Family Case Analysis HAU

HOLY ANGEL UNIVERSITYCollege of Nursing

Angeles City

A FAMILY

CASEANALYSIS

Presented to the College of Nursing

In partial fulfillmentOf the requirements in

Nursing Care Management 102 – Related Learning Experience

Submitted by

N-306/ Group 3

Submitted to

Marilyn B. Punsalan, RN, MSNClinical Instructor

January 15, 2009

I. INTRODUCTION

1. Objectives (student-centered)

After 3 weeks of accomplishing the family case analysis, the student nurses shall

have:

Cognitive:

Collected facts regarding the demographic data of the family

Performed physical assessment for each member of the family

Determined existing problems with the family

Formulated nursing diagnosis related to family problems

Explained existing problems identified to family

Implemented some activities that will make the home conducive for health

development and improvement

Psychomotor

Practiced therapeutic communication

Gained knowledge as they interact with family

Affective

Introduced to one’s self the family and emphasized the purpose of the home visit

in order to establish rapport

Built a harmonious working relationship with the family members

Discussed the problems identified and pointed out solutions to prevent the

problem

Perform interventions associated with the diagnosis of the family to promote

wellness

2. Entry

“What you leave behind is not what is engraved in stone monuments, but what is

woven into the lives of others”

-Anonymous

Simple deeds that are done by student nurses may be left behind or remembered

but it won’t mean anything if it didn’t affect the people. It’s hard to change how the

world is but trying to improve how one lives and giving hope in little ways can affect the

way people choose to live and their perspective in life. For this Family Case Analysis, the

mission is not how student nurses are going to help them but it should be how the student

nurses are going to help the family help themselves.

For this rotation, the Family Case Analysis was conducted in the area of

Pandacaqui Resettlement, Mexico, Pampanga specifically in district-5. The researchers

had the freedom to choose who the respondent would be as long as it follows the criteria

given. Group 3 were clueless of who they were going to interview and render services to

since it was their first time being at that community. This may be a way to train the

student nurses to give services to people they don’t know and how to earn trust and

cooperation by the residents.

The criteria that were given for choosing a family for the subjected Family Case

Analysis are as follows: The family must consist of at least five members (three

children), there must be a member who belongs to the vulnerable groups (pregnant

women, children, and old-age adults) and the youngest child must be at least 1 year old.

At first, the Group 3 of section N-306 had a prospective family per student. They

each interviewed a family and assessed the family members and noted down present

problems. Trying to figure out who would best fit the criterions, they discussed their

adopted family to the other group mates and mentioned why their family adopted would

be fascinating to study. After talking and analyzing who they should interview,

consultation with their instructor occurred. Given the advice of choosing a family with

evident health problems and interventions that can be carried out, Group 3 found the

family that would be excellent to study and entailed all the criteria, Mr. and Mrs. Cuayan.

After the discussion between the researchers, simple preparations such as

questions ready written down and reviews of how to do assessment were gathered; they

then went to the house of Mr. and Mrs. Cuayan. They saw the children wearing no

footwear, shorts, had running nose and the mother pregnant caring an infant. The

researchers then without hesitation introduced themselves and stated their purpose. To

their surprise, the mother agreed to be the family involved for their Family Case Analysis

and showed some interest in learning. All members got up and started doing something.

Data collection and assessments were then being started.

II. Family Constellation

Name Age Position Sex Civil Status Educational

Attainment

Mr. Cuayan 29y/o Father Male Married Elementary

Graduate

Mrs. Cuayan 29y/o Mother Female Married High School

Under

Graduate

Dipsie 8y/o 1st Child Female Elementary

Level

Teletubbies 2y/o 2nd Child Male Not yet in

studying

Po 1y/o 3rd Child Male Not yet

studying

III. Health Assessment

Mr. Cuayan

a. General Description

Mr. Cuayan is the head of the family. He has brown skin; his hair is above

shoulder, poorly shaved mustache. Upon initial contact, the student nurses

observed that the father was hungry because of his work. He is kind and

approachable. He wears a blue t-shirt and denim shorts; he does not wear any

footwear, or any other accessories.

b. Vital Signs

Final home visit – January 10, 2009

T: 36.5 C P: 67 bpm R: 17 bpm BP: 120/70 mmHg

(Due to his work, we only met the father once.)

c. Physical Assessment

Skin

Dark Brown skin complexion

Dry

Presence of tattoo on the right lower leg and back

Presence of scar on left arm and right leg

Dirty and long nails

Good capillary refill test (2 seconds)

Head

Hair is shoulder length, black and equally distributed

With unshaved mustache

Eyes

With dark brown iris

White sclera

Pupils equally round and reactive to light accommodation (PERRLA)

With pink palpebral conjunctiva

Ears and Hearing

Ears recoils after folding

No discharge

Without any obstructions

Nose and Sinuses

With thick nasal hair

No presence of scar

No discharge

Mouth and Throat

With tartar

Seven dentures

With dark lips

With slightly dark pink gums

With halitosis

Neck

No masses

No presence of swelling

Breast

Symmetrical in size

Brown nipple

Slightly protruded

Thorax and Lungs

Symmetrical in size

Abdomen

Flat in contour

Upper and Lower Extremities

Blood vessels on his arms are prominent

Toenails and fingernails are long and dirty

Presence of tattoo in the right lower leg

d. Health History

Mr. Cuayan was never been hospitalized. He previously had coughs, colds, fever

and diarrhea. When feeling sick, he usually gets enough rest and his wife gave him

adequate water. And if illness does not subside in three days, he usually goes to the health

center to avail of medicines. Mr. Cuayan is at high risk of having heart disease since

hypertension runs in their family. He has allergies on grass and other type of grassy

plants. Presently, he has no illness.

e. Growth and Development

Mr. Cuayan is twenty-nine years old. Under Sigmund Freud’s Theory of

Psychosexual Development, he is in Genital Stage, wherein his sexual interest should be

matured already and show or establish satisfactory with his opposite sex. The student-

nurses think that Mr. Cuayan achieved it.

