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ANGELES UNIVERSITY FOUNDATION

ANGELES CITY
COLLEGE OF NURSING

In partial fulfilment

of the requirements in

Related Learning Experience

“Family Case Analysis”

Submitted to:

RONNIE ROMERO, R.N.


Submitted by:

BAUTISTA, DANIEL JACOB

DELA CRUZ, NIKKI D.

SAWALLICH, CHRISTINE CHERA

BSN II-9

CHAPTER I
Introduction

“Every family carries their own doctor inside.”


Albert Schweitzer (1875 - 1965)

The nurse’s responsibility as a health care provider is mainly focused on


the promotion of health and prevention of illnesses. These can be attained by
providing health teachings to the families and individuals. In this situation, the
nurse, whose goal is to make each family self-reliant with regards to their health
management patterns and way of living, just serves as a temporary aid for the
family to improve their health and way of living. This concept can be associated
with the above quotation that even if the nurse had already done all the health
promotion methods and provision of awareness for the family, if their practices
and attitudes regarding health did not change at all, then the nurse’s goal was
not met.

The family is the basic unit of society. It is very important that the family
should be physically, emotionally, mentally, and spiritually healthy. The healthier
the family, the more productive the family is to the community. Since the family is
the primary clientele in Community Health Nursing, quality care must be provided
regardless of their socio-economic status and cultural/ ethnic background. With
this, the family will be able to functions as an essential part of the society.
(Kozier, 2008)

Community Health Nursing has a tremendous impact on human well being


with a unique blend of nursing and public health practice woven into human
practice and service that should be developed in order to produce positive
outcomes in the society. Its responsibilities extend to the care and supervision of
individuals and families in their homes, in schools, clinics and even in their
workplaces. The Community Health Nurses, as members of the health care
team, are expected to integrate within the context of family health care, the
priority programs of the Department of Health towards health maintenance,
illness prevention and most especially, family self-reliance.
(http://www.scribd.com/doc/17162230/Concept-of-Public-Health-and-Community-
Health-Nursing)

Family Health Nursing is the most basic level of the Community Health
Nursing in which its primary unit of care is the family. Family Health Nursing’s
goal is health, which includes disease prevention, maintenance of wellness and
rehabilitation by using nursing as a medium or channel for providing care. GHN
helps families cope with the discontinuities in health and threats in such a way as
to maximize their potential for high level wellness, as well as to promote
reciprocally supportive relationship between people and their physical social
environment.( http://www.answers.com/topic/family-health)

There have been many debates around family issues, from the
incarceration of juveniles, now forbidden by a law just passed in 2006, to family
planning, which has faced unprecedented opposition from organized groups that,
predictably, declare themselves pro-family. Attempts to introduce divorce have
been shot down several times, again supposedly in defense of the family so that
today, we are one of only two countries in the world — the other being Malta —
that does not have divorce.
Most of these debates take place in the legal arena, particularly around
legislation, which tends to make people forget that the future of the family is
being shaped, with or without laws, in the economic and social spheres. Of the
myriad of factors that are shaping what the Filipino family will be like in 2010 and
beyond, the following have the most impact:
First and most important is the worsening income inequity in the country. The
signs of boom are there with all the glowing headline statistics rolled out by
government, from the growth of the gross national product (albeit at a much
slower rate than our neighbors) to the "strengthening" peso (or, as some pundits
would more accurately put it, the weakening U.S. dollar). No doubt, we are
seeing unprecedented prosperity for some Filipinos. Yet amid new shops offering
brand-name products, there are families living in the streets, and even those who
have (rented) roofs over their heads are skipping meals. According to the 2003
Family Income and Expenditures Survey, 30 percent of Filipinos live in poverty;
sometimes, however, it feels like there are more impoverished families out there.
Second among the factors affecting the family is the erosion of social services,
including family planning. For all the rhetoric in the constitution about the State
protecting the family, there has been a cutback in funds for education, health,
and other social services that directly affect family welfare. The problems are not
just financial in nature but extend into the sphere of policy-making around social
services. For instance, when the Health Department launched a "Ligtas Buntis
(Safe Pregnancy)" campaign two years ago, conservative Roman Catholics
protested because it had a family planning component. The same groups
strongly oppose sex education in schools, insisting on vague moralistic
messages about abstinence.
The third development that is having profound impact on the Filipino family is the
continuing massive diaspora. About one out of every five adult Filipinos is now
living overseas, either temporarily or as a permanent migrant. That proportion is
likely to increase, driven by unemployment and poverty at home.
Technically, the Filipino diaspora should also consider internal migration,
involving thousands of Filipinos who flock from rural to urban areas seeking jobs.
This includes the Muslim diaspora, involving thousands of migrants from
Mindanao who are now to be found in most major Philippine cities, something
unheard of just a decade ago.
Finally, a major development closely related to the third is the increasing
feminization of labor. At home, more women are joining the labor force, both in
the informal and formal sectors. From fast-food restaurants to the factories in
special economic zones, the job openings tend to be more for females than
males. For overseas placements, the demand is also skewed toward women,
particularly as domestic helpers, nurses, caregivers, and entertainers.
All four factors are interrelated, often in ways that may not be readily apparent.
For example, many of the nurses who leave to work overseas are older women,
forced to leave behind families. But besides the direct loss for families, their
departure also means a scarcity of trained frontline personnel in both public and
private health facilities jeopardizing the health of Filipino families.
Taken collectively, these four developments have already been reshaping
Filipino families over the last two decades. The years leading us into 2010 will
only see an intensification of these four factors, with mixed results. (Tan, M. L.,
2009)

The family case analysis is mainly directed on identifying and analyzing


the families’ past and present health status. The nursing process which includes
assessment, diagnosis, planning, implementation and evaluation are important
factors for the student nurses to accomplish the FCA’s goals which are geared
towards the family’s optimum level of functioning in order for them to be
productive and self-reliant members of the society in which they belong.
Cooperation of the family, maximizing use of resources and collaboration with the
health care team are essential parts in improving the health status of the family
as well as to alleviate the identified problems.
(familyimpactseminars.org/doc.asp?d=tfp_assign_familyimpactcsfia_kb.pdf)

The student nurses set criteria for choosing their adopted family for the
family case analysis. The family to be adopted must be depressed/ deprived, with
for or more children w/ at least one member belonging to 0-5 age bracket, with
visible poor environmental conditions and most of all, one which gives the
student nurses their consent for the FCA. The said criteria had been met
although the barangay health worker, and not student nurses, was the one who
chose the family to be adopted.

The adopted family is the “Imba Family” and is composed of 10 members, a


mother, a father, four sons and four daughters. The mother and father are not
married but they are living together. The parents are living together with their six
children; the other two children are living with their true father. They are living in a
rented room in Agapito, del Rosario Angeles City

A. Objectives

The following objectives were formulated in order to guide the


student nurses in the accomplishment of the Family Case Analysis:

SHORT TERM
Student-centered
After the first exposure to the community, the students will be able to:
 Set criteria for the family to be chosen
 Familiarize themselves with the physical setup of the community
 Collected data regarding the family’s demographic profile through
interview and other data that may be significant in identifying problems
 Identify the family’s problems and needs based on the analysis of the
data obtained
 Establish a good working relationship with their adopted family

Client-centered
After the first home visit, the family members will be able to:
 Accept the student nurses in an accommodating manner
 Familiarize themselves with the student nurses
 Provide the student nurses necessary information they need
 Recognize the actual and potential problems in their family with the help of
the student nurses
 Cooperate with the student nurses throughout the initial home visit

LONG TERM
Student-centered
At the end of the home visits, the student nurses will be able to:
 Accomplish thorough physical assessment of the whole family
 Work with the family in solving identified health problems
 Gave necessary health teachings and suggestions based on each family
member’s needs
 Evaluated family’s response to health teachings given

Client-centered
At the end of the home visits, the family members will be able to:
 Participate in the individual physical assessment
 Work with the student nurses in solving identified health and health related
problems
 Become responsive to the health teachings provided by the student
nurses
 Become self-reliant in managing identified health problems
 Utilize available resources in the community

RESEARCH-CENTERED
At the end of the home visits, the students shall be able to identify:
 The family’s demographic profile described as to:
a. Age
b. Sex
c. Position in the family
d. Educational status

 The family described as to:


a. Structure
b. Composition
c. Socio-economic status
d. Cultural and religious beliefs
e. Relationship to the larger community
 The family’s home and environment as to:
a. Housing
b. Sanitation facilities
c. Kind of neighborhood
d. Availability of social health
e. Communication facilities
f. Transportation facilities

 The family’s health status as to:


a. Current and past illnesses
b. Mother’s obstetrical history
c. Practices conducive to health and illnesses
d. Developmental status
e. body mass index
f. Physical assessment findings
g. Immunization status
h. Activities of daily living

 Values, habits and practices of the family on health promotion,


maintenance and disease prevention including:
a. Preventive services
b. Rest and sleep adequacy
c. Exercise
d. Relaxation activities
e. Stress management

 How may the problems encountered by the family be identified, classified


and prioritized
 How may the problems experienced by the family be formulated as family
nursing care plan
 How may the family coping index be evaluated

B. Entry, Climate of Acceptance, First Few Words, Number of Home


Visits

During the first day of exposure, November 12, 2009, in the community of
Agapito del Rosario, Angeles City, Pampanga, the Group 41 of BSN 2-9 was
consign to find and choose a family that will suit their set criteria wherein the
chosen criteria should be underserved, deprived and depressed, with at least
seven family members, a family who needs improvement with their health status
and very willing to cooperate and accept changes especially in their health
practices for the group’s requirement, the Family Case Analysis.

At first, the group discussed about their set of criteria for the family that they
are about to adopt. When they all agreed upon the criteria, they divided
themselves into three subgroups. Fortunately for the group, the Brgy. Health
Worker had already chosen beforehand some families that meet the criteria of
the student nurses for their Family Case Analysis.

On the first day of home visit, the BHW accompanied the student nurses on
their way to the families that were assigned to them. The student nurses
immediately conversed with them. “Hood morning po ‘nay”, were the first few
words that the student nurses uttered to their chosen family. The mother greeted
them back willingly and without hesitation and said, “Good morning din, ano
yun?”. The student nurses introduced themselves as 2nd year nursing students
from Angeles University Foundation and explained their purpose. The group
asked the family if they could have a series of interaction with them which they
gladly agreed upon.
Home Visits

1st Home Visit: November 12, 2009

On the first hime visit, the group set the following objectives:
At the end of the ocular visit, the student nurses shall be able to:
1. Identify a family based on the criteria
2. Establish a good working relationship with the family
3. Explain their purpose of visiting and made a contract about their
available time
4. Put into practice the therapeutic communication technique in gathering
data and ideas from the family
5. Assess the family members and obtain baseline data

During the first day of exposure, November 12, 2009, the student nurses from
Group 41 of BSN 2-9, together with their respective clinical instructor, Mr. Ronnie
Romero had their courtesy call with the Brgy. Officials.

Even if it’s first time for the student nurses to be exposed in community home
visits, their clinical instructor still guided them and gave them advices on what
they should do during the home visits. Their clinical instructor gave them tips on
how to interact with the family that they are to adopt.

The student nurses did not have difficulty in finding a family to adopt because
it is the barangay health worker who had chosen beforehand those families that
are to be adopted since they satisfy all the criteria that has been set by the
student-nurses. These criteria are family with four or more children, with a
member whose age is 0-5, poor environment and housing, depressed and
deprived, and the family should consent the student nurses.

The assigned family for the half of Group 41 was the Imba family. Their house
is located in a compound, one street away from the Brgy. Heath Center. The way
through the house is dirty and smells stinky, there are laundry basins scattered.
There are also lots of suspended clothes. When the student nurses finally
reached the house, they greeted the owner. They immediately established
rapport with the family. They explained the purpose that they need them as an
adopted family and that they will perform some interventions in accordance to the
different health and health-related problems that they may encounter and that it
may last until for 2 weeks until before the end of the rotation in the community.
They’ve explained that they will be conducting home visits during Thursdays and
Fridays. The family agreed to the proposal and was very compliant. They
assessed the family members and also their environment. The family was
cooperative and answered all the questions being asked by the student nurses.

2nd Home Visit: November 13, 2009

On the second home visit, the group set the following objectives:
At the end of the 2nd home visit, the student nurses shall be able to:
1. Identify and observed both the actual and potential problems with the
family
2. Perform physical assessment to the all the family members
3. Identify new problems through the continuous physical assessment of
the family members
4. Plan on the needed interventions on the problems identified in the
family
5. Provide health teachings to the family

On the second home visit, the student nurses were tasked to perform
thorough physical assessment on each of the family members. When the student
nurses came on the house of the adopted family, the mother is out for collecting
bets for jueteng , which is the family’s source of living. The student nurses had
only seen the children, Tzu, Tri, Sixtu, Seven and Baby Eight. Tzu was taking
care of her brother, Baby Eight during the time their mother was not at home.

The student nurses performed thorough physical assessment and cranial


nerves assessment for each of the family members for obtaining baseline data
and identifying actual and potential problems. Whiles some of the srudent nurses
are performing physical assessment, the others are assessing the housing
condition, sanitation, floor area, ventilation, lighting, and the like.
Only Juliana and Julieta were at home then. The other siblings were at school
and Mr. Nicanor was at work. Because of that, physical assessment was only
performed on Mrs.Luisita, Juliana, and Julieta who were present that time.

After performing physical assessment and cranial nerve assessment, the


student nurses measured the height and weight of the present family members in
order to compute for their Body Mass index. It was evident that all of the
members that were present were undernourished. It was noticeable because of
their physical features.

After that, the student nurses initiated an interview of the mother’s obstetrical
history and if her children suffered any illnesses in the past. The students also
asked about the family’s ADL’s and how they manage their income.

3rd Home Visit: November 19, 2009

On the third home visit, the group set the following objectives:
At the end of the 3rd home visit, the student nurses shall be able to:
1. Continue the physical assessment
2. Identify problems that are related to health
3. Identify health threats, health deficits and foreseeable crisis situations that
may affect the health of the family
4. Identify the etiology of the identified problems
5. Provide health teachings on how to promote health and prevent diseases
6. Perform interventions to attain a clean and healthy home environment

During the third home visit, the student nurses performed continued
assessment and started to intervene with the identified health problems. The
family seemed cooperative and was very compliant with the health teachings
provided by the student nurses.
The house is too small and poorly ventilated and may be a cause of spread of
communicable diseases among the family members. The students also observed
that they have limited utensils and that the children only drink in one glass which
can be a cause of cross contamination.

There are some pointed and sharp objects that are at reach of children that
may cause injuries/ accidents. The gas stove is also at reach of small children
which may cause fire.

The student nurses gave the family health education and instructed them to
follow safety measures. Also, the student nurses assisted the children in bathing.

4th Home Visit: November 20, 2009

On the fourth home visit, the group set the following objectives:
1. Continue thorough physical assessment with the family
2. Gave health teachings and performed nursing interventions
3. Assess the interventions performed on the previous home visits
4. Assess the improvement on the health of each of the family members and
their environment
During the final home visit, the student nurses performed the final physical
assessment of the family members. Again, they bathed the children with
shampoo and soap. The children verbalized that they do not usually use
shampoo in bathing since they cannot afford to buy shampoo. They usually
use soap in replacement for shampoo.

After bathing the children, the student nurses trimmed the children’s dirty
nails and taught them how to promote health and prevent diseases using
simple ways like not walking barefooted and taking a bath everyday.
The housing condition improved in a way that the environment became
cleaner as compared during the initial assessment. Sharp objects were
already placed and kept out of reach of children. Mother already cooked
healthy viands such as vegetables. The change in the attitude of the family is
believed to be affected by the student nurses’ health teachings to the family.

Chapter II
Family Constellation

In this part of the Family Case Analysis, the demographic profile of the
members of the family are stated like name, age, position in the family, sex
and educational attainment. It also includes present health status which
describes the general appearance, mental status, physical assessment,
presence of illness, nutritional status, vital signs and immunization status for
0-12 months.
NAME AGE POSITION SEX EDUCATIONAL PRESENT HEALTH
ATTAINMENT STATUS

Mr. Itay 54 Father Male College He was only present


Undergraduate on the final home visit
(2nd yr college) (Nov. 20,2009)

GENERAL
APPEARANCE
During the day of
the assessment, he was
wearing a pair of dark
blue pants and white
shirt. He was also
wearing a pair of
slippers.

Upon
assessment, Mr. Itay has
proportionate body built,
coordinated movements.
He speaks clearly which
can be easily understood
by the group and he also
exhibits thought
coordination, appears
dirty. He is cooperative
when being asked and
answers appropriately to
the question.

MENTAL STATUS
He is oriented to
time, person and place.
He responded normally
to what the student
nurses asked.

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS
• Thinning of hair
• Presence of
excessive
cerumen
• Dark colored lips
and gums
• Presence of
halitosis
• Discoloration of
teeth

NUTRITIONAL STATUS
Wt: 65kg
Ht: 61in
BMI:27.08
(overweight)

VITAL SIGNS
T- 36.2C
PR- 84bpm
RR-17cpm
BP- 110/90mmHg

Mrs. Ina 34 Mother Female High school INITIAL ASSESSMENT


undergraduate
(2nd year high GENERAL
school) APPEARANCE
During the day of
the assessment, she
was wearing a pair of
brown short and blue t-
shirt. She was also
wearing a pair of
slippers.

Upon
assessment, Mrs. Ina
has proportionate body
built, coordinated
movements. She speaks
clearly which can be
easily understood by the
group and she also
exhibits thought
coordination, appears
dirty. She is cooperative
when being asked and
answers appropriately to
the question.
MENTAL STATUS
She is oriented to time,
person and place.
Mother’s facial
expression is
appropriate for her
words.
Her responses to
questions are
appropriate and her
organization of thoughts
are good and relevant

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS

• Teeth yellow in
color, and dental
caries noted on
the right lower
premolars and
first molar.

• presence stretch
marks
• With adventitious
breath sounds
noted upon
auscultation
PRESENCE OF
ILLNESS
none

NUTRITIONAL STATUS
Wt: 56kg
Ht: 63in
BMI: 21.875
(normal)
VITAL SIGNS
T- 36.2C
PR- 70bpm
RR-21cpm
BP- 90/60mmHg
Juan 13 Eldest Male Going to school INITIAL ASSESSMENT
child (Grade 5)
NOT SEEN
(AT SCHOOL)

Tzu 11 2nd eldest Female Not Going to INITIAL ASSESSMENT


child school
(Grade 4) GENERAL
APPEARANCE
During the day of
the assessment, Tzu
appeared in a violet
shorts and a printed
sleeveless shirt. She
was also wearing a pair
of slippers.

