I.

INTRODUCTION Community health nursing is one of the two major fields of nursing in the Philippines; the other is hospital nursing. Nursing practice in the community means different nurses. Many, if not most of us, emphasize the setting of practice; this is, community health nursing is nursing practice outside the hospital. As defined by the American Nurses Association, Community health nursing practice promotes and preserves the health if populations by integrating the skills and knowledge relevant to both nursing and public health. The practice promotes and relevant to both nursing and public health. The practice is comprehensive and general, and is not limited to a particular age or diagnostic group; it is continual, and is not limited to episodic care, while community health nursing practice includes nursing directed to individuals, families, and groups, the dominant responsibility is the population as a whole. Community health purpose and goals are realized through the application of a series of steps that lead to a desired result. The nursing process is central to all nursing actions; it is very essence of nursing applicable in any setting, in any frame of reference and within any philosophy. Its uniqueness will depend on the best application of nursing and public health skills to family and community problems. Community exposure involves the family living in the area to render care provided in order to motivate them to assume responsibility for their care and be able to teach and maintain a desired level of function, explaining and answering questions to clarify doubts, to maximize the clientsconfidence and ability to care for themselves. Thus, the role of the community health nurse shifts from direct care giver to that of a teacher. To maintain their optimum level of functioning, the family needs to support system provide a harmonious, orderly care to enable client to function optimally. Through coordination initiated by the community health nurses, the client is offered planned assistance. All of these inputs gathered will be explained in the study. This case is chosen because of the interest was caught during our community duty exposure: assessment to evaluation. The students chose this study to broaden our knowledge about the chosen case condition.

OBJECTIVES OF THE STUDY This case aims to improve the researchers knowledge about the past, present and future condition adding and is conducted to gain a thorough understanding regarding the family health condition and problems. This also enhances the family knowledge on nursing assessment, problem, identification, nursing interventions and evaluation that is related in the condition.

This study also aims to improve the skills of the student in their profession, interpersonal relationship with care givers and to gain more confidence in their selves in every tasked given to them.

SCOPE AND LIMITATION OF THE STUDY The study focuses on the familys specific condition in connection to health. That is, we are task to assess and even to identify the cause (predisposing and predisposing factors) of such illness, health condition, or disease. And how each of these conditions could be intervene or prevented. And even have a study of the medication taken by a particular client for the awareness or knowledge. Limited only to the profile and personal background of Ms. Montalba. The information is obtained from the client herself. Other relevant information is kept confidential for her privacy.

II. Spot Map

A. Narrative description of the route from the point of reference Liceo de Cagayan University The spot map is our directive path going to our clients residence, from our point of reference the Liceo de Cagayan University which is in north. For us to get there we hired a jeepney and it costs 43 pesos per head for a back and forth fare. Again from the point of origin, we cross Calamansi Street passed Liceo de Cagayan University High School in the point of intersection between Mother of Perpetual Help Ave. (the road towards Barangay Patag) and Calamansi Street we turned left passing St. Marys Academy Carmen Branch, Our lady Mt. Carmel Parish Church (left side) and JR Borja General Hospital (right side). We passed again another intersection at Zone 5 Upper Carmen; we turned left again passing Immanuel International School, Cagayan de Oro Garbage Dumpsite and a Small Bridge, the boundary separating Barangay Carmen and Barangay Canitoan. On the first local road (yellow) after the bridge, was the Calaanan Crossing, turned left another intersection we head on the left side the P.N. Roa Subdivision. Residential Houses at the left side then the P.N. Roa Elementary School (right side) and a small bridge. In the last intersection we turned left and passed another bridge. We stopped after passing the Habitat then from the area, we walked to find a family who fits in our criteria. B. Alternative route if an individual travels through regular means From the point of origin (Liceo de Cagayan university main campus) you can ride a Jeep such as Bonbon, Bayabas, Nazareth route (R2), Kauswagan and NHA and it only cost 6 pesos for the student and 7 pesos for regular worker, passing Carmen bridge and the St. Augustine church then the Xavier University main campus and the Hall of Justice to Cogon terminal located near the XUCHCC (German Doctors). You can then ride a Jeep going to Calaanan. The fare would be 13 pesos to Canitoan Barangay Health Center and 17 pesos to Calaanan relocation area. The driver should be informed first that you would be going to Calaanan relocation area so that he could get you there.

