CCM - FNCP

Our Lady of Fatima UniversityCollege of Nursing

Family Nursing Care Plan

A Written Report Presented to the Faculty ofOur Lady of Fatima University

College of Nursing

In Partial Fulfillment of the RequirementIn Community Care Management

NCM 101

Presented by:Group 62

BSN 3A2-DAvelino, Erlinda

Dela Cruz, DionisioDelfin, Jody Ann D.Diampoc, Aiza L.Espino, Cecile S.

Fernando, Ronell G.Gregorio, Erika

Gubalane, Jhonel A.Hernandez, Ferdinand G.

Jimenez, Lenie G.Legaspi, Lea Mariz S.

S.Y. 2009 – 2010

Presented to Ms. Mary Ann Emeterio

ACKNOWLEDGEMENT

First and foremost, we would like to thank God, above all for showing us the wisdom, confidence and courage that we were able to finish this project and use it with a purpose that could not profit only us but as well as our fellowmen, to whom our service is for.

Secondly, to our parents for it not for their unending support both financially and morally, it certainly would not be possible for us to go this far.

To the Lopez family, for without your support and full cooperation, we won’t be able to make this project possible.

To our friends, thanks for all the help you’ve shared for this project.

Lastly, to our professor, Ms. Mary Ann Emeterio, for giving us this kind of responsibility that test our patience, determination and versatility. For giving us enough knowledge for us to finish this project and for teaching us to have a lot of patience. Through this project, we were able to rediscover a better person in ourselves. It molds us to be responsible students in present and to be more responsible and good nurses in the near future.

Thank you.

TABLE OF CONTENTS

I. Acknowledgement

II. Introduction

III. Objectives, Scope and Calendar of activities

IV. Initial Database for Nursing Care Practice

V. First level Assessment

VI. Second Level Assessment

VII. Prioritation of Problems

VIII. Family Nursing Care Plans

IX. Bibliography

X. Appendices

Pictures

Charts & Tables

INTRODUCTION

“The Family is one of nature’s masterpieces” – George Santayana

We are all born the product of a union between a man and a woman, and we are all very

much shaped by those who raised us, our parents and/or caregivers. We are the product of human

relationships, and most of us spend our days within the context of relationships with other

people. We need other people to be close to us in our lives, or we tend to get sick. Who we are is

very much a function of where we have come from, and who we surround ourselves with.

Despite their vital importance in our lives, relationships can be very difficult to manage. We

expect our intimate partners to provide for many of our needs, but often find that differing

expectations, frustration, and a need to be right create conditions for conflict and erosion of

intimacy. Angels though they may be, our children test us for weaknesses and we don't always

pass. Our adult parents grow older and require care, placing a burden on our other

responsibilities. A diverse set of communication and relationship skills is required if one is to

successfully meet the challenges of family life.

An accurate physical assessment requires an organized and systematic approach using the techniques of inspection, palpation, percussion, and auscultation. It also requires a trusting relationship and rapport between the nurse and the patient to decrease the stress the patient may have from being physically exposed and vulnerable. The patient will be much more relaxed and cooperative if you explain what will be done and the reason for doing it. While the findings of a nursing assessment do sometimes contribute to the identification of a medical diagnosis, the unique focus of a nursing assessment is on the patient's responses to actual or potential problems.

Home visiting is a major strategy for delivering health, social support, and educational services directly to individuals in their homes.

A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.

OBJECTIVES, SCOPE AND CALENDAR OF ACTIVITIES

Objectives

To establish a good working relationship. Efficiently conduct family health assessment. Accurately identify family health problems. Prepare family health care plans for the top five priority problem. Work out details of the family health care plan with the family. Assist client families in implementing family nursing care plan. Evaluate health care conducted on the client family. Develop family's ability and confidence in providing health care to its members.

Scope

This study is confined to the family of Mr. And Mrs. Rolando Lopez of #3911 Franville 4, Yakal St., Caloocan City. It is included in this study the observation and interview of the family members.

Calendar of Activities

February 18, 2010 - 1st Home Visit and ocular inspection of the area. February 19, 2010 – Initial Interview and physical assessment of the family members. February 27, 2010 – Meeting for the First and second level assessment. March 6, 2010 – 2nd Home visit for health teachings and Nursing interventions. March 13, 20010 - Documentation of gathered data.

