INTRODUCTION

Family maintains the health of all the members. Aside from that that it is a
basic unit of the society it is part that forms a community. Health matters most to
a family because health is not just a mere absence of disease but a condition
where physical, mental, emotional and social well-being are present in a stable
and normal level but not in a static condition. Health is a priceless thing every
individual cares a lot for it. The family watches the health of every member
because if one has something wrong upon his/her health condition we can’t deny
the fact that all will be affected. But unfortunately such illnesses and diseases
can’t be avoided.
During this modern times health is equaled with money. Financial status
matters most when it comes to maintenance of health and avoidance of illnesses.
It is not like during old times where in people are contented to take some
medications by means of herbal medicines in their own backyard or just to find it
there in their surroundings. But unfortunately certain diseases nowadays will not
have remedies by just simple herbal medications. That’s the reason behind why
some people turn their simple disease to complicated one due to insufficient
medication.
As a nursing student who will be a future licensed heath care provider is now
trained on how to give an effective impart of knowledge to people in the
community. Enrolled to a subject NCM501202 Related Learning Experience
aside from teaching new nursing practice it is also concern about helping those
people who are far from health centers and hospitals or health care services.
Students learned on how to impart about what they had learned and at the same
time do some actual practice and let it have an improvement to skills. It is not
only the students who got some benefits but also those families who are lack of
knowledge on how to maintain health.
 II. A. OBJECTIVE OF THE STUDY
The Cluster 2 group B5 sought to identify a family or a member of a
family who has a health problem with base to the criteria of the subject. The
objective of the study is to determine the health problem or disease it has, to
know their level of awareness regarding their condition and to give inputs about
to their maintenance of health.

B. SCOPE AND LIMITATION OF THE STUDY

The Cluster 2 group B5 conducted a case study to Baguio family who is
a resident of Zone 5, Baikingon, Cagayan de Oro City. The study set its limitation
to focus only to the said family. The informations gathered were limited. During
the assessment Mr. Baguio was not around and only Mrs. Baguio was our only
source of the informations and that was during the first and second day of
midterm during the community health nursing exposure. Data collected are the
only things to be presented.
Regarding to the interventions the group are limited about this. It is just
concern to the condition and to the health status of the client so as to the
members of the family. Interventions are made to prevent any complications and
promote healthy life and living.
III. FAMILY HEALTH PROFILE

Name: Name:
Sex: Male Sex: female
Age: 29 yrs. Old Age: 25 yrs. Old
Religion: Religion:
Civil status: Married Civil status: Married
Income: 10,000/month Income: none
Nationality: Filipino Nationality: Filipino
Temperature: N/O Temperature: 36.5oC
Pulse rate: N/O Pulse rate: 75 bpm
Respiratory rate: N/O Respiratory rate: 18 cpm
Blood Pressure: N/O BloodPressure:110/70mmHg
Height: N/O Height: 5 ft.
Weight: N/O Weight: 52 kg.

Name:
Sex:
Age: 10 months old
Religion: none
Civil status: single
Income: none
Nationality: Filipino
Temperature: 36oC
Pulse rate: 75 bpm
Respiratory rate: 18 cpm
Blood Pressure: N/A
Height: N/A
Weight: N/A
IV. CHIEF COMPLAINT

A. Family member with a health problem

Mrs. ----------------. old, resident of ----------------- is complaining
about her psoriatic arthritis which affects her skin and the joint of her left
knee. According to Mrs. Baguio, this condition affects her daily work when
it occurs because aside from having itchiness on her skin there is also a
pain felt in her left joint knee.

B. Family member
The daughter of Mr. and Mrs. -------- was having a fever “mag
balik-balik man gud ang iyang hilanat” as verbalized by Mrs. --------

V. HISTORY OF PRESENT ILLNESS

A. Family History
Mrs. ------------- was aware already when she got that psoriatic
arthritis. She knew already that it is cause by hereditary factors from the
side of her mother. Her grandfather had this psoriasis and according to
hereditary factors the second generation is more prone to inherit the
disease. It started when she was 20 years old where in simple itching
started in her upper arms. She just ignore it thinking that it might just an
allergy but it scattered on some part of her skin and accompanied by the
pain felt in her left joint knee where later on it began to swell. She could
not walk, she needs to be carried to move from place to place. Scaling of
her skin appears rashes and red spots too. Her parents did not let it to
come to worse so they immediately confined her to the hospital. When she
got married her condition was not that bad anymore but she is taking
some medications as her maintenance to make her health status stable
until this present time and also there were foods that are restricted to
prevent any complications.
 B. Past Medical History