Upon
assessment, Tzu has
proportionate body built,
coordinated movements.
She speaks clearly
which can be easily
understood by the group
and she also exhibits
thought coordination,
appears dirty. She is
cooperative when being
asked and answers
appropriately to the
question.

MENTAL STATUS
She is oriented to
time, person and place.
Her facial expression is
appropriate for her
words.
Her responses to
questions are
appropriate and her
organization of thoughts
are good and relevant

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS

• Dry skin
• Dirty untrimmed
nails

• Thin, untidy,
uncombed hair

• Presence of
pediculosis

• Scars on her feet

• Calluses on the
feet

• Dental carries

PRESENCE OF
ILLNESS
none

NUTRITIONAL STATUS
Wt: 32kg
Ht: 56in
BMI:15.84

VITAL SIGNS
T- 36.8C
PR- 85bpm
RR-31cpm
Tri 8 3rd child Female Going to school INITIAL ASSESSMENT
Elementary
(Grade 3) NOT SEEN
(STAYS AT A
RELATIVE IN SAN
FERNANDO)
Por 5 4th child Female NEVER BEEN INITIAL ASSESSMENT
TO SCHOOL
GENERAL
APPEARANCE
During the day of the
assessment, she was
seen playing with her
playmates and was
wearing a pair of white
shorts and white shirt.
She was also wearing a
pair of slippers.

Upon
assessment, Por has
proportionate and small
body built, coordinated
movements nad has
dark complexion. She
speaks not so clearly but
can be easily understood
by the group and she
also exhibits thought
coordination, appears
dirty. She is cooperative
when being asked and
answers appropriately to
the question.

MENTAL STATUS
She is kind
enough to participate in
the course of her
physical examination
and answers
appropriately when
asked by the student
nurse

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS
• Yellowish green
mucous
• difficulty in
breathing
• presence of
pediculosis
• dental carries in
the upper incisors

PRESENCE OF
ILLNESS
Presence of coughs and
colds
NUTRITIONAL STATUS
Wt:13kg
Ht: 105cm
IRS: below normal

VITAL SIGNS
T-36.1
PR-101 bpm
RR-26 cpm

Pip 4 5th child Male NEVER BEEN INITIAL ASSESSMENT


TO SCHOOL NOT SEEN
(STAYS AT A
RELATIVE IN
ANGELES CITY)
th
Sixtu 3 6 child Male NEVER BEEN INITIAL ASSESSMENT
TO SCHOOL GENERAL
APPEARANCE
During the initial
home visit, He wears a
green shirt and a ragged
short. His nails were
untidy and he keeps on
biting them. He has an
unkempt hair, dirt on his
hands and feet are
present. He has a good
posture.
MENTAL STATUS
He is talkative and
cooperative for his age.
He responds actively to
the student nurses’
questions

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS
• Yellowish green
mucous
• difficulty in
breathing
• (+) rales

PRESENCE OF
ILLNESS
Presence of coughs and
colds
NUTRITIONAL STATUS
Wt: 12kg
Ht: 95cm
IRS:normal
VITAL SIGNS
T-36.5
PR-108 bpm
RR-24 cpm
Seven 1 7th child Female NEVER BEEN INITIAL ASSESSMENT
TO SCHOOL
GENERAL
APPEARANCE
During the initial
home visit, she wears a
dirty shirt without
undergarments. Her
nails were untidy and
she walks barefooted.
She has an unkempt
appearance. She has a
good posture.
Upon
assessment, Seven has
small body built and has
fair complexion. She still
cannot speak and
hesitates to cooperate at
first.

MENTAL STATUS
When spoken to
Seven, she appears
irritable and does not
respond to the student
nurses

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS
• Yellowish green
mucous
• difficulty in
breathing
• dirty untrimmed
nails
• presence of
wheezes
• has a productive
cough
NUTRITIONAL STATUS
Wt:8kg
Ht: 73 cm
BMI: normal

VITAL SIGNS
T- 37.2
PR- 122 bpm
RR- 37.2 cpm
Baby eight 6 Youngest Male NEVER BEEN INITIAL ASSESSMENT
months child TO SCHOOL
GENERAL
APPEARANCE
Upon initial
assessment, baby eight
was noticed to be
wearing an untidy white
boxer and no
undergarments. He was
being carried by Tzu. He
looked restless and was
crying.

PHYSICAL
ASSESSMENT
ABNORMAL FINDINGS
• Presence of
coughs and colds
• Presence of skin
lesions on the
lower extremities
• Presence of
yellowish green
mucous
• He skin is reddish
right at his gluteus
maximus
• Presence of
hyperthermia

PRESENCE OF
ILLNESS
Coughs and colds
NUTRITIONAL STATUS
Wt: 5lg
Ht: 40in
IRS: below normal

VITAL SIGNS
T- 36.5C
PR- 112bpm
RR-24 cpm
CHAPTER III
Health Assessment

This chapter contains the health assessment of each family member. A


complete health assessment may be conducted using cephalocaudal pattern
(head-to-toe assesment). It is the systematic and efficient manner of evaluating
the body and its function. In assessing the client, we are using the methods-
INSPECTION, PALPATION, PERCUSSION, and AUSCULTATION. But when
assessing the abdomen, it is the other way around- INSPECTION,
AUSCULTATION, PERCUSSION, and, PALPATION.

The purpose of this physical assessment is to obtain data about the


client’s functional ability. It would also help the nurse to make a diagnosis and
care plans for the client. It can also help the nurse to evaluate the client’s health
problem. The data would help the nurse in determining appropriate interventions.

Physical Assessment
Name: Itay
Age: 53 yrs old
Height: 61 Inches
Weight: 65 kg
November 20, 2009 (Last Day of Assessment of father)
He was only present on the last day of the assessment
Vital Signs:
Temperature: 36.2° C
Pulse Rate: 84 beat per minute
Respiratory Rate: 17 cycles per minute
Blood Pressure=110/90 mmHg

General Appearance:
During the final home visit, upon seeing Itay, he wears a white shirt and
dark blue pants. His hair is short and neat. His skin is brown and there were no
lesions or scars seen. Itay’s facial expression is appropriate for his words. His
responses to questions are appropriate and his organization of thoughts is good
and relevant. His posture and gait, is good.

The Integument

Skin
Upon inspection, Itay has a dark complexion but uniform in color. There
are no signs of any discolorations. His skin was warm and soft to touch. He has a
good skin turgor, when his skin is pinched, it returned into its place immediately,
and no presence of edema. There is no foul odor and no excessive perspiration.

Hair
The color of his hair is black and evenly distributed. There are no
infestations and scaling but there is thinning of hair.

Nails
Upon inspection, his nails are pinkish and have a convex curve. His nails
are hard, smooth, and immobile. It has a capillary refill of less than 4 seconds.

The Skull
Upon inspection of Itay’s head, it is rounded and normocephalic. Upon
palpation, there is no presence of lumps.

The Face
Upon inspection, Itay has a symmetrical face and her facial feature is
symmetrical also. His skin is intact and there is no presence of edema.

The Eyes and Vision


Upon inspection, Itay’s eyebrows are aligned and the hair is evenly
distributed. His eyebrows’ movement is equal.
Itay’s eyelashes are evenly distributed and are curled slightly outward.
Upon inspection of the eyelids, skin is intact, moist and pink, and no discharge.
His involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctiva, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, Itay felt no
tenderness.
Upon inspection of Itay’s cornea, it is observed to be transparent, smooth,
moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimeters.

The Ear and Hearing


Upon inspection, Itay’s auricles have a color same as facial skin. His
auricles are aligned with the outer cantus of the eye. Upon palpation, his auricles
are mobile, firm, and non tender. The pinna recoils after being folded.
• In assessing the external ear canal, there is presence of excessive
cerumen.

The Nose and Sinuses

Upon inspection, Itay’s nose has same color of his face. The nasal septum
is in the midline. In assessing the patency of nasal cavities, the air moves freely
when the client breaths though each nares. There is no difficulty of breathing as
observed by the student nurse and as stated by Itay. And upon palpation, no
tenderness in the maxillary and frontal sinuses.

The Mouth and Oropharynx

Upon inspection, the lips are dark in color. The gums are dark in color.
Itay has complete set of teeth, yellow in color.

The tongue is in the center, it is pink in color, moist, slightly rough, and
has no lesions. He does not have difficulty in moving his tongue. The uvula is
located in the midline of the soft palate.
Upon inspection of oropharynx and tonsils, it is observed to be pink,
smooth and no discharge noted, and no inflammation. There is presence of
halitosis and discoloration of teeth.

Neck

The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. He was able to turn his head on one side against the resistance and
the same with the other side. He was able to shrug his shoulders against the
resistance of the hands of student nurse.

The Lymphnodes

Upon inspection of the entire neck, there is no enlargement and lymph


nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.

The Thorax and Lungs


Upon inspection, full and symmetric chest expansion noted while the client
is breathing. No adventitious breath sounds noted upon auscultation. Breathing
pattern is quiet, rhythmic and effortless respiration.
Upon chest auscultation, no adventitious sounds heard on both lung fields.
The Heart
Upon assessing the heart, there is no any abnormal pulsation. The jugular
veins are not distended.

Breast and Axillae


Itay’s breasts were even with the chest wall. Upon assessing, there was
no presence of tenderness, lumps, and lesions.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color.

The Muscle
Upon inspection, Itay’s muscles are equal in size on both sides of his
body.

Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.

Cranial Nerves Assessment

Cranial Nerve Test Expected Actual Result


Performed Result

I.OLFACTORY With both Correctly Itay was able to


eyes close, identifies scent identify the scents
Type: Sensory
ask the client presented to which are perfume,
Function: Sense of smell
to smell the each nostril and vinegar.
Materials used: perfume, different even if his
and vinegar scents like eyes were
perfume, and both closed.
vinegar.

II.OPTIC At a given At a given Itay was able to read


distance of 1 distance, the the newsprint clearly.
Type: Sensory
meter, ask the client must be
Function: Sense of Vision
client to read able to read
Materials used: newsprint the newsprint. the newsprint
without
difficulty.

III.OCULOMOTOR Instruct the Eyes must Pupils are equally


client to open move in a round reactive to light
Type: Motor
and close the smooth, and accommodation.
Function: constricts pupils
eyelids and coordinated He was able to open
when exposed to lights and
follow the motion in all and close his eyelids
ability to open and close
directions of directions. The and follow the
eyelids. Extraocular
penlight. This pupils of eyes directions of the
movement.
is a test for are dilated penlight.
Material used: penlight papillary without the
reaction. light and
constricts in
response to
light.

IV.TROCHLEAR Instruct the Without any Itay was able to move


client to look difficulty, the his eyes upward and
Type: Motor
upward and client must be downward without
Function: Upward and
downward. To able to move difficulty.
downward movement of the
assess his eyes
eyes.
direction of upward and
gaze. downward.

V.TRIGEMINAL Ask the client The clients Itay was able to


to open and must be able clench jaw and chew
clench jaw. to clench jaw without difficulty.
Type: Motor and Sensory
and chew Itay was able to elicit
Function: Jaw movement, The cotton is
properly.
chewing, and mastication; gently placed blinking reflex when
into lateral Must be able cotton was placed at
blinking reflex
side of the to elicit the side of his eyes.
Materials used: cotton
client’s eyes. blinking reflex.

VI.ABDUCENS Ask the client Client must be Itay was able to move
to move the able to move eyes laterally.
Type: Motor
eyes laterally. eyes laterally.
Function: Lateral
movement of the eye.

VII.FACIAL Instruct client Facial muscles Itay was able to


to smile, of the client perform the test
Type: Motor and Sensory
frown, and must work as properly.
Function: Facial muscle
raise he performs
movement; sense of taste
eyebrows. the procedure.
on the anterior two thirds of
Make use of The client
the tongue. Itay was able to
different must be able
identify the different
seasonings to identify the
taste presented.
like vinegar different taste.
and salt to test
taste of
sensation.

VIII.ACOUSTIC Ask the client The client Itay was able to


to repeat the must be able repeat the whispered
Type: Sensory
whispered to repeat the words which are
Function: Sense of hearing
words, “gwapo whispered “gwapo ako”.
ako”. words.

IX.GLOSSOPHARYNGEAL Instruct the The client Itay was able to


client to must be able swallow and move his
swallow or to swallow and mouth in a chewing
Type: Motor and Sensory
move mouth in chew properly movement without
Function: Pharyngeal
chewing without difficulty.
movement and swallowing;
motion. difficulty. Itay was able to
sense of taste on the
posterior one thirds of the Make use of Client must be identify the tastes
different taste able to identify which are vinegar and
tongue
and ask he the taste being salt.
client to presented.
Materials used: vinegar and identify each.
salt

X.VAGUS Ask the client The client Itay was able to


to say “ah” to must be able swallow properly and
Type: Motor and Sensory
swallow. to swallow elicit gag reflex.
Function: For speaking and
Using a properly and
swallowing and sensation
tongue elicit gag
on the posterior one-third
depressor reflex upon
of the tongue
stimulate the pressing the
Material used: tongue posterior part tongue.
depressor of the tongue.

XI. ACCESSORY Against the The client Itay was able to shrug
resistance must be able her shoulders against
Type: Motor
from the to shrug his resistance from the
Function: Shoulder muscle
student shoulders student nurse.
movement
nurses’ hands, against
ask the client resistance
to shrug his from the
shoulder. student
nurses’ hands.

XII.HYPOGLOSSAL Ask the client Client must be Itay was able to move
Type: Motor to move or able to move his tongue in different

Function: Movement of the protrude tongue in directions without


tongue in different difficulty.
tongue
different directions.
directions.

Nutritional Status

Itay is 53 years old, weighs 65 kilograms and stands 61 inches.

BMI = 65kg / (1.55m)2

= 65 kg / 2.40m2

= 27.08 kg/m2

BMI Range

Below 15 = emaciated

15-18.9 = underweight

19-24.9 = normal

25-29.9 = overweight

30-39.9 = obese

40-above = morbidly obese

Itay is considered to be overweight.

History of Past and Present Illness


Itay has no history of hospitalization. He hasn’t suffered from any serious
diseases except for common coughs and colds.

Activities of Daily Living

Itay wakes up at 5:30 am and prepares his self to work. At around 10-11
a.m he goes home to rest. If he is bored he goes around their streets and chat
with his friends and he usually sleeps at 9 p.m.

Eating Habits

He normally eats 2-3x a day. He eats breakfast at wotk and usually eats
Lunch and dinner with his family. He has no food preference, he eats whatever is
served.

Sleeping Pattern

Itay usually sleeps at 9:00 pm and wakes at 5:30 am. He takes short naps
at the afternoon.

Leisure Time

Itay usually has no leisure activities except for wathching his step children
play and taking care of his son. Other than that, he also chat with their
neighbours

Name: Ina
Age: 34 y/o
Height: 63 inches
Weight: 56kg
November 12, 2009 (1st Day of Assessment of mother)

Vital Signs:
Temperature: 36.2° C
Pulse Rate: 70 beat per minute
Respiratory Rate: 21 cycles per minute
Blood Pressure: 90/60 mmHg

General Appearance:
During the initial home visit, upon seeing Ina, she wears a blue shirt and
brown pants. Her hair is unkempt. Her skin is brown and there were no lesions or
scars seen. Mother’s facial expression is appropriate for her words. During that
time she has cough and colds. Her responses to questions are appropriate and
her organization of thoughts is good and relevant. Her posture and gait, standing
and walking is good.

The Integument

Skin
Upon inspection, Ina has a dark complexion but uniform in color. There
are no signs of any discolorations. Her skin was warm and soft to touch. She has
a good skin turgor, when her skin is pinched, it returned into its place
immediately, and no presence of edema. There is no foul odor and no excessive
perspiration.

Hair
The color of her hair is black and evenly distributed. There are no
infestations and scaling.
Nails
Upon inspection, her nails are pinkish and have a convex curve. Her nails
are hard, smooth, and immobile. It has a capillary refill of less than 4 seconds.

The Skull
Upon inspection of mother’s head, it is rounded and normocephalic. Upon
palpation, there is no presence of lumps.

The Face
Upon inspection, mother has a symmetrical face and her facial feature is
symmetrical also. Her skin is intact and there is no presence of edema.

The Eyes and Vision


Upon inspection, mother Ina’s eyebrows are aligned and the hair is evenly
distributed. Her eyebrows’ movement is equal.
Mother Ina’s eyelashes are evenly distributed and are curled slightly
outward. Upon inspection of the eyelids, skin is intact, moist and pink, and no
discharge. Her involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctiva, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, mother Ina felt no
tenderness.
Upon inspection of mother Ina’s cornea, it is observed to be transparent,
smooth, moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimeters.

The Ear and Hearing


Upon inspection, mother Ina’s auricles have a color same as facial skin.
Her auricles are aligned with the outer cantus of the eye. Upon palpation, her
auricles are mobile, firm, and non tender. The pinna recoils after being folded.
In assessing the external ear canal, there are no discharges and lesions.

The Nose and Sinuses

Upon inspection, mother Ina’s nose has same color of her face and no
nasal secretions. The nasal septum is in the midline. In assessing the patency of
nasal cavities, the air moves freely when the client breaths though each nares.
There is no difficulty of breathing as observed by the student nurse and as stated
by Mother Ina. And upon palpation, no tenderness in the maxillary and frontal
sinuses.

The Mouth and Oropharynx

Upon inspection, the lips are slightly pinkish and uniform in color. The
gums are pinkish. Mother Ina has complete set of teeth, yellow in color, and
dental caries noted on her teeth.

The tongue is in the center, it is pinkish, moist, slightly rough, and has no
lesions. Does not have difficulty in moving her tongue. The uvula is located in the
midline of the soft palate.

Upon inspection of Oropharynx and tonsils, it is observed to be Pink,


smooth and no discharge noted, and no inflammation.

Neck

The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. She was able to turn her head on one side against the resistance and
the same with the other side. She was able to shrug her shoulders against the
resistance of the hands of student nurse.

The Lymphnodes

Upon inspection of the entire neck, there is no enlargement and lymph


nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.

The Thorax and Lungs


Upon inspection, full and symmetric chest expansion noted while the client
is breathing. With adventitious breath sounds noted upon auscultation.
Breathing pattern is rhythmic and effortless respiration.
Upon chest auscultation, presence of adventitious sounds heard on both lung
fields.

The Heart
Upon assessing the heart, there were no abnormal pulsations. The jugular
veins are not distended.
Breast and Axilla
Upon assessing the breast, they are round, and not engorged, generally
symmetric. The skin color of the breast is uniform, smooth and intact. No
localized discoloration or hyper pigmentation noted. The size of the areola is
round and bilaterally the same. Color is brown, no mass or lesion or discharge
noted on the breast.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color. There are presence stretch marks on the lateral side of the abdomen.

