I.

INTRODUCTION

“Pregnancy demonstrates the deterministic character of woman’s

sexuality. Every pregnant woman has body and self-taken over by a chthonian
force beyond her control. In the welcome pregnancy, this is a happy sacrifice. For
a fetus is a benign tumor, a vampire who steals in order to live. The so called
miracle of birth is nature getting her own way.” – Camille Paglia

The statement above refers to pregnancy or child bearing and child

rearing which has been defined as the gestational process, comprising the
growth and development within a woman of a new individual from conception
through the embryonic and fetal periods to birth which usually lasts
approximately 266 days (38weeks) from the day of fertilization but it is clinically
considered to last 280 days (40 weeks; 10 lunar months; 9 and 1/3 calendar
months) from the first day of the last menstrual period. Because pregnancy
changes a woman’s normal hormone patterns, one of the first signs of pregnancy
is a missed menstrual period.

The first few months of pregnancy are the most critical for the developing
infant, because during this period the infant’s brain, arms, legs and internal
organs are form. For this reason, a pregnant woman should be especially careful
about taking any kind of medication except on the advice of a physician who
knows that she is pregnant. Pregnant women should avoid x-rays, smoking and
alcohol consumption.

Delivery, the process by which the baby is expelled from the uterus
through the birth canal and into the world, begins with irregular contractions of
the uterus that occur every 20-30 minutes. As labor progresses, the contraction
increase in frequency and severity. The usual length of labor for a first time
mother is about 13-14 hours, and about 8 or 9 hours in a woman who has given
birth previously. Wide variations exist, however, in the duration of labor.

The care of childbearing and childrearing families is a major focus of

nursing practice, because to have healthy adults you must have healthy children
and to have healthy children, it is important to promote the health of the
childbearing woman and her family from the time the children are born until they
reach adulthood.

As part of the curriculum, Level III – Block 1, Group 1, were assigned to

get a case which is a pregnant mother at Barangay Mauway Health Center to
assess the health and condition of the pregnant client and her family members
and to determine the health deficits and foreseeable crisis that might serve as
threats to her pregnancy.

This study focuses on the care of childbearing and childrearing family by

promoting health of the childbearing woman and her family. Through home visit,
we are able to assess our chosen client and her family by rendering simple
nursing interventions and giving health teachings that help to minimize their
health problems, increase their knowledge about the importance of healthy
lifestyle and health awareness and to further maximize their optimum wellness
through self-reliance.
II. OBJECTIVES:

General Objectives:
To present a study about Normal processes that happens in pregnancy
through effective nurse-patient interaction and relevant researches with critical,
competent and collaborative application of nursing process.

Specific Objectives:

 To obtain pertinent information about the patient’s demographic and socio-

economic profile.
 To evaluate the patient’s history including the past and present condition.
 To identify normal from abnormal results of diagnostic procedures.
 To include the family as a whole, in the concept of “Family-centered
maternity care”.
 To formulate health teachings thereby educating the mother-to-be and her
family for the parenting role.
III. INITIAL DATA BASE

A. Family Structure and Characteristics

B. Socio-Economic and Cultural Factors
C. Environmental Factors

The living space for Mrs. M. L. B’s family is inadequate. The family sleeps
in their room together. They have one room enough for them to stay together.
There’s also presence of vector diseases such as cockroaches and mosquito.
Mrs. M. L. B’s house is noted to have some accident hazard such as broken
stairs, fire and fall hazard. They store their food by covering it and later place it in
a small screened cabinet, which may imply that there’s a possibility of food
spoilage. They have small are for cooking. Mrs. M. L. B. uses Level III water work
system which is supported by Manila Water. This is convenient, accessible and
fairly safe because hose and pipes are periodically check to keep water free from
contamination. For their toilet type, they use pour flush because they find it
cheaper. Mrs. M. L. B. clean their toilet weekly using Zonrox. They throw their
garbage through open dumping nearby, which may cause growth of
microorganism that can affect their health. The drainage system is present in
some area of their barangay, but the drainage seems to be breeding site for
some pest.

Their neighborhood may be classified as congested because houses are

very close to each other and may seem to be over populated. Social and health
facilities is available in their community such as Mauway Lying and Health
Center. Communication lines such as PLDT, Globe are available in their
community. For transportation there are tricycles and pedicabs readily available.

