Family Case Analysis

DIVINE WORD COLLEGE OF LAOAG
SCHOOL OF NURSING
Laoag City
The FAMILY that ties the bond: A FAMILY CASE ANALYSIS
An Assessment of Dimagiba Family of Sitio Nagtataluan Dilanis Pasuquin, Ilocos Norte

In partial fulfillment of the course requirements In NCM 107
Presented by:
KATRINA ANNA ALIPIO MARIE JANE CAGAT PRISCILLA MARIE CRUZ JOHN PAUL EDRA JENNIFER FLORENTINO SHELLA PASCUA MICHELLE ROBLES MILANO RIKO RUIZ CLARIE ANNE TALON (BSN IV, GROUP 8)
Presented to:
PROF. MARY C. BALINTONA PROF. IMELDA R. CARLOS PROF. SANCHO A. GARCIA JR. PROF. RIZAL ANGELO GRANDE DR. GLORIA A. SANCHEZ (MEMBERS OF THE PANEL)
August 19, 2011

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I.
INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS
HOUSEHOLD MEMBERS Inocencio Dimagiba Inocensia Dimagiba Juanita Dimagiba Dionisia Dimagiba Kaimito Dimagiba Juanito Dimagiba
RELATIONSHIP TO HEAD Family head Wife Daughter Daughter Son Grandson
AGE 43 years old 41 years old 18 years old 16 years old 10 years old 10 months.
CIVIL STATUS Married Married Single Single Single Single
PLACE OF RESIDENCE Dilanis Pasuquin, I.N Dilanis Pasuquin, I.N Dilanis Pasuquin, I.N Dilanis Pasuquin, I.N Dilanis Pasuquin, I.N Dilanis Pasuquin, I.N
Dimagiba family of 6 members resides in the rural peaceful community of Sitio Nagtataluan Dilanis Pasuquin, Ilocos Norte. Theyve been residing in the said place for the past eighteen years. This family is considered as an extended type of family as to structure, patrilocal as to place of residence, patrilinealas to descent or lineage and egalitarian as to exercise of power/authority. Inocencio, 43y/o heads the family. He is married to Inocencia, 41y/o. Their wedlock was blessed with three children, two girls and one boy. As the breadwinner of the family, Inocencio works as a tenant farmer. He is sometimes accompanied by his wife and children to work in the field and earn for their living. Inocencia on the other hand, monitors the welfare of her children and manages household chores. Juanita, 18 y/o is the first child of the family. Shegot pregnant when she was 17 y/o and gave birth to a baby boy named Juanito who is now 10 months old. Juanitas boyfriend left her and went back to his hometown in Pangasinan and never returned not even once for almost a year as communication between the two also becomes infrequent. Currently, Juanita and her child are living with the other members of the family making it an extended one for Juanito requires support from his grandparents in the absence of his biological father. The second child of the family is Dionisia, 16 y/o. Like her sister, she is already dropped in school. In which case, Dionisia who is left nothing to focus on helps her mother in performing household tasks and sometimes goes with her parents in the field to contribute manpower.
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Kaimito, 10 y/o is the youngest of the children of the family. He is currently a 5th grader at Dilanis Elementary School. His usual task at home includes fetching water in the deep well that is found several meters away from their house and watches his nephew when her mother-sister is away from home to help in the field. The family can be described as patrilocal according to place of residence. They founded a house near the heads family house. As to descent or lineage, the family is categorized as patrilineal and egalitarian according to power/authority. They both share decisions concerning things about the family like financial matters (allocation of family budget). However, when it comes to health care matters Inocencia usually is the one who makes decisions like for instance what should be done to a sick member. When asked about how is the communication in the family going on, Inocencio replied by saying, Mayat met, uray no adda haan nga pinagkikinaawatan no dadduma ket maresresolbar met la nga dagos. (Its fine, even if there are problems and conflicts occurring sometimes, we are still able to resolve it in the soonest time). At present, there is no observable conflict in the family as they display welcoming and wholesome attitude to each other and as verbalized, awan met ti agdama nga di mi pinagkikinaawatan.(There is no miscommunication between us).
B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
b.1 Income and Expenses A portion of the familys income is sourced from the rice field of which Inocencio has been a tenant for almost 10 years now. He estimated the land area to be half a hectare that could generate a ballpark figure of 25 sacks of palay/cropping a year. Due to scarce supply of water in the absence of water irrigation,the family could only plant rice in the first cropping, usually in the rainy season. Of the 25 sacks of palay, three of which is given to the owner of the land. To meet the necessary needs and other demands of the family, they sell 5-8 sacks of palay. In rough calculation of Inocensio, the 5-8 sacks of palay could give them an additional income of P 4,000.00/year (P 333.33/month). Another source of income of the family is the profit generated by selling vegetables in the market. Vegetables like squash, sitaw, eggplant, native tomatoes, daludal, and badbadyuk and fruits like unripe mangoes and cucumber are being sold in the market every Sundays. Kadagijay nga bulan nga pinaglaklakok iti natnateng ket makalako nak met s iti balor P 6,000.00, as verbalized by Inocencia. For the purpose of showing the family income in a month,the sum of P 6,000.00 a year (as generated by selling vegetables and fruits) could yield an income of P 500.00 a month.
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The family also raises poultry and livestock. They currently own 3 months old native pig,3 grown native chickens and 2 ducks. These animals are also a source of the family income. In a year they could usually sell 2 native pigs at around P 8,000.00 and 5 native chickens roughly calculated to generate P 1,300.00. These figures if combined could give the family earnings of P 9,300.00 a year (P 775.00/month). When opportunity comes the family grabs it, no adda oppurtunidad nga agubra ket agubra kami, this was verbalized by Inocencio. Four of the family members (Inocencio, Inocencia, Juanita and Dionisia) go to the field under the heat of the sun to work and be paid. For a period of ten days, 5am- 5pm with lunch and snack break provided free and siesta, the members of the family works as planters of garlic and they are being paid an amount of P 200.00 each a day. Cumulatively, the family gains an additional income of P 8,000.00 a year (P 666.66/month) through manpower services. The accumulated family income in a year as stipulated above is P 27,300.00 which similarly means the family has a monthly income of P 2,275.00. According to NEDA, each individual should at least have P 2,768.60 when the total monthly income of the family is divided among the total family members, thus family Dimagiba with 6 members and with a total monthly income of P 2,275.00 can be considered poor and is unable to sustain all the needs of each family member.
FAMILY MONTHLY INCOME SOURCE OF INCOME RICE FIELD VEGETABLE AND FRUIT POULTRY AND LIVESTOCK RAISING WAGE IN GARLIC PLANTING TOTAL AMOUNT AMOUNT P 333.33 P 500.00 P 775.00 P 666.66 P 2, 275.00
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Illustrated Monthly Expenses of the Family