The Muscle
Upon inspection, mother Ina’s muscles are equal in size on both sides of
her body.

Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.

Cranial Nerves Assessment

Cranial Nerve Test Expected Actual Result


Performed Result

I.OLFACTORY With both eyes Correctly Mother Ina was


close, ask the identifies scent able to identify
Type: Sensory
client to smell presented to the scents which
Function: Sense of smell
the different each nostril are perfume and
Materials used: perfume, scents like even if her eyes vinegar.
and vinegar perfume, and were both
vinegar. closed.

II.OPTIC At a given At a given Mother Ina was


distance of 1 distance, the able to read the
Type: Sensory
meter, ask the client must be newsprint clearly.
Function: Sense of
client to read able to read the
Vision
Materials used: the newsprint. newsprint
newsprint without
difficulty.

III.OCULOMOTOR Instruct the Eyes must Pupils are


client to open move in a equally round
Type: Motor
and close the smooth, reactive to light
Function: constricts
eyelids and coordinated and
pupils when exposed to
follow the motion in all accommodation.
lights and ability to open
directions of directions. The Mother Ina was
and close eyelids.
penlight. This is pupils of eyes able to open and
Extraocular movement.
a test for are dilated close her eyelids
Material used: penlight papillary without the light and follow the
reaction. and constricts directions of the
in response to penlight.
light.

IV.TROCHLEAR Instruct the Without any Mother Ina was


client to look difficulty, the able to move her
Type: Motor
upward and client must be eyes upward and
Function: Upward and
downward. To able to move downward
downward movement of
assess her eyes without difficulty.
the eyes.
direction of upward and
gaze. downward.

V.TRIGEMINAL Ask the client to The clients Mother Ina was

Type: Motor and Sensory open and must be able to able to clench
clench jaw. clench jaw and jaw and chew
Function: Jaw
chew properly. without difficulty.
movement, chewing, and
blinking The cotton is Must be able to Was able to elicit
mastication;
placed elicit blinking blinking reflex
reflex gently
into lateral side reflex. when cotton was
Materials used: cotton
placed at the
of the client’s side of her eyes.
eyes.

VI.ABDUCENS Ask the client to Client must be Mother Ina was


move the eyes able to move able to move
Type: Motor
laterally. eyes laterally. eyes laterally.
Function: Lateral
movement of the eye.

VII.FACIAL Instruct client to Facial muscles Mother Ina was

Type: Motor and Sensory smile, frown, of the client able to perform
and raise must work as he test properly.
Function: Facial muscle
eyebrows. she performs
movement; sense of
the procedure.
taste on the anterior two
The client must
thirds of the tongue. Mother Ina was
be able to
Make use of able to identify
identify the
different the different taste
different taste.
seasonings like presented.
vinegar and salt
to test taste of
sensation.

VIII.ACOUSTIC Ask the client to The client must Mother Ina was
repeat the be able to able to repeat
Type: Sensory
whispered repeat the the whispered
Function: Sense of
words, whispered words which are
hearing
“maganda ako”. words. “maganda ako”.

IX.GLOSSOPHARYNGE Instruct the The client must Mother Ina was


AL client to be able to able to swallow

Type: Motor and Sensory swallow or swallow and and move her
move mouth in chew properly mouth in a
Function: Pharyngeal
chewing without chewing
movement and
swallowing; sense of motion. difficulty. movement
taste on the posterior Client must be without difficulty.
one thirds of the tongue
Make use of able to identify Mother Ina was
different taste the taste being able to identify
her presented. the taste which is
Materials used: vinegar and ask
vinegar and salt.
and salt client to identify
each.

X.VAGUS Ask the client to The client must Mother Ina was

Type: Motor and Sensory say “ah” to be able to able to swallow


swallow. Using swallow properly and
Function: For speaking
a tongue properly and elicit gag reflex.
and swallowing and
depressor elicit gag reflex
sensation on the
stimulate the upon pressing
posterior one-third of the
posterior part of the tongue.
tongue
the tongue.
Material used: tongue
depressor

XI. ACCESSORY Against the The client must Mother Ina was
resistance from be able to shrug able to shrug her
Type: Motor
the student her shoulders shoulders
Function: Shoulder
nurses’ hands, against against
muscle movement
ask the client to resistance from resistance from
shrug her the student the student
shoulder. nurses’ hands. nurse.

XII.HYPOGLOSSAL Ask the client to Client must be Mother Ina was


move or able to move able to move her
Type: Motor
protrude tongue tongue in tongue in
Function: Movement of
in different different different
the tongue
directions. directions. directions without
difficulty.

Summary of Assessment (Day 2- Day 3)

From day 2 to day 3 of physical assessment, mother Ina was still


observed as untidy of herself and her hair is still unkempt. She is cooperative
when being asked and answers appropriately to the question.

Obstetrical History

Mother Ina had her first menstruation when she was 12 years old.
According to her, she has duration of an average of 1 week. Her obstetrical
history as of the present time is T8P0A0L8 which means that all her children are
full term, none of them are premature, and there are no cases of spontaneous or
induced abortion, also her children are all living or there is no cases of mortality
among her children. She delivered all her children via normal spontaneous
delivery. Also, mother stated that all of them are delivered pass the age of
viability. She has complete administration of her Tetanus Toxoid. During her
antepartum period, she regularly go to their health center for check-up. She
verbalized that she experienced no complications during her past pregnancies.
She eats any kinds of food, she did not crave, and though she experienced
nausea during her past pregnancies for the first trimester. She gave birth of all
her children at home and a midwife attended her needs. She has never been
hospitalized.

Nutritional Status

Mother Ina is 34 years old, weighs 56 kilograms and stands 63 inches.

BMI = 56kg / (1.60m)2

= 56 kg / 2.56
= 21.875 kg/m2

BMI Range

Below 15 = emaciated

15-18.9 = underweight

19-24.9 = normal

25-29.9 = overweight

30-39.9 = obese

40-above = morbidly obese

Mother Ina’s Body mass index is ranged as normal.

History of Past and Present Illness

Mother Ina has no history of hospitalization. She hasn’t suffered from any
serious diseases except for common cough and colds. She just waits for the
cough and colds to disappear or sometimes she goes to their health center to
ask for medicines.

Activities of Daily Living

Mother Ina usually wakes up at 6:00 am and then she prepares herself to
go to her work. She prepares breakfast when she comes home at around 9-10
a.m. and if she has money. At 12:00 noon, she will cook for lunch. After having
lunch, she will wash the dishes. After attending all the household chores, she will
take a rest with her children. By 7 p.m., she will cook for dinner. They usually
sleep at around 8:00-9:00 pm.
Eating Habits

Mother Ina usually eats 2-3x a day. Often times she skip breakfast or
sometimes she eats bread and coffee before she go. During lunch and dinner
she eats with her family.

Sleeping Pattern

Mother Ina usually sleeps at 8:00 pm and wakes at 6:00 am. She sleeps
beside her youngest child baby eight. During afternoon, she will take nap for at
least 2-3 hours.

Leisure Time

Mother Ina usually has no leisure activities except for listening to music
and arranging their small room. Apart from that, there are no other leisure
activities that she does in order to relieve day to day stress

Name: Tzu
Age: 11 y/o
Height: 56 inches
Weight: 32 kg
November 12, 2009 (1st Day of Assessment of Tzu)

Vital Signs:
Temperature: 36.8° C
Pulse Rate: 85 beat per minute
Respiratory Rate: 31 cycles per minute

General Appearance:
During the initial home visit, upon seeing Tzu, she was wearing a printed
sleeveless shirt and violet shorts. She has good posture and gait. She looks like
a little tired. She has unkempt appearance.

The Integument

Skin
Upon inspection, Tzu has a dark complexion but uniform in color. There
are no signs of any discolorations. Her skin was warm and dry to touch. She has
a good skin turgor, when her skin is pinched, it returned into its place
immediately, and no presence of edema. There is no foul odor and no excessive
perspiration.

Hair
The color of her hair is black and evenly distributed. With infestations
noted on her hair.

Nails
Upon inspection, her nails are pinkish and have a convex curve. Her nails
are hard, smooth, and immobile. It has a capillary refill of less than 4 seconds.

Dirty untrimmed nails

The Skull
Upon inspection of Tzu’s head, it is rounded and normocephalic. Upon
palpation, there is no presence of lumps.

The Face
Upon inspection, Tzu has a symmetrical face and her facial feature is
symmetrical also. Her skin is intact and there is no presence of edema.
The Eyes and Vision
Upon inspection, Tzu’s eyebrows are aligned and the hair is evenly
distributed. Her eyebrows’ movement is equal.
Tzu’s eyelashes are evenly distributed and are curled slightly outward.
Upon inspection of the eyelids, skin is intact, moist and pink, and no discharge.
Her involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctiva, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, Tzu felt no
tenderness.
Upon inspection of Tzu’s cornea, it is observed to be transparent, smooth,
moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimetres.

The Ear and Hearing


Upon inspection, Tzu’s auricles have a color same as facial skin. Her
auricles are aligned with the outer cantus of the eye. Upon palpation, her auricles
are mobile, firm, and non tender. The pinna recoils after being folded.
In assessing the external ear canal, there are no discharges and lesions.

The Nose and Sinuses

Upon inspection, Tzu’s nose has same color of her face and has a whitish
nasal secretions. The nasal septum is in the midline. In assessing the patency of
nasal cavities, the air moves freely when the client breaths through each nares.
There is no difficulty of breathing as observed by the student nurse and as stated
by Tzu. And upon palpation, no tenderness in the maxillary and frontal sinuses.
The Mouth and Oropharynx

Upon inspection, the lips are slightly pinkish and uniform in color. The
gums are pinkish. Seven has complete set of teeth, yellow in color, and dental
caries noted on the teeth.

The tongue is in the center, it is pink in color, moist, slightly rough, and
has no lesions. She does not have difficulty in moving her tongue. The uvula is
located in the midline of the soft palate.

Upon inspection of oropharynx and tonsils, it is observed to be pink,


smooth and no discharge noted, and no inflammation.

Neck

The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. She was able to turn her head on one side against the resistance and
the same with the other side. She was able to shrug her shoulders against the
resistance of the hands of student nurse.

The Lymphnodes

Upon inspection of the entire neck, there is no enlargement and lymph


nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.

The Thorax and Lungs


Upon inspection, full and symmetric chest expansion noted while the client
is breathing. No adventitious breath sounds noted upon auscultation. Breathing
pattern is quiet, rhythmic and effortless respiration.
Upon chest auscultation, no adventitious sounds heard on both lung fields.

The Heart
Upon assessing the heart, there is no any abnormal pulsation. The jugular
veins are not distended.

Breast and Axilla


Seven’s breasts were even with the chest wall. Upon assessing, there was
no presence of tenderness, lumps, and lesions.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color.

The Muscle
Upon inspection, seven’s muscles are equal in size on both sides of her
body.

Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.
Cranial Nerves Assessment

Cranial Nerve Test Expected Actual Result


Performed Result

I.OLFACTORY With both Correctly Tzu was able to


eyes close, identifies scent identify the
Type: Sensory
ask the client presented to scents which are
Function: Sense of smell
to smell the each nostril perfume, and
Materials used: perfume, different even if her vinegar.
alcohol, and vinegar scents like eyes were
perfume, and both closed.
vinegar.

II.OPTIC At a given At a given Tzu was able to


distance of 1 distance, the read the
Type: Sensory
meter, ask the client must be newsprint
Function: Sense of
client to read able to read clearly.
Vision
the newsprint. the newsprint
Materials used: without
newsprint difficulty.

III.OCULOMOTOR Instruct the Eyes must Pupils are


client to open move in a equally round
Type: Motor
and close the smooth, reactive to light
Function: constricts
eyelids and coordinated and
pupils when exposed to
follow the motion in all accommodation.
lights and ability to open
directions of directions. The She was able to
and close eyelids.
penlight. This pupils of eyes open and close
Extraocular movement.
is a test for are dilated her eyelids and
Material used: penlight papillary without the follow the
reaction. light and directions of the
constricts in penlight.
response to
light.

IV.TROCHLEAR Instruct the Without any Tzu was able to


client to look difficulty, the move her eyes
Type: Motor
upward and client must be upward and
Function: Upward and
downward. To able to move downward
downward movement of
assess her eyes without difficulty.
the eyes.
direction of upward and
gaze. downward.

V.TRIGEMINAL Ask the client The clients Tzu was able to

Type: Motor and Sensory to open and must be able clench jaw and
clench jaw. to clench jaw chew without
Function: Jaw
and chew difficulty.
movement, chewing, and The cotton is
properly.
blinking gently placed Tzu was able to
mastication;
into lateral Must be able elicit blinking
reflex
side of the to elicit reflex when
Materials used: cotton
client’s eyes. blinking reflex. cotton was
placed at the
side of her eyes.

VI.ABDUCENS Ask the client Client must be Tzu was able to


to move the able to move move eyes
Type: Motor
eyes laterally. eyes laterally. laterally.
Function: Lateral
movement of the eye.

VII.FACIAL Instruct client Facial muscles Tzu was able to

Type: Motor and Sensory to smile, of the client perform the test
frown, and must work as properly.
Function: Facial muscle
raise she performs
movement; sense of
eyebrows. the procedure.
taste on the anterior two
The client
thirds of the tongue. Tzu was able to
must be able
to identify the identify the

Make use of different taste. different taste


presented.
different
seasonings
like vinegar
and salt to test
taste of
sensation.

VIII.ACOUSTIC Ask the client The client Tzu was able to


to repeat the must be able repeat the
Type: Sensory
whispered to repeat the whispered words
Function: Sense of
words, whispered which are
hearing
“maganda words. “maganda ako”.
ako”.

IX.GLOSSOPHARYNGE Instruct the The client Tzu was able to


AL client to must be able swallow and

Type: Motor and Sensory swallow or to swallow and move her mouth
move mouth in chew properly in a chewing
Function: Pharyngeal
chewing without movement
movement and
motion. difficulty. without difficulty.
swallowing; sense of
taste on the posterior Make use of Client must be Tzu was able to
different taste able to identify identify the
one thirds of the tongue
and ask he the taste being tastes which are
client to presented. vinegar and salt.
Materials used: vinegar identify each.
and salt

X.VAGUS Ask the client The client Tzu was able to

Type: Motor and Sensory to say “ah” to must be able swallow properly
swallow. to swallow and elicit gag
Function: For speaking
Using a properly and
and swallowing and tongue elicit gag reflex.
sensation on the depressor reflex upon
posterior one-third of the stimulate the pressing the
tongue posterior part tongue.

Material used: tongue of the tongue.


depressor

XI. ACCESSORY Against the The client Tzu was able to


resistance must be able shrug her
Type: Motor
from the to shrug her shoulders
Function: Shoulder
student shoulders against
muscle movement
nurses’ hands, against resistance from
ask the client resistance the student
to shrug her from the nurse.
shoulder. student
nurses’ hands.

XII.HYPOGLOSSAL Ask the client Client must be Tzu was able to


to move or able to move move her tongue
Type: Motor
protrude tongue in in different
Function: Movement of
tongue in different directions
the tongue
different directions. without difficulty.
directions.

Nutritional Status

Tzu is 11 years old, weighs 32 kilograms and stands 56 inches.

BMI = 32kg / (1.42m)2

= 32 kg / 2.02m2

= 15.84 kg/m2

BMI Range
Below 15 = emaciated

15-18.9 = underweight

19-24.9 = normal

25-29.9 = overweight

30-39.9 = obese

40-above = morbidly obese

Tzu’s Body Mass Index is ranged as underweight.

Summary of Assessment (Day 2- Day 4)

From day 2 to day 4 of physical assessment, Tzu was still observed as


untidy of herself and her hair is still unkempt. She is cooperative when being
asked and answers appropriately to the question

History of Past and Present Illness

Tzu has no history of hospitalization. She hasn’t suffered from any serious
diseases except for common cough and colds.

Activities of Daily Living

Tzu usually wakes up 6:30 a.m. or sometimes if her youngest brother


wakes up, she would be forced to wake up and take care of her brother. Tzu
does not go to school because her mother can’t afford to let her go to school.
She plays with her siblings and most of the time she takes care of them all day
when her mother is out to work. And at around 8 p.m., she sleeps.

Eating Habits

Tzu eats 2-3x a day. Sometimes she doesn’t eat breakfast because they
do not have money to buy food for breakfast. She eats lunch and dinner and as
stated by her, she doesn’t have any food preference, whatever her mother
serves she eats.

Sleeping Pattern

Tzu usually sleeps at 8:00 pm at wakes at 6:30 am everyday. She usually


sleep again at the afternoon when her youngest brother sleeps.

Leisure Time

Tzu usually play with her siblings and neighbours and listens to music.
Even though she wants to watch TV, they do not have one.

Tri was not seen because he already lives at her relatives in San Fenando
City.

Name: Por
Age: 5 y/o
Height: 105cm
Weight: 13 kg
November 12, 2009 (1st Day of Assessment of Tzu)

Vital Signs:
Temperature: 36.1° C
Pulse Rate: 101 beat per minute
Respiratory Rate: 26 cycles per minute

General Appearance:
During the day of the assessment, she was seen playing with her playmates and
was wearing a pair of white shorts and white shirt. She was also wearing a pair of
slippers.

Upon assessment, Por has proportionate and small body built,


coordinated movements nad has dark complexion. She speaks not so clearly but
can be easily understood by the group and she also exhibits thought
coordination, appears dirty. She is cooperative when being asked and answers
appropriately to the question.

The Integument

Skin
Upon inspection, Por has a dark complexion but uniform in color. There
are no signs of any discolorations. Her skin was warm and dry to touch. She has
a good skin turgor, when her skin is pinched, it returned into its place
immediately, and no presence of edema. There is no foul odor and no excessive
perspiration.

Hair
The color of her hair is black and evenly distributed. With infestations
noted on her hair.

Nails
Upon inspection, her nails are pinkish and have a convex curve. Her nails
are hard, smooth, and immobile. It has a capillary refill of less than 4 seconds.

Dirty untrimmed nails

The Skull
Upon inspection of Por’s head, it is rounded and normocephalic. Upon
palpation, there is no presence of lumps.

The Face
Upon inspection, Por has a symmetrical face and her facial feature is
symmetrical also. Her skin is intact and there is no presence of edema.

The Eyes and Vision


Upon inspection, Por’s eyebrows are aligned and the hair is evenly
distributed. Her eyebrows’ movement is equal.
Por’s eyelashes are evenly distributed and are curled slightly outward.
Upon inspection of the eyelids, skin is intact, moist and pink, and no discharge.
Her involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctiva, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, Tzu felt no
tenderness.
Upon inspection of Por’s cornea, it is observed to be transparent, smooth,
moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimetres.