For Erik Erikson’s Theory of Psychosocial Development, he is in the stage of

Generativity vs. Stagnation. Generative adult is a type of person that concerned to his

own family, community, and country. Due to their situation in life, Mr. Cuayan as we

observed is only focusing on his family, on how they survive and give a better life to his

family.

f. Activities of Daily Living

Mr. Cuayan works as a construction worker. He wakes up five in the morning,

eats breakfast, takes a bath and goes to work by 7:00 a.m. By eight o’ clock, he arrives at

the construction site and works until five in the afternoon with a 1-hour break in between.

After work, he then go home and play with his children. Then, he, together with his

family, spends the night watching television after dinner and sleeps by ten in the evening.

This is Mr. Cuayan’s routine for the whole week except for Sunday which is his

only day-off.

Mrs. Cuayan


Mrs. Cuayan is the wife of the head of the family. She has brown skin,

her hair is shoulder level, and well combed. Upon initial contact, the student

nurses observed that the mother is busy watching her child, because she’s alone at

that time. She’ so kind and hospitable, she entertained the different questions that

the student-nurses asked. He wears a white t-shirt and denim shorts; she does not

wear any footwear, or any other accessories.

b. Vital Signs


T: 35.3 C P: 80 bpm R: 21 bpm BP: 90/60 mmHg


Skin


Dry and warm to touch

Clean and short nails


Head

Hair is shoulder length, black and equally distributed

No abnormal palpable lumps

Well combed hair

Eyes


White sclera



Ears and Hearing


No discharge


Has ear piercing

Nose and Sinuses


No presence of scar

No discharge

Symmetrical with the midline

Mouth and Throat

With tartar

With dark pinkish lips

With slightly dark pink gums

With halitosis

Neck

No masses


No stiffness present

No swollen lymph nodes

Breast

Symmetrical in size

Brown nipple

No palpable Lumps

Lactating

Thorax and Lungs

Symmetrical in size


Toenails and fingernails are short and clean

d. Health History

Mrs. Cuayan had never been hospitalized or acquired any serious illness in

the past except for Urinary Tract Infection. She had experienced simple cough

and colds some years ago but was resolved through home remedies such as

taking more fluids and citrus fruits and sometimes over-the-counter

medicines. At present, she has no known disease.

e. Obstetrical History

Mrs. Cuayan is 29 years old, within the reproductive age and is still

capable of childbearing as evidence by she is pregnant at the moment.

According to her, she did not use any family planning method because during

those times, it is still not widely known. Her Obstetric score is G4P3 and

T3P0A0L3. All of her children were born via home delivery assisted by a

midwife.

She got pregnant with her first child in the year 2000. By then, she was only

21 years old. She had an initial check up in the public hospital or sometimes in

the health center. She gave birth on her first child on the twenty seventh of

September. According to her, she really had difficulty on her labor. On her

following pregnancies, she no longer experienced difficulty because her labor

takes only about 2 to 4 hours. Succeeding deliveries were dated, 2006, and

2007 respectively.

All her pregnancies did not have any complications or abnormalities. She

strictly adheres to the instructions of the health care providers regarding the

proper foods to eat, taking of vitamins and managing stress. She also follows

some superstitious beliefs such as eating two bananas that are adjacent will

result to twins.

Mrs. Cuayan has a regular 28-day cycle menstruation ever since. She had her

menarche at the age of 12 or 13 (as far as she can remember).

Immunization Status (Tetanus Toxoid)

TT1 TT2 TT3 TT4 TT5

1 1 0 0 0

f. Growth and Development

Mrs. Cuayan is twenty-nine years old. Under Sigmund Freud’s Theory of

Psychosexual Development, she is in Genital Stage, wherein her sexual interest should be

matured already and show or establish satisfactory with his opposite sex. The student-

nurses think that Mrs. Cuayan achieved it.

For Erik Erikson’s Theory of Psychosocial Development, she is in the stage of

Generativity vs. Stagnation. Generative adult is a type of person that concerned to his

own family, community, and country. Due to their situation in life, Mr. Cuayan as we

observed is only focusing on his family, on how they survive and give a better life to his

family.

g. Activities of Daily Living

Mrs. Cuayan starts her day at around Six o’clock in the morning. Upon rising, she

will go to buy for their breakfast at the sari-sari store near their house. She will then

prepare for their food and also prepare the uniform of her eldest daughter in going to

school. After the daughter and her husband had left, she will do her usual routines—

washing the dishes, sweeping the floor and washing the clothes (usually every three days)

and watching her two children. At around eleven o’clock, she will start to prepare for

their lunch. She will serve the lunch at twelve noon. After eating, she will rest for a while

together with two children. Upon waking up she will look for merienda for her two

youngest children. When the clock strikes at six o’clock, she will then prepare for their

dinner. At seven or eight, the family will eat their dinner and watch their favorite

primetime show. Mrs. Cuayan, together with her husband sleeps at around ten o’clock

after watching TV.

Dipsie


Dipsie is the eldest child in the family. She has fair skin, her hair is long.