8.00% 2.00%
FOOD EDUCATION MISCELLANEOUS ELECTRICITY TRANSPORTATION
32%
50%
8%
The family monthly income of P 2,275.00 is then broken down to meet their basic needs. Food is the most important need of a person to survive. The family allots 50 percent of the total income which is equivalent to P 1,137.50. Food expenses include the following: noodles, canned goods, meats, fish, vegetables and food seasonings. Eight percent of the income is apportioned to education expenses like miscellaneous fees (e.g Red Cross ticket, Boy Scout Membership etc.), purchase of school supplies and daily allowance. The family earmarks approximately 2 % (P 45.50) for electric bills. Miscellaneous expenses comprise 32% (P 728.00) of the family income. Of these expenses includes: toiletries (e.g. soap, shampoo, toothpaste, deodorants, cosmetics, etcetera), clothes, cellphone load, medicines and other family needs. Lastly the remaining 8% (P 182.00) is rationed for transportation expenses. As elicit by the group, the income of the family is not adequate enough for their needs. Han nga uman anay deta masapsapulan mi, isu nga agin inot kam lattan, uttered by Inocencio. (Our earning is not enough to meet our needs). No dadduma ket umutang kam pay kadagita karuban tapnu laeng ada masida, Inocencio disclosed. (We sometimes borrow an amount to our neighbors just to have something on our table). Isu nga pinagsardeng mi payla ta dua nga anak mi iti pinagbasa da ta han nga agkasya toy kitkitaen mi, added by Inocencio. (Thats why we decided to end the schooling of our two daughters because we lack the financial means).
Note: The following are just rough calculations as based from the information provided by the interviewees.
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b.2 Educational Attainment, Ethnic Background, Religious Affiliation Name of the Family Member Inocencio Dimagiba Inocencia Dimagiba Juanita Dimagiba Dionisia Dimagiba Kaimito Dimagiba Juanito Dimagiba Educational Attainment Elementary Level Elementary Level High school Level High school Level Elementary Level n/a Ethnicity Ilocano Tagalog Ilocano Ilocano Ilocano Ilocano Religious Affiliation Roman Catholic Roman Catholic Roman Catholic Roman Catholic Roman Catholic Roman Catholic
The family is affiliated to Roman Catholic Church (RCC) and all members except Inocencia are of Ilocano ethnic background. Inocencio claimed that because of poverty he wasnt able to reach even a high school level. Inocencia is of the same educational attainment like her husband. Juanita didnt pursue her secondary education because she got pregnant when she was in 4th year. Her parents then decided not to send her in school anymore. Dionisia stopped schooling when she was in 3rd year high school. Her parents can no longer pay for her liabilities in school like tuition fees, books and any other added fees and more importantly her daily allowance in going to school. Kaimito is currently on his fifth grade in elementary. He walks almost two kilometers a day to reach the school and goes home every lunch time. Narigat iti agpabasaita nga panpanawenlalo ket marigrigat kam met lang, (It is hard for us to send our kids in school especially that we are just poor) says Inocencio. When family experiences financial crisis they borrow an amount to their significant others who also leaves in the same community. Inocencio described the relationship between his family and other families dwelling in the community as mutual for they learn the value of sharing. Dakdakamimetlangketdi ti agkakaruba, sinokumangarud pay iti agtitinulong no di da kami metlangbasta la ketdiaddaan kami, (Who else will help other than our neighbors so in turn we help them also as long as our resources permits) Inocencio puts it. Inocencio is a member of the Farmers Association in their barangay. This association is aimed at building unity and cooperation among farmers of different families. Inocencia actively participates in the endeavors of the community where her family belongs. One of these activities of the barangay is the so-called OplanDalus where Inocencia and her children go to the barangay roads to participate in cleaning. She (Inocencia) also participates in the activities of the school where her son is studying
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like BrigadaEskwela, feeding program and the like. Inocencia is also a member of the Womens Organization that partakes during the town festival and other related activities.
C. HOME AND ENVIRONMENT
c.1 House Structure The family house is made up mostly of light materials like lumber, bamboo, ply wood (sides, foundation and base of the roof) and galvanized iron and pan-aw for the roofing. The house is composed of abedroom and a dining room. Most of the things of the family are stocked in the bedroom and in the dining room making the total surface area of the house reduced. In the absence of cabinets they put their clothes in large boxes. The structure of the house is enliken to a kubo-kubo. The base of the bedroom is made up of bamboo sticks and is slightly elevated leaving a hole below it without a trap allowing entry of mosquitoes, rats, other types of vermin and even snakes.The group spotted only one small window that measure 1x1 m which is located in the bedroom. There is as well one door. Adjacent to the bedroom is the dining room where different cooking materials could be found. Family Dimagiba legitimately owns the small are of land where their house has been built as Inocencio inherited it from his late lamented parents.
c.2 Sleeping Arrangement The children sleep together in the bedroom while the couple sleeps in the small bed located in the dining area. The family makes use of woven abaca to cover the area for sleeping. They share pillows and blankets. Juanito, son of Juanita sleeps in a duyan every night. He is only the one who uses mosquito net for protection against mosquito bites. The family usually sleeps at around 9:00-10:00 at night time.
c.3 Presence of Breeding Sites of Vectors of Diseases The house is a good breeding or resting site for vectors of diseases like mosquitoes, cockroaches, flies, rodents and other types of vermin because of the pile of things stocked inside the house. Layers of boxes can be a good place for rodents and cockroaches to thrive and multiply. In fact, some members of the group even saw couple of rats and some cockroaches rooming around during the first home visit. The stocked water in galloons and uncovered pale in the kitchen area can be a convenient breeding place for mosquitoes. The water being used for cleaning eating utensils flows directly to a small canal; however the water is left stagnated which gives another breeding place for mosquitoes. In the backyard, the groupobserved that there are tall
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uncut grasses. Mosquitoes again are given opportunity to live in there because the area is moist especially in the rainy season. Additionally, tall uncut grasses could also be a place for snakes to inhabit. As aforementioned, the family is placed at great risk for different diseases. c.4Presence of Accident Hazards Through numerous days of home visits the group has identified many accident hazards. Top of the list is the observable open electrical wiring found in the roof of the house. This could promote faulty electrical wiring burns. The group also noted the things stocked just below the roof in the bedroom which is only supported by woods. In case of environmental calamities like earthquake, the whole thing could collapse and could cause fatal injury to the family members. Pan-aw, a grass that has long leaves, is utilized to cover almost half of the roof of the house. The family uses clay stove and burning pieces of woods for cooking. With this scenario, the likelihood of burning the house is likely. Added to the accidental hazards is the looseness of the foundation of the house. The woods and galvanized iron that makes up the sides of the house are not properly nailed. These could disintegrate and crumple which could cause physical injuries to the family members. The group also observed the sharp edged of the rusting galvanized iron which could lead to physical harm. The roofing of the kitchen is also low. One member of the group even accidentally bumped his head that caused him minor head injury. Presence of scattered rusting nails is also seen during the observation. In the vicinity is a large aged sargwelas tree that rests on the roof of the house. When this tree would breakdown, it could cause physical injuries to the family members.
c.5 Food Storage and Cooking Facilities The family prepares their food using a clay stove and pieces of wood. The eating utensils like cups, glass, plates, forks, spoons and sandok are left in an open container. They store their rice grains in a covered biscuit can. The groceries are placed in a plastic bag and are left hanging in the kitchen area. Their leftovers are covered with a plate, and sometimes stored it in a casserole and hang above the cooking area or not, being fed to their pig and chickens.
c.6 Water Supply The water supply of the family is a deep well which is located almost 500 meters away from their house. It is being shared by many families who do not own a water supply facility. As stated by Inocensio, the water facility is being treated by the authorities concerned to ensure the potability of the water supply. The family fetches
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water in the deep well and uses it for drinking, cooking, washing utensils and clothes, flushing of the toilet bowl and bathing. The water is not being boiled by the family before drinking for they believe that the water supply is already clean and safe enough for drinking. The family stores piles of water so that they will not be fetching water every now and then considering the distance of the deep well to their house.
c.7 Toilet Facility The water-sealed latrine is the toilet facility of the family. It is a pit privy type of toilet wherein water sealed toilet bowl is placed instead of the simple platform hole.They share this said facility with another family. It is being surrounded by a trash bag to ensure privacy. The bowl is left uncovered and there are marks of previous defecation which may be due to scanty mechanical flushing of the waste. Upon observation, the toilet facility is odorous and flies are seen all over the area.
c.8 Garbage Disposal, Drainage System In the backyard of the house is a small garbage pit. They put all their waste there and burned in the open air once it is already dry. With this, the garbage disposal of the family can be said to be open burning. The family has an open type of drainage system which is originally designed to flow directly in the field but due to obstruction in the flow of water the drainage system is left stagnant. c.9 Kind of Neighborhood The family lives in a far flung community. It is approximately 25 minutes ride from the town proper of the Municipality of Pasuquin. Numerous families could be found here and houses are diffused. There are some troubles sometimes in the community but never did the family involved with any of those as claimed.
c.10 Social and Health Facilities There are several social and health facilities in the community where the family resides. Of these are the following: an elementary school and a day care center where most of the children of the community are sent to study; a barangay hall where assemblies and meetings are being convened; a basketball court adjoined with the barangay hall where festivities, programs, barangay sports competition, masses are conducted. There is no barangay health center found in the community. It is however, with the assigned BHWs, BNSs and the lone midwife that sectors the community that they gain access to some free health care services.The BHWs monitors the weight of
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the young children and together with the Midwife determines who is underweight. They also help jointly with the BNS in the feeding programs sponsored by different agencies. The pregnant women in the community are being monitored by the midwife. They are being administered with necessary vaccinations. The midwife also administers immunizations to the young children of the community. The family sometimes consults the RHU Pasuquin for more serious health conditions where they are given free checkups and medications.
c.11 Communication and Transportation Facilities The use of cellular phones serves as the main communication facility of the family. Juanita has one cellular phone which is being used to communicate to their relatives and in cases of emergency situations. The family does not own a transportation facility. They usually ride on a tricycle or jeepney in going to the town proper.
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II. HEALTH STATUS OF FAMILY MEMBERS

A. Inocensio Dimagiba 43 years old CEPHALOCAUDAL PHYSICAL ASSESSMENT GENERAL SURVEY During the assessment, Inocencio was noticed to be unkempt in a light brown long-sleeved shirt, navy blue pants and a pair of rubber boots. He has a medium body build, exhibits relaxed and erect posture and coordinated movement. He is conversant, coherent and oriented to person, place and time. He also exhibits thought association, moderate pace and has a sense of reality. He has no difficulty recalling past and present events. He looked exhausted. He stands 164 cm and weighs 65 kg. VITAL SIGNS Blood Pressure Respiratory Rate Pulse Rate (Radial) Body Temperature (Axilla) SKIN y y y y HEAD Skull & Face y y Hair y Nails y y y y y untrimmed and dirty intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec) No infection/infestation. No bruises, nodules and masses noted Symmetrical facial movements and facial features Light brown skin complexion Hypopigmentation spotted in the neck, arms, abdomen and back Abrasions present in both lower arm Intact sensation to touch, pain and temperature FINDINGS 130/90 mmHg 25 counts per minute 75 beats per minute 37.5 C
Eyes structures and Visual Acuity y no discharge y bilateral blinking y white sclera y pale palpebral conjunctiva
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y y y y
positive blinking reflex on corneal sensitivity test PERRLA Coordinated movements Able to read newsprint at 14 inches distance
Ears and Hearing y y y y Auricles aligned with the outer canthus of the eyes Minimal amount of cerumen observed Good gross hearing acuity (normal tone voice is audible) Able to hear ticking of watch in both ears
Nose and Facial Sinuses y y y y Symmetrical Clear discharge Nasal septum intact and in midline Facial sinuses are not tender
Mouth y y y y y Neck y y Neck muscles equal in size and strength Coordinated, smooth movements with moderate discomfort Incomplete set of teeth (30 set) Yellowish colored teeth with some dental carries Tongue moves freely Intact gag reflex With moderate breath odor
Thorax and lungs y y y y Full and symmetric chest expansion Full symmetric anterior chest respiratory excursion No abnormal breath sounds heard over the whole lung fields.
Bilateral symmetry of vocal fremitus
Abdomen y y Uniform and unblemished skin Audible vowel sounds
Upper Extremities y y y firm with coordinated movements able to flex and extend without difficulty can resist against pressure
Lower Extremities y able to flex and extend without difficulty or discomfort