The Ear and Hearing


Upon inspection, Por’s auricles have a color same as facial skin. Her
auricles are aligned with the outer cantus of the eye. Upon palpation, her auricles
are mobile, firm, and non tender. The pinna recoils after being folded.
In assessing the external ear canal, there are no discharges and lesions.
The Nose and Sinuses

Upon inspection, Por’s nose has same color of her face and has a
yellowish green. The nasal septum is in the midline. In assessing the patency of
nasal cavities, the air moves freely when the client breaths through each nares.
There is difficulty of breathing as observed by the student nurse and as stated
by Por. And upon palpation, no tenderness in the maxillary and frontal sinuses.

The Mouth and Oropharynx

Upon inspection, the lips are slightly pinkish and uniform in color. The
gums are pinkish. Seven has complete set of teeth, yellow in color, and dental
caries noted on the teeth.

The tongue is in the center, it is pink in color, moist, slightly rough, and
has no lesions. She does not have difficulty in moving her tongue. The uvula is
located in the midline of the soft palate.

Upon inspection of oropharynx and tonsils, it is observed to be pink,


smooth and no discharge noted, and no inflammation.

Neck

The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. She was able to turn her head on one side against the resistance and
the same with the other side. She was able to shrug her shoulders against the
resistance of the hands of student nurse.

The Lymphnodes
Upon inspection of the entire neck, there is no enlargement and lymph
nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.
The Thorax and Lungs
Upon inspection, full and symmetric chest expansion noted while the client
is breathing. No adventitious breath sounds noted upon auscultation. Breathing
pattern is quiet, rhythmic and effortless respiration.
Upon chest auscultation, no adventitious sounds heard on both lung fields.

The Heart
Upon assessing the heart, there is no any abnormal pulsation. The jugular
veins are not distended.

Breast and Axilla


Seven’s breasts were even with the chest wall. Upon assessing, there was
no presence of tenderness, lumps, and lesions.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color.

The Muscle
Upon inspection, seven’s muscles are equal in size on both sides of her
body.
Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.

Cranial Nerves Assessment

Cranial Nerve Test Expected Actual Result


Performed Result

I.OLFACTORY With both Correctly Por was able to


eyes close, identifies scent identify the
Type: Sensory
ask the client presented to scents which are
Function: Sense of smell
to smell the each nostril perfume, and
Materials used: perfume, different even if her vinegar.
alcohol, and vinegar scents like eyes were
perfume, and both closed.
vinegar.

II.OPTIC At a given At a given Por was able to


distance of 1 distance, the read the
Type: Sensory
meter, ask the client must be newsprint
Function: Sense of
client to read able to read clearly.
Vision
the newsprint. the newsprint
Materials used: without
newsprint difficulty.

III.OCULOMOTOR Instruct the Eyes must Pupils are


client to open move in a equally round
Type: Motor
and close the smooth, reactive to light
Function: constricts eyelids and coordinated and
pupils when exposed to follow the motion in all accommodation.
lights and ability to open directions of directions. The She was able to
and close eyelids. penlight. This pupils of eyes open and close
Extraocular movement. is a test for are dilated her eyelids and
papillary without the follow the
Material used: penlight
reaction. light and directions of the
constricts in penlight.
response to
light.

IV.TROCHLEAR Instruct the Without any Por was able to


client to look difficulty, the move her eyes
Type: Motor
upward and client must be upward and
Function: Upward and
downward. To able to move downward
downward movement of
assess her eyes without difficulty.
the eyes.
direction of upward and
gaze. downward.

V.TRIGEMINAL Ask the client The clients Por was able to

Type: Motor and Sensory to open and must be able clench jaw and
clench jaw. to clench jaw chew without
Function: Jaw
and chew difficulty.
movement, chewing, and The cotton is
properly.
blinking gently placed Tzu was able to
mastication;
into lateral Must be able elicit blinking
reflex
side of the to elicit reflex when
Materials used: cotton
client’s eyes. blinking reflex. cotton was
placed at the
side of her eyes.

VI.ABDUCENS Ask the client Client must be Por was able to


to move the able to move move eyes
Type: Motor
Function: Lateral eyes laterally. eyes laterally. laterally.
movement of the eye.

VII.FACIAL Instruct client Facial muscles Por was able to

Type: Motor and Sensory to smile, of the client perform the test
frown, and must work as properly.
Function: Facial muscle
raise she performs
movement; sense of
eyebrows. the procedure.
taste on the anterior two
The client
thirds of the tongue. Por was able to
must be able
identify the
to identify the
Make use of different taste
different taste.
different presented.
seasonings
like vinegar
and salt to test
taste of
sensation.

VIII.ACOUSTIC Ask the client The client Por was able to


to repeat the must be able repeat the
Type: Sensory
whispered to repeat the whispered words
Function: Sense of
words, whispered which are
hearing
“maganda words. “maganda ako”.
ako”.

IX.GLOSSOPHARYNGE Instruct the The client Por was able to


AL client to must be able swallow and

Type: Motor and Sensory swallow or to swallow and move her mouth
move mouth in chew properly in a chewing
Function: Pharyngeal
chewing without movement
movement and
motion. difficulty. without difficulty.
swallowing; sense of
taste on the posterior Make use of Client must be Por was able to
one thirds of the tongue different taste able to identify identify the
and ask he the taste being tastes which are
client to presented. vinegar and salt.
Materials used: vinegar
identify each.
and salt

X.VAGUS Ask the client The client Por was able to

Type: Motor and Sensory to say “ah” to must be able swallow properly
swallow. to swallow and elicit gag
Function: For speaking
Using a properly and reflex.
and swallowing and
tongue elicit gag
sensation on the
depressor reflex upon
posterior one-third of the
stimulate the pressing the
tongue
posterior part tongue.
Material used: tongue of the tongue.
depressor

XI. ACCESSORY Against the The client Por was able to


resistance must be able shrug her
Type: Motor
from the to shrug her shoulders
Function: Shoulder
student shoulders against
muscle movement
nurses’ hands, against resistance from
ask the client resistance the student
to shrug her from the nurse.
shoulder. student
nurses’ hands.

XII.HYPOGLOSSAL Ask the client Client must be Por was able to


to move or able to move move her tongue
Type: Motor
protrude tongue in in different
Function: Movement of
tongue in different directions
the tongue
different directions. without difficulty.
directions.
Nutritional Status

Wt: 13kg
Ht: 105cm
IRS: below normal

Por’s IRS is ranged as underweight.

Summary of Assessment (Day 2- Day 4)

From day 2 to day 4 of physical assessment, Por was still observed as


untidy of herself has pediculosis.

History of Past and Present Illness

Por has no history of hospitalization. She hasn’t suffered from any serious
diseases except for common cough and colds.

Activities of Daily Living

Por usually wakes up 6:30 a.m. or sometimes if her youngest brother


wakes up, she would be forced to wake up and take care of her brother. Por
does not go to school because she is too young. She plays with her siblings and
most of the time she takes care of them all day when her mother is out to work.
And at around 8 p.m., she sleeps.

Eating Habits

Por eats 2-3x a day. Sometimes she doesn’t eat breakfast because they
do not have money to buy food for breakfast. She eats lunch and dinner and as
stated by her, she doesn’t have any food preference, whatever her mother
serves she eats.
Sleeping Pattern

Por usually sleeps at 8:00 pm at wakes at 6:30 am everyday. She usually


sleep again at the afternoon when her youngest brother sleeps.

Leisure Time

Por usually play with her siblings and neighbours and listens and dances
to music.

Pip was not seen during the home visit because he was already staying at a
relative ion Angeles City

Name: Sixtu
Age: 3 y/o
Height: 95 cm
Weight: 12 kg
November 12, 2009 (1st Day of Assessment)

Vital Signs:
Temperature: 36.5° C
Pulse Rate: 108 beat per minute
Respiratory Rate:24 cycles per minute

General Appearance:
During the initial home visit, He wears a green shirt and a ragged short.
His nails were untidy and he keeps on biting them. He has an unkempt hair,
dirt on his hands and feet are present. He has a good posture.
The Integument

Skin
Upon inspection, Sixtu has a light complexion but he has dry skin. There
are no signs of any discolorations. His skin was warm and soft to touch. He has a
good skin turgor, when his skin is pinched, it returns into its place immediately,
no presence of edema noted, has a wound on his right hand and lesions on his
lower extremities. There is no foul odor and no excessive perspiration.

Hair
The color of his hair is black and evenly distributed but is not well kept.
There are no infestations and scaling.

Nails
Upon inspection, his nails are pinkish in color and have a convex curve.
His nails are hard, smooth, and immobile. He has a capillary refill of less than 1
seconds.
The Skull
Upon inspection of Sixtu’s head, it is rounded and normocephalic. No
presence of elevations and depressions noted.

The Face
Upon inspection, Sixtu has a symmetrical face and his facial features are
symmetrical also. His skin is intact and there is no presence of edema.

The Eyes and Vision


Upon inspection, Sixtu’s eyebrows are aligned and evenly distributed. His
eyebrows’ movement are equal.
Sixtu’s eyelashes are evenly distributed and are curled slightly outward.
Upon inspection of the eyelids, skin is intact, moist and pink, and no discharge.
His involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctive, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, he felt no
tenderness.
Upon inspection of Sixtu s cornea, it is observed to be transparent,
smooth, moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimeters.

The Ear and Hearing


Upon inspection, Sixtu s auricles have a color same as facial skin. His
auricles are aligned with the outer cantus of the eye. Upon palpation, his auricles
are mobile, firm, and non tender. The pinna recoils after being folded.
In assessing the external ear canal, there are no discharges and lesions.

The Nose and Sinuses

Upon inspection, Sixtu’s nose has same color of his face and has whitish
nasal secretions. The nasal septum is in the midline. In assessing the patency of
nasal cavities, the air moves freely when the client breaths though each nares.
There is difficulty of breathing as observed by the student nurse. No tenderness
in the maxillary and frontal sinuses upon palpation.

The Mouth and Oropharynx


Upon inspection, the lips are slightly pinkish and uniform in color. The
gums are pinkish in color. Sixtu has complete set of teeth, yellow in color, and
dental caries noted.

The tongue is in the center, it is pink in color, moist, slightly rough, and
has no lesions. Does not have difficulty in moving his tongue. The uvula is
located in the midline of the soft palate.

Upon inspection of oropharynx and tonsils, it is observed to be pink,


smooth and no discharge noted, and no inflammation.

Neck

The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. He was able to turn his head on one side against the resistance and
the same with the other side. He was able to shrug his shoulders against the
resistance of the hands of student nurse.

The Lymphnodes

Upon inspection of the entire neck, there is no enlargement and lymph


nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.

The Thorax and Lungs


Upon inspection, full and symmetric chest expansion noted while the client
is breathing. No adventitious breath sounds noted upon auscultation. Breathing
pattern is quiet, rhythmic and effortless respiration.
Upon chest auscultation, (+) rales on both lung fields.

The Heart
Upon assessing the heart, there are no any abnormal pulsations. The
jugular veins are not distended.

Breast and Axillae


Sixtu’s breasts were even with the chest wall. Upon assessing, there was
no presence of tenderness, lumps, and lesions.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color. There is no presence of reddish striae or bulging part.

The Muscle
‘ Upon inspection, Sixtu’s muscles are equal in size on both sides of his
body.

Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.

Cranial Nerves Assessment

Cranial Nerve Test Expected Actual Result


Performed Result

I.OLFACTORY With both Correctly Dodoy was able


eyes close, identifies scent to identify the
Type: Sensory
ask the client presented to scents like
Function: Sense of smell to smell the each nostril perfume and
different even if his vinegar.
Materials used: perfume,
scents like eyes were
alcohol, and vinegar
perfume, both closed.
alcohol, and
vinegar.

II.OPTIC At a given At a given Dodoy was able


distance of 1 distance, the to read the
Type: Sensory
meter, ask the client must be newsprint
Function: Sense of Vision
client to read able to read clearly.
Materials used: newsprint the newsprint. the newsprint
without
difficulty.

III.OCULOMOTOR Instruct the Eyes must Pupils are


client to open move in a equally round
Type: Motor
and close the smooth, reactive to light
Function: constricys pupils
eyelids and coordinated and
when exposed to lights and
follow the motion in all accommodation.
ability to open and close
directions of directions. The He was able to
eyelids. Extraocular
penlight. This pupils os eyes open and close
movement.
is a test for are dilated his eyelids and
Material used: penlight papillary without the follow the
reaction. light and directions of the
constricts in penlight.
response to
light.

IV.TROCHLEAR Instruct the Without any Dodoy was able


client to look difficulty, the to move his
Type: Motor
upward and client must be eyes upward
Function: Upward and
downward. To able to move and downward
downward movement of assess his eyes without difficulty.
the eyes. direction of upward and
gaze. downward.

V.TRIGEMINAL Ask the client The clients Dodoy was able


to open and must be able to clench jaw
Type: Motor and Sensory
clench jaw. to clench jaw and chew
Function: Jaw movement,
and chew without difficulty.
chewing, and mastication; The cotton is
gently placed properly. Dodoy was able
blinking reflex
into lateral Must be able to elicit blinking
Materials used: cotton
side of the to elicit reflex when
client’s eyes. blinking reflex. cotton was
placed at the
side of his eyes.

VI.ABDUCENS Ask the client Client must be Dodoy was able


to move the able to move to move eyes
Type: Motor
eyes laterally. eyes laterlly. laterally.
Function: Lateral
movement of the eye.

VII.FACIAL Instruct client Facial muscles Dodoy was able


to smile, of the client to perform he
Type: Motor and Sensory
frown, and must work as test properly.
Function: Facial muscle
raise He performs
movement; sense of taste
eyebrows. the procedure.
on the anterior two thirds of
the tongue. Dodoy was able
The
client to identify the

Make use of must be able different taste


to identify the presented.
different
different taste.
seasonings
like vinegar
and salt to test
taste of
sensation.

VIII.ACOUSTIC Ask the client The client Dodoy was able


to repeat the must be able to repeat the
Type: Sensory
whispered to repeat the whispered
Function: Sense of hearing
words, “pogi whispered words which are
ako”. words. “pogi ako”.

IX.GLOSSOPHARYNGEAL Instruct the The client Dodoy was able


client to must be able to swallow and
Type: Motor and Sensory
swallow or to swallow and move his mouth
Function: Pharyngeal
move mouth in chew properly in a chewing
movement and swallowing;
chewing without movement
sense of taste on the
motion. difficulty. without difficulty.
posterior one thirds of the
Make use of Client must be Dodoy was able
tongue
different taste able to identify to identify the
and ask he the taste being taste which are
Materials used: vinegar client to presented. vinegar and salt.
and salt identify each.

X.VAGUS Ask the client The client Dodoy was able


to say “ah” to must be able to swallow
Type: Motor and Sensory
swallow. to swallow properly and
Function: For speaking and
Using a properly and elicit gag reflex.
swallowing and sensation
tongue elicit gag
on the posterior one-third
depressor reflex upon
of the tongue
stimulate the pressing the
Material used: tongue posterior part tongue.
depressor of the tongue.

XI. ACCESSORY Against the The client Dodoy was able


Type: Motor resistance must be able to shrug his

Function: Shoulder muscle from the to shrug his shoulders


student shoulders against
movement
nurses’ hands, against resistance from
ask the client resistance the student
to shrug his from the nurse.
shoulder. student
nurses’ hands.

XII.HYPOGLOSSAL Ask the client Client must be Dodoy was able


to move or able to move to move his
Type: Motor
protrude tongue in tongue in
Function: Movement of the
tongue in different different
tongue
different directions. directions
directions. without difficulty.

Growth and Development

Eric Erickson’s Theory of Psychosocial Development

He belongs to 2nd stage which is autonomy vs. shame and doubt. In here,
learning to control one’s body functions leads to a feeling of control and sense of
independence, while those who don’t successfully complete this stage are left
with sense of inadequacy and self-doubt.

Freud’s Psychosexual Development

The source of pleasure at this stage is genitals. This is also the stage
where the conflict of Oedipus complex is worked through.

NUTRITIONAL STATUS
Wt: 12kg
Ht: 95cm
IRS:normal

History of Past and Present Illness

Sixtu has no history of hospitalization. He hasn’t suffered from any serious


diseases except for common coughs and colds.

During the initial home visit, he has colds and cough.

Activities of Daily Living

Sixtu usually wakes at 7:30 am. After taking his breakfast, he will go
outside and play. During afternoon, he takes a nap of at least 2-3 hours.

Eating Habits

According to Mother, bread and coffee is the usual breakfast of Sixtu. He


is also fond of eating junk foods and candies.

Sleeping Pattern

Sixtu usually sleeps at 8:00 pm at wakes at 7:30 am. He takes a nap


during afternoon for at least 2-3 hours.

Leisure Time

Sixtu usually have no leisure activities except playing with his friends or
siblings. Apart from that, he has no other leisure activities.

Summary of Assessment (Day 2-4)


On days 2 to 4, Sixtu can be found playing with his siblings. He was
observed to be untidy on both days. He was wearing dirty clothes and has long
has long untrimmed nails. He was observed to have coughs and colds.

Name: Seven
Age: 1 y/o
Height: 73 cm
Weight: 10 kg
November 12, 2009 (1st Day of Assessment)

Vital Signs:
Temperature: 36° C
Cardiac Rate: 112 beat per minute
Respiratory Rate: 28 cycles per minute

General Appearance:
During the initial home visit, she wears a dirty shirt without undergarments.
Her nails were untidy and she walks barefooted. She has an unkempt
appearance. She has a good posture.

The Integument

Skin
Upon inspection, Seven has a light complexion, uniform in color. There
are no signs of any discolorations. Her skin was warm and soft to touch. She has
a good skin turgor, when her skin is pinched, it returned into its place
immediately, no presence of edema noted, no lesions on her extremities. There
is no foul odor and no excessive perspiration.

Hair
The color of her hair is black and evenly distributed but is not well kept.
There are no infestations and scaling.

Nails
Upon inspection, her nails are pinkish in color and have a convex curve.
Her nails are hard, smooth, and immobile. She has a capillary refill of less than 2
seconds.
The Skull
Upon inspection of Seven s head, it is rounded and normocephalic. No
presence of elevations and depressions noted.

The Face
Upon inspection, Seven has a symmetrical face and his facial features are
symmetrical also. His skin is intact and there is no presence of edema.

The Eyes and Vision


Upon inspection, Seven’s eyebrows are aligned and the hair is evenly
distributed. Her eyebrows’ movement is equal.
Seven’s eyelashes are evenly distributed and are curled slightly outward.
Upon inspection of the eyelids, skin is intact, moist and pink, and no discharge.
Her involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctive, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, mother felt no
tenderness.
Upon inspection of Seven’s cornea, it is observed to be transparent,
smooth, moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimeters.