D. Health Assessment of Family Members

As source of health information and services the family prefer to go/

consult to their barangay health center. For the children’s food eating habits, both
of them prefer to eat chips, candies, and packed noodles rather than home
cooked meals. The 3 year old son shows late development for speech
capabilities, and both children appears pale, thin and short for their age. In
addition to this their father is a cigarette smoker that is one of the main factor in
an unhealthy lifestyle.

E. Value Placed on Prevention of Disease

Due to lack of financial support, the family is having a hard time feeding
every member. In result of this, the two children are suffering from malnutrition.
Their weight is not sufficient for their age. The eldest, KLB is 7 years old, weighs
17 kilograms (normal: 23 kilograms) and the second child, ALB, 3 years old and
is weighing 10 kilograms (normal: 15 kilograms).

Since the father is tired from work everyday, Mrs. MLB is the one who
takes care of the children. The mother usually sleeps at 11:30pm –which is not a
really good activity for a pregnant woman as she wakes up as early as 5 in the
morning to prepare for her husband’s needs for work.

Mrs. MLB walks her first child, KLB to school every morning at 7:00am –
this serves as one of her exercises everyday not to mention other household
chores like cleaning the dishes, doing the laundry (usually every Fridays), and
cooking for the family.

During Sundays, after going to church, the family goes directly to the park
for the kids’ enjoyment.

As for the source of their health information and services they usually
consult and go to the health center in their barangay. Especially, that the first
child has asthma and the two of them are undernourished.
IV. SPECIFIC CASE STUDIES

A. OB Case Study (Pregnant Client)

1. OB History

a. Menstrual

Mrs. M.L.B.‘s menarche was at the age of 12 with regular monthly

cycle lasting for 4-5 days consuming 4-5 pads a day. She was
negative for dysmenorrheal and amenorrhea. The first sexual
contact was at the age of 21 with her husband.

b. Obstetrical

Last Menstrual Period: October 12, 2009

EDC: July 19, 2010

AOG: 35 weeks and 2 days as of June 16, 2010

OB History:

G- 3

P- 2

T- 2

P-0

A-0

L-2

c. Past / Family History

Mrs. MLB’s health condition is in a good state. Though her mother has
asthma and migraine, Mrs. MLB does not develop such diseases. She had
chicken pox during her second pregnancy and there was no complication
on her baby. Aside from physical chances, Mrs. MLB had discomforts
during her pregnancy –which are considered normal.

d. Present Pregnancy

There is no present illness / disease aside from normal during

pregnancy, according to her regular check-ups on health center and
undergone diagnostic test.
 2. Physical Assessment

Date and time Performed: June 16, 2010; 4:00 pm

Body Parts Technique Used Findings Analysis

(IPPA)
Skin Inspection; brown in color; Normal
Palpation warm and moist;
skin turgor springs
back to its previous
state in 2-3 seconds

Normal
Hair Inspection; wavy;
Palpation black in color;
shoulder length;
not extremely oily;
evenly distributed;
negative for lice
Normal
Scalp Inspection; shiny;
Palpation smooth;
no dandruff;
white in color;
negative for lesions
Normal
Head Inspection; normocephalic;
 Palpation with smooth
contour; without
masses;
symmetrical;
proportion to body Normal
Face Inspection;
Palpation symmetrical facial
features;
elongated in shape;
has no pimples;
no masses Normal
Eyes Inspection;
Palpation eyelids appear
symmetrical with no
drooping;
eyelashes are black
in color and well
curved; lacrimal
apparatus has no
discharges upon
palpation and no
pain felt;
with 20/20 vision;
pupils are equally
round and reactive
to light and
accommodation
with a size of 3mm;
conjunctiva is clear
and pale pink; Normal
iris is round
Ears Inspection;
Palpation symmetrical and at
level of eyes outer
cantus;
brown in color;
smooth;
can hear normally;
no inflammation or
lesion noted;
(+) in Rinne’s test;
(-) in Weber’s Test; Normal
(-) in Romberg’s
Nose Inspection; Test
Palpation
symmetrical to the
midline of the face;
no lesions or
swelling noted;
no discharges;
airways are patent
and free from
obstructions;
sinuses are
negative for
congestion and no
pain felt upon
palpation; nasal
Mucosa is free from
inflammation or any
indication of an Normal
infection or
Mouth Inspection; infestation of certain
Palpation microorganisms