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can resist against pressure
NUTRITIONAL ASSESSMENT Height: 164 cm Weight: 65 kilograms Asia-Pacific Obesity Guidelines Underweight Healthy Weight Overweight At risk Obese I = 65 kg (1.64 m) 2 65 kg. 2.69
=
Formula in computing for BMI BMI= Weight in Kilograms (Height in meters)2
< 18.5 18.6-22.9 > 23.0 23.0-24.9 25.0-29.9 > 30.0
Obese II
24.2
Inocencio likes to eat fatty and salty foods. He mentioned that these foods often
give him the appetite to eat. His diet consists of vegetables like squash, sitaw, daludal, badbadyuk, eggplant and the like. He eats at least 2 cups of rice every meal time. Inocencio admitted that he consumes large amount of coffee a day. He drinks 2 cups of coffee in the morning before going to work, another 2 cups for pm snack and 1 cup at night time. Past and Present Health History Incocensio experienced some common illnesses in the past. In his childhood years he experienced mumps, measles and chicken pox. These illnesses were treated non-pharmacologically and use of traditional means. Akot-akot (beehive) was utilized to treat mumps. As believed by old folks, the akot-akot mixed with water and then applied to the area will bring relief to pain. As a management to measles, his mother told him to avoid eating salty and fatty foods as these would aggravate his condition. Eating egg and shrimp was the advice of his late mother to treat chicken pox as these foods would hasten his recovery from the said condition. Inocencio can no longer recall if he received all childhood immunizations, however a mark was seen in his right upper arm. Way back in the year 2002 when Inocencio was then 35 years old, he was rushed to GRBASMH and stayed there for 10 daysdue to a kidney problem. Unfortunately, he could no longer bring to memory the diagnosis of the doctor that attended him, the medications that were prescribed and other treatments done, however he mentioned that he had kidney stones. He didnt undergo an operation
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because according to the doctor the kidney stones can still be eliminated through medication therapy. The signs and symptoms he experienced include flank pain, pain upon urination and blood in his urine. After 15 days of hospitalization he was discharged with medications to take and from then on he longer presents any of the signs and symptoms stated above. Just two months ago while Inocencio was clearing the field of tall grasses he accidentally wounded his right arm with a sickle. The wound was cleaned with tap water and protected with a clean piece of cloth before going to RHU Pasuquin. The wound was cleaned using a solution he could not name. At this moment the wound is already healed. Inocensio also experienced headache, fever and cough and colds. These conditions were treated with periods of long rest and sometimes medications like Biogesic and Paracetamol both at 500 mg. doses taken until the condition subsides. To date of the first contact Inocencio has cough and colds. He manages this health condition by increasing his intake of water. He takes no medication to treat cough and colds. ACTIVITY OF DAILY LIVING Inonceciowakes up at 5:00 am in preparation for going to the field to work. Before doing so, he drinks two cups of coffee. He usually works in the field from 5:30 am to 6 pm. Inocencio goes home at around 8 oclock for his breakfast and then goes back to the field and continue his work after he has taken a bath. At 11:00 he takes his lunch and then goes to sleep until 2:00 pm. After the short break he goes to work again and stops when the sun sets. He eats his dinner together other family members at 7:00 and watches television after. Inocensio usually falls asleep early in the night at around 9:00 pm.
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B. Inocencia Dimagiba 41 years old CEPHALOCAUDAL PHYSICAL ASSESSMENT GENERAL SURVEY Upon initial visit, Inocencia was neat looking in dark yellow colored floral sleeveless, maong short and a pair of sleeper. She is moderately thin with relaxed, erect posture and coordinated movement. She has no foul breath odor, however, she was observed with minimal body odor. There is no obvious sign of illness. She is cooperative and appropriately responses to situation. Inocencia presents a moderate pace, thought association and a sense of reality. VITAL SIGNS Blood Pressure Respiratory Rate Pulse Rate (Radial) Body Temperature (Axilla) SKIN y y y y Nails y y y y y HEAD Skull, Hair, and Face y y y y normocephalic with frontal, parietal and occipital prominences No bruises, nodules and masses noted No area of loss of hair and no infection/infestation Symmetrical facial movements and facial features . untrimmed and dirty intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec) Light brown skin complexion Intact sensation to touch, pain and temperature Dry Normal skin turgor FINDINGS 110/90 mmHg 22 counts per minute 66 beats per minute 36.9 C
Eyes structures and Visual Acuity y no discharge observed y bilateral blinking y lids close symmetrically y white sclera y pale palpebral conjunctiva y pupils in 3 mm diameter y illuminated pupils constricts
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y y y y y
non illuminated pupil constrict positive blinking reflex on corneal sensitivity test PERRLA Coordinated movements in 6 ocular movement Able to read newsprint at 14 inches distance
Nose and Facial Sinuses y y y Symmetrical Nasal septum intact and in midline Facial sinuses are not tender
Mouth y y y y Neck y y Neck muscles equal in size and strength Coordinated, smooth movements without discomfort Yellowish colored teeth with some dental carries Tongue moves freely Intact gag reflex With moderate breath odor
Lower Extremities y y able to flex and extend without difficulty or discomfort can resist against pressure
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PAST AND PRESENT HEALTH HISTORY Inocencia has been hospitalized once at GRBASM in the year 2004 due to a liver problem. She can no longer recall the exact diagnosis of the doctor, the medication she took and other treatment done to her. She told us that she got the liver problem from consuming too much alcohol and cigarettes. She could still recall the days wherein she used to consume a pack of cigar a day. This situation shed been through that endangered her life convinced her not to smoke cigarette anymore. Inocencia experienced some common childhood diseases like measles, mumps and chicken pox. These were all treated non-pharmacologically as her mother used traditional means and cultural beliefs. Whenever Inocencia experiences headache, she self-medicate with Biogesic 500 mg once for the relief of pain but when there is no money to buy medicine she just treat it with periods of rest. Cough and colds is managed using OTC drug Carboceistein 500 mg every after meal or when in financial crisis she utilizes yerba buena decoction. At present, Inocencia has no concerns regarding her health. NUTRITIONAL ASSESSMENT Height: 163 cm Weight: 58 kilograms Formula in computing for BMI BMI= Weight in Kilograms (Height in meters)2 =
=
Asia-Pacific Obesity Guidelines Underweight Healthy Weight Overweight At risk Obese I Obese II < 18.5 18.6-22.9 > 23.0 23.0-24.9 25.0-29.9 > 30.0
58 kg (1.63 m) 2 58 kg. 2.67
21.7
Inocencia wakes up at 5:00 am, listens over the radio, drinks a cup of coffee and
ACTIVITIES OF DAILY LIVING
prepares breakfast. Early in the morning she cleans the house, the back and front yard. She sometimes helps her husband in the field. She takes her breakfast usually at 6:00 am with her children. Inocencia goes to the nearby houses to have a chat. At 10:30 she prepares for lunch and then dinner at 5:00. Most of the time, Inocencia is out of the house to go to the mountains and harvest badbadyuk or not clean the small area oftheir vegetable plantation. During Sundays, she goes to the market to sell vegetables fruits and sometimes chicke
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C. JUANITA DIMAGIBA 18 years old CEPHALOCAUDAL PHYSICAL ASSESSMENT
GENERAL SURVEY On initial contact, Juanita was fairly groomed in blue shirt and pantaloons. She has normal body built with relaxed, erect posture and coordinated movement. She has no foul breath and body odor. There is no apparent sign of illness as she presents a healthy appearance. She is cooperative, with appropriate response to situation. She exhibits understandable speech in moderate pace, shows thought association and has sense of reality. VITAL SIGNS Blood Pressure Respiratory Rate Pulse Rate (Radial) Body Temperature (Axilla) SKIN y y y Nails y y y y HEAD Skull & Face y y y Hair y No area of loss of hair and no infection/infestation. No bruises, nodules and masses noted Normocephalic Symmetrical facial movements and facial features intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec) Light to dark brown skin complexion Hypopigmentation spotted in the neck, arms, abdomen and back Intact sensation to touch, pain and temperature FINDINGS 100/80 mmHg 19 counts per minute 61 beats per minute 36.4 C
Eyes structures and Visual Acuity y no discharge y bilateral blinking y white sclera y pale palpebral conjunctiva y positive blinking reflex on corneal sensitivity test
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y y y
PERRLA Coordinated movements Able to read newsprint at 14 inches distance
Mouth y y y y Neck y y Neck muscles equal in size and strength Coordinated, smooth movements without discomfort Yellowish colored teeth with some dental carries Tongue moves freely Intact gag reflex With moderate breath odor
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PAST AND PRESENT HEALTH HISTORY Juanita received all her childhood immunizations as validated by her mother. She experienced some common childhood illness like measles, mumps, and chicken pox. These were all managed non-pharmacologically and traditional means. Juanita when she was 10 years old was rushed to the GRBASMH due to dengue fever. She stayed at the hospital for 5 days. On those five days, Inocencia as she recalled told us that Juanita received IVF and some medications she could no longer recall. She was discharged in good condition and fully recovered after numerous days of discharge from the health facility. She had given birth to an alive baby via NSD through a partera (traditional birth attendant). Juanito mentioned that shed been attending prenatal checkups at the RHU Pasuquin and according to her she received a shot of Tetanus Toxoid vaccine. NUTRITIONAL ASSESSMENT Height: 156 cm. Weight: 49 kilograms Formula in computing for BMI BMI= Weight in Kilograms (Height in meters)2 = 49 kg (1.56 m) 2 = 49 kg. 2.43
20.2
Juanita wakes up at around 5:30 in the morning and breast feed her baby. She
ACTIVITIES OF DAILY LIVING
takes her breakfast together with her sibling at 6:00-7:00 am. Sometimes she is entrusting her baby to her brother or neighbors to help in the field but most of the time she is left at home to monitor her baby and prepare food in the absence of her mother. Jaunita takes her breakfast at 11:30- 12:00 and then takes a bath after. She sleeps at night at around 9:00-10:00.
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D. DIONISIA DIMAGIBA 16 years old CEPHALOCAUDAL PHYSICAL ASSESSMENT Date Performed July 24, 2011 General Survey On the first day of contact with the family, Juanita was seen in good grooming in baby blue shirt and shorts. She has normal body built with relaxed, erect posture and coordinated movement. She has no foul breath and body odor. There is no apparent sign of illness as she presents a healthy appearance. She is cooperative, with appropriate response to situation. She exhibits understandable speech in moderate pace, shows thought association and has sense of reality. Likewise, she is oriented to person, time and place. VITAL SIGNS Blood Pressure Respiratory Rate Pulse Rate (Radial) Body Temperature (Axilla) SKIN y y HEAD Skull & Face y y Hair y Nails y y y y intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec) No area of loss of hair and no infection/infestation. No bruises, nodules and masses noted Symmetrical facial movements and facial features Light brown skin complexion Intact sensation to touch, pain and temperature FINDINGS 90/70 mmHg 21 counts per minute 64 beats per minute 36.7 C
Eyes structures and Visual Acuity y no discharge y bilateral blinking y white sclera y pale palpebral conjunctiva y positive blinking reflex on corneal sensitivity test y PERRLA
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y y
Coordinated movements Able to read newsprint at 14 inches distance
Ears and Hearing y y y Auricles aligned with the outer canthus of the eyes Good gross hearing acuity (normal tone voice is audible) Able to hear ticking of watch in both ears
Mouth y y y Neck y Neck muscles equal in size and strength Tongue moves freely Intact gag reflex With moderate breath odor
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PAST AND PRESENT HEALTH HISTORY Dionisia received all the childhood immunization as claimed by her mother. She as well experienced childhood illnesses like mumps, measles, and chicken pox. These were all managed non-pharmacologically and traditional means. Common illnesses like headache, fever, cough and colds and dysmenorrhea were all treated
pharmacologically as long as there is a fund to buy medicines. Dionisia was hospitalized when she was an infant at GRBASMH due to pneumonia as claimed by her mother. She fully recovered after she was discharged at the hospital. Way back in 2006, the young Dionisia was beaten by a dog at her left leg. The area was thoroughly washed with soap and running water and then after she was brought to RHU Pasuquin. According to Inocencia, her daughter was administered with an injection of which she is uncertain if it was anti-rabies. NUTRITIONAL ASSESSMENT Height: 160 cm. Weight: 48 kilograms Formula in computing for BMI BMI= Weight in Kilograms (Height in meters)2 = 48 kg (1.6 m) 2 = 48 kg. 2.56 Asia-Pacific Obesity Guidelines Underweight Healthy Weight Overweight At risk Obese I Obese II < 18.5 18.6-22.9 > 23.0 23.0-24.9 25.0-29.9 > 30.0
= 18.8
ACTIVITIES OF DAILY LIVING Dionisia wakes up at 5:30-6:00 in the morning. After taking a cup of coffee she sometimes goes to the field with the other family members to work. She helps in performing household chores like sweeping the front and backyard. She takes her breakfast at 6:00 and takes a bath at 9:00-10:00. Dionisia accompanies her mother and older sister in washing their clothes. At 11:30 she takes her lunch and then goes to their neighbor to watch movies or have a chat. Dionisia sleeps at 9:00-10:00 at night time after watching television.
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e. KAIMITO DIMAGIBA 10 years old CEPHALOCAUDAL PHYSICAL ASSESSMENT Date Performed July 24, 2011 GENERAL SURVEY Kaimito on the initial contact was observed to be unkempt in yellow t-shirt and camouflage short. He has thin body build, walks, stands and sits relaxed with erect posture and coordinated movements. Minimal body and breath odor was observed. He is cooperative and responds appropriately to situation. He has understandable speech, in slow pace, exhibits thought association and has sense of reality. On the other hand he is oriented to time, place and person. VITAL SIGNS Blood Pressure Respiratory Rate Pulse Rate (Radial) Body Temperature (Axilla) SKIN y y y y Nails y y y y y HEAD Skull & Face y y y Hair y y y No area of loss of hair no infection with minimal lice infestation No bruises, nodules and masses noted normocephalic Symmetrical facial movements and facial features untrimmed and dirty intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec) dark brown skin complexion Hypopigmentation spotted in the neck, arms, abdomen and back Scratches seen on right leg with scab formation Intact sensation to touch, pain and temperature FINDINGS 90/60 mmHg 23 counts per minute 66 beats per minute 37.1 C
Eyes structures and Visual Acuity y no discharge y bilateral blinking y white sclera
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y y y y y
pale palpebral conjunctiva positive blinking reflex on corneal sensitivity test PERRLA Coordinated movements Able to read newsprint at 14 inches distance
Mouth y y y y Neck y Neck muscles equal in size and strength Yellowish colored teeth with some dental carries Tongue moves freely Intact gag reflex With moderate breath odor
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PAST AND PRESENT HEALTH HISTORY Kaimito was hospitalized at GRBASMH when he was an infant due to pneumonia. Before Inocencia decided to submit her son to the hospital she sought consultation at RHU Pasuquin first. In there, the infant Kaimito was given medication to take, however, the condition persist and worsen. It was only that time that Inocencia rushed Kaimito to the hospital for immediate care. Kaimito was found out to have pneumonia. Successfully treated and freed from unhealthy condition, he was discharged after almost 2 weeks. Kaimito also experienced common childhood illnesses like mumps, measles, and chicken pox. These were all treated non-pharmacologically and traditional means same as those aforementioned.
NUTRITIONAL ASSESSMENT Height: 141 cm. Weight: 34 kilograms Formula in computing for BMI BMI= Weight in Kilograms (Height in meters)2 =
=
34 kg (1.41 m) 2
34 kg. 1.98
= 17.2
ACTIVITIES OF DAILY LIVING Kaimito wakes up at 5:30 am. Together with his father, they fetch water in the deep well early in the morning. At 6:00 he takes his breakfast and then takes a bath in preparation for school. At around 6:30 he walks to school for 25-30 minutes. At lunch time he goes home to take his meal and goes back to school for his afternoon class. At Saturdays and Sundays when her mother-sister goes to the field to work he is the one who takes care of his nephew. Kaimito is the one who feeds their pig early in the morning and late in the afternoon. He sleeps at 8:00-9:00 after accomplishing his assignments.
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f. JUANITO DIMAGIBA 9 months old CEPHALOCAUDAL PHYSICAL ASSESSMENT Date Performed July 24, 2011
VITAL SIGNS Respiratory Rate Pulse Rate (Radial) Body Temperature (Axilla)
FINDINGS 25 counts per minute 92 beats per minute 37.5 C
PAST AND PRESENT HEALTH HISTORY Juanito was never hospitalized due to any disease condition. As stated by her mother she completed all his immunizations. Currently, to date of first initial contact, he has cough and cold. There were no interventions done to treat the condition.
NUTRITIONAL ASSESSMENT Weight: 8 kg. Age: 9 months old AGE IN MONS. 8 9 10 BELOW NORMAL 6.2 kg 6.5 kg 6.8 kg NORMAL FROM TO 6.3 kg 10.1 kg 6.6 kg 6.9 kg 10.5 kg 10.9 kg ABOVE NORMAL 10.2 kg 10.6 kg 11 kg
*source: FNRI Users Manual, 2003 INTERPRETATION: NORMAL BODY WEIGHT
DEVELOPMENTAL ASSESSMENT Childs Profile Date of Birth: September 16, 2010 Date of Test: July 24, 2011 Computation: (Year) (Month) (Day) 2011 07 24 2010 09 16 __________________________ 10 8 days
AGE
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METRO MANILA DEVELOPMENTAL SCREENING TEST a. PERSONAL-SOCIAL Action Smiles responsively Score Passed Procedure/Result During the test the tester went close to the child and smiled at the baby while playing with him. The child smiled back at him and produced chuckling sound. The child occasionally smiles with or without stimulation.
Smiles spontaneously
Passed
Regards face
Passed
The first time the tester came face to face with the child, the child curiously look at her. Childs vision is good. The child is studying a face with a fixed stare.
INTERPRETATION The child was able to pass the three activities: smiles spontaneously, smiles responsively and regards face. With this, we could conclude that the child has no developmental milestone delay under personal-social criteria. b. FINE-MOTOR ADAPTIVE Score Procedure/Result Procedure: Passed While the child is sitting on his mothers lap, the tester put the rattle at his palm. Result: The child instantly grasps the rattle within a few seconds. Ability to hold small object is visible. The childs thumb opposition is beginning in scooping motion. Regards cheese curls Passed Procedure: A piece of cheese curl was dropped at the mothers lap while the child is sitting on one lap. Result: The child looked at the cheese curls and tried to get it. It indicates that coordination of eyes and hands is developing. Procedure: Toys were put to a place 2 feet near the child. Result: The child tried to reach them out and eventually held one toy. This indicates that vision is clear, especially if there is stimulation. Procedure: The child was lying in supine position. The tester put the red yarn in about 6-8 inches in
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Action Grasp Rattle
Reaches object
Passed
Follows 180
Passed
front of the child and wiggled it to get his attention. Then it was transferred from his left going to his right side in a slow motion. Result: The child followed the yarn as evidenced by the movement of his eyes as well as his neck on the same manner of movement of the yarn. The tester performed it twice. Presence of eye movement was observed. The child has a strong sense of sight. He was able to follow the moving objects. Hands together Passed Procedure: The tester watched the child to see if he touches his hands together frequently. Result: The child often touches his hand together during the test. This means that the child is developing self-discovery Follows past midline Passed Procedure: While the child is lying in a supine position, the tester held the red yarn for about 6-8 inches in front of him and moved it slowly from one side in an arc over the middle of the child to the other side. Result: The child followed the red yarn from his left side to the middle then paused and from the middle to his right side. The childs eyes followed the yarn. The tester performed it twice. Eye movement was observed. The childs binocular vision was achieved. Procedure: While the child is lying in a supine position, the tester places the yarn at about 6-8 inches in front of the child. Then place it from his left side going to the middle. Result: The childs eyes followed the yarn. His neck also moved from left to the middle of his body. The tester performed this twice. The childs binocular vision was achieved. INTERPRETATION: The examiner performed seven activities under the fine-motor adaptive sector. These are: grasp rattle, regards cheese curls, reaches object, follows 180, and follows midline and past midline and hands together. The child passed all these seven activities. For this criterion the examiner ruled out no developmental delay.
Follow to midline
Passed
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Area Turns to voice
Score Passed
c. LANGUAGE Procedure/Result Procedure: As the child was sitting on her mothers lap, the tester went to his right side and called him by his name. Result: Upon calling the name of the child he faced the direction of the voice of the examiner.
Squeals
Passed
Procedure: The tester asked the mother if the child already laughs, or produces a squealing sound if hes overjoyed. Result: The mother verbalized that her child was able to produce different sounds. The child squeals because of pleasure.
Laughs
Passed
Procedure: The tester asked the mother if the child laughs loud even without being tickled or any stimulation. Result: The mother positively confirmed that her child lough loud even if her child is alone lying.
Vocalizes not crying
Passed
Procedure: The tester observed if the child is able to vocalize and producing different sounds. Result: As the tester proceeded with the test, it was observed that the child can produce sound like ahh.
Responds to bell
Passed
Procedure: The tester rang the bell quietly at the left side of the child where the child could not see it. Then the tester rang again the bell, this time, louder. Result: The tester rang the bell first at the left side of the child, the child momentarily stopped wiggling. Then the tester rang again the bell, this time more sound was produced, the child moved his head to the direction of the sound produced by the bell. The child has a distinctive hearing awareness. He turns his head toward the direction of the sounds.
INTERPRETATION: The child was able to pass all the activities mentioned above which means he has no developmental delay on this criteria.
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d. GROSS MOTOR Procedure Bear some weight on legs Score Passed Procedure/Result Procedure: The tester held the child upright on the mattress. Result: The child stood straight for a few seconds holding his weight on his legs, as the loosen support to the child. Procedure: The tester put the child in a supine position and slowly pulled him up through his hands. Result: The childs head hang as he pulled to a sitting position. It means that head lag is still prominent. Muscles of neck are not strong enough to give support to his head while in motion. Procedure: The child is placed on the mattress in a prone position. The tester observed if the child can lift his head and chest up using arms for support. Result: The child lifted up his head and chest but did not extend his forearm for support. This means that the child cannot rest his torso's weight. Procedure: The mother was asked if she have observed her child roll from side to side in supine position. Result: The mother confirmed that she have seen her baby roll in bed many times already. Procedure: The child is placed at his mothers lap, in a sitting position. The tester counted for a full minute while looking at the childs head if there is no swaying. Result: The tester observed that the childs head did not sway. The childs muscle control is already established. It allows the child for a more visual interaction. Procedure: The child was positioned lying in his stomach on a mattress and was observed if he can lift his head to make a 90 angle. Result: The child was not able to lift his head and chest to produce a 90 angle. The childs head is still held facing down-ward. Procedure: The child was put in a lying position on his stomach and was observed if he can lift his head to make a 45 angle with the table.
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Pull to sit
Failed
Prone chest up arm support
Failed
Rolls over
Passed
Sit head steady
Passed
Prone head up to 90
Failed
Prone head up 45
Passed
Result: The child was able to lift his head and raise his chin from the mattress. His neck muscles can support his head movement up to 45 degrees angle.
INTERPRETATION: The child wasnt able to perform some of the task which includes: prone head up to 90, Prone chest up arm support and pull to sit, however this doesnt mean that he is already developmentally delayed on this criteria. He still have time to achieve all these developmental milestone.
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VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND DISEASE PREVENTION.