The Ear and Hearing


Upon inspection, Seven’s auricles have a color same as facial skin. Her
auricles are aligned with the outer cantus of the eye. Upon palpation, her auricles
are mobile, firm, and non tender. The pinna recoils after being folded.
In assessing the external ear canal, there are no discharges and lesions.

The Nose and Sinuses

Upon inspection, Seven’s nose has same color of her face and has whitish
nasal secretions. The nasal septum is in the midline. In assessing the patency of
nasal cavities, the air moves freely when the client breaths though each nares.
There is difficulty of breathing as observed by the student nurse. No tenderness
in the maxillary and frontal sinuses upon palpation.

The Mouth and Oropharynx

Upon inspection, the lips are slightly pinkish and uniform in color. The
gums are pinkish in color. Seven has complete set of teeth, yellow in color, and
dental caries noted on the right lower premolars and first molar.

The tongue is in the center, it is pink in color, moist, slightly rough, and
has no lesions. Does not have difficulty in moving her tongue. The uvula is
located in the midline of the soft palate.

Upon inspection of oropharynx and tonsils, it is observed to be pink,


smooth and no discharge noted, and no inflammation.

Neck
The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. She was able to turn her head on one side against the resistance and
the same with the other side. She was able to shrug her shoulders against the
resistance of the hands of student nurse.

The Lymphnodes

Upon inspection of the entire neck, there is no enlargement and lymph


nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.
The Thorax and Lungs
Upon inspection, full and symmetric chest expansion noted while the client
is breathing. Wheezes are noted upon auscultation. Breathing pattern is noisy,
rhythmic and has DOB.
Upon chest auscultation, wheezes are heard upon expiration.
The Heart
Upon assessing the heart, there are no any abnormal pulsations. The
jugular veins are not distended.

Breast and Axillae


Seven s breasts were even with the chest wall. Upon assessing, there
was no presence of tenderness, lumps, and lesions.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color. There is no presence of reddish striae or bulging part.

The Muscle
‘ Upon inspection, Seven’s muscles are equal in size on both sides of her
body.

Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.

Cranial Nerves Assessment

Cranial Nerve Test Expected Actual Result


Performed Result

I.OLFACTORY With both Correctly Seven was able


eyes close, identifies scent to identify the
Type: Sensory
ask the client presented to scents which are
Function: Sense of smell
to smell the each nostril perfume and
Materials used: perfume, different even if her vinegar.
alcohol, and vinegar scents like eyes were
perfume, both closed.
alcohol, and
vinegar.

II.OPTIC At a given At a given Seven was able


distance of 1 distance, the to read the
Type: Sensory
meter, ask the client must be newsprint
Function: Sense of Vision
client to read able to read clearly.
Materials used: newsprint the newsprint. the newsprint
without
difficulty.
III.OCULOMOTOR Instruct the Eyes must Pupils are
client to open move in a equally round
Type: Motor
and close the smooth, reactive to light
Function: constricys pupils
eyelids and coordinated and
when exposed to lights and
follow the motion in all accommodation.
ability to open and close
directions of directions. The She was able to
eyelids. Extraocular
penlight. This pupils os eyes open and close
movement.
is a test for are dilated her eyelids and
Material used: penlight papillary without the follow the
reaction. light and directions of the
constricts in penlight.
response to
light.

IV.TROCHLEAR Instruct the Without any Seven was able


client to look difficulty, the to move her
Type: Motor
upward and client must be eyes upward
Function: Upward and
downward. To able to move and downward
downward movement of
assess her eyes without difficulty.
the eyes.
direction of upward and
gaze. downward.

V.TRIGEMINAL Ask the client The clients Seven was able


to open and must be able to clench jaw
Type: Motor and Sensory
clench jaw. to clench jaw and chew
Function: Jaw movement,
and chew without difficulty.
chewing, and mastication; The cotton is
gently placed properly. Seven was able
blinking reflex
into lateral Must be able to elicit blinking
Materials used: cotton
side of the to elicit reflex when
client’s eyes. blinking reflex. cotton was
placed at the
side of her eyes.
VI.ABDUCENS Ask the client Client must be Seven was able
to move the able to move to move eyes
Type: Motor
eyes laterally. eyes laterlly. laterally.
Function: Lateral
movement of the eye.

VII.FACIAL Instruct client Facial muscles Seven was able


to smile, of the client to perform he
Type: Motor and Sensory
frown, and must work as test properly.
Function: Facial muscle
raise she performs
movement; sense of taste
eyebrows. the procedure.
on the anterior two thirds of
the tongue. Seven was able
The client to identify the

Make use of must be able different taste


to identify the
different presented.
different taste.
seasonings
like vinegar
and salt to test
taste of
sensation.

VIII.ACOUSTIC Ask the client The client Seven was able


to repeat the must be able to repeat the
Type: Sensory
whispered to repeat the whispered
Function: Sense of hearing
words, whispered words which are
“maganda words. “maganda ako”.
ako”.

IX.GLOSSOPHARYNGEAL Instruct the The client Seven was able


client to must be able to swallow and
Type: Motor and Sensory
swallow or to swallow and move her mouth
Function: Pharyngeal
move mouth in chew properly in a chewing
movement and swallowing;
chewing without movement
sense of taste on the motion. difficulty. without difficulty.
posterior one thirds of the Make use of Client must be Seven Seven
tongue different taste able to identify was able to
and ask he the taste being identify the taste

vinegar client to presented. which are


Materials used:
identify each. vinegar and salt.
and salt

X.VAGUS Ask the client The client Seven was able


to say “ah” to must be able to swallow
Type: Motor and Sensory
swallow. to swallow properly and
Function: For speaking and
Using a properly and elicit gag reflex.
swallowing and sensation
tongue elicit gag
on the posterior one-third
depressor reflex upon
of the tongue
stimulate the pressing the
Material used: tongue posterior part tongue.
depressor of the tongue.

XI. ACCESSORY Against the The client Seven was able


resistance mustb be able to shrug her
Type: Motor
from the to shrug her shoulders
Function: Shoulder muscle
student shoulders against
movement
nurses’ hands, against resistance from
ask the client resistance the student
to shrug her from the nurse.
shoulder. student
nurses’ hands.

XII.HYPOGLOSSAL Ask the client Client must be Seven was able


to move or able to move to move her
Type: Motor
protrude tongue in tongue in
Function: Movement of the
tongue in different different
tongue
different directions. directions
directions. without difficulty.

Growth and Development

Eric Erickson’s Theory of Psychosocial Development

She belongs to 2nd stage which is autonomy vs. shame and doubt. In here,
learning to control one’s body functions leads to a feeling of control and sense of
independence, while those who don’t successfully complete this stage are left
with sense of inadequacy and self-doubt.

Freud’s Psychosexual Development

The source of pleasure at this stage is genitals. This is also the stage
where the conflict of Oedipus complex is worked through.

NUTRITIONAL STATUS
Wt: 8kg
Ht: 73 cm
BMI: normal

History of Past and Present Illness

Seven has no history of hospitalization. She hasn’t suffered from any


serious diseases except for common coughs and colds.

During the initial home visit, she has colds and cough.

Activities of Daily Living

Seven usually wakes at 7:00 am. After taking her breakfast, she will go
outside and play. During afternoon, she takes a nap of at least 2-3 hours.
Eating Habits

According to the mother, bread and coffee is the usual breakfast of Seven
She is also fond of eating junk foods and candies just like her other siblings.

Sleeping Pattern

Seven usually sleeps at 8:00 pm at wakes at 7:00 am. She takes a nap
during afternoon for at least 2-3 hours.

Leisure Time

Seven usually have no leisure activities except for playing with her friends
or siblings. Apart from that, she has no other leisure activities.

Summary of Assessment (Day 2-4)

On days 2 to 4, Seven can be found playing with his siblings. She was
observed to be untidy on both days. She was wearing dirty clothes and has long
has long untrimmed nails. She was observed to have coughs and colds and
presence of wheezes was noted.

Name: Baby eight


Age: 6 months old
Height: 40 Inches
Weight: 5 kg
November 12, 2009 (1st Day of Assessment of father)

Vital Signs:
Temperature: 36.5° C
Pulse Rate: 112 beat per minute
Respiratory Rate: 24 cycles per minute
General Appearance:
Upon initial assessment, baby eight was noticed to be wearing an
untidy white boxer and no undergarments. He was being carried by Tzu. He
looked restless and was crying.

The Integument

Skin
Upon inspection, Baby eight has a dark complexion but uniform in color.
There are signs of redness on the gluteus maximus. His skin was warm and
soft to touch. He has a good skin turgor, when his skin is pinched, it returned into
its place immediately, and no presence of edema. There is no foul odor and no
excessive perspiration. Has lesions on the lower exremeties.

Hair
The color of his hair is black and evenly distributed. There are no
infestations and scaling.

Nails
Upon inspection, his nails are pinkish and have a convex curve. His nails
are hard, smooth, and immobile. It has a capillary refill of less than 4 seconds.

The Skull
Upon inspection of Baby eight’s head, it is rounded and normocephalic.
Upon palpation, there is no presence of lumps.

The Face
Upon inspection, Baby eight has a symmetrical face and her facial feature
is symmetrical also. His skin is intact and there is no presence of edema.
The Eyes and Vision
Upon inspection, Baby eight s eyebrows are aligned and the hair is evenly
distributed. His eyebrows’ movement is equal.
Baby eight’s eyelashes are evenly distributed and are curled slightly
outward. Upon inspection of the eyelids, skin is intact, moist and pink, and no
discharge. His involuntary blinks are approximately 15-20 blinks per minute.
In assessing the bulbar conjunctiva, the eyelids are retracted with thumb
and index finger. The bulbar conjunctiva is transparent and there is no presence
of lesions. While the palpebral conjunctiva, lower lids are everted. The palpebral
conjunctiva is shiny, smooth, pink, and there is no presence of lesions.
Upon inspection of the lacrimal sac and nasolacrimal duct, there is no
edema or tearing. And upon palpation of the lacrimal gland, Itay felt no
tenderness.
Upon inspection of Itay’s cornea, it is observed to be transparent, smooth,
moist, and shiny.
In assessing the pupils, it is seen to be black in color, smooth border, and
size of around 3 millimeters.

The Ear and Hearing


Upon inspection, Baby eight’s auricles have a color same as facial skin.
His auricles are aligned with the outer cantus of the eye. Upon palpation, his
auricles are mobile, firm, and non tender. The pinna recoils after being folded.
• In assessing the external ear canal, there is presence of excessive
cerumen.

The Nose and Sinuses

Upon inspection, Baby eight’s nose has same color of his face. The nasal
septum is in the midline. In assessing the patency of nasal cavities, the air moves
freely when the client breaths though each nares. There is no difficulty of
breathing as observed by the student nurse and as stated by Itay. And upon
palpation, no tenderness in the maxillary and frontal sinuses.. there is yellowish
green secretions on his nose.

The Mouth and Oropharynx

Upon inspection, the lips are pink in color. The gums are pink in color.
Itay has complete set of teeth, yellow in color.

The tongue is in the center, it is pink in color, moist, slightly rough, and
has no lesions. He does not have difficulty in moving his tongue. The uvula is
located in the midline of the soft palate.

Upon inspection of oropharynx and tonsils, it is observed to be pink,


smooth and no discharge noted, and no inflammation.

Neck

The head is centered in the neck. Movements of the neck are coordinated,
smooth movements with no discomfort observed. No swelling and masses noted.
Coordinated head movements; able to move freely and able to turn head from
left to right. He was able to turn his head on one side against the resistance and
the same with the other side. He was able to shrug his shoulders against the
resistance of the hands of student nurse.

The Lymphnodes

Upon inspection of the entire neck, there is no enlargement and lymph


nodes are not palpable.

The Trachea
Upon palpation, the trachea is located at the midline of the neck.

The Thyroid Gland


Upon inspection and palpation, the thyroid gland ascends when
swallowing.

The Thorax and Lungs


Upon inspection, full and symmetric chest expansion noted while the client
is breathing. No adventitious breath sounds noted upon auscultation. Breathing
pattern is quiet, rhythmic and effortless respiration.
Upon chest auscultation, no adventitious sounds heard on both lung fields.

The Heart
Upon assessing the heart, there is no any abnormal pulsation. The jugular
veins are not distended.

Breast and Axillae


Baby eight’s breasts were even with the chest wall. Upon assessing, there
was no presence of tenderness, lumps, and lesions.

The Abdomen
Upon inspection of the abdomen, the skin of the abdomen is uniform in
color.

The Muscle
Upon inspection, Baby eight’s muscles are equal in size on both sides of
his body.

Bones and Joints

There are no deformities on the bones and the joints can move freely
without pain.

REFLEXES
BLINK REFLEX

A blink reflex in a newborn serves as the same purpose as it does in an


adult- to protect the eye from any object coming near it by rapid eye closure. It
may be elicited by a shining strong light such as a flashlight or an otoscope light
on the eye. A sudden movement towards the eye can sometimes elicit the blink
reflex.

Upon assessment, the student nurses used a cotton ball to touch his
eyelashes, and the client was observed to have a positive blink reflex.

ROOTING REFLEX

If the cheek is brushed or stroked near the corner of the mouth, a newborn
infant will turn the head in that direction. This reflex serves to help the baby find
food; when a mother holds a child and allows her breast to brush the newboen
cheek, the reflex makes the baby turn towards the breast. This refles
disappears as about 6th week of life. And about this time, the newborn’s eyes
focus steadily, so a food source can be seen, and the reflex is no longer
needed.

Upon assessment, the rooting reflex is not present.

SUCKING REFLEX

It triggers an infant to forcibly suck on any object put in the mouth.


Upon assessment, there is positive sucking reflex as he was fed by his mother.

SWALLOWING REFLEX

Swallowing caused by stimulation of the palate, fauces, or posterior pharyngeal


wall.
Upon assessment, there is positive swallowing reflex as he was fed by his
mother.

PALMAR GRASP REFLEX

Stroking or touching the palm of your newborn baby's hand will automatically
trigger the grasp reflex, which makes her clench her fist. This reflex enables
your baby to hold on and acts as a type of insurance against falling. The grasp
reflex lasts only a couple of months and is stronger in pre-term babies.
Because a baby will hold on tightly, this reflex is sometimes mistaken as fear of
being alone.

Upon assessment, there is NO PALMAR GRASP REFLEX

EXTRUSION RELEX

A newborn baby is not developmentally ready to eat solid foods. Her throat
muscles will not be developed enough to swallow solid foods until she is at
least four months old. It is roughly around this time that she will be able to use
her tongue to transfer food from the front to the back of the mouth to swallow
safely. To see this in action, touch her tongue -- she should react by pushing
her tongue outward or forward to resist.

Upon assessment, there is NO EXTRUSION REFLEX

BABINSKI REFLEX
You can see this newborn reflex in action by running your finger down the center
of the bottom of your baby's foot. His toes will spread apart and the foot will turn
slightly inward. If you do the same thing to an adult's foot, you will see the
opposite happen. The toes should clench together tightly.
Upon assessment, there is NO BABINSKI REFLEX

WALK IN PLACE REFLEX


If you hold your baby upright and place her feet on a flat surface, she will place
one foot in front of the other and appear to "walk." Of course without strength,
coordination, and balance, she could never really walk at this point. This reflex
should disappear after around three months.
Upon assessment, there is NO WALK IN PLACE REFLEX

GALANT REFLEX

You can see this reflex by placing your baby face down across your lap. If you
run your finger down the left side of his spine, you will see him seem to curl in
sideways to the left. The same should happen on the right side as well.
Upon assessment, there is NO GALANT REFLEX

TONIC NECK REFLEX


When you lay your baby on his back and his head is turned to the side, you will
notice one arm will straighten, the opposite arm will bend, and often one knee will
significantly bend. If he were standing, it would look as though he were ready to
face off in a fencing duel.

Upon assessment, there is TONIC NECK REFLEX

CHAPTER IV

Socio Economic, Cultural, and Developmental Assessment

There are great many factors that affect the health of a family. As a result, the
health status of each family is different. These factors may be social, economical
and/or cultural. These factors need to be assessed to determine accurately the
health status of the family. In this chapter, these are depicted through thorough
assessment.

A. TYPE OF FAMILY

The family is the basic unit of the society. It is a group of people united by ties
of marriage, birth or adoption, who carries common purpose which is to create
and maintain common culture that promotes the physical, mental, emotional, and
social development of each of its members. It also refers to two or more
individuals who depend on one another for emotional, physical and or financial
support. (NCM 101 Handout # 1: The Family and Family Health)

Family Imba is classified under cohabitating. A cohabitating type of family


refers to those who live together outside the blessing of the church or the law.
The family is composed of 10 members: Mr. Itay and Mrs. Ina, and their children:
Juan, Tzu, Tri, Por, Pip. Sixtu, Seven and Baby Eight, all in chronological order.
Juan and Tzu has a different father, Tri also has a different father and so as Por.
Only Pip, Sixtu, Seven and baby Eight are the biological children of Mr. Itay.
The family practices the traditional expected duty that each family member must
perform.

B. DOMINANT FAMILY MEMBERS IN TERMS OF DECISION MAKING


The assessment of family’s decision making process and the identification
of the dominant family member would enable the student nurses to identify the
predominant decision maker and how the family interacts with each other. This
would greatly influence their perception of the identified problem and the family’s
pattern of decision making particularly on health issues.
Being a cohabitating type of family, decision making revolves around
either the mother or the father, but in the Imba family’s case it is the mother who
takes over the decision making. As the head of the family, she works and
supports the family with their financial needs, and she has the final decision on
issues like physical, emotional, and financial and all other aspects that are
involve in the family. Mrs. Ina stated that she takes charge of the decision making
in terms of health care and is responsible in looking after their children.

C. SOURCE OF INCOME, EXPENDITURES


Mrs. Ina, as the head of family, is the only one who works hard to provide
the basic needs of each member. She is not being accompanied by her partner
in the working part though she receives P1500 as support from her partner’s
parents. She works as a bet collector of Jueteng and her total monthly income is
P2000. Having a total of P3500, the family’s income is not sufficient to support
the corresponding family members on a monthly basis. According to NEDA, the
annual poverty threshold is P 33,223.2 per individual or P 2,768.60 per month.
According to the National Statistical Coordination Board, poverty threshold
is the annual income required or the amount to be spent to satisfy nutritional
requirements (2000 kcal) and other basic needs. This means that she should be
earning P27,686 per month to sustain the needs of her family as compared to
2000 pesos that she is earning and the 1800php that she receives as support.
When the group asked the mother if their income is enough and if they have
savings for emergency situations, she said that all their spare income is allotted
for food.
The family’s income is allotted for the following expenses:
EXPENSES AMOUNT
APARTMENT RENT 1000
FOOD 1000
ELECTRIC BILL 300
WATER BILL 200
SCHOOL EXPENSES 1000
TOTAL: P 3500

With this, the family is considered poor. This means that they need an
additional income of P24,186 a month in order to meet the qualification of NEDA.
Their income is not sufficient to meet their basic needs. Also, according to the
mother they have no savings at all in times of emergencies, so they tend to
borrow from their relatives.
D. WORKING HOURS
Mrs. Ina is the only one who works in the family. She works as a bet
collector for Jueteng she works from 7am to 10:30am and then from 1:30pm to
3:30pm and again, from 6pm to 9pm. The remaining hours are spent in
homemaking.