C. SPOT MAP ILLUSTRATION

III. FAMILY PROFILE Name Position in the family Gender Age Educational attainment Civil status Birth date Birth place Citizenship Religion Occupation Monthly income Name Position in the family Gender Age Educational attainment Civil status Birth date Birth place Citizenship Religion Occupation Monthly income : JI : Head : Male : 39 years old : College Level : Live-in : March 3, 1973 : Cagayan De Oro City : Filipino : Roman Catholic : Driver : 4,000 pesos : RM : Wife : Female : 31 years old : College Level : Live-in : October 28, 1981 : Cagayan De Oro City : Filipino : Roman Catholic : Del Monte Employee : 1,500 pesos/15 days

Name Position in the family Gender Age Educational attainment Civil status Birth date Birth place Citizenship Religion

: VJI : Only Child : Male : 2 years old : N/A : Child : August 30, 2010 : Cagayan De Oro City : Filipino : Roman Catholic

IV. Family Health History A. Present Health Status Head (Father) Mr. JI is the second child among four siblings. There is no history of familial diseases such as hypertension, diabetes or heart disease. He and his wife are not yet married but living together. About his diet he eats what is served in the table. He smokes at least three times per week and consumed 2 sticks per smoke and drink alcoholic drinks occasionally. Mother Mrs. RM was born through normal spontaneous vaginal delivery. She is not choosy when it comes to food. RM gave birth to her one and only child through normal spontaneous vaginal delivery. Her menstruation is regular which lasts 3-4 days. She was not engaged in any kind of vices and does not practice any kind of family planning method. There is no history of familial disease. Son VJI was delivered through normal spontaneous vaginal delivery. He is the only child. According to her mother he was fully immunized. He may caught colds, cough and fever sometimes and as of now he is having a runny nose.

V. Present Health Status A. Father (Head) Mr. JI stated that he is not experiencing any illness and is feeling well. The client latest vital signs are: BP=120/80, RR=20, PR=74, Temperature=37.1 degree Celsius, Height=168cm, weight=65kg. Mother Ms. RM stated that she is feeling well and healthy. About her way of living and lifestyle she eats vegetables most of the time, she sleeps or rest well during daytime or

night time and she doesnt drink alcoholic beverages and never smoke ever since now and then. The client latest vital signs are: BP=110/70, RR=22, PR=70, Temperature=36.8 degree Celsius, Height=160, weight=57kg. Son VJI was having a colds and cough during my assessment. The mother stated that it was the 5th day of his cough and colds. He didnt give her son any medication; she only let him drink enough water and hot milk. He has some skin allergy on his lower extremities and because he scratches it, it turned into small wounds. His latest vital signs are: Temperature=36.9 degree Celsius, RR=26, PR=89, Height=86cm, Weight 10.4kg.

VIII. NURSING SYSTEM REVIEW CHART OF THE FAMILY MEMBER NURSING SYSTEM REVIEW CHART DAY 1 NAME: MR. JI Vital Signs: PR: 74bpmRR: 20cpm BP: 120/80 mmHg cm .Weight: 65 kg Temp: 37.1C Height: 168

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [ X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass Dirty Toenails Drinks minimal alcoholic beverages occasionally

DAY 2 NAME: MR. JI Vital Signs: PR: 74bpmRR: 20cpm BP: 120/80 mmHg cm .Weight: 65 kg Temp: 37.1C Height: 168

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [ X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass Drinks minimal alcoholic beverages occasionally

DAY 3 NAME: MR. JI Vital Signs: PR: 74bpmRR: 20cpm BP: 120/80 mmHg cm .Weight: 65 kg
EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [ X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass

Temp: 37.1C

Height: 168

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the Drinks minimal problem in the figure using [X].

alcoholic beverages occasionally

EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X ] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [ X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass

DAY 1 NAME: MS. RM Vital Signs: PR: 70bpm RR: 22cpmBP: 110/70 mmHg Temp: 36.8C Height: 160 cm. Weight: 57 kg.