teeth are complete,

no dentures, slightly
yellow in color with
no indication of any
tooth decay or other
tooth related
problems;
gums are pinkish
with no bleeding;
tongue is red in
color, symmetrical
to the midline of the
mouth, moves Normal
freely;
lips are pale pink in
Neck Inspection; color, closes
Palpation symmetrically and
negative for lesions

free from any

aberration or injury;
Sternocleidomastoid
and trapezius
muscle are equal in
strength;
chloasma noted;
no inflammation
noted on the thyroid
glands; lymph Normal
nodes are not
inflamed;
Chest Inspection; no masses of any
Palpation; type were noted in
Auscultation the general area of
the neck;
no vein extended

brown in color;
no lesions noted;
equal chest
expansion and
registers a clear
breath sound;
No cough of any
condition was
present; absence of
adventitious sounds Normal
upon auscultation;
Heart Inspection; respiratory rate is
Palpation 20 cycles per
minute from the
normal range of 16-
20 cycles per
minute.

with normal heart Normal

sounds;
Breast Inspection; has a regular
Palpation rhythm with 75
 beats per minute
from the normal rate
of 60-100 beats per
minute;
no visible pulsations

both left and right

breast are
engorged; have
smooth contour; no Normal
redness;
no dimpling/
Abdomen Inspection; retractions;
Palpation; lymph nodes are
Auscultation not bulged;
with symmetrical
nipples;
no swellings noted;
with a discharges of
breast milk Normal

linea nigra and

striae gravidarum
Upper Extremities Inspection; noted;
Palpation with 3 bowel sound
per minute upon
auscultation;
no masses were
noted on the
general area
Normal

warm to touch;
good skin turgor;
Lower Extremities both hands have
five fingers;
nails are short
slightly pinkish;
slightly dark
pigmented
underarm noted

equal strength;
negative for edema
formation; lesions
are noted; nails are
clean and short;
warm to touch; good
skin turgor

C. DIAGNOSTIC PROCEDURES

• Urinalysis
 URINALYSIS

TEST RESULT NORMAL VALUES

Color Yellow Straw/Amber

Appearance Clear Clear

pH 7.0 4.6 – 8.0

Specific gravity 1.010 1.005 – 1.030

Protein Negative Negative

Glucose Negative Negative

RBC 0-1 <2

WBC 0-3 0-4

• Complete blood count

COMPLETE BLOOD COUNT

TEST RESULT NORMAL VALUES

WBC 9,300/mm3 5,000 – 10,000/mm3

Segmenters 63.3% 47-80%
Lymphocytes 25.5% 20-40%
Monocytes 6.2% 2-8%
Eosinophils 4.7% 1-4%
Basophils 0.3% 0.5-1%
RBC 4.35 x 106/µL 4.2 – 5.4 x 106/µL
Hemoglobin 12.9 g/dl 12.0 – 16.0 g/dl
Hematocrit 38.3% 37% - 47%
MCV 88 mm3 80 – 95 mm3
MCH 29.7 pg 27 – 31 pg
MCHC 33.7 g/dl 32 – 36 g/dl
Platelet 269,000/mm3 150,000 – 400,000/mm3

5. Anatomy and Physiology

• Anatomy

FEMALE REPRODUCTIVE SYSTEM

 EXTERNAL FEMALE GENITALIA

Mons pubis

It is the most visible part of the woman's external genitalia, which is the

pad of fatty tissue that covers the pubic bone and is commonly covered by pubic

hair.

Labia majora

The labia majora are two thick folds of skin running from the mons pubis to

the anus. The outer sides of the labia are covered with pigmented skin,

sebaceous (oil-secreting) glands, and after puberty, coarse hair. The inner sides

are smooth and hairless, with some sweat glands. Beneath the skin layer, there

is mostly fatty tissue with some ligaments, smooth muscle fibers, nerves, and

blood and lymphatic vessels. The labia majora correspond to the scrotum in the

male.

Labia minora

The labia minora, two smaller folds of skin between the labia majora,

surround the vestibule of the vagina; they have neither fat nor hairs. The skin is

smooth, moist, and pink and has sebaceous and sweat glands.

Vestibule

It is the space into which the vagina and urethra open.

Clitoris

The two labia minora meet at the clitoris, a small erectile structure. Like

the penis, it is very sensitive to stimulation.

Prepuce

The clitoris is covered by a fold of skin, called the prepuce, which is similar

to the foreskin at the end of the penis.

