Group 5 Grand Family Case Presentation
Abela Caro Cosalan
DatorDe Castro
J. HernandezL. Hernandez
IshimuraPascuaA.Que
Index Case: A.E.
• 3 year-old male
• Chief complaint:– Multiple pustular skin lesions on scalp and both
upper and lower extremities of 1 week duration
History of Present Illness
1 week PTC • Development of multiple erythematous pruritic pustules on scalp and lower extremities
• Lesions were noted to be gradually increasing in size and number
• No associated symptoms of fever, cough and colds, diarrhea, loss of appetite, and weakness
• No medications taken
CONSULT
• Past Medical History– Recurrent viral URTIs since birth
• Family History– Unremarkable
• Birth History– Born full-term via NSD – 29-yr old G4P4 (4004)– Birth attended to by a midwife at a lying-in clinic– Unrecalled birth weight; No perinatal/neonatal complications– Completed EPI vaccinations from health center
• Nutritional History– Breastfed exclusively until 6 months– Formula: Bear Brand– No food allergies and specific food preferences
• Developmental History– Milestones are at par with developmental age
group
Physical Examination
• General survey– Active and cooperative– Stable vital signs
• Unremarkable systemic PE
• Skin– Multiple furuncles with sizes ranging from 1x1 cm to 2x2 cm– Lesions in different stages of healing concentrated on the
scalp and lower extremities
• Assessment– Furunculosis
• Plan– Cloxacillin suspension 0.6 ml 3x a day for 7 days– Mupirocin ointment to be applied 2x daily on
lesions– Daily bathing with antibacterial soap with a
change of clean clothes
Case Summary
28
7 4 mo811 312
3232
ACUTE MI
Family Map
Home Situation
• Currently live in a 1-room unit in an apartment-type complex– Unit on 2nd floor; Accessed by a single narrow wooden
staircase– Rent: P700 monthly– Single room acts as a living room, dining area, bedroom,
and storage space– “Dirty kitchen”-like space with a charcoal stove and
makeshift sink– Dimly lit by a single light source– Windows provide moderate ventilation
Home Situation
• Appliances owned: Single light bulb and radio• Communal toilet and poso– Located outside the unit– Shared by other tenants of the complex– Also doubles as a bathing area and laundry area
• Water supply from communal faucet• Stray animals wander freely around the area
Family Profile
• Parents are both high school undergraduates– Primary breadwinner: Stepfather• Part-time mason/welder• Occasional parking attendant at a mall• Earns ~P200 per day
– Primary caregiver: Mother• Maintenance of the house• Oversees children’s school activities and health
concerns
Family Profile
• 5 children (ages ranging 4 mos-12 years old)– Eldest child (12 y/o male) lives separately with
maternal grandmother in the province
– 2nd eldest (11 y/o female) is out of school and helps mother with household chores
– Only 1 child in school (7 y/o male)
Family Profile
• Few resources for basic amenities (food and clothing
• Recreational activities– Visiting the plaza– Going to mass
• Minor health concerns directed to health center– Children have all completed vaccinations– No major illnesses necessitating hospitalization
Family APGAR ScoreFather Mother Eldest Daughter
Adaptation 2 2 2
Partnership 2 2 2
Growth 2 2 2
Affection 2 2 2
Resolve 2 2 2
Overall Assessment Highly Functional
SCREEMParameter Resource Pathology
Social Good relationship with neighbors and in-laws
None
Cultural Urbanized and Filipino (modern and nuclear)
None
Religious Roman Catholic (non-practicing) Only attend mass together when they have extra funds for
commuting expensesEconomic Father’s unstable employment
status as part-time mason/welder/parking attendant
provides for financial needs
Basically jobless when no contractual mason/welder jobs are
available
Current income as a parking attendant is insufficient to meet
basic needs
SCREEMParameter Resource Pathology
Educational Only 1 child is currently in school
Other kids had to stop schooling after getting sick and were unable to resume
studying due to lack of funds
Family does not seem to place much importance on education (added expense)
Medical Mother oversees health concerns
Free health consultations c/o Ilugin community
center and barangay health center
Poor environmental sanitation and hygiene
mainly contribute to the family’s common health problems like viral URTI’s and Staphylococcal skin
infections
Family Promotive Care PlanFamily
MemberScreening Tests Chemoprop
hylaxisLifestyle Modification Counseling Needs
L.E. (Father)
None None Consider using contraception
Get a stable job to provide properly for
family
Do not engage in vices
Clear up misconceptions about
family planning
A.E. (Mother)
Self Breast Exam
Annual Pap Smear
HPV vaccine Consider using contraception
Consider undergoing bilateral tubal ligation
Clear up misconceptions about
family planning
Importance of proper hygiene & sanitation
practices
A.E. (11 y/o female)
Routine wellness consultation for
adolescents
HPV vaccine Maintain good hygiene practices
Should start sex education
Counseling regarding proper
sanitation and hygienic practices
Regular adolescent interview
A.E. (8 y/o female)
A.E. (7 y/o male)
A.E. (3 y/o male)
Well child check-ups
EPI vaccines with complete boosters
Maintain good hygiene practices
Should eat a more nutritious
diet
None
A.E. (4 mos female)
Well baby check-ups
Newborn screening and newborn care
package
Developmental screening
EPI vaccines with complete boosters
Continue exclusive
breastfeeding until 6 mos old
None
Overall Promotive Health Care Plan
• Educate family about importance of good hygiene and sanitation practices– Prevent spread of communicable diseases– Boost immunity– Improvement of overall health and well-being in
the community
Recommendations
• Cultural limitations within a community may hinder adaptation to hygiene education– Change is brought about by experience and
experimentation– A community’s inherent knowledge, beliefs, &
values are integral to developing proper health education and hygiene programs
– Family meeting dialogues allow people to discuss problems freely and make sense of them and their proposed solutions
Biological & Psychosocial Assessment
• Index patient’s main health issue is related to improper hygiene and sanitation practices
• Primary caregiver should be educated regarding basic aspects of good hygiene:– Handwashing with soap & water– Daily baths– Use of slippers/proper footwear
Insights
• Proper hygiene and sanitation play a big role in preventive health measures.
• A disease’s biomedical aspect is only the tip of the iceberg when dealing with a patient’s problems.
• Family meeting is both a diagnostic and curative tool in assessing the family’s overall state of health