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

DAY 2 NAME: MS. RM Vital Signs: PR: 70bpm RR: 22cpmBP: 110/70 mmHg Weight: 57 kg. Temp: 36.8C Height: 160 cm.

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X ] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [ X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass

DAY 3 NAME: MS. RM

EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X ] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [ X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass

Vital Signs: PR: 70bpm RR: 22cpmBP: 110/70 mmHg Temp: 36.8C Height: 160 cm. Weight: 57 kg.

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

DAY 1
NAME: VJI Vital Signs: PR: 89bpm RR: 26cpmTemp: 36.9C Height: 86 cm. Weight: 10.4 kg

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [X] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass Small wounds, Some skin allergy Colds Dry, non-productive cough

DAY 3 NAME: VJI Vital Signs: PR: 89bpm RR: 26cpmTemp: 36.9C Height: 86 cm. Weight: 10.4 kg
EENT: [ ] impaired vision [ ] blind [ ] pain [ ]redden [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion teeth [ ] assess eyes ears nose [ ] throat for abnormality [X] no problem RESP: [ ] asymmetric [ ] tachypnea [ ] barrel chest [ ] apnea [ ] rales [X] cough [ ] bradypnea [ ] shallow [ ] bronchi [ ] sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic [ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [X] no problem CARDIOVASCULAR: [ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate rhythm, pulse, blood Pressure, circ., fluid retention, comfort [X] no problem GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass Small wounds, Some skin allergy

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X]. Colds
Dry, non-productive cough

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES Date: September 10, 2012 Childs Name: VJI Age: 2yrs.old Sex: Male Weight 10.4 kg Temperature: 36.4 degrees Celsius Initial Visit? ASK: What are the childs problems? COUGH AND COLDS ASSESS (Encircle all signs present) CLASSIFICATION CHECK FOR GENERAL DANGER SIGNS *NOT ABLE TO DRINK OR BREASTFEED *VOMITS EVERYTHING *ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN *CONVULSIONS

Height: 86 cm Follow-up Visit ____

YES_ NO

 DOES THE CHILD HAVE COUGH OR DIFFICULTY BREATHING? Yes__No For how long? 1 day minute breathing? - Look for chest in drawing. - Look and listen for stridor. DOES THE CHILD HAVE DIARRHEA? Yes __ No For how long? condition awaken? -Restless or irritable? * Look for sunken eyes. * Look for sunken eyes. *Offer the child fluid. Is the child: -Not able to drink or drinking -Poorly? . -Drinking eagerly, thirsty? * Pinch the skin of the abdomen. Does it go back: -Very slowly (longer than 2 -Seconds? Slowly? 4sec DOES THE CHILD HAVE FEVER? (by history/feels hot/ temp 36.9C or <) Yes No Decide Malaria Risk Does the child live in a malaria risk area? stiff neck. - Look or feel for NO DIARRHEA * Look at the childs general -Abnormally sleepy or difficult to - Count the breaths in one NO PNEUMONIA 86 breaths per minute Fast

Has the child visited a malaria are in the past 4 weeks? - Look for runny nose. If malaria risk, obtain a blood smear ( + ) ( Pf ) ( Pv) ( - ) Not done NO MALARIA RISK