E. ETHNIC BACKGROUND AND RELIGIOUS AFFILIATION


The assessment of ethnic background and religious affiliation of a
family affects the family’s norms, belief and practices especially in decision
making. Given the information regarding their respect of family’s identity, it would
give the group a background as to how the family would interact, perceive and
address the problems that are to be identified during the conduction of family
case analysis.
Mrs. Ina was born and raised in Pampanga and so as Mr. Itay. The family
is affiliated to Roman Catholic Church. They seldom attend Sunday mass
together.

F. SIGNIFICANT OTHERS’ ROLE


The assessment of significant others’ role is very important as the
significant others may help when it comes to the health needs of the family.
The family has no relatives living near them. But, once a week, the sisters
of Mrs. Ina and her nieces visit the family and have lunch together. It is also Mrs.
Ina’s sisters that family turns to when they are in need of financial support for the
health needs or emergency needs of the family.

G. HEALTH HABITS AND BELIEFS


The family’s health habits and practices are traditional. They believe in
herbolarios and hilots. W hen a family member is sick, Mrs. Ina immediately take
her children to the Barangay Health Center. But when the Barangay Health
Center does not have the necessary medications, they will go to the hospital and
have the sick member checked-up.
During the assessment, the student nurses have noticed that the family
has a poor personal hygiene. They were observed wearing dirty clothes and the
children have long finger nails and toenails with presence of dirt as well as their
hands and feet. Their hairs are uncombed and they were noted to have smell of
sweat. Also, some of the children have pediculosis.
Despite these, the children have complete immunization care from the
health center.

H. FAMILY’S INVOLVEMENT IN COMMUNITY ACTIVITIES


They do not participate much in community activities because they think
that there are lots more of important things to do other than that. Like earning
money for the family and looking for food.

I. FAMILY’S UTILIZATION OF COMMUNITY SERVICES/ RESOURCES


In times of sickness, the family can utilize the health center . Aside from
consultations, they also got their vaccinations in the health center.
Aside from the health center, the community has its own court near the
barangay station.
There are also mini stores in the community, wherein the family gets their
daily necessities like food, and the like.

J. HOUSING CONDITION
The type of house the family has is made up of wood in which the
structure, foundation and walls of the house are made up of lumber and timber.
Their house is like all in one, the living room, bed room, and dining area, area are
all in one room.
The house measures 3.35m x 3m. The total floor area is 10.05m2. It shows
that there is no adequate space. Required space for each adult member is 3m2
andand 1.5 for each child. In the computation of adequacy of living space, the
total floor area is divided with the total number of the family members living in
the house. There are originally 10 members but since 2 of the children don’t live
on the household anymore, the computation will only include those 8 that still
stays on the said house.

3.35m

3m

COMPUTATION OF ADEQUACY OF LIVING SPACE


Floor Area = Length x width of the house
= 3.35m x 3m
= 10.05m2
Adequacy of Living Space
= (3 x 2) =+ (1.5 x 5) + (0 x 1)
= 13.5m2
10.05m2 < 13.5m2 = inadequate

The house has two windows which measures 1.24 x .85m and 1.3 x
1.56m. The house’s door measures 1.77 x .8m The total measurement of the
windows are 1.054m2 and 2.028m2 and the total measurement of the door is
1.42m2. The total air or ventilation space is considered to be adequate because it
more than 20% of the total floor area.
Computation:
> Adequate
Windows: 1.24 x .85m = 1.054m2
1.3 x 1.56m = 2.028m2
Door: 1.77 x .8m = 1.42m2
The family sleeps beside each member. The family has 1 chair. The sink
where they put their utensils can be easily reached by the children.

K. FOOD RESOURCES, STORAGE, AND COOKING FACILITIES


Food sources, storage and their present cooking facilities must be
adequate to sustains family’s nutritional needs. Since this greatly affects the
family in proper handling of food.
The family usually eats canned goods and noodles. They rarely cook
viand because they don’t have enough budget. The family buys their food in a
nearby sari sari store. Mrs. Ina said that she only prepares 1 viand of food if there
is enough money since their budget would not allow them to have more. Also,
they don’t have a refrigerator or a cabinet to store there food they make use of
plates which are covered to store leftover food if ever there is.
But most of the time, they tend to finish what is prepared for them. The
family doesn’t have enough cooking utensils they only have one casserole and
frying pan, both of which are already black due to repetitive uses and are indeed
prone to fire, 2 sandok and 1 knife. Their cooking facility is situated outside their
house. Also, it is situated in a low area, which can be easily reached by the
children which is a hazard for the family.

L. WATER SUPPLY
Water is very vital to human life because it is our main source of fluid. If
water source is unsafe and infected it can cause diseases that are brought by
harmful microorganisms Thus, health can be compromised. Water potability
should also be assessed.
The family has owned a connection of water supply. They are connected to
NAWASA which is their only source. Their usual water bill is P200 per month.
They use the water for bathing, washing of dishes, laundry, and even in drinking.
The potability of the water is not assured because everytime the family drinks,
they get it directly from the faucet. But sometimes they use pitcher to store the
water they drink.

M. DRAINAGE SYSTEM
The assessment of drainage system is necessary to determine the
presence of water stagnation or flow in the household. Poor drainage induces
stagnation of water that may result to presence of mosquitoes and eventually can
cause diseases.
Since the family doesn’t have any drainage, the student nurses did not
assess the drainage system.

N. TOILET FACILTY
Toilet facility is assessed in order to determine if the family practices
proper hygiene, sanitation that could greatly affect human health. This is also
essential in maintaining cleanliness in their surroundings.
The family doesn’t own their toilet facility. There is only one toilet that is
being used by the family and the nearby households. The sanitation is poor as
evidenced by the discoloration of the toilet bowl and foul smell.

O. SOCIAL AND HEALTH FACILITIES AVAILABLE


The health center in Brgy. Agapito del Rosario is usually utilized by the
family because of free vaccines and check-up. Their children got their
immunization in the Brgy. Health Center.
P. COMMUNICATION AND TRANSPORTATION FACILITIES
All of the family members speak kapampangan.
The family doesn’t have their own vehicle. Their main mode for
transportation is walking. The father and the 3 children go to work and school by
means of walking because it is just some streets away. And the other 2 children
use the public vehicle. They do not have any communication facilities like
telephone and the likes.

Chapter V

Problem Prioritization

A. List of Problems Identified

Problems Identified Score

Presence of cough and colds


1 5
Improper garbage disposal
2 4.67

3.5 Poor personal hygiene 4

Smoking Cigarette
3.5 4

Presence of Pediculosis
5 3.17

Family size beyond what family


resources can adequately provide
6 3

Inadequate living space


7 2.5
Presence of cough and colds

COMPUTATIO
CRITERIA SCORE JUSTIFICATION
N
Coughs and Colds is a health deficit because the
family failed to maintain good health condition
Nature of the specifically because of inadequate intake of Vitamin
problem 3/3 x 1 1 C. Coughs and Colds, if not treated immediately and
effectively can lead to more serious problems such
as pneumonia.

Modifiability 2/2 x 2 2 The problem is easily modifiable as supported by the


of the problem following factors:
Current Current Knowledge, Technology and
Knowledge; ↑ Intervention

Resources of --The family has sufficient knowledge about

the Family; ↑ the problem. They know that increase in fluid intake
may help in alleviating the problem. This
Resources of
intervention is effective in treating coughs and colds.
the SN; ↑
They sometimes drink orange juice, which is rich in
Resources of
Vitamin C. This is to increase their immunity against
the Community;
↑ further infection.

Resources of the Family


--The family has sufficient knowledge and
skills in carrying out effective interventions to the
problem. They have orange juice as a resource in
their interventions which is useful in eradicating the
problem.
Resources of the Student Nurse
--The student nurses are well-equipped with
knowledge and skills so they are capable of
imparting additional health teachings regarding the
problem such as increasing oral fluid intake and
eating fruits rich in Vitamin C.
Resources of the Community
--The Barangay Health Center is open for the
population. It offers free check-ups and some
medications.
The problem has a high preventive potential as
Preventive 3/3 x 1 1 supported by the following factors:
Potential Gravity/Severity
-- It’s not yet considered severe on their case
because it’s still manageable by the family. The
family knows what to do to treat the problem
Gravity/Severity whenever it is present.
:↑ Duration
Duration: ↑ --Sixtu and Seven have been experiencing
Current coughs and colds for a week.
Management : ↑ Current Management
Exposure of any --Mother is increasing Sixtu and Seven‘s oral
High Risk fluid intake. They are also drinking Orange Juice to

Group: ↑ prevent the problem from predisposing further


complications.
Exposure of any High Risk Group
--5 out of 8 family members are at risk since
only Dodoy and Duday have coughs and colds.

Salience The family knows that it is a health problem and in


2/2 x1 1 response to this, they do some interventions which
are found to be effective in curing coughs and colds.
TOTAL SCORE: 5
Improper garbage disposal

CRITERIA COMPUTATI SCORE JUSTIFICATION


ON
Nature of the Improper garbage disposal is a health threat to the
family as it predisposes a good breeding ground for
problem
2/3 x 1 .67 vectors of disease such as rodents and insects which
could bring about diseases such as leptospirosis,
dengue and the like.
2/2 x 2 2 The problem is partially modifiable as supported by
Modifiability of the following factors:
the problem Current Knowledge, Technology and
Current Intervention
Knowledge; ↑ --The family is aware of this problem; they

Resources of the know that improper garbage disposal may

Family; ↑ predispose a good breeding ground for vectors of


diseases.
Resources of the
Resources of the Family
SN; ↑
--The family has physical resources such as
Resources of the
brooms and dust pans; Mother has also the
Community; ↑
capability to clean their house and environment.
Resources of the Student Nurse
--The Student nurses could give the family
health teachings regarding proper garbage disposal
such as segregating their trash to biodegradable and
non- biodegradable.
Resources of the Community
--The barangay has a garbage truck which
collects the garbage of the barangay.

Preventive 3/3 x 1 1 The problem has a high preventive potential as


Potential supported by the following factors:
Gravity/Severity: ↑ Gravity/Severity

Duration: ↑ --The problem is not yet severe since there

Current are no breeding sites of vectors of diseases present

Management: yet.
Duration
↑Exposure of any
--The problem has existed for over a month
High Risk Group: ↑
because of lack of trashcans that may be due to low
income.
Current Management
--The family doesn’t have any management
for this problem since they are not yet separating
biodegradable materials from non-biodegradable.
Exposure of any High Risk Group
-- All of the family members are exposed to
this problem since all of them live on the same
house and are susceptible to diseases that rodents
and insects may bring.

It is a felt problem but because of lack of motivation


Salience 2/2 x 1 1 to make change, no measures are taken by the
family
TOTAL SCORE: 4.67
Poor personal hygiene

CRITERIA COMPUTATI SCORE JUSTIFICATION


ON

Nature of the
A health threat. Poor health practices will weaken
problem 2/3 x 1 .67
body defenses against entrance of microorganisms

2/2 x 2 2
Modifiability of The problem is easily modifiable as supported by the
the problem following factors:
Current Current Knowledge, Technology and
Intervention
Knowledge; ↑ -- The family is aware of the problem and
Resources of the what it may cause. The children are now taking a
bath every day.
Family; ↑ Resources of the Family
Resources of the --The family has physical resources such as
shampoo, soap, and the like which can be used for
SN; ↑ hygienic purposes.
Resources of the Resources of the Student Nurse

Community; ↑ --The student nurses are well-equipped with


knowledge and skills so they are capable of
imparting additional health teachings regarding the
problem such as cutting their fingernails and proper
hand washing.
Resources of the Community
--The community offers mother’s class where
the family could learn about good personal hygiene.
The problem has a high preventive potential as
Preventive supported by the following factors:
Potential Gravity/Severity

Gravity/Severity ↑ --The problem is not yet severe, because the


only the children have poor hygiene. The family can
Duration: ↑ still manage the problem.
Duration
Current
--The problem has been existing for 2 weeks,
Management: ↑ 3/3 x 1 1
since the parents are busy working to earn money,
Exposure of any thus affecting the family hygiene.
Current Management
High Risk Group: ↑
--The family still assures that they take a bath
at least once a day as a management for the
problem.
Exposure of any High Risk Group
--4 out of 8 family members are at risk and
are susceptible to health problems.
The family recognizes it is as a minor problem which
Salience ½x1 0.5
does not need an immediate action
TOTAL SCORE: 4
Smoking Cigarette

COMPUTATIO
CRITERIA SCORE JUSTIFICATION
N
Nature of the It is a health threat because the both parents smoke
and they are at risk for acquiring respiratory
problem 2/3 x 1 .67
diseases such as Lung Cancer.

2/2 x 2 2 The problem is easily modifiable as supported by the


Modifiability of following factors:
the problem Current Knowledge, Technology and
Current Intervention
Knowledge; ↑ --The family has sufficient knowledge about the

Resources of the problem. They are willing to reduce their smoking

Family; ↑ habits.
Resources of the Family
Resources of the
--The family has sufficient knowledge and skills in
SN; ↑
carrying out effective interventions for the problem
Resources of the
such as candies that can be used as alternatives for
Community; ↑
smoking.
Resources of the Student Nurse
--The student nurses are able to give the family
health teachings about how to reduce their smoking
habits such as making alternatives for cigarettes like
candies.
Resources of the Community
--The community is promoting a smoke-free
environment through giving health teachings to the
people and stating the diseases that they may get
through smoking.
Preventive 1/3 x 1 .33 The problem has a low preventive potential as
Potential supported by the following factors:
Gravity/Severity: Gravity/Severity
↑ --The problem is not yet severe because both

Duration: ↓ parents are not yet manifesting respiratory diseases.

Current Duration
-- Both parents have been smoking for more than 10
Management: ↓
yrs now.
Exposure of any
Current Management
High Risk Group:
--The family doesn’t have yet any management for

the problem. But they are willing for a lifestyle
change.
Exposure of any High Risk Group
--All of the family members are exposed to this
problem since all of them may be exposed to
secondhand smoke.
It is perceived problem needing immediate attention.
Since the father is aging, he needs to reduce his vice
Salience 2/2 x 1 1 (smoking) because his respiratory system’s function
is diminishing which can lead to serious illnesses or
even death if not prevented.
TOTAL SCORE: 4

Presence of Pediculosis
CRITERIA COMPUTATIO SCORE JUSTIFICATION
N
Nature of the Pediculosis is considered to be a health deficit
brought about by the infestations of these parasites
problem 3/3 x 1 .67
wherein they feed themselves by getting the
nutrients from the host.
2/2 x2 1 The problem is easily modifiable as supported by the
Modifiability of following factors:
the problem Current Knowledge, Technology and
Current Intervention
Knowledge; ↑ --The family is aware of the problem, they

Resources of the know that these parasites are feeding themselves

Family; ↑ through their host.


Resources of the Family
Resources of the
--The family has manpower resources that the
SN; ↑
family can use to minimize Ella’s lice by removing
Resources of the
them
Community; ↑
Resources of the Student Nurse
--The students nurses knowledge and
initiative will enable the student nurses to provide
health education for the family on how to minimize if
not to eradicate their problem regarding pediculosis
such as the use of shampoos that kills the lice.
Resources of the Community
--The Barangay Health Center is open for
consultations regarding pediculosis.

Preventive 3/3 x 1 1 The problem has a high preventive potential as


Potential supported by the following factors:
Gravity/Severity: Gravity/Severity
↑ --The problem is not yet severe since only one

Duration: ↑ of the family members has pediculosis.

Current Duration
--The Problem existed for over a month now ,
Management: ↑
according to the mother
Exposure of any
Current Management
High Risk Group:
 The family has current management on the

problem as the mother removes Ella’s lice
whenever she has free time.

Exposure of any High Risk Group
--7 out 8 are at risk because only Ella has lice
infestations.
It is a felt problem though not needing immediate
Salience ½x1 0.5
action as family sees it.
TOTAL SCORE = 3.17

Family size beyond what family resources can adequately provide

CRITERIA COMPUTATIO SCORE JUSTIFICATION


N
Nature of the A health threat. Inadequate income control can
2/3 x 1 .67 compensate for the needs of the family especially for
problem food and may therefore lead to undernourishment.
1/2 x 2 1 The problem is partially modifiable as supported by
Modifiability of the following factors:
the problem Current Knowledge, Technology and
Current Intervention
Knowledge; ↑ -- The family is aware of the problem. The
parents are working for money for alleviating the
Resources of the problem.
Family; ↓ Resources of the Family
--The family’s physical and manpower
Resources of the
resources are not enough to correct the problem.
SN; ↑
The daily’s income is not enough for the whole
Resources of the
family to be considered not poor.
Community; ↓
Resources of the Student Nurse
--The student nurses are well-equipped with
knowledge and skills so they are capable of
imparting additional health teachings regarding the
problem such as giving tips on how to minimize the
family’s water and electric consumption like closing
the faucet when not in use, keeping the house open
to let the sunlight in thus, reducing their needs for
turning on the lights.
Resources of the Community
--Community resources are not available.
Preventive 1/3 x 1 .33 The problem has a low preventive potential as
Potential supported by the following factors:
Gravity/Severity: Gravity/Severity
↓ --The family's monthly income is really small

Duration: ↑ and would not suffice their needs and if to compare

Current with the NEDA prescribed share amount of money


that each of the family members must have it is
Management: ↑
really far behind. Family income – P3,500/8 =
Exposure of any
P437.50/family member NEDA - P2,768.60
High Risk Group:
Duration

--The problem existed for 3 yrs because the
Exposure of any
family has grown more within this time span.
High Risk Group:
Current Management

-- The family has a current management on
the problem since the father was able to find a job
on a construction firm at the city vicinity.
Exposure of any High Risk Group
--All of the family members with emphasis on
the children are the risk group of the problem as
they have all their basic need that must be sufficed.
The family sees this as a problem needing an
immediate attention because low income
Salience 2/2 x 2 1
corresponds to low nutrition which may lead to
compromised health.
TOTAL SCORE: 3

Problem no. 3.5 : Presence Of Health Threats: Unhealthful Lifestyle And Personal Habits: Cigarette Smoking
Method of
Analysis of the Objectives Nursing Resources Expected
Cues Rationale family
problem interventions required outcome
contact
S> O Inability to make Short term: 1. Encoura 1. To Home visit, >Student Short term:
decisions with After 1 hour ge the lessen the Physical nurses time, After 1 hour of
O > Cigarette respect to taking of nursing mother to children’s assessment effort and nursing
sticks seen at appropriate health interventions, keep the exposure to and Interview skills interventions,
Ina’s hands actions due to: the family will children out smoke. the family shall
be able to of far from >Family’s have
> presence of a. failure to verbalize her while time, verbalized
cigarette ash comprehend the understandin she is cooperation understanding
nature/magnitude of g of the smoking. and active of the health
>Ina is seen the problem health 2. So that participation teachings
while cigarette teachings the children given regarding
smoking b. low salience of the given 2. Instruct won’t have >Community the importance
problem regarding the the mother asthma flare health of quitting
importance of to inform not ups teachings cigarette
quitting to smoke anymore. smoking,
cigarette inside and effects of it to
smoking, close to the the children
effects of it to children and ways of
the children 3. Quitting correcting the
and ways of 3. Instruct smoking can problem
correcting the Ina to increase the
problem somehow try health of Ina Long term
to quit After 4 days of
smoking. home visit Ina
Long term shall limit her
After 4days of cigarette
home visit Ina smoking inside
will limit her the house and
cigarette demonstrate
smoking compliance to
inside the health
house and teachings
demonstrate provided
compliance to
health
teachings
provided

Inadequate living space

COMPUTATI
CRITERIA SCORE JUSTIFICATION
ON
Nature of the 2/3 x 1 .67 The problem is considered to be a health threat to
the family, inadequacy on the living space denotes a
problem
crowd home environment, which is a very favorable
environment for easy transfer of infections.
1/2 x 2 1 The problem is partially modifiable as supported by
Modifiability of the following factors:
the problem Current Knowledge, Technology and
Current Intervention
Knowledge; ↑ --The family is aware of the problem, they

Resources of the know that their environment can contribute to the

Family; ↓ transfer of diseases.