Perineum

The perineum is the area of skin between the vaginal opening and the

anus.

Bartholin’s gland

Are located besides the vaginal opening and produce a fluid (mucus)

secretion.

INTERNAL FEMALE GENITALIA

Vagina

The vagina is a muscular and ridged sheath connecting the external

genitals to the uterus. In the reproductive process, the vagina functions as a two

way street, accepting the penis and sperm during intercourse and roughly nine

months later, serving as the avenue of birth through which the new baby enters

the world.

Uterus
 The uterus is a hollow, pear – shaped organ that functions to receive a

fertilized egg and to protect a fetus during development. The part of the uterus

superior to the entrance of the uterine tubes is called the fundus, while the main

part is called the body or corpus. The corpus is highly muscular so that it can

enlarge to hold a developing baby. Cervix, is the lower part that opens into the

vagina.

Ovaries

These small, oval – shaped glands are suspended in the pelvic cavity. The

ovaries produce ova, the female cell of reproduction, and produce hormones.

Fallopian tube

These narrow, muscular tubes are attach to the upper part of the uterus

and serve as tunnels for the ova to travel from the ovaries to the uterus, where it

implants to the uterine wall.

• Physiology
CONCEPTUAL FRAMEWORK ON THE PHYSIOLOGY OF CONCEPTION

MALE
FEMALE
(XY Chromosomes)
(XX Chromosomes)

SPERMATOGENESIS PRODUCTION OF OOCYTES

SPERMATOZOA OVULATION

OVA

INTERCOUSRE

OVULATION OR
INSEMINATION OF THE EXPULSION OF MATURE
SEMINAL FLUID FROM OVUM FROM THE
THE MALE URETHRA GRAFIAN FOLLICLE INTO
INTO THE FEMALE THE PELVIS
VAGINA
SPERM MEET THE
EGG
FERTILIZATIO
N

ZYGOTE FORMATION

MORUALA BECOMES A BLASTOCYST

BLASTOCYST TURNS INTO EMBRYO

EMBRYO NOW TERMED AS FETUS

LABOR

UTERINE
CONTRACTIONS

NSVD

BIRTH OF THE INFANT

 Fertilization occurs when the sperm penetrates the ovum. The ovum is

receptive to fertilization for approximately 24-48 hours, after release from the

ovary, and the sperm are viable for 24-72 hours after ejaculation into the female

reproductive system. During the act of intercourse, the man ejaculates

approximately 300-600 million sperm. However, only one sperm will fertilize the

mature ovum. Conception usually occurs when the ovum is in the ampulla of the

fallopian tube.

Once fertilization is complete, the zygote migrates toward the body of the

uterus. It takes 3-4 days for the zygote to reach the body of the uterus. During

this time the mitotic cell division or cleavage occurs. By the time the zygote

reaches the body of the uterus, it consists of 16-50 cells and is already termed as

the morula. Once implanted, the zygote is now called the embryo. The placenta

arises out of the trophoblast tissue, a group of cells found in the outer ring of the

zygote.

This placenta serves as the fetal lung, kidneys, gastrointestinal tract, and

as a separate endocrine organ throughout the pregnancy. The cord is composed

of two arteries and one vein. The function of the cord is to transport oxygen and

nutrients to the fetus from the placenta and to return waste products from the

fetus to the placenta. The development of organs and organ systems proceeds in

a cephalocaudal direction. The cardiovascular is one of the first systems to

become functional in the uterine life. After 28th week of pregnancy, the heart rate

begins to show a baseline variability of 5 bpm on a FHR rhythm strip. Both

respiratory and digestive tracts exist as a single tube during the 3rd week of the
intrauterine life. The nervous system develops as early as the 3rd-4th week of

pregnancy. Digestive tract separates from the respiratory tract by the 4th week.

Meconium, the fetal waste forms in about 16th week while the ability of the GI

tract to secrete enzymes for CHO and CHON digestion matures in the 36th week

of pregnancy. For the musculoskeletal system, fetal movements can be felt in the

20th week while bone ossification begins in the 12th week. For the reproductive

system, a child’s sex organ can already be determined as early as 8 weeks of

chromosomal analysis. For the urinary system, fetal urine is formed by the 12 th

week and is excreted into the amniotic fluid by the 16th week of gestation. In

integumentary system, the skin appears thin and almost translucent. A soft

downy hair called lanugo and a cream cheese-like substance called vernix

caseosa that covers the skin. The average time for gestation is usually about 38

weeks. Within this time, labor can be experience. It is a series of events in which

uterine contractions; abdominal pressure expels the fetus and placenta from the

woman’s body.