----------------------------

Types of Previous Illness/ Pregnancy/ Date

Deliveries
Cough December 2006
Psoriasis 2001
NSVD January 2006

Has received blood in the past____Yes_/_No If yes list dates____

Reaction of the patient _N/A__

Medication Name Dose/frequency Time of last dose

Mometason (Elocon) thin film of cream to _______

affected area

Psoriatic arthritis of Mrs. ------------- started last 2001, when she was still
20 years old. She use to apply a thin film of momentason cream to affected area
once daily after taking a bath. She did not receive blood transfusion. Since 2001,
she found out that she’s allergic to some foods like squash, eggplant, salted fish,
chicken meat, eggs and some sea foods such as shrimps and crabs.

C. Social History

In ------------o family Mr. ------------was the only one who smoke but
seldom only and drinks occasionally.

VI. GROWTH AND DEVELOPMENT

A. Family Member with a Health Problem
Honeynin Chandel Baguio

She’s already 10 months and the only child of Mr. Mrs. ---------------.
She was reared and presently nurtured by her parents especially by her
mother. She was breastfed in her early months but now is feed by lugao.
She crawls by her own and can walk with someone’s support. She has
already five teeth and is presently teething and so she likes biting her stuff
toys.

B. Family Member
I. Infancy
Basing on Freudan Theory this stage covers the Oral stage ( birth
to 18 months). Sensations of the lips, mouth, tongue and cheeks are
exciting in and by client’s self. Freud points to the prevalence of thumb
sucking without the reward of food. The client thumb sucked in the
absence of her mother’s breast. Sucking for her is very pleasurable. The
infant’s general mouth centeredness is also illustrative. According to her
parents she loves putting something to her mouth.

II. Early Adulthood

This Erik Erikson’s second stage of psychosocial development or

what he considered the stage of autonomy vs. shame and doubt (18
months to 3 yrs). When the client was still on this stage, she was striving
for new and more activity-oriented experiences places a dual demand
upon it: a demand for self-control and a demand for the acceptance of
control from others in the environment. Client was encouraged to
experience situations that require the autonomy of free choice such as
choosing a dress to wear for the day. A sense of self-control provides her
with a lasting of good will and pride.
III. Late Childhood
According to Erik Erikson the child in this stage develops initiative
(initiative vs. guilt, 3-5 yrs. old). This initiative gives the client a quality of
pursuing, planning and determination of achieving tasks and goals. She
strived to grow in the sense of obligations and performances as
demonstrated in how she helps her parents at home in simple ways. At
this time she loves experimenting with toys, in addition to physical games
it undertakes mental games by playing “bahay-bahayan” with other
children, assuming roles of parents and other adults in a make-believe
world. This play realizes to some degree what is like and to be like then
and provides intermediate reality.

IV. School Age

This stage is the stage of industry vs. inferiority according to Erik

Etrikson (6-12 yrs. old). The child now needs specific instruction in
fundamental methods to become familiar with a technical way pf life. Work
for the client, in this sense, includes many and varied forms such as
attending school, doing chores at home, assuming responsibilities as well
as participating in skillful games and sports with neighborhoods or with
classmates at school.

V. Adolescence

According to ErikErikson this is the stage of identity vs. identity

confusion (12-20 yrs. old) . The adolescent sense a feeling of her own
identity. The client observed different changes in her body and starts
dressing good to look good in the eyes of the other people. At that time
she loved hanging with her friends and enjoyed talking about their
crushes, admirers and suitors.
 VI. Early Adulthood

The stage of intimacy vs. Isolation according to Erik Erikson (18-25

yrs. old). I n this stage, they are prepared and willing to unite their identity
with others. Now, the first time in her life, our client developed true sexual
genitality in mutuality with a loved partner after she got married. Cheryl
was able to bear a lovely baby girl and shares her care with her girl and
husband.