Resources of the Family
Resources of the
--The family’s resources are not available
SN; ↑
especially their financial resources, as shown on
Resources of the
their problem regarding “Family size beyond what
Community; ↓
family resources can adequately provide” it reflects
that their monthly income is really not enough to
suffice their daily needs therefore they cannot also
suffice the expenses they need for increasing their
living space to make it adequate for them.
Resources of the Student Nurse
--The Student Nurses skills and knowledge
can help the family by planning on how to arrange
their furniture so that they may increase their living
space somehow, at least to minimize the problem if
not to fix it totally.
Resources of the Community
--The community’s resources are not available
since the community must implement any actions
they will do to the family to other families who has
the same problem.

Preventive 1/3 x 1 .33 The problem has a low preventive potential as


Potential supported by the following factors:
Gravity/Severity: ↓
Duration: ↓ Gravity/Severity

Current --The problem is severe since there is already


presence of coughs and colds in family members,
Management: ↓
lack of living space may contribute to the transfer of
Exposure of any
coughs and colds between family members.
High Risk Group: ↓
Duration
--The problem existed for almost 5 yrs due to
the growing family.
Current Management
--The family does not have any current
management on their problem regarding Inadequate
living space
Exposure of any High Risk Group
--All of the family members are exposed to
the problem as they all live on that house.

It is a felt problem though not needing immediate


Salience ½x1 0.5 action as family sees it, considering their economic
status.
TOTAL SCORE: 2.5

Chapter VI

Family Nursing Care Plan

Problem no.1 :Presence of Cough and Colds


Method of
Analysis of the Nursing Expected
Cues Objectives Rationale Family Resources
Problem Interventions Outcome
Contact
S > ““sinisipon Inability to provide Short term: 1. Assess for the 1. To have a Home visits Student Short term:
at inu-ubo kami adequate nursing After 1 hour family’s ability basis for the with Health nurse’s time, After 1 hour of
lagi” as care to the sick, of nursing to care for the health Teachings effort and nursing
verbalized by vulnerable/ at risk interventions presence of teaching to knowledge interventions
Ina. member of the family and health the problem. be given and health
due to: teachings the within the Family’s time, teachings the
O > baby eight a. Financial family will family’s cooperation family shall
has nasal constraints verbalize capability. and active have
secretions and b. Lack of or understandin 2. Discuss and participation verbalized
fever inadequate g of health identify with 2. To Increase understanding
knowledge of teachings the family the their Health Center of health
> Presence of nature and given, like the potential awareness Services teachings
non productive extent of importance of complications and interest given, like the
cough. nursing care having that may arise in alleviating importance of
needed. nutritious food and how to the problem. having
initiate nutritious food
Long Term: appropriate
After 2 home interventions Long Term:
visits and and correct After 2 home
health unhealthy visits and
teachings, the practices. health
family will be teachings, the
3. To maintain
able to apply 3. Teach the family shall
adequate
measures on family about have applied
and patent
therapeutic proper measures on
airway.
management position to therapeutic
in relation to loosen management in
the problem secretions relation to the
and (semi-fowlers) problem and
understand understood the
the 4. Instruct the importance of
importance of mother to 4. To going to health
going to monitor any recognize center for
health center feeding any health
for health intolerance presence of management
management and difficulty factors that
of breathing. may
compromise
airway.

5. Encourage to 5. To loosen
increase fluid secretions.
intake.

6. Encourage 6. To mobilize
the mother to the
keep secretions
environment and to
allergen free. prevent
further
complication
7. Teach the s.
children with
cough and 7. To loosen
colds deep secretions.
breathing
exercises.

8. Encourage to
increase
vitamin intake, 8. To boost
like citrus immune system.
fruits.

9. Advise the
mother to
9. To
provide warm
loosen and
versus cold
mobilize
liquids as
secretions.
appropriate.

10. Encoura
ge to take
enough rest 10. To
periods. promote
wellness, to
11. Encoura prevent
ge to fatigue.
maximize
health center 11. For
privileges. further
medical
attention.

PROBLEM 2.5: POOR ENVIRONMENTAL SANITATION: IMPROPER GARBAGE DISPOSAL


RESOURC
ANALYSIS NURSING METHOD
CUES ES EXPECTED
OF THE OBJECTIVES INTERVENTIO RATIONALE OF FAMILY
REQUIRE OUTCOMES
PROBLEM NS CONTACT
D
Short term: Short term:
S: ∅ 1. Assess the 1. To let the Home Visits
O: >Inability to After 2 hours family’s family be Presence, After 2 hours
>Presence recognized of student knowledge aware of the Interview time, and of student
of scattered towards present
dirt all over the presence nurse-family improper problem. Observation cooperatio nurse-family
the house. of the interaction, garbage n of the interaction,
problem due the family disposal and Health family in the family
>Used of to: will its health teachings the shall have
untied sack participate in effect. discussion participated in
bag for a. lack of planning of 2. This is to of the planning of
container. knowledge actions to 2. Discuss with stimulate the problem. actions to
on the improve the family the initiative of improve their
>Presence importance their way of importance of the family in way of
of of having garbage good modifying garbage
improperly properly disposal. environment the - disposal.
disposed managed condition as environment. involveme
garbage garbage well as the nt of the
container. disposal. effect of poor family in Long term:
Long term: environment performing After 4 days
>Presence condition. actions to of home
of flies After 4 days improve visits, the
around the >Inability to of home 3. Encourage garbage family shall
the family to 3. To
garbage make visits, the disposal. have
use covered minimize the
disposal decision with family will demonstrated
trash can or tie occurrence of
area. respect to demonstrate and
plastic bag or vectors that
taking and maintain maintained
sack. may cause
appropriate proper student proper
infectious
>The sac health garbage nurses garbage
diseases
bag and actions due disposal as knowledge disposal as
such as
some plastic to: evidenced in evidenced by
Dengue
bag with by covering providing covering their
Fever.
garbage a. Low their health garbage
was seen salience of garbage 4. Encourage teachings containers.
4. To
inside the the problem containers. also to burn or for the
minimize
house bury the bio- family.
trash and
>Inability to degradable molding of
provide a garbage. leftover
foods. These
home are possible
environment sources of
which is poisoning. student
conducive to 5. Encourage nurses’
health the family to 5. To skills and
maintenance have separate minimize or effort in
and personal box that may eliminate the providing
development serve as a bad odor and and
due to: laundry basket will prevent implement
and for shoe the presence ing actions
a. keeping of mosquitoes to the
Inadequate and flies. problem.
family
resources 6. Encourage
specifically the father to To serve as a
financial dig a temporary
constraints. temporary canal.
groove and
b. lack of cover.
skills in
carrying out
measures to
improve their
garbage
disposal.

Problem# 3.5 Poor Personal Hygiene


INTERVENTION PLAN
ANALYSIS METHOD
CUES OF THE OBJECTIVES NSG. OF RESOURCES EXPECTED
RATIONALE
PROBLEM INTERVENTIONS FAMILY REQUIRED OUTCOME
CONTACT
S>O Inability to Short Term -Assess for signs -to know health H Short term:
O
take After 2° of NI of poor personal threats Family The family
O> The M
appropriate of home hygiene -to know factors E resources: shall have
student
health actions visits, the -Determine contributing to -open to new verbalized
nurse have V
due to: family will factors associated health threat I information understanding
observed
S
>lack of verbalize with poor and about the
the I
adequate understanding personal hygiene -to provide T involvement of importance of
following:
S
knowledge about the -Discuss the health teachings nursing good personal
> The
regarding importance of importance of that will let them interventions hygiene to
members
proper good personal having good maintain a good Student their health
are seen
hygiene hygiene to personal hygiene. personal nurses Long term:
wearing dirty
>inadequate their health hygiene. resources: The family
clothes-
financial -Time & effort shall have
>The
resources to Long Term: -Give health -to provide to explain demonstrated
members of
avail proper After 2 days teachings general comfort proper maintenance
the family
hygiene of NI of regarding different and clean body. hygiene of good
have long
practices and home visits, practices on good practices and personal
and dirty
resources the family will personal hygiene. adequate hygiene and
fingernails
demonstrate knowledge applied health
and toenails-
maintenance about the teachings
>The
of good diseases in a given as
members of
personal poor personal evidenced by
the family
hygiene as hygiene taking a bath
has dirty
evidenced by Community everyday, and
skin as a
taking a bath resources: proper
sign of not
Problem no.3.5 : Presence Of Health Threats: Unhealthful Lifestyle And Personal Habits: Cigarette Smoking
Method of
Analysis of the Objectives Nursing Resources Expected
Cues Rationale family
problem interventions required outcome
contact
S> O Inability to make Short term: 4. Encoura 4. To Home visit, >Student Short term:
decisions with After 1 hour ge the lessen the Physical nurses time, After 1 hour of
O > Cigarette respect to taking of nursing mother to children’s assessment effort and nursing
sticks seen at appropriate health interventions, keep the exposure to and Interview skills interventions,
Ina’s hands actions due to: the family will children out smoke. the family shall
be able to of far from >Family’s have
> presence of a. failure to verbalize her while time, verbalized
cigarette ash comprehend the understandin she is cooperation understanding
nature/magnitude of g of the smoking. and active of the health
>Ina is seen the problem health 5. So that participation teachings
while cigarette teachings the children given regarding
smoking b. low salience of the given 5. Instruct won’t have >Community the importance
problem regarding the the mother asthma flare health of quitting
importance of to inform not ups teachings cigarette
quitting to smoke anymore. smoking,
cigarette inside and effects of it to
smoking, close to the the children
effects of it to children and ways of
the children 6. Quitting correcting the
and ways of 6. Instruct smoking can problem
correcting the Ina to increase the
problem somehow try health of Ina Long term
to quit After 4 days of
smoking. home visit Ina
Long term shall limit her
After 4days of cigarette
home visit Ina smoking inside
will limit her the house and
cigarette demonstrate
smoking compliance to
inside the health
house and teachings
demonstrate provided
compliance to
health
teachings
provided
Problem# 5 Presence of Pediculosis

INTERVENTION PLAN

ANALYSIS OF THE METHOD


CUES OBJECTIVES NSG. OF RESOURCES EXPECTED
PROBLEM RATIONALE
INTERVENTIONS FAMILY REQUIRED OUTCOME
CONTACT

S>O Inability to Short Term >Explore the > To obtain a H The family
provide family’s idea baseline data for O Family shall have
adequate After 2° of NI of how the health M Resources: demonstrated
nursing care the family will pediculosis teachings to be E understanding
O> The
to the be able to occurs and given to the >Manpower of the health
student
infected demonstrate their family. V resources teachings
nurse have
member of understanding management I such as time given about
observed
the family of the health to control it. S and effort. Pediculosis
the
due to teachings I such as
following:
inadequacy given about > Provide the > to increase/ T >Physical methods to
of time r/t Pediculosis family with the suffice the S resources control
> Presence
Mrs. Ina’s such as information inadequacy of such as pediculosis as
of
ADL. methods to regarding knowledge of the cleaning and evidenced by
pediculosis
control Pediculosis family regarding grooming Mrs. Kisses
upon
Inability to pediculosis as including the pediculosis. article e.g. will be able to
inspection
provide a evidenced by management shampoo, restate the
of Tzu and
home Mrs. Ina will that could be comb, soap health
Por’s hair.
environment be able to done to and the like. teachings
conducive to restate the control the given
personal health disease. according to
development teachings Student her
due to given >Provide the > To promote Nurses understanding.
inadequate according to family with personal hygiene Resources:
knowledge her health to the family. The family
about understanding teachings >Knowledge, shall have
hygiene and . regarding skills, time practiced the
sanitation. personal and effort of methods of
Long Term: hygiene the student controlling
especially hair nurses. pediculosis.
After 2 days of care.
NI the family Community
will be able to > Instruct the > To have a resources:
practice the family to visit proper
methods of the health pharmacological Availability of
controlling center for management of the Barangay
pediculosis. consultation. the problem. health center
for
>Explore the > To measure consultation.
family’s the
reaction about understanding of
the health the health
teachings teachings
given. presented.
Problem# 6 Family size beyond what family resources can adequately provide

INTERVENTION PLAN
ANALYSIS METHOD
CUES OF THE OBJECTIVES NSG. OF RESOURCES EXPECTED
PROBLEM RATIONALE
INTERVENTIONS FAMILY REQUIRED OUTCOME
CONTACT
S> Inability to Short Term: > Explain to the > For the Short Term:
"minsan recognize family the family to be H Health
may ulam the After the initial importance of able to O teachings The family
minsan presence of home visit, having adequate increase their M from the shall have
wala”. the the family will and nutritious awareness E student been able to
condition or be able to foods in everyday regarding nurses maximize
their budget
O> problem maximize living. having V regarding
considering
due to their budget adequate and I ways on the nutritional
> the economic considering > Provide health nutritious S budgeting the and health
family implications. the nutritional teachings food in I family’s status of each
consists and health regarding everyday T income family
of 8 status of each possible living. S especially member.
children, a family consequences of with regards
mother member. having to healthy and
and a inadequate and affordable
father. non-nutritious foods that will
food for everyday fit to what the
> the living. family can
mother id avail.
the only > Help the family
member to identify > Acceptance
who possible health and
works and problems that compliance of
only earns may occur the family
2000php regarding having regarding the
a month inadequate and health
non-nutritious teachings of
food for everyday the nursing
living. students
about
> Teach the affordable but
family to identify nutritious
affordable but foods.
nutritious food.

> Teach the


mother on how to
prepare variety of
foods which are
affordable and
nutritious.
Problem# 7 Inadequate Living Space
INTERVENTION PLAN
ANALYSIS METHOD
CUES OF THE OBJECTIVES NSG. OF RESOURCES EXPECTED
PROBLEM RATIONALE
INTERVENTIONS FAMILY REQUIRED OUTCOME
CONTACT
S> O There is an Short Term: > Emphasize the > Provide Short Term:
inability to positive effects of opportunity H Health
O> provide a After the initial adequate living for the family O teachings The family
home home visit, space like to realize and M from the shall
> ten environment the family will decreasing the formulate E student become
members which is become possibility of plans nurses aware of
of the conducive to aware of having respiratory towards V regarding measures to
family health measures to disease. problem I importance of achieve
share maintenance achieve more solving. S having more
and comfortable > Discuss the I adequate comfortable
> the total personal living space. possible untoward > For the T living space living space.
floor area development results of family to S
is only due to Long Term: inadequate living realize the > Acceptance Long Term:
3.35m x limited space like effects of and
3m physical After the final contagious inadequate compliance of The family
resources. home visit, disease space living the family shall do the
the family will regarding the proposed
do the > Assist mother to health measures
proposed remove > Free space teachings and and will
measures unnecessary for adequate health issue achieve
and will things inside the movements of the student conditional
achieve house nurses. living space.
conditional
living space. > Assist mother
not to hang > Allows
clothes inside the more space
house for the family
members to
utilize

> Assist family in > To space


changing the needed for
position of the the family
furniture member
VII. FAMILY COPING INDEX

Initial Final
Category Justification
1 3 5 1 3 5

1. PHYSICAL
INDEPENDENCE  Initial Visit:

This category is concerned During the initial visit, the group had
with the ability to move observed that Mrs. Ina has failed to
about, to get out of bed, to provide required personal care for
take care of daily grooming, herself and her children as
walking, etc. Note that it is evidenced by the presence of lice
the family competence that infestation, poor hair care and long
is measured- even though fingernails of the children. The
an individual is clothes of her children too are soiled
independent, if the family is with sweat and dirt.
able to compensate for this.
The family is important-
hence, if the focus of care  Final Visit:
is poor, for instance, if the
mother is giving care to a The Student nurse had given them
handicapped child that she health teachings about the
shared with other members importance of proper hygiene; the
of the family, the family was cooperative to fully
independence might be comply with it. The mother has
considered incomplete. The allotted time and effort to manage
causes of independence the hygiene of herself and her
may vary however. Lack of children. The fingernails of her
independence in the family children were trimmed and they
may be due to actual were also seen wearing their
physical incapacity, the slippers most of the time especially
inability of “know-how”, the when they are outside the house.
willingness or fear of doing
necessary tasks.
2. THERAPEUTIC  Initial Visit:
COMPETENCE
The group gave the family a score of
three because Mrs. Ina gives some
This category includes all over the counter medications to her
children or other family members
the procedures or
when needed. She sometimes asks
treatment prescribed for the for the opinions of health workers at
care of illness, such as the health center. They are not able
giving medications and to provide other therapeutic
using appliances, measures to some illness like cough
dressings, exercises, and and colds because of their financial
relaxation and special limitation and lack of knowledge as
well.
diets.