INITIAL DATE BASE FOR NURSING CARE PRACTICE

A. Family Structure, Characteristics and Dynamics Members of the household and relationship to the head of the family

1. Rolando Lopez - Head of the family2. Gleponia Lopez - Wife3. Valentina Lopez - Daughter4. Francis Jeffrey Lopez - Son5. Frank Jude Lopez - Son6. Pedro Cantos - Brother-in-law

1. Demographic DataFamily Member Age Sex Civil

StatusPosition in the Family

1.Rolando Lopez 60 M married Head of the family2. Gleponia Lopez 32 F married Wife3. Pedro Cantos 28 M single Brother in law4. Valentina Lopez 12 F single Daughter5. Francis Jeffrey Lopez 7 M single Son6.Frank Jude Lopez 3 ½ M single Son

2. Place of residence of each member

All members of the family are residing at #3911 Franville 4, Yakal St. Caloocan City.

3. Type of Family Structure Patriarchal Nuclear

4. Dominant family members in terms of decision making (in terms of Health Care) Rolando and Gleponia Lopez

5. General family relationship/dynamics NO presence of any obvious and observable conflict between family members. Children can be heard using “po” and “opo” during conversations with their

elders.

\

B. Socio-economic and Cultural Characteristics

1. Income and Expensesa. Occupation, place of work and income of each working member:

Rolando Lopez – freelance all around technician (plumbing, carpentry, construction)- ₱4000.00/month

Gleponia Lopez – laundry woman- ₱2000.00/month Pedro Cantos – security guard- ₱ 6000.00/month

b. Adequacy to meet basic necessities The family spends at least ₱100/day for their needs. Income of the family is

adequate to meet the necessities of every member. The following are the priority expenditure of the family ranked from the most prioritized to the least:- Food- Education- Water- Clothing- Electricity- Health care

c. Who makes decisions about money and how it is spent? Rolando and Gleponia Lopez are the ones making the decisions about the

finances of the whole family.

2. Educational Attainment of each member

Rolando Lopez – 2nd year high school Gleponia Lopez – High school graduate Valentina Lopez – currently in gr. 4 Francis Jeffrey Lopez – currently in gr.1 Frank Jude Lopez Pedro Cantos – High school graduate

3. Ethnic Background and religious affiliation The family speaks Waray and Tagalog. They are also members of the Born

Again Christians.

4. Significant others The lot where the family currently resides is owned by another private citizen.

5. Relationship of the family to the larger community The family actively participates in church activities. They also participate in

community activities like the women’s organization and their children also participate in youth activities.

C. Home and Environment

1. Housing

a. Adequacy of living space Not crowded

b. Sleeping arrangement Mr. and Mrs. Lopez sleep with their children in one room. Mr. Cantos stay in

another room beside the family’s room.

c. Presence of breeding or resting sites of vectors of disease Open and unsanitary drainage system. Improper and open garbage disposal pit.

d. Presence of accident hazards Sharp objects Steep stairs Poor lighted place.

e. Food storage and cooking facilities The family sees to it that the food and water containers are always covered.

They also use wood and charcoal to cook food.

f. Water supply Water supply of the family comes from the water works system.

g. Toilet facility The toilet facility is owned but sanitation is quite poor.

h. Garbage disposal Garbage is usually collected on Mondays and Thursdays but they also burn

their garbage from time to time and sometimes just throw it in the garbage pit near their house.

i. Drainage systemThe house has its own septic tank and toilet. The drainage system is open and

sanitation is poor.

2. Kind of Neighborhood

slum

Social and Health Facilities available

the family mentioned that they avail the following services from the community: Immunizations, check up for both children and adults.

The health center, government hospital (East Avenue Medical Center) is the primary source of health care of the family. They sometimes visit Bernardino General Hospital, which is a private hospital for consultations.

Communication and Transportation Facilities available

The family's means of communication includes a cellphone and newspaper.

Their means of transportation is by the public utility vehicles.