Upon initial contact, the student nurses observed that Dipsie was eating. She is

kind and shy-type person. She wears a black t-shirt and shorts; she does not wear

any footwear, or any other accessories.

b. Vital Signs


T: 36.7 C P: 71 bpm R: 17 bpm BP: 90/60mmHg


Skin


Dry and warm to touch



Head

Hair is long, black and equally distributed

Well combed hair

Eyes


White sclera



Ears and Hearing


No discharge


With ear piercing

Nose and Sinuses


No presence of scar

With nasal discharge

Symmetrical in midline

Mouth and Throat

With tartar

With pinkish lips

With slightly pink gums

Neck

No masses


Breast

Symmetrical in size

Brown nipple

Thorax and Lungs

Symmetrical in size

Presence of wheezing upon auscultation

Abdomen

Flat in contour


Blood vessels on his arms are not prominent


d. Health History

Dipsie had not acquired any serious disease or illness in the past and had

not been confined in a hospital. At present, she is experiencing cough and colds

which begun in the last week of December.


Dipsie is eight years old. Under Sigmund Freud’s Theory of

Psychosexual Development, she is in Latent phase, the student-nurses failed to

assess this.

For Erik Erikson’s Theory of Psychosocial Development, she is in the

stage of Industry vs. Inferiority. In this stage the children is in the phase of doing

things right or observing if what she is doing can give her accomplishment. Dipsie

showed some of the characteristics of this phase.


Dipsie is currently studying, so she wakes up at seven o’clock in the

morning and prepares her self going to school. By twelve o’clock she will arrive

in their house to eat for her lunch, and goes back in school by one o’clock. That’s

her daily routine for Monday to Friday. By Saturday and Sunday she helps her

mother in household chores, also in cooking and in taking good care of Po.

Teletubbies


Teletubbies is the second child of the family. He has fair skin, his hair is

blonde and at the shoulder level. Upon initial contact, the student-nurses

observed that the child was dirty and that there is presence of nasal discharge. He

is kind and approachable. He was wearing a red t-shirt, that alone. He was not

wearing any footwear. He was shy and timid.

b. Vital Signs

First home visit – January 8, 2009

T: 36.7 C P: 89 bpm R: 21 breaths/min

Second home visit – January 9, 2009





Skin

Brown skin complexion

Dry and warm

Presence of rashes on the hip and buttocks

Presence of abrasion on right knee


Good capillary refill: 2 sec

Head

Hair is shoulder length, blonde and equally distributed

Eyes


White sclera


With pale palpebral conjunctiva

Blurred lenses

Ears and Hearing

Ears recoil after folding

Presence of dirt and cerumen

Late response when being called

Nose and Sinuses

Presence of discharge, green in color

Nasal septum in midline

Mouth and Throat

Pink mucous membranes

Presence of seventeen teeth

Yellowish tooth enamel

Presence of tooth cavities

Neck

Chin can touch the anterior chest

No masses


No difficulty in swallowing

Lymph nodes not palpable

Breast

Symmetrical in size

Brown nipples and areola

Slightly inverted nipples

Thorax and Lungs

Symmetrical in size

Abdomen

Round and protuberant

Umbilicus in midline



Presence of abrasion on right knee

Good capillary refill

d. Health History

Teletubbies has allergies to grass and weeds like his father. Presently, he has

cough and colds and it has been present since the first week of December. Nasal

discharge is already green in color and has a thick consistency.


Teletubbies is two years of age. Under Sigmund Freud’s Theory of Psychosexual

Development, he is on the Anal Stage, wherein his sexual interest should be focused on

the anal region and must have begun toilet training which Teletubbies gets interested

with. He also shows signs of independence.

According to Erik Erikson’s Theory of Psychosocial Development, his

developmental task is Autonomy vs. Shame and Doubt wherein he learns to be

independent in his own little ways such as buying from the store, eating by himself and

taking pride in things he does.


Teletubbies usually wakes up by seven or eight in the morning and eats breakfast.

For the rest of the day he would only be seen playing inside or outside of the house with

other children in the neighborhood. He takes a bath with the assistance of his mother by

midday, and then sleeps in the afternoon. He wakes up again by three or four and plays

again. He takes his meals with his family and eats without his parents’ assistance. After

watching television with the whole family in the evening, he sleeps by 8 or 9 p.m.

g. Immunization Status

VACCINE FIRST DOSE SECOND DOSE THIRD DOSE

BCG

DPT

OPV

HEPATITIS B

MEASLES

- administered

- not administered

Po


Po is the third child of the family. He has fair skin, his hair is blonde and

above the shoulders. Upon initial contact, the student-nurses observed that he was

not wearing undergarments and that there is presence of rashes on his hips and

buttocks. He was wearing a white sando and had a pacifier put into his mouth.

b. Vital Signs

First home visit – January 8, 2009


Second home visit – January 9, 2009

T: 36.5 C P: 110bpm R: 25 breaths/min




Skin

Fair skin complexion

Dry and smooth

Presence of rashes on the hips and buttocks


Good capillary refill: 2 sec

Head

Hair-length is above the shoulders, blonde and equally distributed

Eyes


White sclera



Ears and Hearing

Ears recoil after folding

No discharge


Nose and Sinuses

No presence of scar

No discharge

Mouth and Throat

With moist and pink mucous membranes

Presence of four teeth

With sucking reflexes

Neck

No masses


Breast

Symmetrical in size

Brown nipples and areola

Slightly inverted

Thorax and Lungs

Symmetrical in size

Abdomen

Slightly protuberant



Good capillary refill

d. Health History

Po was rushed to the hospital when he was months old because of a chief

complaint of convulsion. Besides that, he has not yet experienced any severe forms of

childhood illnesses.


Po is one year and two months old. Under Sigmund Freud’s Theory of

Psychosexual Development, he is at the Oral Stage, wherein the mouth is the center of

gratification. It has been evident enough that with his pacifier on his mouth, he gains

satisfaction since he does not have cries and tantrums while it is put on.

