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I. INTRODUCTION

Community Health Nursing is a synthesis of nursing practice, Public Health

practice, Health Promotion and Primary Health Care.

The practice of community health nursing expands into the areas of disease

prevention, health enhancement, empowerment, advocacy, community development

and research.

The nature of community health nursing is comprehensive directed towards the

individual, families and the community at large. The community health nurse fulfils a

unique role in the community, promoting and protecting the health of the community,

whilst using a framework of sustainability.

Community health nursing acts to promote optimum health of individuals and the

community by promoting the right to informed choice, advocacy and self determination.

Community health nurses identify and challenge barriers to wellness and

empower people to change the agents that effect their health adversely. Community

health nursing practice is built upon the foundation of nursing science.

The focus of this Community health nursing is more on the individual family. Let

us first know the basic background of what society views family as.

Family denotes a group of people or animals (many species form the equivalent

of a human family wherein the adults care for the young) affiliated by a consanguinity,

affinity or co-residence. Although the concept of consanguinity originally referred to

relations by "blood," anthropologists have argued that one must understand the idea of

"blood" metaphorically, and that many societies understand 'family' through other

concepts rather than through genetic distance.

One of the primary functions of the family is to produce and reproduce persons,

biologically and socially. Thus, one's experience of one's family shifts over time. From

the perspective of children, the family is a family of orientation: the family serves to

locate children socially, and plays a major role in their enculturation and socialization

From the point of view of the parent(s), the family is a family of procreation the goal of

which is to produce and enculturate and socialize children. However, producing children

is not the only function of the family; in societies with a sexual division of labor,

http://en.wikipedia.org/wiki/Enculturation

http://en.wikipedia.org/wiki/Children

http://en.wikipedia.org/wiki/Genetic_distance

http://en.wikipedia.org/wiki/Household

http://en.wikipedia.org/wiki/Affinity

http://en.wikipedia.org/wiki/Consanguinity

http://en.wikipedia.org/wiki/Animals

http://en.wikipedia.org/wiki/People

marriage, and the resulting relationship between two people, is necessary for the

formation of an economically productive household.

This is a case of Gludo family living at Upper Zone 7, Bulua, Cagayan de Oro

City. They belong to low-income families in the area an income of 150-200 per day as

raised by Marlon Edrozo and Abel Edrozo. The mother and father are both physically

unwell and is having insufficient treatment and consultation. The daughter does the

household chores while her husband is the breadwinner. They have two children and

only one is complete with immunization.

Objectives of the Study

The family case study aims to have a profound and broad understanding on the

concept of community health nursing as one of the concept in delivering quality nursing

care to an individual not just in hospital setting but along with the families in the

community. The study also aims to have the following effect on the clients:

a)Promotion and understanding of health as a complete state of physical, social and

emotional well-being, not merely the absence of disease.

b) Contribution to identifying and meeting the main health needs of the family in the

community.

c) Accessible, available and affordable services based on principles of social justice and

equity.

e) The participation and consultation of people and communities about health issues

and their own health care.

Scopes and Limitations

The study is bounded only to the identification of the health deficits, heath

threaths and foreseable crisis gathered on the clients family(elderly clients) based on

the nursing process as to data gathering and on the implementation of available and

appropriate nursing services and interventions to identified problem. The data gathered

is limited only to the clients subjective and obejctive cues. The data is also dependent

on the number of home visits, that is, Thursday-Saturday in two weeks with two hours

interaction.

http://en.wikipedia.org/wiki/Household

http://en.wikipedia.org/wiki/Marriage

II. SPOT MAP

Mr. and Mrs. Virgilio Gludo Residence is at Upper Zone 7, Barangay Bulua,

Cagyan de Oro City.

Liceo de Cagayan University will be the point of reference. From the point of

reference, we could ride a jeepney, either IPONAN or BARRA, BULUA going to the

area. The regular fare is P10.00 while student priviledge is P8.00. From the School, you

only have to stop and drop at Land Transportation Office just ahead the Villa Candida

Subdivision. Across the way, we walk by about by 50 meters from the high-way and get

inside the boundary of Villa Candida Subdivision left side of the zone. From there, we

go straight to Cherry St. and go staight ahead to Upper Zone 7. Upon reaching the

basketball court, turn right. The Gludo Residence is the second house at the upper right

of the basketball court.

