CHAPTER I INTRODUCTION Community is a collection of people interacting with one another, sharing common interests, needs, resources and

environment. It came from the Latin word comunicas meaning a group of people geographically bounded with one goal and one mission in life. (Hitchcock et al., 2003) Comprising the community are smaller social units called families. Friedman (1992) defines a family to be composed of two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family. (Maglaya, 2003) A family refers to two or more individuals joined together or related by ties of blood, marriage or adoption and who constitutes a single household, interact with each other in their respective familial roles and who create and maintain a common culture. (Bailon-Reyes, 2006) Family is the basic unit, the primary social group and the fundamental institution of human society that provides the physical and psychosocial environment for the natural development and fulfillment of all its members. The family is part of a larger system encompassing communities and cultures. A family is a member for the community, an ethnic group, a culture and a race. Its the primary mediating agent between the individual and his society; through its teachings, examples and sanctions, the young are socialized into the habits, customs, beliefs, values, and traditions of the culture. (Bailon-Reyes, 2006)

High blood pressure (hbp) or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the

body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high. (MedicineNet, 2008)

The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed. (MedicineNet, 2008)

An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications. (MedicineNet, 2008)

In the Philippines, the ten leading causes of morbidity for the year 2002 are the following: pneumonia, diarrhea, bronchitis/bronchiolitis, influenza, hypertension, tuberculosis, heart disease, malaria, chickenpox, and measles, respectively. From this, hypertension is the top five cause of morbidity, having a number of 304, 690 out of the total population of 79, 503, 675. (Department of Health, 2002)

Purpose of the Study The purpose of the study is to present a nursing care of a family with a mother and father having Hypertension, and to analyze the variables that led to the development of the problems. Specifically, this study aims to achieve the following objectives: 1. To identify the factors that led to the development of the familys problems. 2. To explain the interrelationship of factors leading to the development of the familys problems. 3. To discuss relevant interventions that was utilized to resolve problems. 4. To describe the familys response towards the interventions.

Significance of the Study This study is intended to benefit the following: To the family, this study will make them more aware of their present and future health problems. This study may also help them improve their coping ability through the health teachings rendered by the researchers. To the community, this study will help in providing a basis for the health problems in the community. This will also help them in improving the health services and programs in their community by means of promoting health and preventing illness. To the health care team, this study will help them determine the health status of the family and respond to the health condition through the application of the health care process in the community setting.

To the student nurse, this study will serve as a reference for further knowledge about community health nursing and will enhance their skills in assessing, planning and implementing interventions based on the set goals. To the clinical instructor, this study may supplement their knowledge by using the data obtained in their teaching-learning process as a basis in evaluating the effectiveness of the interventions rendered by the researchers. To the future researchers, this study may serve as their baseline data in understanding the health needs of a family in the community setting, having the similar problems. Also, they can utilize this to guide them in presenting cases related to the study.

Scope and Limitations This is a prospective A type of study, wherein the actual and potential problems were identified and were followed forward in time. This study will analyze the factors that led to the development of the problems of the family. Also, this study will discuss the identified actual and potential problems and the nursing process done by the researchers within the three-day home visits. These three days of home visit were done within the duty hours, having one to two hours per home visit. The scope of this case study is the care of a nuclear family, with a mother having Hypertension, in the community setting. This study will present the case of Family V, which consists of L.V. and L.V.

The collection of data was done through observation and interview of the family, conducted last July 7, 8, 9, and 15, 2011. Interventions were all applied and explained during the duration of the family interaction. During the physical examination, the assessment of the breast, abdomen and genitalia were not done. The study is limited only to the problems encountered by the family during the time they were handled July 7-9, 2011. The delimitation of the study is solely focused on the care for hypertension, presence of breeding sites, and cigarette smoking.

