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Community

Pediatrics
Individual Report
By: Vincent Patrick Uy
3-D
Family Profile

Names Age/Gender/Stat Educational Occupation Health Status


us Attainment
Aristotle Sese 34/M/Married 2nd year Overseas Healthy
college Worker (Dubai)
Lydia Sese 30/F/Married 1st year college None Healthy
Joel Ramirez 38/M/Single 2nd year None Healthy
college
Allen Sese 3/M/Single None None Healthy
Alleris Sese 2/M/Single None None Healthy
* BOLDFACE: Assigned child

Family Roles

The Sese family is a nuclear family. Only the father (Aristotle Sese)
contributes to the family earnings. The father is often abroad, and is usually absent
from family activities. The mother (Lydia Sese) stays at home to care for the
children and is responsible for the partitioning of daily expenses. The children are
still too young to start schooling; they stay at home. The uncle (Joel Ramirez), does
not contribute to the family earnings.

Environmental Checklist

Parameters Observation
House/Room Owned (Inherited)
Type of House/Make Concrete & wood
Number of Partitions 1
Cleanliness / Orderliness No
Ventilation Poor / 1 window only
Lighting Yes
Lighting Facility Fluorescent light; Candle sticks when
brownout
Water Source Tap water (private); Commercial sources
for drinking water
Garbage Collection Municipal garbage collection system;
frequent collection
Drainage System Open; Often gets flooded on heavy rains
Vermin and Insect Control Not a concern
Vermin and Insect types Rats and Flies
Animals None (inside the home)
Neighborhood Residential type
Transportation Pedicab/jeep

Household Appliance Checklist

The family owns a few common household appliances, but due to the cramp
space, these appliances are stored in a neighbor’s house.

Appliance √ Electric Fan √


TV √ Refrigerator √
CD Player √ Electric flat iron √
Radio √ Washing √
machine

Other appliances that we observed includes a gas stove and a DVD player

Economic Profile
The combined family income is about 25,000 pesos a month. One hundred
percent of the family income is derived from the monthly salary of the father.
Monthly expenses were partitioned by the mother. Almost half of the monthly
income is dedicated to acquisition of daily food. Household items, electricity and
water bills, and daily consumables are divided among the other half of the income.
Since the family owns the house, they do not shoulder any expenses for this matter.

Floor Plan of The House (Not drawn to scale)

Children’s
Bedroom
Master Bedroom

Living Area

Counter
Kitchen

Location of house (In respect to Neighboorhood) [Not drawn to scale]


437-B Palmera St., Sampaloc Manila
Alleywa
Bingo
Area

The highlighted box represents the location of the house in respect to other
houses in the neighborhood. If the map is drawn to completion, the house
should be located at the far end of the whole street. The house is shared by
two families, but each has his own house number. One of the many dark
alleyways is located proximal to their house. A bingo/gamble area is also

Picture 2: Allen Sese with Vincent Uy Picture 3: The Sese family with Mayjane
Picture 1: The Sese family outside
their house Tumulak and Vincent Uy
Review of the Child

HISTORY / PHYSICAL EXAM

I. General data
This is the case of Allen Sese, a three (3) year old male, born in UERM
hospital and presently residing in Sampaloc. The informant is Mrs. Lydia Sese, the
child’s mother. Her reliability is tagged at 90%.
II. Chief Complaint
The child was seen as a well-child care patient.

III. History of Present Illness


The child is not ill, and has no significant history to present

IV. Past Personal History


The child is being offered a variety of food, and eats three meals a day
including occasional snacks. The child has no food preference and is not a picky
eater. The usual food consists of rice, fish, pork and vegetables. The mother claims
to avoid offering fatty foods. On the other hand, she does not restrain the child
from eating junk food and drinking softdrinks.
By gross observation, the child is able to perform well, and does not have any
developmental impairment. The child is attentive and listens to
command/instructions. The child plays with his friends and does not avoid social
contact with others.
The child had a previous admission in UERM hospital for accidental ingestion
of firecrackers a year ago. The mother narrates that while preparing food, the child
was seen with black residues on his tongue. The mother then reports seeing the
child convulsing within a few minutes prior to this admission. She immediately
rushed the child to UERM hospital for emergency care. The child was treated with an
unknown medication and was sent home. The mother denies any surgical
procedures done on the child, history of allergies and gross injuries. No other
significant admissions were revealed.
Initial immunizations at birth were provided by the UERM hospital, and all
other follow-ups and completion doses were administered by a private practitioner.
The following table summarizes the child’s immunization status:

BCG DPT OPV Hepatitis B Measl HiB


1 2 3 1 2 3 1 2 3 es
√ √ √ √ √ √ √ √ √ √ √ √

V. Family History
The parents of the child, including their ages and occupations were already
stated above. Both parents have a good bill of health and denied any significant
familial illnesses such as diabetes, hypertension, thyroid anomalies, epilepsy,
mental retardation and congenital defects. The patient has one 2 year old brother
who is also in good state of health.