 For how long has the child had fever? MEASLES - Look for signs of

If more than 7 days, has fever been present every day? - Generalized rash and one of these, cough, runny nose or red eyes. Has the child has measles within the last 3 months? If the child has measles now or if yes, within the last 3 months extensive? eye. - Look for clouding of the cornea. Decide Dengue risk: YES__ If dengue risk then ask: Has the child had any bleeding from the nose or gums or in the vomitus or stools? - look for bleeding from nose or gums - look for skin petechiae Has the child had black vomitus or black stool? -feel for cold and clammy extremeties Has the child had abdominal pain? _seconds Has he child been vomiting? child is - Check capillary refill - Perform tourniquet test if NO FEVER; DENGUE HEMORHHAGIC FEVER UNLIKELY NO -Look for mouth ulcers are they deep and - Look for pus draining from the

6months 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? ear *Is there ear discharge? the ear. If yes, for how long? ____ days - Look for pus draining from the - Feel for tender swelling behind

NO EAR INFECTION

 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 Encircle immunizations needed today __ __ BCG _ ___ DPT1 ___ DPT2 Measles ____ DPT3 _____ OPV3 _____ HEP B3 _ ___ OPV1 _____ OPV2 _ HEP B1 ________ HEP B2 ________ Return for next immunization on: SEPTEMBER 19, 2012 Not Fully Immunized Child (FIC) NO ANEMIA NOT VERY LOW WEIGHT

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older. Is the child six months of age or older? ____ Yes ___ No

Vitamin A needed today 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 the child? ___ If yes, how many times in 24 hours? 5 times. Do you breastfeed during the night? No___ - Does the child take any other food or fluids? No ___ If yes, what food or fluids? rice, porridge, bread, crackers, fish, meat -How many times per day? _5_Times. What do you use to feed Yes ___ NO FEEDING PROBLEMS Yes ___ No

Yes__

 the child? spoon ASSESS OTHER PROBLEMS: NONE

VI. DESCRIPTION OF HOME AND ENVIRONMENT A. House a. Ownership: ( ) Owned ( ) Rented (/ ) Rent-free b. Construction material used: (/ ) Light ( ) Mixed ( ) Strong c. Number of rooms used for sleeping: 0 room d. Lighting facilities: (/ ) Electricity ( ) Kerosene ( )others e. General Sanitary condition: moderately clean

The house is made-up of woods. The roof is partially made up of sen. The windows are only covered with curtains. The house has no division of rooms, no appliances, and sala set. They used electric light as their source of light during nigh time.

B .Kitchen f. Cooking facility () Electric stove ( ) Gas stove (/ ) Firewood/charcoal g. Sanitary condition: moderately clean

They used firewood as the method for cooking their food. They cook at the back of their house They do have enough space to keep their food and washed dishes from flies and other vectors. They have a small table where they eat during meal time. They dont have proper place where they can wash their plates and other kitchen utensils. They just wash it using a basin.

1. Presence of Health hazards No drainage. No proper window cover. Fire hazard. 2. Water Supply

They get their water from a faucet (common source) as their drinking water. They stored water in jars, galloons and drums.

3. Toilet They used water sealed toilet and it is located outside from their house.

4. Sanitary Condition The house was moderately clean. Their house surrounded with some plants. Proper practice of waste disposal. Proper hygiene was practiced by the family members.

5. Garbage System They do not practice waste segregation. They place their garbage in a sack or plastic cellophane.

6. Drainage System They do not have drainage system; it can also help in minimizing the breeding ground of the mosquitoes. 7. Kind of Neighbourhood Their neighbours are good and they have good relationship with them. It can help in doing their daily activities freely.