According to Erik Erikson’s Theory of Psychosocial Development, he is in the

stage of Trust vs. Mistrust. Since Po is being taken cared of, he renders trust even to

strangers, but with ample visual stimulation for a more active child involvement. When

he is being cuddled, his discomforts are easily and/or quickly removed.


Po wakes up anytime in the morning, usually at seven or eight. When his mother

does not have to wash their clothes, he stays at home and was cared by his mother. When

his mother has a lot of chores to finish, he was left on his grandmother’s home.

What he does all day is to suck his pacifier, be bottle-fed, sleep, and be carried by

his mother or his father, and at times, by his grandmother.

g. Immunization Status

VACCINE FIRST DOSE SECOND DOSE THIRD DOSE

BCG

DPT

OPV

HEPATITIS B

MEASLES

- administered

- not administered

IV. SOCIO-ECONOMIC, CULTURAL, and ENVIRONMENT ASSESSMENT

A. Family Structure, Characteristics, and Dynamics

i. Members of the household and relationship to the head of the family

Mr. Cuayan is the man of the house, breadwinner and head of the family. He is

married to Mrs. Cuayan and blessed with three children. A girl is the eldest then

followed by two boys. Mrs. Cuayan is now 5 months pregnant.

ii. Demographic profile of each member-age, birth date, and birth place

Member Age Birthday Birth place

Mr. Cuayan 29 August 16, 1979 Montalban, Rizal

Mrs. Cuayan 29 August 3, 1979 Lubao, Pampanga

Dipsie 8 September 27, 2000 Quezon City

Teletubbies 2 September 25, 2006 Quezon City

Po 1 and 2 mos October 26, 2007 Cuayan, Angeles

City

iii. Place of residence of each member –whether living with family or elsewhere

All of the family members live together at Gawad Kalinga Center, Purok 5, Brgy.

Cuayan, Angeles City.

iv. Type of family structure

The type of family they have is a nuclear type. Consisting of the mother, father,

and their 3 children. They are practicing traditional Filipino family.

v. Dominant family members in terms of decision making, especially in matters

of health care

The dominant family members that are responsible for decision-making are both

of the parents. The father makes decision regarding economic aspects of family life

while the mother manages the home and care for the children and also budgets their

daily expenses. Whenever there are emergency cases, they usually go to the health

center.

vi. General family relationship/dynamics-presence of any obvious/readily

observable conflict between members, characteristic

communication/interaction patterns among member

Mr. and Mrs. Cuayan try to keep a good relationship with the members of their

family. Like other families they also encounter problems but they try their best to

manage and don’t let it affect the relationship with each other. Whenever the family is

complete, they bond together in simple ways such as watching television, playing

with their children and going to mass regularly. When Mr. Cuayan saves extra cash

he treats his family out by taking them to the malls.

B. Socio-economic and Cultural Characteristics

i. Educational attainment of each member

Mr. Cuayan finished elementary while Mrs. Cuayan finished third high school

due to financial constraints. Dipsie is currently a 3rd grade student at Cuayan

Elementary.

ii. Significant others / relatives roles in the family’s life

The significant other who plays a major role in the family’s life is Mr. Cuayan.

Mrs. Cuayan cannot turn to her brothers and sisters for the reason of being so far

away from them, except for her one sister. But when a problem occurs, the family

takes action first and when all fails, they ask for help from the mother’s sister.

iii. Relationship of the family to larger community

The house of Nallatan family is lies a little far for the Barangay Hall and

Barangay Health Center. However, they still utilizes the program of the Barangay such

as the Elementary School and immuzation program of Barangay Health Center.

iv. Occupation, place of work and income of each working member

The father starts his day by waking up around 6am, and works at the construction

site from 8:00-5:00pm. As stated by the mother, she watches their children and does the

household chores whole day.

v. Source of income

Mr. Cuayan is a construction worker who earns 9,000 pesos a month while the

mother is a housewife.

vi. Mode of expenditure

Mrs. Cuayan gives the eldest kid 10 pesos each day for her allowance. Regarding

expenses for their food, they buy ready made food at the carinderia as a medium for food

with a budget of 150 pesos a day. For their water and electricity resources, they spend an

amount of 9000 pesos a month.

vii. Ethnic background and religious affiliation

Mrs. Cuayan is from Lubao Pampanga, while Mr. Cuayan grew up in Rizal,

Manila. After their marriage, they decided to reside at Quezon City and then moved to

Pampanga in 2007. Within the members of the family, they use Tagalog more often as

their medium of communication.

The family goes to a Catholic church regularly, and they usually spend the whole

Sunday together.

viii. Family health habits, beliefs and practices, superstitions

The family believes in modern medicine with regards to its effect. However, due

to financial constraints, they often leave diseases untreated and remain quite prolonged

and if the sickness doesn’t disappear they result to self-medication.

C. Home and Environment

i. Housing

1. Adequacy of living space

The family stays inside the house most of the time and usually in front of the

house which is also covered, resembles a patio when looking at it. But when looking at

the 8 members of the family in the house, there is an obvious evidence of inadequate

living space. It is hard to understand how they can all manage to live in such a limited

space of area. But seeing that they do not have too much furniture and appliances, you’ll

slightly see that they can move around the house.

LIVING SPACE

FORMULA:

TFA (IN SQM) = LENGTH ON THE HOUSE x WIDTH OF THE HOUSE

TSR = NUMBER OF HOUSEHOLD MEMBERS x CORRESPONDING SPACE REQUIRED FOR THAT MEMBER

CONSIDER:

ADULTS (13 Y/O AND ABOVE) = 15 SQMCHILDREN (1 Y/O TO 12 Y/O) = 8 SQMINFANTS ( BELOW 12 MONTHS) = 0 SQM

COMPARE THE TFA (TOTAL FLOOR AREA) WITH THE TSA (TOTAL SPACE REQUIREMENT)

CROWDED IF: TFA < TSRNOT CROWDED IF: TFA > TSR

TFA = 21 SQM

TSR = 2 (15) + 3 (8) = 30 + 24 = 54

INTERPRETATION: TFA< TSR (CROWDED)

2. Sleeping pattern

The family usually wakes up at 6am to get ready for work and school for Dipsie.