VII. FAMILY SERVICE and PROGRESS RECORDS

A. Head of the family: Mr. ---------------
B. Family Member:
------------------
-------------------

C. Address--------------------------
D. Family Member Number: 2 members only
E. Names of Family Member(s):

------------------------
Relation to head: Wife Relation to head: daughter
Sex: Female Sex: Female
Birth date: December 17, 1980 Birth date: January 17,2006
Highest Education Completed: Highest Education
College Undergraduate Completed: none
Occupation: none Occupation: none
Type of Work: none Type of Work: none
Place of Work: at home Place of Work: none
VIII. DESCRIPTION OF HOME AND ENVIRONMENT

A. House
a. Ownership: (/) Owned ( ) Rented ( ) Rent-free
b. Construction material used: (/) Light ( ) Mixed ( ) Strong
c. Number of rooms used for sleeping: 4 room
d. Lighting facilities: ( ) Electricity ( ) Kerosene ( )others
e. General Sanitary condition: clean

B. Water Supply
a. Drinking water
Source: Water Works
Distance from house: 600 meters away from the house
Storage: ( ) None (direct from faucet or pipe)
( ) jar or can with faucet
( ) jar or can without faucet
( ) other (specify)________

C. Kitchen
a. Cooking facility (∕ ) Electric stove ( ) Gas stove ( )
Firewood/charcoal
b. Sanitary condition: clean

D. Waste Disposal
1. Refuse and garbage
a. Container: ( /) covered ( ) open ( )none
b. Method of Disposal: Burning method
2. toilet
a. type: Flush-type
b. sanitary condition clean
E. Domestic Animals
Kind Number Where kept
Chicken 10 Backyard

F. The Community in General

a. General sanitary condition: clean
b. Housing congestion ( )yes (/)no
c. Recreational facilities: radio, t.v
d. Availability of health care facilities: Barangay Health Center
IX. Nursing System Review Chart
A. Physical Assessment
NURSING SYSTEM REVIEW CHART
Name: Cheryl K. Baguio ___________________ Date: December 06, 2006_________
EENT:
Vital Signs:
Impaired
Pulse: vision BP:
70 bpm__ blind
110/70 mmHg Temp: 36.5 ۫C___ Height: 5’______ Weight: 52kg____
pain reddened drainage
gums hard of hearing deaf
burning edema lesion teeth
Asses eyes, ears, nose
Throat for abnormality no problem
RESP.
asymmetric tachypnea
apnea rales cough barrel chest
bradypnea shallow rhonchi
sputum diminished dyspnea Rashes, red spots and
orthopnea labored wheezing
pain cyanotic scaling at both arms
Asses resp. rate, rhythm, depth, pattern
breath sounds, comfort no problem
CARDIO VASCULAR
arrhythmia tachycardia numbness
diminished pulses edema fatigue
irregular bradycardia murmur
tingling absent pulses pain
Assess heart sounds, rate, rhythm, pulse, blood Swelling at the right
pressure, etc., fluid retention, comfort knee
no problem
GASTRO INTESTINAL TRACT
obese distention mass
dysphagia rigidity pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort no problem
GENITO-URINARY and GYNE
pain urine color vaginal bleeding
hematuria discharge nocturia
Assess urine freq., control, color, odor, comfort/
Gyn-bleeding, discharge no problem
NEURO Scaling on her scalp
paralysis stuporous unsteady seizures
lethargic comatose vertigo tremors
confused vision grip Rashes, red spots and
Assess motor function, sensation, LOC, strength, scaling at both arms
grip, galt, coordination, orientation, speech.
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 moist
Asses mobility, motion, galt, alignment, joint function
/skin color, texture, turgor, integrity no problem