8. The Community in General 1- General sanitary condition: moderately clean 2- Housing congestion (/ )yes 3- Recreational facilities: radio 4HOME AND ENVIRONMENT Table I.
FACTORS DESCRIPTION SIGNIFICANCE

( )no

 Type of house Made-up of woods. The roof is made up of sen. The windows are only covered with curtains. Electric light It is not an ideal kind of house because it can easily be damage and catch fire. It is the ideal source of light because of its safety. But the fact is that it involved money. Inaccessible to their part. They need to have enough storage for water. It can be cause of fire accidents. Full attention is highly needed during cooking time so that accident can be prevented. The cellophanes should be closed after placing the waste so that flies and other vectors cant enter it before collected by garbage collectors. Ideal toilet. Can minimize the breeding grounds of mosquito. It is far to the family, it is not easy to easy to get to, in time of emergency cases It can be a source of their food. It can help them to live harmoniously if they have good relationship to others because neighbour sometimes become our stress points in our daily living.

Source of light during nighttime Distance of source of water

They get their water a long distance from their house, approximately 50 meters away from their house Located at the back of the house. They cook outside the house, which they use firewoods. They disposed their waste in a sack or plastic cellophanes and are collected regularly.

Location of kitchen Way of cooking

Ways of garbage disposal

Type of toilet Drainage system Distance of health center Domesticated animals Relationship to their neighborhood

Water sealed No drainage system Approximately 1 kilometer

Chicken Good

V.FAMILY COPING INDEX The purpose of this FCI is to provide a basis for estimating the nursing needs of the particular family. It can also help the nurses to organize and plan nursing care with precision so that the care given is tailored to fit the particular family situation. The coping index consists two parts: 9. A POINT in the scale consisting the following:

1- No competence 3- Moderate competence 5- Complete competence

NO PROBLEM- when there is NO problem or the area is not prevalent to make decision. 2. A JUSTIFICATION statement- consists of brief statement or phrases that explain why you have rate the family as you have.

Table I.
AREA Physical Independenceconcerned with ability to move about to get out of bed, to take care of daily grooming and walking and the like also includes the unwillingness or fear of certain individual in doing the necessary task. Therapeutic Independenceincludes procedure or treatment prescribed knowledge to condition. Knowledge of Health Condition RATE 3 JUSTICATION The individual member of the family is partially performing daily activities without any assistance. The mother gives care to her child according on her knowledge and available resources. The father is away to work.

The family carried out some but not all the treatment prescribed. When a family member gets sick, they do not go directly to health center for treatment The parent has a little background of some diseases which is typically happen in a certain family. They able to do immediate action based on her knowledge. The family is partially practicing general hygiene as evidenced of: organized kitchen, some things inside their house is properly arranged but there are some that are not. The child is well groomed. The child is fully immunized. Also, the family knows the health programs in the health center but not all the time that they join the programs. The family members are still in immature on how to deal with different stress points in their living. The only parents can settle those stress points especially the financial crisis they were experiencing right now which can interfere in the way of their living. The father does his best to provide the needs of his family that is why the family able to cope with the necessary things needed by their child. The family needs more improvement in their house; sanitation in outside the house and

Application of Principles of personal and general hygiene

Health Attitude

Emotional Competence

Family Living

Physical Environment

 practiced waste segregation. Use of Community facilities 1 The family partially utilized some resources in the community but not all times, because of the lack of trust in the barangay workers in their health center, which is far from their house.

VII.

Schematic Presentation of the Family Health Problem

SOCIAL BIOLOGICAL ENVIRONMENTAL

ECONOMIC

CULTURAL

POLITICAL

PSYCHOLOGICAL

PHYSIOLOGICAL

PRESENCE OF HEALTH HAZARD

Father as a driver. Mother is working in a company; packing section and sometimes stays home doing household chores.

They have been eating vegetables planted at the back of their house as primary source of food.

Poor allocation of government resources. Family does not fully utilize available community services and resources.

Rest & Relaxation

Nutrition and Diet

The child is drinking milk but no vitamins supplement.

During free time, mother stays inside the house taking care of her child.