All the children of the family were all fully immunized as claimed by their mother. Both the husband and wife are not certain if they received completely all the childhood immunizations. None of the family members have vices that could trigger different diseases. There is adequate rest and sleep among family members. They sleep at around 8:00-10:00 and wake up between 5:00-6:00 which means they get 9 hours of sleep every day which is adequate enough. The family seldom observes the use of protective measures. Inocencio uses rubber boots in going to the field to ensure safety against snake bites, puncture, cuts and laceration of the feet. He makes use of hat, long-sleeves, and pants to minimize exposure to UV rays, however he dont use hand gloves. When other family members go to the field, the protection that they only use is a hat, long-sleeves and pants. None of the family members walks barefooted. At night time only Juanito uses mosquito net, the other members just use blanket to cover up and protect themselves from mosquito bites. Inocencia regards and recognizes the importance of health of each family member, nevertheless because of financial constraints they are unable to buy medicines so they just resort to rest or sleep to deal with different illnesses. The family sometimes utilizes herbal plants to treat common illness like cough and cold which is treated with the use of Yerba Buena decoction. Whenever the condition of a family member gets worst they seek consultation at the RHU Pasuquin. The family consults a quack doctor for illnesses they believe were acquired through invisible creatures. They refer to a manghihilot or traditional healer when a family member experiences stomachache, fainting, severe headache and difficulty of breathing. Eating vegetables as stated by Inocencia is one of the best practices that could prevent different diseases as these boosts body resistance against disease. She also mentioned that she would want to buy Vitamin supplements if only theyve got financial reserves.
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FAMILY COPING INDEX