D. Health Status of each family member

1. Medical and nursing history indicating current or past significant illnesses.

▪ Rolando Lopez y Pilande

- Family History

*Father side: rheumatism

*Mother side: none

-Past History

*Childhood illnesses: fever, cough and colds, chicken pox, mumps

*Injuries: none

*Hospitalization: none

-Present Health Status

*colds for 2 weeks

Glepionia Lopez y Quitorio

- Family History

*Father side: Diabetes Mellitus

*Mother side: Breast cancer, hypertension

*Childhood sickness: fever, cough&colds

Valentina Lopez y Quitorio

- Family History

* Father side: rheumatism

* Mother side: Diabetes Mellitus, breast cancer, hypertension

* Childhood sickness: cough&colds, chicken pox, measles

Francis Jeffrey Lopez y Quitorio

- Family History

* Father side: rheumatism


Frank Jude Lopez y Quitorio

- Family History

*Father side: Rheumatism

*Mother side: Diabetes Mellitus, breast cancer, hypertension

- Childhood sickness: fever, cough&colds,

Pedro Cantos

- Family History:

* Father side: Rheumatism


2. Beliefs and practices conducive to one's illness

- Gleponia Lopez agrees to the following statements:

Food rich protein such as meat, fish & eggs are needed.

Headache, nausea, and vomiting are common signs of pregnancy.

Umbilical cord of the newborn baby that remained fresh may only be cleaned by wiping.

Breastfed infants are healthier than bottle fed infants.

Illness such as measles, polio, diptheria and tetanus can be avoided through immunization.

Thick clothing should be removed when babies have fever.

Oresol are given to babies who have diarrhea.

Family planning is good for maternal health.

Herbal meds are safe and causes no side-effects when taken in excessive amounts.

Blood streaked sputum from coughing is a symptom of TB.

Small cuts and contusions may be cleansed using soap and tap water.

Not taking a bath during menstruation.

Don't cut fingernails during Tuesday & Wednesday.

Do not sleep when hair is wet.

Do not wash hands after ironing.

Do not eat too much at night before sleeping.

Do not eat sour foods during menstruation

Consults faith healers.

Do not allow family members to take a bath when they are sick.

Feed “am” as an alternative to milk.

Believes in “paglilihi”

- Mrs. Lopez disagrees to the following statement:

Common illness such as measles can be prevented.

Putting first menstruation on the face to prevent pimples.

3. Nutritional assessment

- Eating/feeding habits/practices

The family's food preferences are: meat, poultry, fish, fruits, vegetables and instant food.

The family usually eats three times a day but there are instances that they eat two times a day only.

Physical Assessment indicating Presence of Illness State

(Undiagnosed by a Medical Practitioner)

Rolando Lopez - colds for 2 weeks

Gleponia Lopez - cough for 2 days

Valentina Lopez - cough & colds for 5 days

Francis Jeffrey Lopez - fever and colds for 4 days

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

1. Immunization Status of the Family Members

▪ All members of the family have a complete immunization

2. Health Lifestyle Practices

Trimming of fingernails

Hand washing

Bathing

Use of slippers

Medical check-up

Dental check-up

De-worming of children (2x a year)

3. Adequacy of:

a. Rest & sleep

-The family sleeps at night and usually have an average of 7-8hrs of sleep.

b. Exercise / Activities

- Mr. Lopez has a regular exercise of walking every morning.

c. Use of Protective Measures

- The family uses mosquito nets when sleeping at night.

d. Relaxation and Stress management activities

- The family usually participates in church/worship activities. Their children also play with other children in the neighborhood.

FIRST LEVEL ASSESSMENT

1. Fire hazard as a health threat + use of candles at night due to lack of electricity inside the house.

2. Threat of cross infection from a communicable disease case +

3. Unsanitary food handling and preparation

4. Unhealthful lifestyle and personal habits/practices – self medication

5. Unhealthful lifestyle and personal habits/practices – walking barefooted or inadequate footwear.

6. Poor home environment condition/sanitation – improper garbage disposal

7. Poor home environment condition/sanitation – unsanitary waste disposal

8. Poor home environment condition/sanitation – lack of food storage facilities

9. Presence of foreseeable crisis situations – hospitalization of a family member

10. Presence of foreseeable crisis situations – loss of job

11. Presence of health deficit - asthma

SECOND LEVEL ASSESSMENT

1. Fire hazard as a health threat + inability to recognize the presence of the condition or problem due to the lack of or inadequate knowledge.