Place an (X) in the area of abnormality. Comment at the

space provided. Indicate the location of the problem in
the figure if appropriate, using (x)
 NURSING SYSTEM REVIEW CHART
Name: Honeynin Chandel K. Baguio________________ Date: December 06,2006_____
Vital Signs:
Pulse: 75 bpm ___BP: N/O_____ Temp: 36.۫C____ Height: N/O___ Weight: N/O______
EENT:
Impaired vision blind
pain reddened drainage
gums hard of hearing deaf
burning edema lesion teeth
Asses eyes, ears, nose
Throat for abnormality no problem
RESP.
asymmetric tachypnea
apnea rales cough barrel chest
bradypnea shallow rhonchi
sputum diminished dyspnea
orthopnea labored wheezing
pain cyanotic
Asses resp. rate, rhythm, depth, pattern
breath sounds, comfort no problem
CARDIO VASCULAR
arrhythmia tachycardia numbness
diminished pulses edema fatigue
irregular bradycardia murmur
tingling absent pulses pain
Assess heart sounds, rate, rhythm, pulse, blood
pressure, etc., fluid retention, comfort
no problem
GASTRO INTESTINAL TRACT
obese distention mass
dysphagia rigidity pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort no problem
GENITO-URINARY and GYNE
pain urine color vaginal bleeding
hematuria discharge nocturia
Assess urine freq., control, color, odor, comfort/
Gyn-bleeding, discharge no problem
NEURO
paralysis stuporous unsteady seizures
lethargic comatose vertigo tremors
confused vision grip
Assess motor function, sensation, LOC, strength,
grip, galt, coordination, orientation, speech.
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 moist
Asses mobility, motion, galt, alignment, joint function
/skin color, texture, turgor, integrity no problem

Place an C.
(X) Pathophysioplogy
in the area of abnormality. Comment at the
space provided. Indicate the location of the problem in
the figure if appropriate, using (x)
Pathophysiology: Psoriatic arthritis is an autoimmune inflammatory condition
affecting the skin and the joints as well as the insertion sites of tendons,
ligaments, and fascia. Overexpression of tumor necrosis factor (TNF)-alpha is
thought to play a key role. Multiple HLA associations are known. Although
psoriatic arFrequency:

PSORIATIC ARTHRITIS

CAUSES
unknown

PREDISPOSING FACTORS PRECIPITATING FACTORS

Environmental, immunologic and Over expression of tumor necrosis
vascular factors factor (TNF)-alpha

Warning signs

• Pain and swelling in the fingers or toes.

• Fingernails or toenails lifting up from the skin or getting small holes in
them (known as pitting).
• Pain and swelling over tendons and ligaments.
• Reduced range of motion.
• Morning stiffness and tiredness.
 FAMILY CARE PLAN

Cues Nursing Objective Intervention Evaluation

Diagnosis

Subjective : Risk for infection At the end of 1 hour 1. Checked motivation At the end of 1 hour
related to poorly the family members and willingness to the family members
“Hugaw usahay sanitized water will verbalize learn. were able to
ang among tubig na reservoir understanding about verbalized
pangkaligo na gikuha the risk factors on 2. Identify the understanding about
sa unahan” as contaminated water misconception of the risk factors on
verbalized Mrs. Cheryl and will understand drinking contaminated contaminated water
Baguio. the importance of water. and will understand
clear and clean water. the importance of
3. Discuss the risk clear and clean water.
Objectives : factor of using
contaminated.
- Water is not
clear 4. Discuss the
- Minute particles importance of using
floating in the clean and safe water.
drinking water
5. Instruct the family
members to strained
bath water.
 ACTUAL NURSNG CARE PLAN
Mrs. Cheryl Baguio

CUES NURSING OBJECTIVES OF INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS CARE
Subjective: Independent
Chronic pain At the end of 30 At the end of 30
“magsakit pirme related to disease minutes, the patient 1. Apply warm moist Heat promotes minutes the patient
akong tuhod kung process, Psoriatic will be able to compress to affected muscle relaxation was able to
mag –ulan.” as Arthritis reduce the pain at joints several times a and mobility, and verbalize relief of
verbalized by Mrs. tolerable level. day. decreases pain. pain and displays
Baguio. relaxed manner.
2. Provide gentle To promote
massage. relaxation and
Objective: reduce muscle
tension.
• Grimace
3. Encourage the patient It maximizes joint
• Limited mobility to maintain upright and function,
erect posture when maintains mobility
• Hands over sitting, standing and and lessen joint
affected area walking. stress and pain.

4. Assist with active To improve joint

/passive ROM and function, muscle
resistive exercise when strength.
able.
Dependent

1. Administer Ibuprofen This drug control

as indicated mild to moderate
pain and
inflammation of
prostaglandin
synthesis