6. Discomforts of Pregnancy

1. Shortness of breath
>This results from pressure on the diaphragm.
PLAN OF CARE:
- Place or instruct the client to sit in high-fowler’s position.
2. Ankle edema
 This happens during 2nd and 3rd trimesters of pregnancy, results from
vasodilation, with increasing venous pressure below the uterus.
PLAN OF CARE:
- Instruct or position the client in a left side lateral position.
3. Nausea and Vomiting (Morning Sickness) during 1st trimester.
 There was nausea and vomiting due to elevated human chorionic
gonadotropin.
 Levels and changes in carbohydrates metabolism.
PLAN OF CARE:
- Instruct the pregnant mother to eat small frequent meals.
- Upon waking, eat crackers/dry toast.
- Avoid high season foods (fats and spices)
- Take appropriate fluids between meals.
4. Breast tenderness
 This happens during 1st to 3rd trimester, which is due to increased
levels of estrogen and progesterone.
PLAN OF CARE:
- Instruct the client to use well-fitted bra that can be easily
adjusted.
-
5. Heart burn and indigestion
  This happens during 2nd and 3rd trimesters of pregnancy, which is due
to decreased gastrointestinal motility and esophageal reflux,
displacement of stomach due to enlargement of uterus.
PLAN OF CARE:
- Instruct the client to avoid dried foods.
- Instruct the client to remain in upright position after
eating.

6. Headache
 This happens during 2nd to 3rd trimesters of pregnancy, which occurs
from an exgorated lumbosacral curve resulting from the enlarge uterus.
PLAN OF CARE:
- Instruct the client to lie in left lateral position to prevent
supine hypotension.
- Use only low-heeled shoes.
- Instruct the client to have proper body alignment.
- Use only firm mattress.

 Leg cramps during 2nd and 3rd trimester

 This result from altered Ca and P balance pressure on uterus on
nerves.
o Instruct the mother to perform dorsiflexion to relieve cramps.
o Advise the mother to increase intake of Ca and drink plenty
of water.

 Varicose veins during 2nd and 3rd trimester

 This results from weakening walls of the veins or valves or venous
congestion.
o Advise mother to wear elastic stockings if possible.
o Each the mother to elevate her legs frequently.
o Avoid doing crosslegs.

 Hemorrhoids doing 2nd and 3rd trimester

 This results from increased vein pressure.
o Instruct the mother to increase her fiber intake daily.
o Take plenty of water during and in between meals.
o Advise the mother to apply warm compress on the buttocks
or instruct her to dip on warm sits bath.

Constipation occurs during 2nd and 3rd trimester.

 This results from decreased intestinal motility, displacement of
intestines and taking iron supplements.

Urinary frequency occurs during 1st and 2nd trimester.

 Ask the mother to empty her bladder.

Increased vaginal discharge occurs during 1st and 3rd trimester.

 Hyperplasia
o Instruct mother to change underwear and observe proper
hygiene.

Syncope (faintness)
 This occurs when triggered by hormonal increase in blood
volume, anemia, fatigue, or sudden position changes.
o Advise mother to avoid staying in one position.
o Instruct mother to position herself laterally before getting
up in bed in a slow manner.
7. Medications
V. FIRST LEVEL ASSESSMENT
VI. SECOND LEVEL ASSESSMENT
Cues/ Data
A.
• The living for Mrs. M.L.B.’s
family is inadequate.
• Mrs. M.L.B. ver7belized… “We
all sleep in one room”.
B.
• Presence of vector diseases
such as cockroaches and
mosquito.
Family Nursing Problems
A. Inadequate living space as
health threat
1. Inability to make decisions
with respect to taking
appropriate health action due
to:
a. Inaccessibility of
appropriate resources for
care specifically
economic/financial
inaccessibility.
2. Inability to provide a home
environment conductive to
health maintenance and
personal development due to:
a. Inadequate family
resources specifically
financial constraint.
B. Presence of breeding or resting
sites of vectors of disease a
health threat
1. Inability to make decisions
with respect to taking
appropriate health action due
to:
a. Inaccessibility of
appropriate resources for
care specifically
economic/financial
inaccessibility.
2. Inability to provide a home
environment conductive to