Cough/cold
Health Deficit

Kitchen located at the back of the house. The use of firewood in cooking No drainage system Presence of breeding grounds for mosquito

Health Threat

Fair house sanitation Poor drainage system Poor water system

Health Threat

Foreseeable Crisis Health Threat

Foreseeable Crisis

FAMILY HEALTH CARE PLAN

CUES HEALTH PROBLEMS FAMILY NURSING PROBLEM GOAL OF CARE OBJECTIVE OF CARE INTERVENTION MEASURES METHOD OF NURSE FAMILY CONTACT AND EVALUATION

OBJECTIVE Improper garbage *The disposal as garbage health threat. were placed on a sack or plastic cellophane but not properly closed.

*Inability to appreciate the importance of proper garbage disposal.

After 1 hour of health teaching, the family will decide on appropriate actions to take regarding the proper way of disposing the garbage.

After 1 hour the family will be able to: *Identify and classify types of wastes as biodegradable and non-biodegradable. *practice proper method of waste management.

1. Provide health teaching about the correct ways in garbage segregation. 2. Educate the family about the risk and effects of improper garbage disposal to promote better compliance. 3. Encourage the family to maintain environmental sanitation by utilizing proper garbage containers.

* Home visit * Interaction with the family * At the end of 1 hour the family was able to identify and classify the types of waste as biodegradable and nonbiodegradable.

CUES OBJECTIVE *Dirty toenails.

FAMILY NURSING PROBLEM Poor 1. Inability to hygiene recognize the practice as presence of health threat. poor personal hygiene due to lack of knowledge. 2. Inability to provide care to the dependent members of the family due to inadequate family resources for care.

HEALTH PROBLEMS

GOAL OF CARE After one hour, the family will be able to understand the possible consequence s of poor hygiene practice.

OBJECTIVE OF CARE After nursing interventions; the family will be able to: 1. Explain the importance of personal hygiene. 2. Enumerate ways in maintaining good personal hygiene. 3. Understand the importance of personal hygiene. 4. Include application of personal hygiene to activities of daily living

INTERVENTION MEASURES 1. Discuss the implementation of poor hygiene practices such as the infestation of intestinal parasites. 2. Explore the families commitment in maintaining cleanliness by always reminding to observe proper hygiene. 3. Emphasize the importance of proper hygiene practice which could lead to a healthy body, far from illnesses and infection. 4. Develop the skills of family members to wash their hands and feet; cut their nails and wear slippers. 5. Demonstrate to the family proper ways of maintaining good personal hygiene, like bathing and tooth brushing.

METHOD OF NURSE FAMILY CONTACT AND EVALUATION *Home visit *Interaction with the family * At the end of nursing intervention the family will be able to: 1. Explain the importance of personal hygiene. 2. Enumerate ways in maintaining good personal hygiene. 3. Understand the importance of personal hygiene. 4. Include application of personal hygiene to activities of daily living.

CUES

HEALTH PROBLEMS

FAMILY NURSING PROBLEM

GOAL OF CARE

OBJECTIVE OF CARE

INTERVENTION MEASURES

METHOD OF NURSE FAMILY CONTACT AND EVALUATION

OBJECTIVE *The house is not well protected.

Threat of cross infection from a communica ble disease case.

1. Inadequate family resources. 2. Inadequate knowledge of importance of health maintenance.

At the end of one hour, the family will understand and apply health teaching done to them especially on the importance of using mosquito net.

After nursing interventions; the family will be able to: 1. Explain the importance of the immunization. 2. Understand the importance of personal hygiene. 3. The application of personal hygiene to activities of daily living. 4. The importance of having a well living.

1. Discuss to the importance of immunization, proper hygiene and having a well-protected house. 2. Encourage the family to take the grandchildren in the health center promptly for their Immunization. 3. Develop the skills of family members to wash their hands and feet; cut their nails and taking a bath regularly. 4. Encourage the family to initiate skills in improving their house facilities.

* Home visit * Interaction with the family *Give health teachings * At the end of 1 hour the family was able to understand the importance of vaccination, and protected house.

X. NURSING CARE PLAN

CUES OBJECTIVE: -wound -skin allergy

NURSING DIAGNOSIS Risk for infection related to inadequate primary defense.