When Mr. Cuayan and Dipsie aren’t at the house, Mrs. Cuayan is busy doing her

household chores. They usually take a nap in the afternoon and just wait for the two to

come home. At night, they bond while watching their favorite television shows and after

that they go to bed by 10:00 p.m.

3. Breeding or resting sites of vectors of diseases

They also found that there are a lot of mosquitoes present at the house which can

be a source of dengue fever. The mother doesn’t use any precautions to prevent diseases

caused by mosquitoes and other insects. Protective clothing for the children was not

observed by the researchers. The two boys weren’t wearing footwear also shorts.

4. Accident hazards

Even though the children are young and love to play, safety precautions aren’t

given attention by the parents. The researchers observed that the children are prone to

accidents because of evident risk hazards such as sharp objects within the reach of the

children, cooking facilities placed on the ground.

5. Food storage and cooking facilities

Mrs. Cuayan cooks outside the patio, they do not have a refrigerator, and as stated

they do not need one for what they cook is just enough for the whole family. But in cases

of leftovers, they simply cover the food with another plate, and leave it on the table. All

their cooking utensils are kept away for the children to reach. But there are other tools

lying around the house which could be an accident hazard to the children.

6. Water Supply

Their water is supplied by a water faucet (gripo). This serves as their source for

water needs such as in taking a bath and cooking as well as their source of drinking

water.

7. Water storage

For drinking water it is placed in a plastic jar and water for taking baths or others

purposes are stored in a big plastic container with no cover.

8. Toilet facility

The family uses a private toilet facility. They make use of pail system when it

comes to the use of their toilet.

9. Garbage/refusal disposal

Family Cuayan disposes their garbage in a sack that is not covered. When the

sack is filled, every week they dispose it at the public garbage trucks.

10. Drainage system

They have an open and stagnant drainage. There are no canals which are present.

The water just goes to the soil and dirt of the lot.

ii. Social and health facilities communication and transportation facilities

The family hardly goes out of their barangay except for Sundays. The father uses

a bicycle as a source of transportation to work, and when it’s Sunday, they all commute

to visit the mall and walk around, or walk around the market for the kids to see. They do

not have any cellphone or any source of communication, but in cases of emergency they

would use a payphone.

V. Problem Identification

a. List of the problems identified with cues

Health Problem Score

1. Presence of Accidental 4.17

2. Malnutrition 3.67

3. Presence of Cough and Colds 3.22

4. Inadequate Living Space 2.5

5. Inadequate Ventilation 2.01

6. Poor Personal Hygiene 1.34

b. Priority Setting

Presence of Accidental Hazards

CRITERIA COMPUTATIONSCORE JUSTIFICATION

Nature of Problem 2/3 x 1 0.67 This is a health threat

because there is an

improper placement of

sharps and cooking

equipment within the

reach of the children. It

may cause harm and

burn to the members of

the family especially to

children.

Modifiability 1 x 2 2 The problem is partially

modifiable. The family

does not have adequate

knowledge on the

remedy of the problem.

They are somehow

aware to the problem,

but do not recognize it

as a felt need. And

through the health

teachings, knowledge

about the interventions,

of the student nurses the

family had come to

realize such

interventions in

minimizing the

problem. No financial

resources are needed for

them to resolve the

problem. Willingness

and cooperation by the

family is very vital.

Also, no community

resources are needed to

solve the problem

Preventive Potential 3/3 x 1 1 The problem is highly

preventable. Sharp

objects can lead to

accidents and injury of

the members of family

mostly to the children.

The problem is not that

severe and it exists in a

short duration.

Management to the

problem is currently

available.

Salience 1/2 x 1 0.5 The family recognizes

the problem but they do

not feel it needs

immediate action.

Total 4.17

Malnutrition

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the

problem

2 / 3 X 1 0.67 The problem is considered as

health deficit. Malnutrition is also

a contributing factor in acquiring

diseases easily. Lack of vitamins

and minerals which are essential

to our body weakens the immune

system, thus harmful bacteria and

microorganisms could easily get

through the body’s immune

system causing diseases and

infections. Also, a malnourished

individual cannot function well

with his/her outermost potential

since he/she lacks energy to

sustain his/her desired activities.

2. Modifiability of

the Problem

2 / 3 X 2 1.33 The problem is partially

modifiable due to:

Knowledge of the Family:

The family is knowledgeable

about the effects of the situation

but due to their financial

problems, the family could not

sustain adequate nutritional

needs.

Family's Resources:

Mr. and Mrs. Cuayan make

certain that their children, as

much as possible, will be able to

have a complete meal for

everyday to prevent from being

sick.

Nurse's Resources:

The student nurses provided

health teachings and recommend

alternative foods which are

nutritious and affordable.

Community Resources:

The community provides

program concerning about

proper nutrition in order to

alleviate the occurrence of some

health problems within the

community.

3. Preventive

Potential

2 / 3 X 1 0.67 The problem has a moderate

preventive potential because of

the extent of the problem shows

that 3 out of 4 of the children in

the family are already

malnourished.

The condition has already

occurred even before the student

nurses have their home visits.

Management:

Student nurse must be able to

teach parents on preparing an

appetizing meal with their

resources available. Also

encourage adequate rest and

exercise.

Exposure:

There is the exposure of some

members since there’s no

sufficient food to accommodate

all their needs.

