FAMILY HEALTH ASSESSMENT TOOL

Respondent: Harvy Deopita

I. Demographic Data

NAME Father: Harvy Deopita Mother: Nanette Deopita NAME Aeron Cian Deopita II. Economic Data

EDUCATIONA L ATTAINMENT College Level College Level GENDER Male

OCCUPATION

RELIGION

Barangay Employee Housewife AGE 2 years old

Baptist Baptist DATE OF BIRTH April 28, 2009

A. FAMILY MONTHLY INCOME Name Harvy Deopita Source of Income Work in the Barangay Center Monthly Income Php 3,000

B. FAMILY MONTHLY EXPENSES Representation 1. 2. 3. 4. EXPENSES Food Electricity Water Transportation TOTAL: AMOUNT Php 1, 080 Php 1,100 Php 420 Php 400 Php 3, 000

Graph

S ales
13.33% Php 400

14% Php 420 36.67% Php 1, 100

36% Php 1, 080

Food Electricity Water Transportation

III. Home, Sanitation and Environment A. Type of Household Materials: Mixed ( Heavy and Light )

B. Source of Water Supply: Artesian / Pump Bought water for drinking

C. Type of Toilet Facility: Water Sealed

D. Type of Garbage Disposal: Burning

IV. Nutritional Assessment A. 24-hour Food Inventory

Breakfast Rice Egg Noodles Coffee

Lunch Rice Laswa Fish

Dinner Rice Pork

GRAPH

2% 0

5% 0 3% 0

Ca rbohydra tes

Protein

Vita insa Minera m nd ls

B. Family Nutritional Status ( Birth up to 6 years) Name Aeron Cian Deopita Gender Male Age in Months 27 Months Weight 10 kg Nutritional Status Not normal

Nutritional Status BMI = (weight in pounds * 703 ) height in inches

( kg/m )

= (22.05 * 703) 302

BMI of 17.22 which is interpreted to be underweight.

Age Congruence to Appearance Patients appearance suits for his age.

C. Food Preparation: Cooked

D. Frequency: Always

V. Values, Habits, Religious and Health Practices A. Immunization History

FAMILY MEMBER Aeron Cian Deopita

IMMUNIZATION RECEIVED BCG,OPV, DPT, MEASLES, HEPA

REMARKS Complete

B. Lifestyle Practices Family Mmber Harvy Deopita Nanette Deopita Aeron Cian Deopita Cigarette Smoking Alcoholic Beverage Drinker Self Medicatio n Walks Barefoote d Exercises Regularly Annual Medical Check Up

C. Medical/ Surgical History Family Member Nanette Deopita Harvy Deopita Medical Illness Appendicitis Hypertension Surgical Experience Appendectomy Compliance to Treatment Complete Complete

D. Religious Belief What religious denomination does the family belong? Baptist Does the family worship together? Yes 3. What religious denomination practices affecting the health does the family observe? None E. Family Planning Practices 1. What birth control method does the family practice? None

2. Reason: Not using any birth control because of its side effects. F. Conflict Management 1. What conflict does the family experience? If the husband comes home late and drunk. Misunderstanding with their child custody.

2. Who manages the conflict in the family? Both the husband and wife manage the conflict. 3. What is the manner of conflict management? Family Discussion 4. Was it resolved? Yes G. . Barangay Center Visits Family Member Aeron Cian Deopita H. Mortality Is there any death in the family? None Service Availed Check Up Reason for Availing the Service For Check Up

OBJECTIVES: After our case presentation, the BSN 2 Group 1 will be able to: 1. discuss the family and their way of living; 2. assess the health problem; 3. present the spot map and; 4. formulate the FNCP.

OUTPUT IN COMMUNITY HEALTH NURSING

BSN 2 ALPHA1
GROUP 1
SUBMITTED BY: AGOSTO, NOELA ALI, ZIA MARIE ALIPIN, JOCERRIE ALISON, RENA ANACLETO, LIEZEL ANDADOR, RENALY ANTIPATIA, LICEL ANITA APURADO, KIM SUMBITTED TO: GLOREGENE S. GUANZON

CLINICAL INSTRUCTOR