Final Visit:

 The family has recognized their role


in health maintenance and improved
seeking medical assistance from a
physician or from the barangay
health center in order to avoid
further complication or aggravation
of minor illnesses.

3. KNOWLEDGE ON
HEALTH CONDITION  Initial Visit:

This category is concerned Mrs. Ina has very limited


with the particular health understanding regarding disease
condition that is the conditions. She recognizes
occasion for care, presence of disease but has limited
knowledge of the disease knowledge about what are the
or disability, understanding causes of each. She is not aware
of communicability of about what further complication a
diseases and modes of certain disease can bring.
transmission,
understanding of general
patterns of development of
a newborn baby and the
basic needs of infants for
physical care and tender  Final Visit:
loving care.
The student nurse provided health
teachings to the family, the family
did practice what was taught to
them. Mrs. Ina’s knowledge on
diseases is well enough so as to
take actions on the health needs of
her family. They are able to go to
the Health Center to consult for their
condition.

4. APPLICATION OF
PRINCIPLES OF
GENERAL HYGIENE  Initial Visit:

This is concerned with The family’s hygiene is not


family action in relation to prioritized at the Imba’s. This was
maintaining family nutrition, evidenced by the lice infestation in
securing adequate rest and the children, dirty fingernails and
relaxation for family toenails, and dirty soles of the feet.
members and carrying out The children were also seen playing
accepted preventive outside the house without any
measures such as slippers on. Baby eight was seen
immunizations, medical sucking his milk bottle even though
appraisal and safe if fell on the floor without washing it.
homemaking habits in The environment around the house
relation to storing and as well is unorganized and leftover
preparing food. foods are just left on top of the table
covered with plate.

Final Visit:

There are some improvements
noted on the appearance of the
children as evidenced by the
trimmed nails of the children and
wearing of slippers outside the
house.

5. HEALTH ATTITUDES
 Initial Visit:
This category is concerned
with the way the family Mrs. Ina benefits from the services
feels about health care in
offered by the Barangay Health
general, including
preventive services, care of Center. She never fails to seek
illness and public health medical advice whenever her
measures. children need it.

 Final Visit:

The family maintains their positive


attitude towards health. They seek
medical advices as recommended.
6. EMOTIONAL
COMPETENCE  Initial Visit:

This category has to do In times of family crisis, the family


with the maturity and provides emotional support to each
integrity with which the other as their means coping with
their problems. The parents play a
members of the family are
major role in providing their children
able to meet the usual with guidance. They maintain an
stresses and problems of open communication to facilitate
life, and to plan for happy  family solidarity. However, there
and fruitful living. This times when they are not able to
involves the degree to solve other problems especially
which individuals accept when the nature of the problem is
financial.
the necessary disciplines
imposed by one’s family
Final Visit:
and culture; the
development and
The family’s emotional competence
maintenance of individual remains the same. Despite of their
responsibility and decision; low economic status were able to
and willingness to meet cope up on the problems they
reasonable obligations, to encountered and think of ways
accept adversity with where in they can provide their need
fortitude, and to consider such as food for the day.
the needs of others as well
as one’s own.

7. FAMILY LIVING
 Initial Visit:
This category is concerned
largely with the All of the members of the family get
interpersonal or group along. However, sibling rivalry
aspects of family life- how cannot be eliminated in the family.
Mrs. Ina told the group also that she
well the members of the
and Mr. Itay also experiences petty
family get along with one fights but managed to solve them
another, the ways in which immediately.
they make decisions
affecting the family as a
whole, the degree to which
they support one another Final Visit:
and do things as a family, 
the degree of respect and The group taught the children that
affection the show for one petite fights may be normal but they
another, the ways in which should know that they should be
the manage the family patient with each other especially
budget, the kind of the older ones. Tzu as the second
discipline that prevails. eldest agreed to what the student
nurses said.

8. PHYSICAL
ENVIRONMENT  Initial Visit:

This category is concerned The Imba Family’s house condition


with the home and is poor in nature because there are
community or work some presence of accident hazards
environment as it affects that is not recognize by either
family health. This includes Mr.Itay or Mrs. Ina. One of their
the conditions for housing, problems is the presence of the
presence of accident faulty wirings. The clothes are also
hazards, screening, hanged inside the house
plumbing, facilities of unorganized. The children are often
cooking and for privacy; found playing on streets.
level of community
(deteriorated or modern,
presence of social hazards Final Visit:
such as bars, street gangs,
delinquency, pest such as The family improved the cleanliness
rats, etc.), availability and of the interior of the house but the
conditions of schools and surrounding environment still needs
transportation.  more interventions. This was
evidenced by the cleaner
environment. Clothes are hanged
properly and the floor was properly
swept.

9. USE OF COMMUNITY
FACILITIES  Initial Visit:

This category has to do The Imba Family knows or uses


with the degree to which some available community
family members know resources that are needed. Mrs. Ina
about and the wisdom with is aware of the programs offered by
which they use available the Barangay Health Center but
community resources for sometimes fails to attend or comply
health, education, and with it. They also attend or join some
welfare. The coping ability community activities like town fiesta
does not indicate the level and the like. Despite their
of the need for services, awareness, they still lack knowledge
but rather the degree to regarding other free benefits that
which they can cope when they can avail.
they must seek such aid.
 Final Visit:

The family acknowledges the


programs available at the health
center and agrees to seek advice as
necessary.

VIII. LEARNING DERIVED


I personally learned the importance of the family in the society, as the
basic unit of the society, it is important to maintain the health of the family.
Comparing the family with the human body, as when one part of the body is
infected, later on the whole body will be affected systemically, just like with the
family and society, when a family is considered ill, later on the society will be
systemically affected.

I also learned the importance of good communicating skill. With the


absence of a good communicating skill the student nurse will not be able to
establish rapport with his/ her client, thus affecting the assessment process,
making the problem identification and prioritization be difficult, thus, altering the
maximum care you may give to the family.

Assessment is the very crucial part of doing the family case analysis, with
all the data that you will gather throughout the assessment process, there you
will derived the problems you will intervene to correct this problems.

The most important thing that a student nurse must have is the initiative,
time, effort, and patience, without those things you will not be able to gather all
the information you need, the client’s cooperation and compliance is also a vital
ingredients for the success of making a family case analysis.

DELA CRUZ, NIKKI D.


I have learned about the importance families in the society, as the basic
unit of the society, it is important to maintain the health of the family. A family
greatly affects the community, as illness can be transmitted to other families as
well. I also learned the importance of therapeutic communication, without this, it
will be hard for the student nurses to gain the trust of their client, thus, affecting
the level of care that the student nurse may give because of lack of cooperation.

Assessment is the very crucial part of doing the family case analysis, with
all the data that you will gather throughout the assessment process, there you
will derive the problems you will intervene to correct this problems. The most
important thing that a student nurse must have is the initiative, time, effort, and
patience, without those things you will not be able to gather all the information
you need, the client’s cooperation and compliance is also a vital ingredient for the
success of making a family case analysis.

BAUTISTA, DANIEL JACOB


Nursing is the art and science of rendering care to individuals who are sick
and well. It is a profession that requires not only the knowledge of the students
but also their skills and capability of touching the lives and hearts of their
patients. I have been through community health nursing before and this is my
second time when it comes to assessing a family. This experience of being a
community health nurse gives me the privilege of extending my knowledge, my
hands and my care to these individuals who are less fortunate. This part of being
a community nurse makes me somehow feel how fortunate I am of having a life
that is much better than theirs. Community health Nursing thought me to identify
problems and render some interventions that could somehow change or alleviate
the identified problem.

This activity also gave me the chance to be with people who needs attention
that somehow they are deprived of. Our first day with our adopted family, as we
saw the children they were so dirty, haven’t eaten their breakfast they were thin
and you could see and it was really obvious that they were malnourished, and I
felt in my heart that these poor individual’s needed someone that could make
their day different than the other. If only I could give them money and buy what
they want I would, but since I only have enough I hope that someone with a heart
could pay attention with these poor individuals. I have learned through this
experience that if I would be putting-up my own family id better be sure that I
have all the means to put up a big family and I could give everything they want
and need, since its my choice of having a big family. I cannot blame their parents
because maybe no one taught them of putting up plans first before doing things
they like.

This experience has really taught dozens of things in my life, in my heart and
in my chosen profession. It gave me more passion and interest in my chosen
course. The experience I have taught me to understand things using the heart
and not the mind. The mind only gives knowledge, but the heart expresses love
and affection, trust and learning – these are what the community needs; a heart
that feels and a hand that touch and help.

Christine Chera O. Sawallich, S.N.,


FLOOR PLAN

3.35m

3m
Appendix

Weight (kg) for Age of Boys and Girls (0-72 months)

BOYS GIRLS
Below Below Below
AGE Abov Abov
Normal Normal Normal Normal Normal
(Months e e
(Very low) (Low) (Low)
) Norm Norm
≤ Fro Fro Fro Fro
To To al ≥ To To al ≥
m m m m
0 1.8 1.9 2.3 2.4 4.3 4.4 1.0 2.1 2.2 4.0 4.1
1 2.2 2.3 2.8 2.9 5.6 5.7 2.3 2.7 2.8 5.1 5.2
2 2.7 2.8 3.4 3.5 6.8 6.9 2.8 3.2 3.3 6.1 6.2
3 3.2 3.3 4.0 4.1 7.7 7.8 3.3 3.8 3.9 7.0 7.1
4 3.7 3.8 4.6 4.7 8.5 8.6 3.8 4.4 4.5 7.7 7.8
5 4.1 4.2 5.2 5.3 9.2 9.3 4.2 4.9 5.0 8.4 8.5
6 4.6 4.7 5.8 5.9 9.8 9.9 4.7 5.4 5.5 9.0 9.1
10.
7 5.0 5.1 6.3 6.4 10.4 5.1 5.8 5.9 9.6 9.7
3
10. 10.
8 5.3 5.4 6.8 6.5 10.9 5.4 6.2 6.3 10.2
8 1
11. 10.
9 5.7 5.8 7.1 7.2 11.4 5.8 6.5 6.6 10.6
3 5
11. 10.
10 5.9 6.0 7.5 7.6 11.8 6.0 6.8 6.9 11.0
7 9
12. 11.
11 6.2 6.3 7.8 7.9 12.1 6.3 7.1 7.2 11.4
0 3
12. 11.
12 6.4 6.5 8.0 8.1 12.5 6.5 7.3 7.4 11.7
4 6
12. 11.
13 6.6 6.7 8.2 8.3 12.8 6.7 7.5 7.6 12.0
7 9
13. 12.
14 6.7 6.8 8.4 8.5 13.1 6.8 7.7 7.8 12.3
0 2
13. 12.
15 6.9 7.0 8.6 8.7 13.3 7.0 7.9 8.0 12.5
2 4
13. 12.
16 7.0 7.1 8.7 8.8 13.6 7.1 8.1 8.2 12.7
5 6
13. 12.
17 7.2 7.3 8.8 9.0 13.8 7.3 8.2 8.3 13.0
7 9
13. 13.
18 7.3 7.4 9.0 9.1 14.0 7.4 8.4 8.5 13.2
9 1
14. 13.
19 7.5 7.6 9.1 9.2 14.2 7.6 8.5 8.6 13.4
1 3
14. 13.
20 7.6 7.7 9.3 9.4 14.5 7.7 8.7 8.8 13.6
4 5
14. 13.
21 7.7 7.8 9.4 9.5 14.7 7.8 8.9 9.0 13.9
6 8
14. 14.
22 7.9 8.0 9.6 9.7 14.9 8.0 9.0 9.1 14.1
8 0
15. 14.
23 8.0 8.1 9.7 9.8 15.1 8.1 9.2 9.3 14.3
0 2
10. 10. 15. 14.
24 8.3 8.4 15.8 8.4 9.3 9.4 14.7
0 1 7 6
10. 10. 15. 14.
25 8.4 8.5 16.0 8.5 9.5 9.6 15.0
1 2 9 9
10. 10. 16. 15.
26 8.5 8.6 16.2 8.6 9.7 9.8 15.3
2 3 1 2
10. 10. 16. 15.
27 8.6 8.7 16.4 8.7 9.8 9.9 15.7
3 4 3 6
10. 10. 16. 10. 10. 15.
28 8.8 8.9 16.7 8.9 16.0
4 5 6 0 1 9
10. 10. 16. 10. 10. 16.
29 8.9 9.0 16.9 9.0 16.2
5 6 8 1 2 1
10. 10. 17. 10. 10. 16.
30 9.0 9.1 17.1 9.1 16.5
6 7 0 2 3 4
10. 10. 17. 10. 10. 16.
31 9.1 9.2 17.3 9.2 16.8
8 9 2 4 5 7
10. 11. 17. 10. 10. 17.
32 9.2 9.3 17.5 9.3 17.1
9 0 4 5 6 0
11. 11. 17. 10. 10. 17.
33 9.4 9.5 17.7 9.5 17.3
0 1 6 7 8 2
11. 11. 17. 10. 10. 17.
34 9.5 9.6 17.9 9.6 17.6
1 2 8 8 9 5
11. 11. 18. 10. 11. 17.
35 9.6 9.7 18.1 9.7 17.9
2 3 0 9 0 8
11. 11. 18. 11. 11. 18.
36 9.7 9.8 18.4 9.8 18.1
3 4 3 1 2 0
11. 11. 18. 11. 11. 18.
37 9.8 9.9 18.6 9.9 18.4
4 5 5 2 3 3
10. 11. 11. 18. 10. 11. 11. 18.
38 9.9 18.8 18.6
0 6 7 7 0 3 4 5
10. 11. 11. 18. 10. 11. 11. 18.
39 10.0 19.0 18.8
1 7 8 9 1 4 5 7
10. 11. 11. 19. 10. 11. 11. 19.
40 10.1 19.2 19.1
2 8 9 1 2 5 6 0
10. 11. 12. 19. 10. 11. 11. 19.
41 10.2 19.4 19.3
3 9 0 3 3 7 8 2
10. 12. 12. 19. 10. 11. 11. 19.
42 10.3 19.6 19.5
4 0 2 5 4 8 9 4
10. 12. 12. 19. 10. 11. 12. 19.
43 10.4 19.8 19.7
5 2 3 7 5 9 0 6
10. 12. 12. 19. 10. 12. 12. 19.
44 10.5 20.0 19.9
6 3 4 9 6 0 1 8
10. 12. 12. 20. 10. 12. 12. 20.
45 10.6 20.2 20.2
7 4 5 1 7 1 2 1
10. 12. 12. 20. 10. 12. 12. 20.
46 10.7 20.5 20.4
8 5 7 4 8 2 3 3
10. 12. 12. 20. 10. 12. 12. 20.
47 10.8 20.7 20.6
9 7 8 6 9 3 4 5
10. 12. 12. 20. 11. 12. 12. 20.
48 10.9 20.9 20.8
9 8 9 8 0 5 6 7
11. 12. 13. 21. 11. 12. 12. 20.
49 10.9 21.1 21.0
0 9 0 0 0 6 7 9
11. 13. 13. 21. 11. 12. 12. 21.
50 11.0 21.3 21.2
1 0 2 2 1 7 8 1
11. 13. 13. 21. 11. 12. 12. 21.
51 11.1 21.5 21.4
2 2 3 4 2 8 9 3
11. 13. 13. 21. 11. 12. 13. 21.
52 11.2 21.8 21.6
3 3 4 7 3 9 0 5
11. 13. 13. 21. 11. 13. 13. 21.
53 11.3 22.0 21.8
4 4 6 9 4 0 1 7
11. 13. 13. 22. 11. 13. 13. 21.
54 11.4 22.2 22.0
5 6 7 1 5 1 2 9
11. 13. 13. 22. 11. 13. 13. 22.
55 11.5 22.4 22.3
5 7 8 3 6 2 3 2
11. 13. 13. 22. 11. 13. 13. 22.
56 11.5 22.7 22.5
6 8 9 6 6 3 4 4
11. 13. 14. 22. 11. 13. 13. 22.
57 11.6 22.9 22.7
7 9 1 8 7 4 5 6
11. 14. 14. 23. 11. 13. 13. 22.
58 11.7 23.1 22.9
8 1 2 0 8 5 6 8
11. 14. 14. 23. 11. 13. 13. 23.
59 11.8 23.4 23.1
9 2 3 3 9 6 7 0
11. 14. 14. 23. 12. 13. 13. 23.
60 11.9 23.6 23.3
9 3 5 5 0 7 8 2
12. 14. 14. 23. 12. 13. 13. 23.
61 11.9 23.8 23.6
0 5 6 7 0 8 9 5
62 12.0 12. 14. 14. 24. 24.1 12. 13. 14. 23. 23.8
1 6 7 0 1 9 0 7
12. 14. 14. 24. 12. 14. 14. 23.
63 12.1 24.3 24.0
2 7 9 2 2 0 1 9
12. 14. 15. 24. 12. 14. 14. 24.
64 12.2 24.6 24.2
2 9 0 5 3 1 2 1
12. 15. 15. 24. 12. 14. 14. 24.
65 12.2 24.8 24.5
3 0 1 7 3 2 3 4
12. 15. 15. 25. 12. 14. 14. 24.
66 12.3 25.1 24.7
4 1 3 0 4 3 4 6
12. 15. 15. 25. 12. 14. 14. 24.
67 12.4 25.3 25.0
5 3 4 2 5 4 5 9
12. 15. 15. 25. 12. 14. 14. 25.
68 12.5 25.6 25.2
5 4 5 5 6 5 6 1
12. 15. 15. 25. 12. 14. 14. 25.
69 12.5 25.8 25.5
6 5 7 7 6 6 7 4
12. 15. 15. 26. 12. 14. 14. 25.
70 12.6 26.1 25.8
7 7 8 0 7 7 8 7
12. 15. 15. 26. 12. 14. 14. 25.
71 12.7 26.4 26.0
8 8 9 3 8 8 9 9
12. 15. 16. 26. 12. 14. 15. 26.
72 12.8 26.7 26.3
9 9 0 6 9 9 0 2

Bibliography

• Maglaya, Arceli (2004) Nursing Practice in the Community 4th Edition

Argonauta Corp, Marikina City


• Cuevas, Frances Prescilla L., et. al. (2007), Public Health Nursing in the

Philippines, 10th Edition National League of the Philippine Government

Nurses

• Untalan, Aaron Tuesca (2005) Concepts and Guidelines in COPAR

Giuani Prints House, Malabon, Philippines

• Berman, Snyder, Kozier, Erb (2008), Kozier &Erb’s Fundamentals of

Nursing 8th Edition Pearson Education South Asia PTE. LTD

• Micheael Tan (2006)A Reconfigured Filipino Family in Law & Fact

• http://dictionary.reference.com/browse/family

• http://www.nursingcenter.com/library/JournalArticle.asp?

Article_ID=834322

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