4. Salience 2 / 2 X 1 1 The family considered it as a

condition needing an immediate

attention AEB Mrs. Cuayan’s

verbalization, “di nga sila

nakakaen tatlong beses sa isang

araw, kya nangangayayat sila”

TOTAL SCORE 3.67

Presence of Cough and Colds


Nature of Problem 3/ 3 x 1 1 This is a health deficit

because Dipsy, and

Telatubbies were

experiencing runny and

clogged noses with the

presence of nasal

discharges.

Modifiability 1/ 2 x 2 1 This problem is

partially modifiable

because the nurse’s

skill is limited and is

not sufficient to solve

it. Also, many

problems cause this and

this condition is self-

limiting. The sudden

changes of weather

may also be a cause.

Preventive Potential 2/ 3 x 1 0.67 The preventive

potential is moderate

since the problem

exists for about 2

weeks. Resources of

the health center as

well as the health

teachings provided by

the student nurses are

available.

Complications such as

pneumonia can be

prevented if proper

interventions are given.

Salience 2 / 2 x 1 1 The mother sees this as

a problem but does not

continue medications

due to the lack of

financial resources.

Total 3.22

Inadequate Living Space


Nature of Problem 2/ 3 x 1 0.67 The problem is a

health threat because

it makes

communicable

diseases easily

transmitted.

Modifiability 1/ 2 x 2 1 It is not possible to

widen their area. The

family can be taught

of how to arrange

and organize their

things in the house to

widen the space.

Preventive Potential 1/ 3 x 1 0.33 The problem has a

low preventive

potential since the

family had adapted

to the place and they

have no plans in

transferring to

another place that is

more spacious.

Salience 1/ 2 x 1 .5 According to the

mother, they are

already used of that

kind of living space.

She said they don’t

have other choice but

to leave there.

Total 2.5

Poor Ventilation

INADEQUATE VENTILATION

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the

Problem

2 / 3 x 1 0.67 The problem is considered as a health

threat because improper ventilation

makes it easier for communicable

diseases, specifically those transmitted

via air-borne, to be transferred if a

member of the family gets infected.

2. Modifiability of the

Problem

1 / 3 x 2 0.67 The problem is partially modifiable

with the use of the following:

Knowledge of the Family:

The family is not aware about the

problem because as verbalized by them,

they got used to hanging thick curtains

unaware that it adds gloom and makes

their house impermeable to air.

Family Resources:

The family may open the windows

during the day thus allowing a free flow

of air in the house. They may also open

the door to add fresh air exchange.

Student Resources:

The students may provide health

teachings on ways to prevent the

possible occurrence of the effects of the

problem.

Community Resources:

The BHC can provide a seminar on the

effects of inadequate ventilation to

health.

3. Preventive Potential 2 / 3 x 1 0.67 The problem has moderate preventive

potential because the family can make

remedies in order to solve the problem

but may only be limited to opening

their windows and door present in the

house.

Management:

The family may open the windows and

the door to facilitate entry of air and

may use thin curtains.

Exposure:

All the family members are exposed

since they all reside in that area.

4. Salience 0 / 2 x 1 0

The family are not aware to this

problem.

TOTAL SCORE 2.01

Poor Personal Hygiene


Nature of Problem 2/3 x 1 0.67 The problem is a health

threat as it could cause

certain disease

condition such as

parasitism to the family

especially to the

children.

Modifiability 0/2 x 2 0 The problem is not

modifiable since the

family does not have

the knowledge of how

communicable diseases

are transmitted and

resources of the family

and community with the

limited knowledge of

the nurse is not

sufficient to solve the

problem.

Preventive Potential 2/3 x 1 .67 The problem has

moderate preventive

potential since the

student nurse is there to

give some interventions

that can help the family

improve their personal

hygiene.

Salience 0/2 x 1 0 The family does not

perceive this as a

problem needing

immediate change

Total 1.34

VI. Family Case Analysis

Presence of Accident HazardsCues Family Nursing

Problem

Objectives Interventions Rationale Evaluation

Subjective: Ø

Objective:

>Sharps are placed

near the table,

where it is reached

of children.

>cooking area is in

the ground.

>tools of the father

in construction is

placed anywhere.

Inability to

recognize the

presence of the

problem due to

1. Inadequate

knowledge

2. Attitude in life in

which hinders

recognition of a

problem

3. Inadequate

resources for care

(i.e. responsible

family member and

financial

constraints)

Short Term:

After 2 home visits

of nursing

interaction and

nursing

intervention, the

family will be able

to recognize the

importance of

having a safe home

environment

Long Term:

After 2-3 weeks of

home visits the

family will be able

to demonstrate

>Provide

information about

the consequences of

having pointed

objects upon reach

of children

>Instruct the family

to keep sharp

objects in a safer

place

>Advise the family

to place sharp

objects far from

>This will help the

family to realize the

importance of

keeping pointed

objects to prevent

accidents

>This will prevent

injuries such as

cuts, accidental fall

of sharp objects that

can possibly hit the

children

>To provide safety

and prevent the risk

Short Term:

The family shall be

able to recognize

the importance of

having a safe home

environment

compliance on the

health teachings

given.

children’s reach

>Encourage the

family to place the

cooking area out of

reached of children

and out to fire

hazard.

of injury

>prevent burns

among children and

fire.

MalnutritionCues Analysis of the

ProblemObjectives Nursing Intervention Rationale Expected

OutcomesS> “nangangayayat nga sila di kasi kumakaen minsan”O>DipsyWt: 22kg BMI: 15.28>TelatabiesWt: 12 kgBMI:17.41>PoWt: 7.7kgBMI:15.26

1. Inability to provide adequate nursing care to dependent and vulnerable at risk members of the family resources for care, specifically financial constraints.