C.
• Mrs. M.L.B.’s house is noted to
have some accident hazard
such as broken stairs, fire and
fall hazards.
D.
• Mrs. M.L.B. verbalized… “We
don’t have refrigerator, we only
keep our foods in a small
screened cabinet with covering.
E.
• They throw their garbage
through open dumping.
health maintenance and
personal development due to:
a. Inadequate family
resources specifically
financial constraints/
limited financial resources.
b. Lack of skill in carrying out
measures to improve
home environment.
C. Accident hazards specifically
fire and fall hazard as health
threat
1. Inability to recognize the
presence of condition or
problem due to:
a. Attitude in life which
hinders recognition of the
problem.
2. Inability make decision with
respect to taking appropriate
health action due to:
a. Low salience of the
problem.
D. Lack of food storage facilities
as a health threat
1. Inability to make decisions
with respect to taking
appropriate health action due
to:
a. Inaccessibility of
appropriate resources for
care specifically
economic/financial
inaccessibility.
E. Improper garbage disposal as
health threat
1. Inability to make decisions
with respect to taking
appropriate health action due
to:
a. Attitude in life which
hinders recognition of the
problem.
2. Inability to provide a home
environment conductive to
health maintenance and
personal development due to:
 a. Lack of knowledge of
F. importance of hygiene and
• Drainage system seems to be sanitation.
breeding site for some pest.
b. Lack of/ inadequate
knowledge of preventive
measures.

F. Improper drainage system as

health threat

1. Inability to make decisions

with respect to taking
appropriate health action due
to:

a. Attitude in life which hinders

recognition of the problem.

2. Inability to provide a home

environment conductive to
health maintenance and
personal development due to:

a. Lack of knowledge of
G. importance of hygiene and
• Mother verbalized… “My sanitation.
children were very thin since
they were a baby and they are b. Lack of/ inadequate
fond of eating chips, candies knowledge of preventive
and packed noodles…they measures.
don’t want to eat if it is not a
noodle’s are other canned
goods…” G. Malnutrition as a health deficit
• R.L.B. , seven years old ,
weighs 17 kg looks pale, thin,
1. Inability to decide about taking
and short for her age and
appropriate health action due to:
undernourished
• A.L.B., three years old, weight
a. Lack of knowledge about the
10 kg looks pale, thin, short for
health condition and to
his age, undernourished and
alternative courses of action
late for his normal
open to them
development.
b.

2. Inability to recognize the

presence of condition or/problem
due to:

a. Denial about the existence

severity as a result of fear of
consequences of diagnosis of
a problem, specifically
economic/ cost implications

3. Inability to provide adequate care

for the dependent member of the
family due to:

a. Lack of/ inadequate

knowledge about child
H. development and care
• Mrs. M.L.B. verbalized… “My
husband smoke….” b. Inadequate family resources
for care, specifically financial
constraint

H. Smoking as health threat

1. Inability to make decisions

with respect to taking
appropriate health action due
to:

a. Attitude in life which hinders

recognition of the problem.

VII. PRIORITIZATION

Malnutrition

Criteria Computation Actual Justification

Score
1. Nature of the 3/3 x 1 1 It is a health threat because
problem being malnourished means
having a high chance of
acquiring infection due to low
immune system.
2. Modifiability of 2/2 x2 2
the problem The problem is easily modifiable
since we, nursing students can
help them give ideas on how to
do effective budgeting for the
family; help the family member,
especially the mother to develop
skills in selecting the proper
3. Preventive amount and kind of food for all
Potential 2/3 x 1 0.66 the members.

Acquiring diseases and

infections are less likely to
happen if malnutrition can be
prevented. In this case, it is
4. Salience of the moderately preventive because
problem 2/2 x 1 1 the condition of the children is
not that severe.

Total The problem is felt but they do

4.66 not put much attention to it.
Drainage System

Criteria Computation Actual Score Justification

1. Nature of the 2/3x1 2/3 It is a health threat that needs

Problem immediate action.

2. Modifiability 2/2 x 2 2 It is easily modifiable because

of the Broblem it can be resolve through
proper drainage management.

3. Preventive 2/3 x 1 2/3 It is moderately preventive

Potential because it is periodically
cleaned.

4. Salience of 0x1 0 The family does not recognize

the Problem it as a problem.