III. FAMILY PROFILE

Head of the Family

Name: Virgilio GLudo

Age: 54 years old

Birth Date: September 11, 1955

Citizenship: Filipino

Religion: Roman Catholic

Position in the family: Husband/Father

Place of Residence: Upper Zone 7, Bulua, Cagayan de Oro City

Occupation: none

Educational Attainment: Third Year Highschool

Drinking History: Drinks almost everyday

Smoking History: Heavy smoker since a teenager but stopped during

his illness

Allergies: No known food and drug allergies

Members of the Family

Name: Cresencia Gludo

Age: 54 years old

Birth Date: May 5, 1954



Position in the family: Wife/Mother


Occupation: none

Educational Attainment: Grade Four

Drinking History: None

Smoking History: Not a smoker

Allergies: No Known Food and Drug Allergies

Name: Analiza Gludo

Age: 21 years old

Birth Date: August 24, 1988



Position in the family: Daughter/


Occupation: N/A

Educational Attainment: 2nd year high school

Name: Marlon Edrozo

Age: 22 years old

Birth Date: December 24, 1986



Position in the family: Husband of Analiza


Occupation: Laborer

Educational Attainment: 2nd year high school

Name: Abel Edrozo

Age: 19 years old

Birth Date: April 5, 1990



Position in the family: brother of Marlon


Occupation: “konduktor”

Educational Attainment: ongoing 2nd year high school

Name: Anamae Gludo

Age: 3 years old

Birth Date: February 19, 2006



Position in the family: eldest grandchildren


Allergies: No known food and drug allergies

Name: Marianne Kate Gludo

Age: 1 year old

Birth Date: December 30, 2008



Position in the family: 2nd grandchildren


IV. HEALTH HISTORY

Father

Mr. Virgilio Gludo, is the head of the family. His past occupation was a mechanic

and a company driver. He Is known to be a heavy smoker since he was still a teenager

and has mentioned that he consumes 2-3 packs of cigarette per day. He is also drinking

alcoholic beverages almost everyday after work mostly of past-time with co-workers. He

stopped all his vices when he had a physical illness such as Tuberculosis in 2002 and

was admitted at Northern Mindanao Medical Center. He also mentioned that he has

heart enlargement as consulted at German Doctors under Dr. Sayas and Dr. Ramil Del

Rosario. Just this year, he has been experiencing edema at lower extremities with

tenderness upon palpation. He is taking Salbutamol and Aminophylline Tablet for

treatment.

Mother

Mrs. Cresencia Gludo, wife of Mr. Virgilio Gludo, is also having a physical illness.

She had a cataract removal surgery four moths ago at Maria Reyna Hospital. She is

also known to be hypertensive but takes no maintenance of medicine. Presently, she is

complaining cyst at her left buttocks and has not had any consultation done yet due to

financial constraints and expenses going to the maria Reyna Hospital where she is

usually having her check-up.

Daughter

Analiza Gludo, is the only daughter left with her mother and father. She is

undergraduate and has taken only until 2nd year highschool. She has two children, both

girls with ages of 3 years old and a one year old. He is unmarried but living together

with the father of her children, Marlon Edrozo, a laborer and is 22 years old also.

According to her, she has neither physical diabilities nor illness and claims to be in good

health condition. She had a histroy of vaginal bleeding during her first delivery.

Grandchildren

Anamae Gludo, 3 years old is the eldest grandchilren in the house. She was

delivered in Normal Spontaneuos Vaginal Delivery at Northern Mindanao Medical

Center and is complete with immunization. She had a productive cough and fever

during the first visit and was taking Myremol (paracetamol) for her fever.

Marianne Kate Gludo, 1 year old was delivered through Normal Spontaneous

Vaginal Delivery at home by a helot. She is not yet complete with immunization and also

had a fever and cough during the first visit together with her sister.

Both of them were active and playful during the home visits we had. They are

playing with each other and has different interest in the field of playing.

V. PRESENT HEALTH STATUS NURSING SYSTEM REVIEW CHART (Gludo Family)

Name:_____Virgilio Gludo Temp.:_36.2 C__ Pulse Rate:__73 bpm___ Resp. Rate: 16 cpm BP:_110/70 Height: 5’6” Weight: 35 kg___

INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

EENT:[ ] impaired vision [ ] blind [ ] pain[ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teethAssess eyes, ears, nose throat for abnormalities. [x ] no problem

XRESPIRATORY:[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [x] cough [ x] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [x ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse blood breath sounds, comfort [ ] no problem

CARDIOVASCULAR:[ ] arrhythmia [ ] tachypnea [ x] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] painAssess heart sound, rate, rhythm, pulse, blood pressure.circulation, fluid retention, comfort[x] no problem

GASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowing bowel sounds, comfort.[x ] no problem

GENITO-URINARY AND GYNE:[ ] pain [ ] urine color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturiaassess urine frequency, control, color, odor,comfort, gyne bleeding, discharge [x ] no problem