CRITERIA/AREAS 1. Physical Independence DESCRIPTION Concerned with the ability to move about, to get out of bed, to take care of daily grooming, walking Includes all of the procedures or treatments prescribed for the care of illness such as giving medication, using appliances (including crutches), dressing, exercises, and relaxation and special diet Concerned with particular condition RATE 5 JUSTIFICATION The members of the family are able to perform their ADLs without assistance from others (except in the case of Juanito who is an infant). At present, none of them has disability or debilitating disease. In cases that a family member is on illness state or experiences common illnesses (headache, cough and colds, fever) and other health condition ( wounds, animal bites), the family has the basic knowledge on how to provide care but they lack understanding of the principles involved. For instance, Inocencia was asked to tell the reason why she uses yerba buena decoction for cough and cold, she only responds by saying, tapnu maawan toy panatengko. (To cure my cough and colds) Reinforcing the above-mentioned in point 2; the family has some general knowledge of the diseases or conditions they encountered but has not grasped the underlying principles of the interventions. Not all members of the family are practicing general principles of hygiene. Because of the distance of water supply, they sometimes dont take a bath especially Kaimito and Inocencio. The family diet is grossly inadequate or unbalanced. The cooking area was found messy and unorganized and leftovers are just covered with a plate or stored in a casserole. Inocencio works in the farm for long period of time (5:00am-5:00pm). The family understands and recognizes needs for medical care in times of illness state but due to lack of financial means they just treat their condition with OTC drugs or herbal medicines. In cases of emergency situations, they immediately seek health care like when Inocencia and Inocencio were hospitalized due to liver and kidney problems respectively. The advices of the doctor to them upon discharge from the hospital were all taken into account for their faster recovery. Inocencia no longer smokes cigarette and drinks liquor after she was treated. On the other side, the family lacks the skills in caring for their ill member. The members of the family are able to maintain a reasonable degree of emotional calmness when they are troubled. They deal with the problems they encounter with
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2. Therapeutic Competence
3. Knowledge of Health Condition
4. Application of Principles of General Hygiene
Concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for the family members
5. Health Attitudes Concerned with the way the family feels about health care in general including preventive services, care of the ill and the disease and public health measures
6. Emotional Competence
Has to do with maturity and integrity with which the members of the family are able to meet
the usual stresses and problems of life and to plan for happy and fruitful living
7. Family Living
8. Physical Environment
Concerned largely with the interpersonal or group aspects of family life- how well the members of the family get along with one another, the ways in which they make decisions affecting the family as a whole Concerned with the home, the community and the work environment as it affects family health
9. Use of Community Facilities
Has to do with the degree of the familys use and awareness of the available community facilities for health education and welfare
optimism. When Juanita got pregnant, her parents insisted to accept the baby but when she gave birth already, the baby was accepted as a new member of the family even with the absence of his biological father. No adda gaget a ket awan imposible, says Inocencio. (Nothing is impossible when there is patience). He added that being poor is not the reason for them to be discouraged to strive hard. The family is hopeful that someday, somehow they will separate bondage to poverty to a higher economic status where all their needs will be met. The family tasks are being shared to every member. Each one performs their duties and obligations and each acts for the good of the family as a whole. The children go to the field and help their parents to work and earn for their living even at their young age. The children regard respect for their parents and vice versa. Decision making is shared by the husband and wife and somehow they are able to settle all their problems. The whole structure of the house can cause accidents that could result to fatal and nonfatal injuries. There are so many accidental hazards observes like presence of rusting sharp edges of galvanized iron, weak foundation of the house and stocked things on the base of the roof to name a few. To sum all the observations the house is on poor condition.. The family is aware of the available community facilities. The family uses the facilities they need appropriately and promptly but not all the times. Of these facilities are the RHU where they visit for consultation. They know when or who to call for help. They approach the barangay health workers for some concerns if they are around.
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TYPOLOGY OF NURSING PROBLEMS