OBJECTIVES At the end of 30 minutes the client will be able to understand the potential diseases/ complication when having and to have proper hygiene or doing wound care to promote wellness and healing of the wound.

INTERVENTIONS INDEPENDENT: - Encourage to perform hand washing regularly after or before touching it, eating, and defecating -Encourage proper hygiene -Teach proper way in cleaning the wound DEPENDENT: -Administer antibiotics as prescribe by the health worker.

RATIONALE

EVALUATION At the end of 30 minutes the client understands the importance of proper hygiene, diseases that will occur when there is complications and proper wound care.

- To prevent the spread of microorganism -To keep the affected area clean and reduce bacterial growth -To reduce bacterial growth and to promote healing. - Antibiotics inhibit the synthesis of bacterial wall causing cell death.

XI. ACTUAL IMPLEMENTATION 1st visit Last July 16, 20102, we had our first community duty in Amakan 5 Relocation Site, Brgy. Calaanan, Cagayan De Oro City. It was my first visit to my family. First, I introduced myself and explained the purpose of my visit. The good thing is, the family members are participative and cooperative during the interview and assessment. On the same day, I gathered necessary information using the family nursing tool and conducted an initial assessment to each family member. Also, I imparted essential health teachings to them about proper personal hygiene, nutrition, home sanitation and importance of health maintenance and disease prevention. 2nd Visit On the second visit to my family, last July 17, 2012, I conducted an initial evaluation to them. It is to check or evaluate if the health teachings I imparted the previous day were really effective and that they applied it to their everyday living. Upon evaluation, I observed that the family members appearance improved, also the environment inside and outside the house are well arranged. Seeing the improvement really made me happy, though I could tell that the family has some knowledge about proper personal hygiene and home sanitation, they still followed my teachings and was very attentive. 3rd Visit July 18, 2012 was the third and last day of visit to my family. I had my final evaluation and reinforcement of the teachings I have shared to them. I was glad because they were so collaborative with me. During our interaction, the family verbalized how thankful they are in sharing our knowledge about health.

RECOMMENDATION We refer our clients to the health center of Baragay Calaanan for initial consultation and follow-up care for any discomfort or illness to prevent self-medication, and misdiagnosed. The family especially X was taught about diet managements to help lessen or may able to cure the health problem. The family was encouraged to consult any problem to health centers for prompt interventions to avoid complications or reoccurrence. The family was also instructed about using natural way of curing common health illnesses by using herbal plants as an aid of financial problem.

XII. EVALUATION At the end of three days of interaction and observation with the chosen family, I was able to gather information about the family background and their health and family condition. Also, was able to share valuable health teachings as well as imparted to the family corresponding therapeutic intervention measures. The family was able to gain knowledge about certain disease. They were also able to show willingness to know and accept the importance of health promotion, prevention of illnesses, maintenance of proper nutrition and diet. After three home visits implementing the family health plan, I was able to see the willingness of the family to really put into practice the health teachings render to them. The family has been displaying a good compliance of the treatment regimen and health teachings given to them. They had demonstrated the ability to perform skills necessary for their wellness and for the good of their family as well. Knowing the fact that the family members were cooperating and willing to take steps and follow the health teachings in such a privilege. It simply means that I had developed rapport and trust to the family.

XIII. BIBLIOGRAPHY Medical-Surgical Nursing by Susan C. Smeltzer, Brenda Bare, and etc.; Volume 1 and 2,; 7th edition. Fundamentals of Nursing by Kozier and Erbs; page 1154-1163; 8 th edition Maternal and Child Health Nursing; Volume 2; pages 1263; 4 th edition http://en.wikipedia.org/wiki/ http://emedicine.medscape.com/article/195246-overview http://www.ncbi.nlm.nih.gov/pubmed/11405083 www.scribd.com/doc/11901203/ Public Health Nursing in the Philippines; by Frances Prescilla L. cuevas and etc.; 10th edition