NEURO:[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] gripassess motor, function, sensation, LOC, strengthgrip, gait, coordination, speech[x ] no problem

MUSCULOSKELETAL AND SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity[ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain[ ] ecchymosis [ ] diaphoretic [ ] moistassess mobility, motion, gait, alignment, joint functionskin color, texture, turgor, integrity - pale[ ] no problem

Underweightw= 35 Kg

Pale skin

Barrel chest

Numbness and pain

Dyspnea

RR – 16 cpm,

cough

Pale skin

NURSING SYSTEM REVIEW CHART (Gludo Family)

Name:_____Cresencia Gludo Temp.:_36.7 C__ Pulse Rate:__79 bpm___ Resp. Rate: 21 cpm BP:_130/80 Height: 5’3” Weight: 53 kg___



XRESPIRATORY:[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse blood breath sounds, comfort [x ] no problem

CARDIOVASCULAR:[ ] arrhythmia [ ] tachypnea [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] murmur [ ] tingling [ ] absent pulses [ ] painAssess heart sound, rate, rhythm, pulse, blood pressure.circulation, fluid retention, comfort[x] no problem




MUSCULOSKELETAL AND SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity[ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain[ ] ecchymosis [ ] diaphoretic [ ] moistassess mobility, motion, gait, alignment, joint functionskin color, texture, turgor, integrity - with cyst at left buttocks[ ] no problem

cyst


Name:_____Analiza Gludo Temp.:_36. C__ Pulse Rate:__76 bpm___ Resp. Rate: 22 cpm BP:_110/80 Height: 5’3” Weight: 43 kg___



XRESPIRATORY:[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [ ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse blood breath sounds, comfort [x ] no problem





MUSCULOSKELETAL AND SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity[ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain[ ] ecchymosis [ ] diaphoretic [ ] moistassess mobility, motion, gait, alignment, joint functionskin color, texture, turgor, integrity [x ] no problem


Name:_____Anna Mae Gludo Temp.:_37 C__ Pulse Rate:__106 bpm___ Resp. Rate: 42 cpm Weight: 11 kg



XRESPIRATORY:[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [x ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[x ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse blood breath sounds, comfort [ ] no problem





MUSCULOSKELETAL AND SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity[ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain[ ] ecchymosis [ ] diaphoretic [ ] moistassess mobility, motion, gait, alignment, joint functionskin color, texture, turgor, integrity [ ] no problem

With productive

cough

Dirty fingernails

Dirty fingernails


Name:_____Marianne Kate Gludo Temp.:_37 C__ Pulse Rate:__136 bpm___ Resp. Rate: 46 cpm Weight: 11 kg



XRESPIRATORY:[ ] asymmetric [ ] tachypnea [ ] apnea [ ] rales [x ] cough [ ] barrel chest[ ] bradypnea [ ] shallow [ ] rhonchi[x ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse blood breath sounds, comfort [ ] no problem





MUSCULOSKELETAL AND SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity[ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain[ ] ecchymosis [ ] diaphoretic [ ] moistassess mobility, motion, gait, alignment, joint functionskin color, texture, turgor, integrity –with birthbark [ ] no problem

With productive

cough

Dirty fingernails

Dirty fingernails

birthmark

VI. HOME AND ENVIRONMENT

1. Housing

a. The family own’s the house but the lot is not their own property.

b. The house is composed of light materials such as bamboo, nipa and wood.

c. The house has only one bedroom where they share in sleeping.

2. Kitchen

a. They use firewood in cooking since they cannot afford to have gas stove or

electric stove.

b. Kitchen is untidy with the presence of unwashed dishes and cluttered utensils

inside their house.

3. Presence of Health Hazards

a. The kitchen is open and very accessible by the children.

b. No safe source of drinking water.

4. Water Supply

a. They get their water supply for cooking, bathing, washing clothes and dishes

from the faucet.

b. They use Gallon as water storage.

5. Toilet

a. They have their own comfort room outside the house and it is a water sealed

type.

b. The toilet bowl is dirty and full of stain.

6. Sanitary Condition

a. Things inside the house is not properly arranged.

b. There were presence of flies was observed everywhere because of the mess.

7. Garbage System

a. The family doesn’t have any container for there garbage and that they use open

burning as a method of disposal.

b. Does not practice segregation of garbage.

8. Drainage System

a. They don’t have any drainage facility connected to their washing area or lavatory.

9. Kinds of Neighborhood

a. The neighborhood is composed mostly of low – income families.

b. The houses are somewhat congested but are peaceful.

10. Domestic Animals

a. the family raises chickens outside their house and are placed in cages.

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