CUES/DATA FAMILY NURSING PROBLEM Objective: Inocencio and Juanito both First Level Assessment present signs of cough and colds like Presence of cough and colds (Inocencio and clear nasal discharge. Juanito) as health deficit Subjective: Inocencio verbalized, Second Level Assessment maika 4 nga aldawnaitan nga A. Inability to provide adequate nursing care to agpanpanatengnakon, di the sick and vulnerable/at risk-member of metlaumimbagen. (This is already the the family due to: fourth day that I am experiencing cough 1. Lack of/inadequate knowledge about the and colds, its not still treated) diseases/health condition (nature, Ada makalawas nan nga severity, complications, prognosis and agpanpanateng toy anak ko, aguyekmanagement) uyeksuna ken agbutbutegtaposkanayon 2. Lack of/inadequate knowledge about nga mariing iti rabii, uttered by Juanita. child development and care Awan ti tumtumaren nga uray ana nga 3. Inadequate family resources for care, agas. (Its been a week already that my specially financial constraints son is experiencing cough and colds, he B. Inability to provide a home environment is not taking in any medication) conducive to health maintenance and personal development due to: 1. Inadequate knowledge of importance of hygiene and sanitation 2. Inadequate knowledge of preventive measures Objective: The familys total monthly income is P 2,275.00 which is broken down to meet the basic needs of the family. According to NEDA, each individual should at least have P 2768.60 when the total monthly income of the family is divided among the total family members, thus family Dimagiba with 6 members and with a total monthly income of P 2,275.00 and each member having a share of P 379.00 a month can be considered poor. Subjective:Inocencio was noted saying, haan umanaydetoymakitkitaan mi parakadagitimasapsapul toy pamilya mi. (Our income is not enough for our needs) No ada masakit ket iyananos lattan iti agpalaing iti uneg ti balay ta awan met pagpachec up kaskadaigatang iti ag-agas, he added. (If someone experiences illness, he just stays inside the house and rest for we could not afford to pay for checkup or buy medicines) Objective: On observation of the house structure, the group noticed many accidental hazards. To name a few, they are the presence of rusting sharp edges of galvanized iron located in the front First Level Assessment Family size beyond what family resources can adequately provide as a health threat Second Level Assessment A. Inability to make decisions with respect to taking appropriate health action due to: 1. Inaccessibility of appropriate resources for care, specifically cost constraints or economic/ financial inaccessibility
First Level Assessment: Accident Hazards like rusting sharp edges of galvanized iron, fire hazards and fall hazards as health threat Second Level Assessment
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door and sides of the house, use of pan-aw for the house roofing which could cause fire, faulty electrical wiring, and presence of piles of things stocked in the base of the roof, scattered rusting nails. Subjective: not available
Objective: Juanita got pregnant when she was 16 years old. Her boyfriend left her and its been a year already that he didnt show up and there is already limited communication between them. With this, at her young age she is already taking care of her baby who will be turning a year old. She is pressed with the responsibility to care for her child even if she lacks the knowledge to carry out those actions. Subjective: No dadduma ket ni pay mamangko iti magalalagakadeta anak kon ta jak met unayamo pay ngaminmanongngemmakasursuro nak met ketdin ah, (It is sometimes my mother who takes care of my child because I dont fully know how to take care of himbut Im learning though) verbalized by Juanita. Uray kuma met umaylatabumisitasuna (Boyfriend) ta umayna met kitan no kasano iti plastar mi nga aginaditoy yen, jakamo no panindiganna pay toy anak mi no saanen ta nabayag met nga han nga nagparangen ken jak pay unaymakonkontaksunan, (I hope he will come to visit us) she added. Objective: Each individual must have at least a share of 3.5x3.5 m if the total floor area is divided by the number of family members. In the appraisal of the group, it has been found out that the circumference of the house is 5.26x4.14 m. far enough to meet the standard floor area to be occupied by each member. Subjective: No kunkunaek ah ket haan nga umanaydetoyespasyon iti balay me, a kasmakitayo met nailet ken adutgamit nga nakapaigid ken haan kam pay ketdiunaymakakuti-kutiditaunay isu nga alwadanyo no bakamaitumeg kayo, (The space of our house is not adequate enough to accommodate us all and our movement is limited) verbalized by
A. Inability to provide a home environment conducive to health maintenance and personal development due to: 1. Inadequate family resources, specifically limited financial resources and limited physical resources (lack of space to construct facility) 2. Failure to see benefits of investment in home environment improvement 3. Lack of skill in carrying out measures to improve home environment First Level Assessment Presence ofstress-provoking factors like strained marital relationship as a health threat Second Level Assessment A. Inability to provide a home environment conducive to personal development due to 1. Ineffective communication patterns within the family 2. Lack of supportive relationship among family members 3. Negative attitude/philosophy in life which is not conducive to personal development 4. Lack of competencies in relating to each other for mutual growth and maturation
First Level Assessment Poor home/environmental condition: inadequate living space as a health threat Second Level Assessment A. Inability to make decisions with respect to taking appropriate health action due to: 1. Low salience of the problem 2. Inaccessibility of appropriate resources, specifically cost constraints
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Inocencio. Objective: There is no available food storage like refrigerator or flies resistance coverings. Subjective: Awan iti nasayaat nga pagipanan mi dagitamabatbati nga magmakanpara iti sumarno, kaluban mi nukwa iti pingganwennoipan iti uneg iti kaserola tapnu haan nga mabangles, (We dont have proper storage for food, we usually cover it with place or put it inside a casserole) as verbalized by Inocencio. Objective: On observation of the home and environmental condition, there were presence of vermin like cockroaches, flies and rodents. Subjective: Ada da lattaipeskadakabkabalay, ta adu met ngaminnakatambak nga gamitditoybalay mi,(There are cockroaches and rats because weve got many things sticked inside our house) says Inocencio.
First Level Assessment Poor home/environmental condition/sanitation: lack of food storage facilities as a health threat Second Level Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Inadequate family financial resources 2. Inadequate knowledge of importance of sanitation
Objective: The garbage disposal being used by the family is an open pit system that measures 1x1 m circumference and less than foot deep that is overflowing which could attract flies that carry different microorganisms and eventually cause different diseases. Subjective:Deta ada ditalikod mi nga nakali iti agdama nga pagibelbelengan mi iti basbasura mi,(Weve got pit behind out house where we dumped all solid waste) says Inocencio. Objective:A small canal of approximately 10 inches wide and 5 inches deep is the drainage system that the family has. There were obstructions seen like leaves, rocks and plastics that impedes the flow of water and leaves it stagnated. The water is also overflowing. Subjective: not available
First Level Assessment Poor home/environmental condition/sanitation: presence of breeding or resting sites of vector of diseases (e.g mosquitoes, flies, cockroaches, rodents etc. as a health threat Second Level Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Inadequate family financial resources 2. Inadequate knowledge of importance of maintaining proper environmental condition First Level Assessment Poor home/environmental condition/sanitation: improper garbage disposal as a health threat Second Level Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Failure to see benefits of investment in home environment improvement 2. Inadequate knowledge of importance of sanitation
Objective:The house has only one source of lighting. Its an incandescent bulb of 15 watts that lights up the whole house at night time. There is as well one small window that measures 1x1 m, which is located in the bedroom. Subjective:not available
First Level Assessment Poor home/environmental condition/sanitation: Improper Drainage System as a health threat Second Level Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Failure to see benefits of investment in home environment improvement 2. Inadequate knowledge of importance of sanitation 3. Inadequate family financial resources First Level Assessment Poor home/environmental condition/sanitation: poor lighting and ventilation as a health threat Second Level Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Failure to see benefits of investment in
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Objective:The cooking area is messy and disorganized. The eating utensils and cooking facilities are held in a place uncovered. Subjective: Haan unaynaplastardetoypaglunglungan mi atakurang iti espasyon ken awan pay ketdiigatang iti pagyanandagitapingpingganen, (Our eating and utensils are not properly placed because of financial problem) verbalized by Inocencia.
Objective: Some members of the family have been found out to be on somewhat unpleasant personal hygiene. Presence of long untrimmed and dirty fingernails, moderate breath and body odor were observed along with lice infestation. These objective cues could indicate poor personal hygiene. Subjective:Narigat iti danumditoyayan mi ta adayo iti pagsakduan, isu nga haan kam malimlimitaranlang iti panagusar mi iti danum, (Our water supply is away from our house, so our use of water is limited) stated by Inocencia.
home environment improvement 2. Inadequate family financial resources First Level Assessment Unsanitary food handling and preparation as a health threat Second Level Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Inadequate knowledge of importance of sanitation 2. Cost constraints.
Objective:not available Subjective: Agag-agas kami iti Paracetamol no adda gurigor ken Biogesic no para iti sakit iti ulo, ngem han unaykanayon ta awan met igatang no dadduman, (We are self-medicating with Paracetamol for fever and Biogesic for headache but we sometimes cannot avail these medicines) verbalized by Inocencia.
Objective: The family has one mini mosquito net which is good for Juanitos use. Subjective: Di kami agususar iti mosketero deta langapokok ah iti agusar tapnu haan nga kagaten iti lamlamok, (We are not using mosquito net, only my grandson uses it) verbalized by Inocencio.
First Level Assessment Unhealthy lifestyle and personal habits/practices: poor personal hygiene as a health threat Second Level Assessment A. Inability to recognize the presence of the problem due to: 1. Lack of knowledge about the benefits of proper personal hygiene 2. Attitude in life which hinders recognition of the problem First Level Assessment Unhealthy lifestyle and personal habits/practices: self-medication as a health threat Second Level of Assessment A. Failure to utilize community resources for health care due to: 1. Lack of knowledge of community resources for health care 2. Unavailability of required care due to physical inaccessibility B. Inability to make decisions with respect to taking appropriate health action due to: 1. Failure to comprehend the nature of the health problem First Level Assessment Unhealthy lifestyle and personal habits/practices: non-use of self-protection measures (mosquito nets) as a health threat Second Level of Assessment A. Inability to provide a home environment conducive to health maintenance due to: 1. Failure to comprehend the nature of the health problem 2. Lack of knowledge as to alternative courses of action open to them 3. Cost constraints of appropriate resources
4. Failure to see the benefits of investment in home condition improvement 5. Inadequate knowledge of preventive measures
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PROBLEM IDENTIFICATION
Problem # 1. Presence of COUGH AND COLDS (Inocencio and Juanito) as a health deficit COMPUTATION ACTUAL CRITERIA JUSTIFICATION
SCORE
A. Nature of the problem
3/3 x 1
B. Modifiability of the problem
2/2 x 2
C. Preventive Potential
2/3 x1
0.67
D. Salience
2/2 x 1
It is a health deficit that affects the normal functioning of the individual concerned that also requires immediate attention and adequate management to reduce the likelihood of transfer to the other members of the family. The problem is easily modifiable because: Current Knowledge The family recognizes the presence of the health condition and the need for the the family member affected to be properly taken cared of AEB the verbalization of the problem by Inocencia and Juanita Resources of the Family The family has necessary resources to make a particular intervention to the problem since they have and are knowledgeable of the use of herbal medicines useful for treating the cough and colds like yerba buena which is planted beside their house. Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. Also, they have proper know-how to perform independent nursing intervention to help treat the condition. Resources of the Community The community resources are also available to assist the family in terms of consulting about the disease condition like RHU Pasuquin and the BHWs. The problem is moderately preventable because: The family recognizes it as a problem. Awareness is highly necessary to implement the plan of action in treating the condition. Knowledge, skills and time of the student nurses adds up to the preventive potential. They could give the family health teachings on how to manage this illness. However: The family lacks the financial means to avail medicine in curing the illness. Health facilities are from their place. The family recognizes the need to make necessary interventions especially for Juanito. AEB Juanito, innakkumangarudipacheckupisunan ket kumarkarongamin toy kondisyonnanammuna ket no ubingnababa iti resistansyana.
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TOTAL SCORE
4.67
PROBLEM #2. Family size beyond what the family resources can adequately provide as a health threat
CRITERIA COMPUTATION ACTUAL SORE JUSTIFICATION
A. Nature of the Problem
2/3 x 1
.67
1/2x 2
C. Preventive potential
1/3 x 1
0.33
D. Salience
2/2 x 1
This problem becomes a health threat because the family cant sustain the health needs of a sick member like provision of medications and access to health care facilities in the presence of another problem which is inadequate family income. The problem is not modifiable because: Current knowledge The family recognizes this as a problem. AEB by Inocensio, their income is not enough to meet their needs, pagkaskasyaen mi laengendetoykapiranggot nga kita mi ta nammuna ket aduka mi ditoypamilya mi, he added. Awan pay ketdi iti igatang ti ag-agas no ada agkasakitkanyamin, uray kumaagaslang toy apokok, Resources of the family The family lacks the financial means to support and give the needs of the family, like food, health care, and conducive home environment. Resources of the Student Nurses The student nurses have the knowledge, skills and time to teach the family some relevant alternatives for nursing health care which are economically wise like the use of common herbal medicines. Resources of the Community There are available facilities in the community that offers free medicines and health checkups. The problem has low preventive potential because: The sources of income are scarce and often unstable. They cant avail health care services because of their low income. The income of the family is not enough to meet all their basic needs and health needs. The family perceived this as a problem specially in providing adequate care for both well and ill member but regards it as not needing immediate attention.
TOTAL SCORE
Problem #3 Accident hazards like rusting sharp edges of galvanized iron, fire hazards and fall hazards as health threat
A. Nature of the Problem B. Modifiability of the problem
2/3 x 1 1/2 X 2
0.67 1
The problem is a health threat. The problem is partially modifiable because: Current Knowledge:
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2/3 x 1
0.67
D. Salience
2/2 x 1
The family recognizes the presence of the different accidental hazards but they knew that modification of these things would cost them an amount. Resources of the family: Financial and physical resources are obviously not the asset of the family which are necessary to eliminate these accidental hazards but when it comes to manpower, it is fair enough to make some modifications especially to those hazards that dont require some money to be shelled out. Resources of the student nurses: Knowledge, time and skills of the student nurses could help in the modification of the problem. They could empower the family to act on eliminating these hazards by merely educating them the illeffects on them. Resources of the community: There are no available resources of the family that could help them solve this problem. The likelihood of modifying the home environment is increased by the awareness of the family of the existing problem but unfortunately, they cannot totally eliminate all the accidental hazards, for some modification needs money to successfully carry out actions. Through their time and effort these accidental hazards could be eliminated and prevent future accidents. The family perceives it as a serious problem that may endanger their lives and may cause injuries to them.
TOTAL SCORE
3.34
Problem #4 Presence of stress provoking factors like strained marital relationship as a foreseeable crisis
1/3 x 1
0.33
1/2 x 2
This problem is a foreseeable crisis that may affect the everyday life Juanita and could encroach on the family as a whole. The problem has a partial modifiability because: Current Knowledge Juanita and her family are aware that this is a problem that could affect most specially the baby because he (Juanito) is growing up and he has an increasing need. Resources of the family: There is little family resources that could help sustain and support the needs of the child. Resources of the student nurses: Presence and time for motivation are the resources of the student nurses available. Resources of the community: There are no available community resources that could solve this problem.
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1/3 x 1
.33
D. Salience
0/2 x 1
There is a low preventive potential for this problem because: Juanita is still young to assume mother roles in the absence of her boyfriend. The family lacks the financial means to support the needs of an additional member. There are already many effects of her early pregnancy like dropping in school. Most likely there will be less opportunity for her to find a stable job so that she could give the needs of her child. Juanita denied this as an occurring problem and her family does the same.
TOTAL SCORE
1.66
Problem #5Poor home/environmental condition/sanitation: inadequate living space as a health threat