2. Threat of cross infection from a communicable disease case + Inability to provide adequate nursing care to the sick, disabled, dependent, or vulnerable/at-risk member of the family due to lack of or inadequate knowledge and skill in carrying out the necessary interventions/treatment/procedure/care

3. Unsanitary food handling and preparation + Inability to provide a home environment conducive to health maintenance and personal development due lack of/inadequate knowledge of importance of hygiene and sanitation

4. Unhealthful lifestyle and personal habits/practices – self medication+ inability to make decisions with respect to taking appropriate health action due to misconceptions or erroneous information about proposed course(s) of action

5. Unhealthful lifestyle and personal habits/practices – walking barefoot or inadequate footwear.+ Inability to provide a home environment conducive to health maintenance and personal development due to inadequate family resources, specifically financial constraints/limited financial resources.

6. Poor home environment condition/sanitation – improper garbage disposal + Inability to provide a home environment conducive to health maintenance and personal development due to lack of skill in carrying out measures to improve home environment

7. Poor home environment condition/sanitation – unsanitary waste disposal + Inability to provide a home environment conducive to health maintenance and personal development due to lack of/inadequate knowledge of importance of hygiene and sanitation.

8. Poor home environment condition/sanitation – lack of food storage facilities+ Inability to provide a home environment conducive to health maintenance and personal development due to inadequate family resources, specifically financial constraints/limited financial resources

9. Presence of crisis situations – hospitalization of a family member +inability to make decisions with respect to taking appropriate health action due to inaccessibility of appropriate resources for care, specifically cost constraints or economic/financial inaccessibility.

10. Presence of health deficit – asthma + Inability to provide adequate nursing care to the sick, disabled, dependent, or vulnerable/at-risk member of the family due to Lack

of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management)

PRIORITATION OF HEALTH PROBLEMS

1. Cough and colds

Criteria

Nature of the problem

Modifiability of the problem

Preventive potential

Salience of the problem

Computation

3/3x1

1/2x2

2/3x1

1/2x1

Actual Score

1

1

.67

.50

3.17

Justification

Possibility of transferring infection to other members of the family is moderate and should be given immediate attention.

The family recognize it as a problem, however it does not see the problem as needing immediate action.

2. Poor environmental sanitation: Improper garbage disposal





2/3x1

2/2x2

3/3x1

2/2x1

.67

2

1

1

It is a health threat.

Resources are available and intervention are feasible.

Communicable disease transferred by insects and rodents can be prevented.

The family perceives it as a serious

4.67

problem needing attention.

3. Presence of accident hazards



Preventive Potential


2/3x1

2/2x2

3/3x1

2/2x1

.67

2

1

1

4.67

It is a health threat

The resources and intervention are available to the family.

Accidents can be prevented if sharp and pointed objects are properly kept and cannot be reached by children.

The family recognizes the problem as a condition needing immediate attention.

4. Malnutrition





3/3x1

2/2x2

3/3x1

0/2x1

1

2

1

0

4

It is a health deficit that requires immediate management to eliminate untoward consequences.

The problem is easily modifiable since the nurse’s resources are available; she can develop the skill of other members to achieve good nutrition and proper food selection and preparation.

Susceptibility of other diseases and infections can be prevented if malnutrition is eliminated.

It is not felt as a problem.

5. Asthma





3/3x1

1/2x2

3/3x1

1/2x1

1

1

1

.50

3.50

It is a health deficit that requires immediate attention.

The family does not have adequate resources to solve the problem.

Occurrence of asthma can be minimized

The family recognizes it as a problem but it does not see the problem as needing immediate action.

6. Fire hazard as a health threat




2/3x1

1/2x2

.67

1

It is a health threat that does not demand immediate action.


Fires can be prevented


3/3x1

No data available

1

2.67

through the practice of safety precaution.

7. Cross infection as a health threat





2/3x1

1/2x2

2/3x1

1/2x1

.67

1

.67

.50

It is a health threat that does not demand immediate action.


Possibility of transferring infection to other members, therefore it needs to be given immediate attention.

The family recognizes it as a problem, however it does not see the problem as needing immediate action.

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CCM - FNCP