2. Inability to recognize presence of the problem due to lack of knowledge of present condition.

3. Inability to decide

Short Term:After 2 hours of nursing interventions, the family will be able to verbalize understanding of health teachings and is able to give causes and effects and prevention of malnutrition.

> Assess each members present nutritional status

> Discuss with the family presence of malnutrition

> Discuss with the family a list of suggested nutritious food

> Discuss and identify causes and effects of malnutrition like having

> To have a baseline data

>To make the family aware of the presence of such problem

> To correct faulty food habits

> To increase knowledge;

Short Term:The family shall have verbalized understanding of health teachings and able to give causes and effects and prevention of malnutrition.

about taking appropriate action due to failure to comprehend the nature, magnitude & scope of the problem.

low body wt., decrease resistance to diseases and easy fatigue

> Emphasize the importance of having ideal body weight to become healthy

> Encourage mother to make use of community resources like ampalaya, talbos-kamote etc.

> Explain to them what specific vitamins and minerals they need for their respective ailments and health.

> Discourage eating junk food in between meals

> Considered criteria in planning meals by

stimulate family to attend the situation as soon as possible

> To serve as a gauge for the family in identifying their current nutritional heath status and be able to monitor it effectively> For low-cost food alternatives having the same nutritional value

> To be able to inform the family what deficiency they could acquire, if there is a lack on these vitamins and minerals > To encourage proper food intake, prevent loss of appetite

involving mother in planning meals in accordance to available resources in the community

prior to meals and promote healthy eating habits

> To guide family in preparation of meals without sacrificing nutritional value

Presence of Cough and ColdsCues Analysis of

Problem

Objectives Nursing Intervention Rationale Evaluation

Subjective :

“sinipon nga

halos sila e”

Objective:

>The children

experience runny

noses and

The mother is

aware that this is

a problem but

lacks knowledge

on how to cure

and prevent it

from occurring

frequently. She

also does not

After 2 home visits

of student nurse-

family interaction,

the family will be

able to verbalize

understanding that

the present condition

is a problem needing

immediate action and

>Suggest to the mother to

provide enough rest for

the children and increase

their fluid intake.

>Encourage the mother to

>Rest will decrease

the chances of

lowering body

resistance and the

fluid promotes

expulsion of mucus

secretions on the

upper respiratory

Family would be

able to perform

the health

teachings given

and eliminate the

presence of the

disease and

minimize its

presence of

discharges.

>Dipsy has

wheezes upon

auscultation.

know of the

possibility of

spreading the

infection easily

and the possible

complications it

may cause such

as pneumonia.

conform with the

health teachings

given.

feed the children with

foods rich in vitamin C

like oranges, guava and

fruit juices.

>Demonstrate to the

children in covering their

mouth when coughing

and wiping the nasal area

when secretions are

flowing out.

>Encourage the children

to drink plenty of water.

> Advise the mother to

bring her children to the

Health Center for a check-

up and to seek

medications

tract.

>Vitamin C will

increase the body’s

resistance against

infection.

>This will prevent

the spread of the

infection.

>For better

expectoration of the

mucus secretion.

>This will help

them for when they

have problems

regarding health,

they can confide to

occurrence.

the Health Center to

seek medication and

have daily check-

ups

Inadequate Living SpaceCues Analysis of

Problem

Objectives Nursing Intervention Rationale Evaluation

Subjective:

“Pasensya na

kayo maliit lang

ang bahay

naming.”

Objective:

Total floor

area=

21sqm

Their desired

TFA must be

The family is not

aware of the

problem that

could arise from

this condition

due to lack of

knowledge about

communicable

diseases.

After 2 home visits

of Student nurse

family-interaction,

the family will be

convinced that this

may lead to health

problems.

>Provide general

knowledge on how

communicable diseases

could be easily

transmitted in a limited

space.

> Assist the family in

arranging and organizing

their things such as

furnitures and appliances.

>To increase

awareness of the

family about

possible illness

they could acquire.

> To maximize the

space of house.

>lessen the waste

and obstruction

After 2 home visits

of Student nurse

family-interaction,

the family will

become aware and

be cautious enough

in prevention of

illness.

54m2. This

means that the

family has

crowded living

space.

> Advise the family to

remove thing that are

unnecessary and not

being use.

causing inadequate

space.

Poor VentilationCues Analysis of the

ProblemObjectives Nursing Intervention Rationale Expected

OutcomesS> “sinara nga namen yung bintanang yan. Di na nga nabuksan”O> There are presence of:

>the inside of the house is hot and with thick curtains > one of their window is covered with plywood.

>Window are always close.

1. Inability to provide a home environment which is adequately ventilated for health maintenance, growth and development due to financial problems.

2. Inability to recognize the presence of congestion and its probable/possible effects to each

Short term:

After 2 hours of nursing interventions the family will be able to verbalize understanding about the effect of having poor ventilation such as poor circulation of air and prone in cross infection of communicabl

> Assess the environmental condition of the family > Provide health information regarding the necessity of adequate ventilation at home

> Explain to the family the need for more supply of air for proper circulation on the house

> Inform family about possible complications or risk for a congested place, such as easy transmission of disease>Instruct the family to

> To obtain base line data

> To inform the family how ventilation helps improve our health

> Improve ventilation inside the house by providing open windows

> To make the family aware and for the family to act on it

>For better circulation

Short term:

The family was able verbalize understanding about effect of having poor ventilation.

member of the family

e diseases. remove the cover in their window.

of air

Poor Personal HygieneCues Analysis of the

ProblemObjective(s) Nursing

InterventionsRationale Evaluation

S> O

O> Children have

soiled skin because

they don’t take a

bath everyday

>Long and dirty

nails presence in

father and children

> Children wearing

rugged clothes.