TOTAL SCORE 3 1/3

Vector

Criteria Computation Actual Score Justification

1. Nature of the 2/3x1 0.66 It is a health threat

Problem

The family does not have

2. Modifiability 1/2 x 2 1 adequate resources to solve
of the Broblem the problem. Prevention of
vectors in their house can be
done if the family will practice
good hygiene and proper
sanitation.

3. Preventive 2/3 x 1 0.66 Susceptibility to other disease

Potential can be prevented if vectors
can be reduced in number.

4. Salience of 1/2 x 1 1 The family recognizes it as a

the Problem problem. It requires immediate
action through discipline
among the family members
when it comes to proper
sanitation to prevent vectors
staying in their house.

TOTAL SCORE 2.82

Inadequate Living Space

Criteria Computation Actual Score Justification

1. Nature of the 2/3x1 2/3 It is a health threat

Problem

2. Modifiability ½x2 1 A financial expenditure will

of the Broblem require in increasing the living
space. The family’s monthly
income may not accommodate
the expenses for house
renovation.

3. Preventive 1/3 x 1 1/3 The possibility of transfer of

Potential communicable disease may
increase if they have enough
living space and it an provide
privacy for each member of the
family.

4. Salience of ½x1 1/2 The family recognizes it as a

the Problem problem but not needing
immediate action.

2 1/2
TOTAL SCORE

Smoking

Criteria Computation Actual Score Justification

1. Nature of the 2/3x1 0.66 It is a health threat

Problem

2. Modifiability 1/2 x 2 1 The problem is slightly

of the Broblem modifiable since habitual
smoking is hard to stop.
Instead, educate the family
especially the father that
smoking is a threat for the
family.

3. Preventive 2/3 x 1 0.66 The problem cannot be easily

Potential prevented since it is not
modifiable but proper
education to the family about
health problems caused by
second-hand smoking may
lessen the occurrences of
diseases.

4. Salience of 0/2 x 1 0 The problem is not recognized

the Problem by the family.

TOTAL SCORE 2.32

VIII. FAMILY NURSING CARE PLAN
IX. RECOMMENDATION

A. For Pregnant Women

• Visit the barangay health center for all the information and teachings
for safer delivery, less complication, if not eliminated, and to prevent
congenital defects to the newborn.
• To learn the risk factors for congenital defects to the newborn caused
by smoking and drinking alcohol.
• Taking ferrous sulfate will protect the mother from excessive loss of
iron after the delivery.
• Having the knowledge about family planning method will be very useful
to prevent inadequate living space and other shortage problems.

B. For the Community

• People in the community have different privileges; they just have to

know what these are and how to utilize them especially with
regards to the barangay health center.
• Second-hand smokers are more prone to certain lung illnesses.

• People in the community would be happier if they have a better

place to live in:
 Cleaning the environment
 Volunteer as a barangay health worker
 Be aware of the schedule of garbage disposal and its
method to prevent:
a) Certain diseases related with vectors, example,
mosquitoes, flies, rats, and the likes.
b) Problems like clogging and over flowing of drainage
system in the community.

X. EVALUATION

A. Learning Experience

Community health nursing is a nursing process outside the hospital.

Us, Third year, Block 1 Group 1 learned a lot during our stay in
 Mauway Health Center, such learning experiences are inclined with
how to admit patient during consultation, pre-natal and immunization
day, application of the concept of parentheral administration and
improving our clinical eyes to identify the normal from abnormal state.
Application of the concepts and knowledge, thus, enhance our
capabilities and can help us to be efficient nurses someday.

B. Problems Encounter:

Honestly speaking, we didn’t encounter any problems during our

stay in Mauway Health Center because we are well-oriented by our
Clinical Instructor, Ms. Torres, and we are also accommodated in a
warm manner by the staffs as well.

Our Lady of Guadalupe Colleges, Inc.

Sierra Madre St. Cor. I Esteban, Manadaluyong City

CASE PRESENTATION
COMMUNITY HEALTH NURSING

LEVEL III – BLOCK 1

GROUP 1

Leader:
Bernal, Anne Lorraine

Members:
Acibar, Vergel
Alda, Aiza
Arroyo, Precious Rose
Baracinas, Eangel Bert
Bautista, Ma. Zyra Mea
 Bautista, Regine
Bautista, Veralyn
Bosch, Yliah Niña
Caluya, Archieval Vica

Clinical Instructor:
Mrs. Evelyn Torres

23 June 2010