2/3 x 1 0/2 x 2
0.67 0
This is a health threat. This is not a modifiable problem because: Current Knowledge and Resources of the family: They acknowledge this as a problem but financial, physical and manpower resources makes this problem impossible to modify at this very moment. Resources of the student nurses: The student nurses could only give their time in planning for the rearrangement of the things stocked in the house but cannot actually solve the problem because 3.5x3.5 m is required for every member to have an adequate space inside the house. Resources of the community: There are no available resources of the community that could help solve this problem. There is low preventive potential for this problem because: The family lacks the financial means to improve the living space for each member. The family perceives this as a problem that doesnt need immediate attention or solution for this is not a priority for them to solve.
1/3 x 1
0.33
D. Salience
1/2 x 1
0.5
TOTAL SCORE 1.5

Problem #6 Poor home/environmental condition/sanitation: lack of food storage facilities as a health threat
2/3 x 1
0.67
This is a health threat because the family is at risk to different diseases like diarrhea and poisoning.
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1/2 x 2
2/3 x 1
0.67
D. Salience
1/2 x 1
0.5
There is a partial modifiability for this problem because: Current Knowledge The family recognizes this as a problem but not aware of the different illness they could get from improper food storage. Resources of the family There is little available financial resource of the family. Resources of the student nurses Time, knowledge of the ill effects of improper food storage and assistance are the available resources the student nurses have. Resources of the community There are no community resources that could help this problem The is a moderate preventive potential for this problem because: Knowledge of the family will be increased with the health education of the student nurses. Of the high modifiability of the problem. Practice of proper food storage could prevent different diseases. The family recognizes this as a problem but thinks it does not need immediate attention.
TOTAL SCORE
2.84
Problem #7Poor home/environmental condition/sanitation: presence of breeding or resting sites of vector of diseases (e.g. mosquitoes, flies, cockroaches, rodents, snake etc. as a health threat
2/3 x 1
0.67
1/2 x 2
3/3 X 1
This problem is a health threat because the family is predisposed to different nonfatal as well as fatal diseases when they come in contact with these vectors. The problem is partially modifiable because: Current Knowledge The family recognizes the problem and is aware of the presence of these vectors of diseases. Resources of the family: There are no available financial resources but family gets an advantage in both physical and manpower means. Resources of the student nurses: Time, knowledge and assistance are the things that could be contributed by the student nurses to resolve the problem. Resources of the community: There are no available resources that could help in solving the problem. There is a high preventive potential for this problem because: Once actions are taken the likelihood of contracting different vector-borne diseases
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D. Salience
2/2 x 1
will be reduced. The family understands the seriousness of the problem for theyve come in contact already with all the vectors stated above and acknowledges the negative impact of these to their health and safety.
TOTAL SCORE
4.67
Problem #8Poor home/environmental condition/sanitation: improper garbage disposal as a health threat

2/3 x 1
0.67
2/2 x 2
3/3 x 1
D. Salience
1/2 x 1
0.5
This is a health threat for the family different insectsthrive in garbage that carriesmicroorganism that causes different diseases The problem has a high modifiability because : Current Knowledge The family has the knowledge on the problem and understands the different effects of improper garbage disposal to health. Resources of the family Physical and manpower resources are available. Resources of the student nurses Time, knowledge and assistance are what the student nurses could contribute to modify the problem. Resources of the community There is no needed assistance from the community to carry out action in solving this problem. There is a high preventive potential for future problems because: Proper garbage disposal could minimize the transmission of microorganism from vectors of diseases to human The problem perceives the problem as not a serious one and not needing attention however it is still a recognize problem.
TOTAL SCORE
4.17
Problem #9Poor home/environmental condition/sanitation: Improper Drainage System as a health threat

2/3 X 1
0.67
2/2 x 2
Not flowing water form canal is a good place for mosquito to multiply and with this the family is placed on health threat. There is a high modifiability for the problem because: Current Knowledge The family acknowledges the problem and the effects of it on their health. Resources of the family Physical and manpower resources are the available
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3/3 x 1
D. Salience
2/2 x 1
to carry out plan of action in solving this problem. Resources of the student nurses Knowledge, time and assistance are available to help the family carry proper actions. Resources of the community: There are no needed community resources for this situation. The is a high preventive potential for future problems because: As the drainage system will be fixed to an ideal one different diseases caused by mosquito bites could be minimize. The family perceives this as a serious problem that needs immediate attention.
TOTAL SCORE
4.67
Problem #10Poor home/environmental condition/sanitation: poor lighting and ventilation as a health threat
2/3 X 1
0.67
0/2 x 2
1/3 x 1
0.33
D. Salience
0/2 x 1
This is a health threat because the family is placed at risk for accidental banging their heads especially at night time and fresh air could not enter the house in the presence of only one small window. The problem is not modifiable: Current Knowledge The family doesnt recognize the two as existing problems. Resources of the family There are only physical and manpower resources to treat this problem. Resources of the student nurses Knowledge and time are available on the side of the student nurses. Resources of the community No available community assistance for this problem. Good lighting is beneficial for the family members so that they could clearly see what they are doing at night and for good ventilation, so that there is a good exchange of gases but since the problem is not modifiable the preventive potential is low. Not a felt problem/need
TOTAL SCORE1
Problem #11Unsanitary food handling and preparation as a health threat
2/3 x 1
0.67
1/2 x 2
This is a health threat to the family since different microorganism from improper food handling and preparation could cause different diseases. The problem is moderate modifiable because: Current Knowledge The family doesnt recognize the problem on
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unsanitary food handling and preparation but admits that because their eating and cooking utensils are not stored properly it could somehow affect the food they eat. Resources of the family The family lacks the financial means to purchase storage of eating utensils but they have both physical and manpower resources which could be utilized in properly cleaning the cooking and eating utensils. Resources of the student nurses Time and knowledge in imparting health teachings could be utilized by the student nurses. Resources of the community There is no available resources/assistance of the community to solve this problem. C. Preventive potential 2/3 X 1 0.67 There is moderate preventive potential for future problems to occur because: The modifiability of the problem is fair Actions to implement sanitary food handling and preparation could ensure food safety and minimize diseases. This is perceived by the family as a problem but thinks that it is not a needing an immediate attention.
D. Salience
1/2 x 1
0.5
TOTAL SCORE
2.84
Problem #12Unhealthy lifestyle and personal habits/practices: poor personal hygiene as a health threat
2/3 X 1 3/3 x 2
0.67 2
This is a health threat. This is an easily modifiable problem because: Current Knowledge The family has knowledge in the unhealthy personal hygiene practices and their effects on health. Resources of the family Physical resources are available to solve the problem. Resources of the student nurses Time for health teaching and assistance in carrying out action are available. Resources of the community The water supply from the deep well being shared by many households could be utilized for their bath. There is a high preventive potential for future problems to occur considering the modifiability of the problem. Good hygiene is beneficial to the family member for it brings a sense of well-being. No available data
2/2 x 1
D. Salience
TOTAL SCORE 3.67

