressure hygiene proper wound care ways of implementing wound based on our
ulcer due to being bed management of measures to maintain cleaning and Material observation
ridden Inability to care for wound care. -implement the agreed- personal hygiene sanitation Resources:
Grade 2: partial wounds due to: upon measures in order -reports of slight
thickness skin loss on bony -lack of knowledge LONG TERM: to improve her 3. Have the patient Date:8/23/22 -gauze, changes regarding the
prominences of the butt about basic wound After 6 days of personal hygiene return-demonstrate the betadine, preventive measures
-wounds on the neck and identification and intervention the within himself/herself proper ways and techniques on Time:10:00A mupirocin, that have been
legs due to scratching care pressure ulcer at home proper wound cleaning, M gloves imparted
-long unclipped dirty nails -lack of necessary will decrease and sanitation and proper hygiene.
equipment to show signs of -to be able to recognize venue:DND Financial -after 6 days of the
perform basic healing, with no beginning cases of 4. Usage of guava leaves Family Resources: client taking care of the
wound care formation of new simple hygiene decoction for washing and house wound the pressure
pressure ulcers. measures the he/she cleaning of wounds -expenses for ulcer has regressed
can adopt easily materials used from grade 2 ulceration
5. Use of banana leaves as in basic wound with partial thickness
wound dressing or bedding care skin loss to grade 1
for areas with presence of pressure ulcer with
pressure ulcer good signs of wound
healing
 HEALTH PROBLEM 2. UNSANITARY WATER SUPPLY AS HEALTH THREAT

ASSESSMENT: Family Nursing Goal of Care Objectives of Care Interventions Method of Resources Evaluation
Problem Measures Nursing-Client required
Interaction

S: "Haan mi I sterilize Ken Inability to provide After 1-2 hours After 1-2 hours of 1. Inform the family -home visit Human After 1-2 hours of
ipappapudot Tay danum ta a home of student student nurse-client about the risk factors of lectures resources: student nurse-client
Madi pay met ketdi environment nurse-client interaction, the family using the pot water/dug interaction, goal
nagsaksakit buksit mi gapu conducive to health Interaction, the will be able to: well as a permanent -establish rapport -time and effort of partially met as
kadayta danom nga al alan mi maintenance and family will water as a permanent both the student evidenced by:
dita bombaan" personal consider taking 1. Understand the risks of water supply, -health teaching nurses and the
development due appropriate using water from pot specifically: regarding risks of client themselves -family reconsidered
O: to: actions on water/dug well having possible taking appropriate
-Water supply is near the prioritizing -Discuss possible unsanitary water actions on prioritizing
drainage and restroom -lack of knowledge home facilities 2. Will understand the diseases that can be supply home facilities that
-unclean water from pot in preventive for a proper importance of hygiene acquired from bathing they can achieve for
water/dug well measures and water supply from the pot water/dug Date:8/24/22 proper water supply
limited resources 3. Will decide whether to well
prioritize the problem Time:9:00am -currently performing
among others or will -Discuss parasite alternative actions to
ignore it considering infections coming from Venue: DND family prevent diseases
their financial unsanitary water supply house coming from
difficulties unsanitary water
2.Instruct the family supply
alternative actions to
prevent disease
coming from the
unsanitary water
supply
 HEALTH PROBLEM 3. HEALTH DEFICIT - HYPERTENSION, AS DIAGNOSES ILLNESS STATE
ASSESSMENT: Family Nursing Goal of Care Objectives of Interventions Measures Method of Resources Evaluation
Problem Care Nursing-Clien required
t Interaction
S: “tawen 2017 ,bigla Inability to Within 1 hour Within 1 hour of 1. Assess and inform the family Home Partially met, after 30
simmakit ulok tapos kala recognize the of student health teaching the about existing hypertension risk Visit Time and effort minutes of nursing
maulaw nak ,idi napanak presence of health nurse- client- family will: factors. Lectures of student intervention the
nagpacheck up imbaga problem due to interaction, the 2. Assess the family's nurse and patient verbalized his
diay doctor nga adda inadequate patienssst will 1. 1.Learn about knowledge of the current Date: family awareness of the
highblood ko” as knowledge about make necessary modifiable lifestyle health issues disease process and
verbalized by the patient hypertension measures to practices that can 03/02/2023 was able to identify
properly help to manage blood 3. Discuss lifestyle changes that hypertension risk
“awan met paggatang ko manage control pressure and avoid can be implemented: Time: 8:00 factors. The family
maintenance ko asi ti apo and lessen the future issues. also learned about the
sibibyag nak pay ” risk factors of -Continuing smoking cessation AM disease's
hypertension 2. Be able to -as verbalized by Lolo D alcohol complications.
O: identify risk factors consumption Venue:
Vital Signs taken of hypertension -low salt low fat diet Residence of
Date:3/02/2023 -eating fried garlic as Family DSMC
BP140/100 3.Be able to have hypertensive herbal medicine
knowledge a good
proper nutrition 1. 1. Discuss hypertension
that reduce consequences, including signs and
hypertension symptoms that necessitate medical
attention.

2.  2. Inform the client about

community resources for
hypertension patients.

3. Associate the patient with

barangay health personnel.

HEALTH PROBLEM 4. POOR water drainage AS HEALTH THREAT

 ASSESSMENT: Family Nursing Goal of Care Objectives of Care Interventions Measures Method of Resources Evaluation
Problem Nursing-Client required
Interaction

Inability to provide Within 2 Within 2 hours of - Establish rapport Home Visit Time and effort of After 1 hour
O: a home hours of nursing interventions, Lectures student nurse and of student
- open drainage environment nursing the family will be able - assess the family's level family nurse- client
-dirty stagnant water as seen conducive to health interventions to: of understanding of the Date: 2/23/2023 interaction
- presence of mosquitoes and maintenance and the family will condition. the GOAL
flies on the stagnant water personal be able to Time: 8:00 AM PARTIALLY MET
* Be oriented with - Explain the importance of as evidenced by:
development due decide and the problem and
to: demonstrate proper water drainage Venue:
identify at least 3 system such as: * The family
appropriate importance of Residence of
- inadequate measures to  Prevention of Family DSMC acknowledges
having a proper acquisition of vector- the problem and
knowledge of eliminate, if drainage system
the not reduce related illness or emphasizes the
importance problem to possible breeding of need of having a
* List at least three vector related suitable drainage
of proper improve disadvantages and
water environmental illnesses system.
consequences of a * After a week
drainage and sanitation. bad drainage
preventive the dsmc family
system. - Assist the family in reported slight
measure
cleaning the house changes in their
* List at least three especially removing water drainage
possible vector- blockage in the canals. system
related illnesses that
the family may
develop from.