>Telatabies and Po

don’t wear shorts or

any underwear

the seen walking

bare-footed during

the home visit

Inability to

recognize the

presence of the

problem due to lack

of knowledge on

the causes and

effects of such.

Personal hygiene is

important as a it is a

contributing factor

to being healthy

and keeping our

resistance against

infection stronger

Short term:After 2 hours of nursing interventions, the family will be able to verbalize understanding on the importance of having a good personal hygiene AEB bathing the children everyday and cutting of finger and toenails.

> Explain to the family the importance of maintaining proper hygiene.

> Discuss to the family the relevance of having good hygiene in maintaining a healthy life.

> Instruct them to cut nails regularly and prevent nails from becoming dirty

> Instruct the children to wear

> To encourage the family to comply with the instructions given.

> To motivate the family in maintaining proper hygiene

> Nails are good source of contamination and can be a reservoir for microbes

> To avoid injury as well as to prevent parasitism

> To prevent dental

The family shall

have understood the

importance of

having a good

personal hygiene.

slippers inside and outside of the house

> Encourage family to brush teeth at least 2 times a day.

> Encourage family to wash hands before and after meal.

> Demonstrate proper hand washing technique to the members of the family.

carries and promote healthy gums and teeth

> To prevent food borne diseases and contamination of food.

> To have a clearer picture and knowledge as to hand washing technique.

VII. Family Coping Index

Category

Initial

Visit Justification

Final

Visit Justification

1 3 5 1 3 5

1. Physical

Independence

x All family member are

well and no disabilities.

Sometimes the mother

cannot do all household

chores because she’s

taking care of her 2

children that are

dependent to her.

x Same on what student-

nurse observed on the

initial interview.

2. Therapeutic

Competence

x The 2nd son is

experiencing cold and

flu since December and

there is no medication

given by the parents.

x Health teachings were

done and the student-

nurses saw the changes

on the condition of the

2nd son.

3. Knowledge of

Health Condition

x The mother knows the

complication and

consequences of colds

and flu. But there is

know medication that

given or any preventive

measures that was

observed

x Health teachings were

done, the family is now

more knowledgeable

about colds and flu.

4. Application of

Principles of

Personal Hygiene

x The house is partially

clean, but there are

some area in the house

that needs to be

improve. The children

takes a bath once a day,

x The family gained more

knowledge about the

importance of clean

environment and proper

hygiene.

but because of playing

outside they turn out

dirty.

5. Health Care

Attitudes

x The student- nurses

observed that the

family have knowledge

about the importance of

health care but its quite

not enough.

x The family gained more

knowledge about seeking

health providers in

dealing with different

illnesses. The family

knows now different

interventions in dealing

health problems.

6. Emotional

Competence

x Sometimes family with

different communities

is lacking of security

and maturity maybe

because of their

unstable life due to

financial and family

problem that they are

facing. The mother is

not enough watching

her two small children

because she is pregnant

and she have a lot of

household chores that

should be done.

x The family failed to

comply with the health

teachings done of

student- nurses because

of lack of resources and

at the same time because

of the condition of the

mother. But we saw a

willingness of the family

to comply with the

teaching.

7. Family Living

Patterns

x The father is making all

the majority decision in

the family, he is the

bread winner of the

family. And the mother

x As what we saw in the

initial visit. The family

doesn’t have any

problem with each other.

is the light of the house

who’s making all the

household works. This

family is an example of

a traditional Filipino

family. Each of the

children is dependent to

the parents.

8. Physical

Environment

x The house of the family

is partially clean that

needs improvement.

There is a part of the

house that is hazardous

to the family and can

cause illness.

x The family complied

with the health teaching,

but because of financial

factor, some of the

problem that observed

are still present.

9. Use of Community

Resources

x The family is aware of

the different services

offered by the barangay

health center. But

because of limited time

and the location of their

house, they cannot

avail those services.

x After the health teaching

the mother knows the

importance of visiting the

health center once a week

because of her condition.

VIII. Learning Derived

We all know that the Family is the Basic need of Society, meaning if there is no

Family, there is no society. We never expected to learn this much from a family whom

were just strangers at one point as well as from on another.

This FCA proved to show that this isn’t just a report that is required to pass. But

a report where you get so caught up and so involved, you tend to find yourself

understanding the real reason. This project has given us the meaning why

communication and interacting is so important. Communicating takes place so much in

everyday life but this time it felt different. Those words became actions and actions made

a difference.

The Family Case Analysis has taught us so many things. It taught us how to

really get involved in work, and take it seriously and of course emotionally. You cannot

just work without any feelings, what would that make you, numb? We all wanted to be a

reason for hope for a better life of this family and that being too serious isn’t enough,

loving and enjoying what you are doing will make the work more meaningful. We all

struggled to make this report possible but if you look deeper, this just proves to show that

cooperation, dedication and unity were combined.

The community is just not a place where they live in, but a place where many

people are affected as one and being there with the family made us feel that we too

gained something.

We learned that there are a lot of people who are less fortunate and health

education can teach them important information to help prevent certain infections,

diseases or unwanted outcomes. We can make a difference in people’s actions and it is

possible to change the way they perceive life.

With this report, it enhanced our social skills, and getting all the information

we’ve acquired showed that we can get along with people. How many people can go up

and ask all theses questions, not to mention when some of them are very personal. We

were able to gain the family’s trust, and that gave us a plus factor feeling knowing that

we’re doing a good job with them, and that they enjoy our company.

Socially, we were able to develop better therapeutic communication skills,

physically, we finally had time to exercise by going up to the family’s house,

psychologically, we used our minds to come up with possible writings and emotionally,

we learned how to be thankful of what we have and share our blessings with other people

who are in need.

Documents

Family Case Analysis HAU