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Problem #13Unhealthy lifestyle and personal habits/practices: self medication as a health threat
2/3 x 1
0.67
1/2 x 2
C. Preventive potential D. Salience
1/3 x 1
0.33
0/2 x1
This is a health threat for the family members could take in the wrong medication for a certain disease/illness. The problem is moderately modifiable because: Current Knowledge The family members dont recognize the negative effects of self-medication. Resources of the family The family lacks the financial means in for consultation in a health care facility. Resources of the student nurses Time, knowledge and skills are available on in making changes to the wrong actions of the family. Resources of the community There are available community resources like the RHU. There is a low preventive potential for future problems to happen for the family dont recognize the problem as well as resources are limited. The family perceives this as not a problem.
TOTAL SCORE2.0
Problem #14Unhealthy lifestyle and personal habits/practices: non use of self-protection measures (mosquito nets) as a health threat
2/3 X 1 1/2 x 2
0.67 1
3/3 x 1
This is health threat because mosquito bites could cause deceases like DF, DHF, Malaria etc. The problem is moderately modifiable because: Current Knowledge The family has knowledge on the problem. Resources of the family The family is deficient in terms of financial and physical resources to stamp out the problem. Resources of the student nurses The students could impart their knowledge about the effects of mosquito bites on human which is necessary for the family to make prompt action. Resources of the community Fogging is available which is done every rainy season or if there is an outbreak. The problem has a high preventive potential because: Problems on mosquito bites could be minimize if speedy action is discharged. The family recognizes that the problem is in existence
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PROBLEM IDENTIFIED
I. Presence of cough and colds (Inocencia and Juanito) as health deficit II. Poor home/environmental condition/sanitation: presence of
SCORE 4.67 4.67
RANK 1st 1st
D. Salience
2/2 x 1
It was perceived by the family that the problem needs immediate attention upon knowing that there are many cases of Dengue in Ilocos Norte.
TOTAL SCORE3.67
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breeding or resting sites of vector of diseases (e.g. mosquitoes, flies, cockroaches, rodents, snake etc. as a health threat III. Poor home/environmental condition/sanitation: Improper Drainage System as a health threat IV. Poor home/environmental condition/sanitation: improper garbage disposal as a health threat V. Unhealthy lifestyle and personal habits/practices: poor personal hygiene as a health threat VI. Unhealthy lifestyle and personal habits/practices: non-use of self-protection measures (mosquito nets) as a health threat VII. Accident hazards like rusting sharp edges of galvanized iron, fire hazards and fall hazards as health threat VIII. Family size beyond what the family resources can adequately provide as a health threat IX. Poor home/environmental condition/sanitation: lack of food storage facilities as a health threat X. XI. Unsanitary food handling and preparation as a health threat Unhealthy lifestyle and personal habits/practices: selfmedication as a health threat XII. Presence of stress-provoking factors like strained marital relationship as a health threat XIII. Poor home/environmental condition/sanitation: inadequate living space as a health threat XIV. Poor home/environmental condition/sanitation: poor lighting and ventilation as a health threat
4.67 4.17 3.67 3.67 3.34 3.0 2.84 2.84 2.0 1.66 1.5 1
1st 2nd 3rd 3rd 4th 5th 6th 6th 7th 8th 9th 10th
SUMMARY, EVALUATION AND RECOMMENDATION The subject of this family case analysis is the Dimagiba Family who is residing at the peaceful community of Sitio Nagtataluan Barangay Dilanis of the Municipality of
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Pasuquin. This is family is composed of 6 members and is considered as extended as to structure, patrilocal as to place of residence, patrilinear as to decent or lineage and egalitarian as to exercise of power/authority. The family has an overall monthly income of P 2,275.00 which is sourced from the selling rice, vegetables and fruits, raising poultry and livestock and salary from planting garlic. The amount is then distributed to meet the demands of the family. On observation of the home and environment through numerous days of home visit, the group has found out many problems. Alongside with the accidental hazards like presence of rusting sharp edges of galvanize iron, scattered rusting nails, fire and fall hazards, presence of breeding sites of vectors of diseases were also spotted. The family utilizes a uncovered deep well located meters away from their house as their water supply. Moreover, water-sealed latrine of pit privy type is the familys toilet facility which is being shared with other families. The family makes use of a small pit of 1x1 meter wide and less than a foot deep as their form of garbage disposal. There are available community resources like RHU which will take almost 25 minutes ride an elementary and preschool center and barangay hall. On problem identification, the group has determined 14 family nursing problems. Arranged according to priority, these are the following: presence of cough and colds (Inocencio and Juanito) as health deficit, poor home/environmental condition/sanitation: presence of breeding or resting sites of vectors of diseases (e.g mosquito, flies, cockroaches, rodents and snake as s health threat, poor home environmental condition/sanitation: improper drainage system as a health and improper garbage disposal as a health threat, unhealthy lifestyle and personal habits/practices: poor personal hygiene, non-use of self-protection measures (mosquito nets) as health threat, family size beyond what the family resources can adequately provide as a health threat, lack of food storage facilities as a health threat, unsanitary food handling and preparation as a health threat, self-medication as a health threat and presence of stress-provoking factors like strained marital relationship as a health threat, inadequate living space and poor lighting and ventilation as health threats. These problems were made known to the family and interventions were done.
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SPOT MAP
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DIVINE WORD COLLEGE OF LAOAG

The FAMILY that ties the bond: A FAMILY CASE ANALYSIS

An Assessment of Dimagiba Family of Sitio Nagtataluan Dilanis Pasuquin, Ilocos Norte

August 19, 2011

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

RELATIONSHIP TO HEAD Family head Wife Daughter Daughter Son Grandson

CIVIL STATUS Married Married Single Single Single Single

B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

Illustrated Monthly Expenses of the Family

FOOD EDUCATION MISCELLANEOUS ELECTRICITY TRANSPORTATION

C. HOME AND ENVIRONMENT

II. HEALTH STATUS OF FAMILY MEMBERS

Abdomen y y Uniform and unblemished skin Audible vowel sounds

Lower Extremities y able to flex and extend without difficulty or discomfort

can resist against pressure

Formula in computing for BMI BMI= Weight in Kilograms (Height in meters)2

< 18.5 18.6-22.9 > 23.0 23.0-24.9 25.0-29.9 > 30.0

Abdomen y y Uniform and unblemished skin Audible vowel sounds

58 kg (1.63 m) 2 58 kg. 2.67

ACTIVITIES OF DAILY LIVING

C. JUANITA DIMAGIBA 18 years old CEPHALOCAUDAL PHYSICAL ASSESSMENT

PERRLA Coordinated movements Able to read newsprint at 14 inches distance

Abdomen y y Uniform and unblemished skin Audible vowel sounds

ACTIVITIES OF DAILY LIVING

Coordinated movements Able to read newsprint at 14 inches distance

Abdomen y y Uniform and unblemished skin Audible vowel sounds

Abdomen y y Uniform and unblemished skin Audible vowel sounds

FINDINGS 25 counts per minute 92 beats per minute 37.5 C

*source: FNRI Users Manual, 2003 INTERPRETATION: NORMAL BODY WEIGHT

Action Grasp Rattle

Area Turns to voice

Vocalizes not crying

Prone chest up arm support

Sit head steady

VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND DISEASE PREVENTION.

FAMILY COPING INDEX

3. Knowledge of Health Condition

4. Application of Principles of General Hygiene

9. Use of Community Facilities

TYPOLOGY OF NURSING PROBLEMS

A. Nature of the problem

B. Modifiability of the problem

A. Nature of the Problem

B. Modifiability of the problem

A. Nature of the Problem B. Modifiability of the problem

A. Nature of the Problem B. Modifiability of the problem

Problem #5Poor home/environmental condition/sanitation: inadequate living space as a health threat

A. Nature of the Problem B. Modifiability of the problem

TOTAL SCORE 1.5

A. Nature of the Problem

B. Modifiability of the problem

A. Nature of the Problem

B. Modifiability of the problem

Problem #8Poor home/environmental condition/sanitation: improper garbage disposal as a health threat

A. Nature of the Problem

B. Modifiability of the problem

Problem #9Poor home/environmental condition/sanitation: Improper Drainage System as a health threat

A. Nature of the Problem B. Modifiability of the problem

A. Nature of the Problem

B. Modifiability of the problem

A. Nature of the Problem B. Modifiability of the problem

A. Nature of the Problem B. Modifiability of the problem

TOTAL SCORE 3.67