Background of the Study This case study was conducted at the municipality of Cavinti, in Laguna. It is situated at the eastern side of Laguna province, approximately at 14 15 longitude and 12131 latitude. It is approximately 122 kilometres from Manila. Cavinti is the third largest community in Laguna (next to Calamba and Paete, respectively), with a land area of 25, 770 hectares. From this totality, the forested area is 10,470.06 hectares; the agricultural area is 10,705.45 hectares; and the build-up area (residential, commercial, industrial, institutional, parks and open space) is 4,595.19 hectares. The north political boundary is the municipality of Lumban, Kalayaan and Paete; while the south political boundary is the municipality of Luisiana. The east political boundary is the municipality of Sampaloc and Mauban in Quezon province; while the west political boundary is the municipality of Pagsanjan.

According to the 2007 Census of population, Cavinti has a total of 20,469 residents. Based on the 2000 Census, the estimated/projected population is 23,843 with a total of 5,558 households. Out of this, the voting population is 14,675. Political leaders include the municipal mayor, municipal vice mayor, sangguniang bayan, municipal administrator and the 18 department heads. The sangguniang bayan is composed of 11 members, which include a secretary and 10 committees namely: committees on education and culture; human rights, good government public ethics and accountability; finance, budget and appropriations, trade, commerce and industry; women and family, health and sanitation, social services; peace and order, public safety and barangay affairs; agriculture, cooperatives market and slaughterhouse; environmental protection, public utilities and facilities, housing and land utilization; public works and transportation; rules and privileges, ordinances and legal matters; and youth and sports development, games and amusements. In terms of economy, agriculture, and banking and lending is involved. The common type of livelihood in the area is agricultural in nature. People greatly rely on farming to survive. Their major crops typically include the following: coconut, rice, vegetables, root crops, santol, lanzones, banana, citrus and rambutan. They also produce rice products like kalamay and sinukmani. The people also engage in pandan weaving to create hats, bags, envelopes, and other pandan-based products. As for banking and lending, the community has one rural bank and a lending firm. The modes of transportation include jeepneys and tricycles. In terms of communication, the facilities include one telephone company, one telegraph, one post office and six communication towers (three Globe towers, two Smart towers and one Sun Cellular tower).

In terms of climate, the summer months of April and May have warm days but cool nights despite an annual relative humidity of 81%. For the 19 years, PAG-ASA recorded an annual mean rainfall of 2,864mm with most rains during the long rainy season, which start from the first half of May to November then tapers towards the first half of December when dry season begins. The municipality has an annual mean temperature of 25.2 C. Annual maximum temperature is 28.6 C, while its minimum annual mean temperature is 21.9 . Tourist spots in the area include four falls, two lakes, two caves and one garden. One of the tourist spots was even named after the municipalitys patron saint for 403 years, El Salvador del Mundo (Jesus). There are also six major resorts in the area. Overall, Cavinti is classified as a fourth class municipality. It is composed of 19 barangays (6 urban and 13 rural). One of which is Barangay Bukal. The assigned area for the researchers to conduct their study is between Purok Marikit and Purok Mahinhin. Specifically, the actual case study was carried out at Family Vs residence at Purok Marikit, Barangay Bukal. Their house is made up of mixed concrete and wooden materials, situated along the route of public vehicles. The researchers chose family V to be the focus of this study, as they were the assigned foster family. Moreover, the researchers chose them thinking that they will be able to come up with a better assessment since they are living with them in their house. Furthermore, the two identified problems which are classified to be a Health Deficit and Health Threat, which are Hypertension and Cigarette Smoking. In addition, they chose this as to help the family to know the complications that may attribute to this problem, since that when a person is hypertensive, cigarette smoking can greatly aggravate or complicate, and possibly lead to other health

illnesses. This opted the researchers interest to conduct a study because of their interest in the complexity of the family set-up, and due to the identified problems, risk factors and its effect on the health, lifestyle and activities of the whole family. Hence, through formulating and implementing the appropriate care plan, it may help eradicate, if not, help alleviate the health problems of the family.