VI. Socioeconomic and Environment


(As emphasized above)

VII. Physical Examination


A. General Appearance
The child is conscious, not in respiratory distress and listens to simple
instructions. He appears well-nourished with a healthy external
feature. Because he child responds to simple play activities, he is
considered well developed.
B. Vital Signs
0
a. Temperature: 36.5 C e. Height: 93 cm.
(Axillary) f. WFA: 92.8%
b. Pulse rate: 83 bpm g. HFA: 97%
c. Respiratory rate: 22 cpm h. WFH: 96%
d. Weight: 13 kg.
C. Skin
The child is fair skinned. The description of the skin is warm and moist
and does not exhibit and external lesions or active dermatoses
D. Head
The head is normocephalic and atraumatic. Hair on the scalp has
adequate quantity and equally distributed. There is no evidence of any
prominences of the skull bones and there is also no evidence of
swelling
E. Eyes
The eyes were irritable to stimulus, and the infant would guard his face
when approached. The red orange reflex was appreciated on both
eyes and shows no dullness or irregularities. Extraocular movements
were normal, and the child was able to perform the maneuvers with
ease. Due to lack of materials, vision screening was not done
F. Ears and Mastoids
Ears were normal in shape and size and were equal on both sides of
the head. There was absence of abnormal discharges. Hearing was
equal on both sides. Otoscopic exam reveals no obstruction and a
clear tympanic membrane (with a cone of light) on both sides.
G. Nose and Sinuses
The child’s nose show normal patency with no evidence of trauma.
There is n evidence of discharge. Further examination reveals a
pinkish mucus membrane with no inflammation of the turbinates.
Septum appears to be in the midline.
H. Mouth and Throat
Lips were moist, red and showed no fissuring and masses. The buccal
mucosa appears pinkish and moist with no evidence of bleeding and
infection. There was absence of excessive drooling. The child has
complete set of deciduous teeth. The tongue was midline with no
evidence of trauma or infection. There was absence of swollen tonsils
or any other abnormalities
I. Neck
Neck was smooth and supple with absence of remarkable masses or
enlargements. The thyroid gland and thymus glands were unpalpable
(WHO Goiter Grade 0). There was absence of neck enlargements such
as hematoma or thyroglossal duct cysts.
J. Thorax and Lungs
The child had symmetrical chest expansion without chest retractions.
The transverse diameter of the chest is greater than the anterior-
posterior diameter. Vocal and tactile femitus were equal bilaterally.
Breath sounds were clear with absence of stridorous breathing and
other abnormal breath sounds.
K. Cardiovascular
The child had an adynamic precordium with absence of precordial
bulge and thrills. The apex beat was located at the left 4th intercostal
space midclavicular line. No murmurs and aortic bruits were
appreciated.
L. Gastrointestinal
The abdomen was soft and globular. Abdominal distention seems to be
absent due to the inverted umbilicus and absence of venous
engorgements.
M. Renal
Was not evaluated
N. Anus
Was not evaluated
O. Spine and Extremities
The spine showed absence of gross deformities and was not deviated
to any side. There was absence of sacral dimpling and pilonidal
sinuses. The child did not complain of local tenderness when the spine
was being palpated. Ortolani maneuver tested negative for hip
dislocation.
P. Lymph Nodes
Negative for lymph node enlargement and tenderness.

Assessment on Health and Psychosocial Problems

The nutritional status of the child is summarized below:


Weight Height WFA HFA WFH Interpretat
(kg) (cm) ions
13 93 92.8% 97% 96% The child
appears to
have a
normal
nutritional
status
Compared to his brother, this child rarely gets sick, probably due to. The
child is both active and playful.
Hygienic practices are poor, and the child is often seen without pants and
slippers. The child does not know how to wash his hands before eating, and still
defecates in inappropriate places.

Proposed Environment and Health Promotion Strategies

• Mother must be educated with regards to the importance of hygienic


practices. There is a need to teach the children good toilet habits and simple
ways to help around in the maintenance of the home.
• Get the children used to more nutritious food (consequently, nutritious foods
are cheaper) instead of allowing them to drink carbonated beverages or junk
food.
• Avoid exposure to cigarette smoke by doing more frequent activities indoors
rather than outdoors. However, early morning outdoor activities will promote
physical exercise.
• The mother should be more aware of diseases that can be transmitted, and
they should impress on their children the importance of wearing appropriate
clothes and slippers when playing outdoors.
• Protect the child from ingesting or playing with dangerous household items.
Some of these items were seen lying around the house and should be put
away.

Reflection

Time is very precious in such crucial moments of a 3rd year student’s life, and
every minute consumed is important. When I first heard about this activity, I was
actually excited. Aside from the regular school work that we are often exposed to
almost 8 hours a day, this activity is a means to mirror what is being learnt inside
the classroom.
When I arrived in the community, however, my impression changed from
excitement to disgust. I was surprised to see the crowded spaces, the way of living,
children exposed to many hazards and the disarrayed environment. On top of the
heat, it was also hard to convince families to get involved.
Fortunately, my partner and I were able to convince the Sese family to
undergo the study. Unlike any family, our family is less productive. They live on the
many simplicities of daily living paying no particular attention to items that will not
make them survive a day.