ACKNOWLEDGMENT

The student nurse would like to acknowledge the indebtedness and render the

warmest thanks to their Professor, Professor Jim Vinuya, who made this case study possible. His

friendly guidance and expert advice have been invaluable throughout all stages of the work.

The student nurse would also like to wish to express my gratitude to the professor for extended

discussions and valuable suggestions which have contributed greatly to the improvement of the

Case Study. The Case Study has also benefited from comments and suggestions made by the

sister of the Student Nurse Ma. Crisila brutas who have read through the manuscript. I take this

opportunity to thank them.

Special thanks are due to her classmates, for their continuous support and

understanding, but also for more concrete thinks like commenting on earlier versions of the

Case study, helping with the figures and the final preparation of the manuscript.

Also, thank you to the family become the respondents, whose help and cooperative at

every point during the study and helped the student nurse to work in time and for being

approachable and spending their time answering all the question that is being asked;

And most of all, the student nurse would like to extend wholeheartedly the gratitude

and praise to ever loving and merciful God for touching and bringing together those people

who literally shared their abundant resources, talents, skills, time and effort for the completion

of the study.

MARY GRACE G. BRUTAS

 INTRODUCTION

According to Alice Petiprin (2016), Family nursing is a part of the primary care provided

to patients of all ages, ranging from infant to geriatric health. Nurses assess the health of the

entire family to identify health problems and risk factors, help develop interventions to address

health concerns, and implement the interventions to improve the health of the individual and

family. Family nurses often work with patients through their whole life cycle. This helps foster a

strong relationship between health care provider and patient.

Family nursing is not as much patient-centered care as it is centered on the care of the

family unit. It also takes a team approach to health care. A family nurse performs many duties

commonly performed by a physician. They have the ability to write prescriptions, and need a

broader base of knowledge and skills in order to care for their patients. Nurses may work in

clinics, private offices, hospitals, hospice centers, schools and homes to care for their patients.

Community health Nursing is the synthesis of nursing and public health practice applied

to promote and protect the health of population. It combines all the basic elements of

professional, clinical nursing with public health and community practice. Community health

nursing is essential particularly at this point in time because it maximizes the health status of

individuals, families, groups and the community through direct approach with them. Today

community participation and involvement is getting a due attention before the occurrence of

illnesses as life-style changes to continue to play a significant role in morbidity and mortality.

Chronis illnesses, tobacco smoking, road traffic accident (RTA) …etc, and environmental

changes that affect health are steadily becoming the major concerns influencing human health
in our country. As nurses of 21st century we have duties and responsibilities to keep a dynamic

balance with the ever changing needs of the health of our society. To maintain abreast with this

societal needs we professional nurses must understand concepts and models of the community

health nursing, the importance of health promotion and disease prevention and health care

planning, implementation and evaluation of health care efforts for the advantage of the

community. (Mengistu, D. and Misganaw, E.(2006))

A system-based conceptualization of family nursing is suggested, with family nursing

practised on three system levels. The level of individual family members views the family as the

context of the individuals. The interpersonal level addresses dyads and larger units and the

family system level includes the structural and functional system components interacting with

the environment. Intervention on a higher system level includes the lower levels. While family

nursing falls within the practice scope of all nurses, intervention aimed at system change

requires holistic understanding of the intricate relationships between family system

components and the skills of clinical specialists. (Friedemann ML(1989))

  According to Baumbusch (2014) defines family as the basic social institution because of

its important functions of procreation and socialization and because it is found, in some forms

in all societies.Family is a term used in everyday language whose meaning is cognate with the

culturally and historically specific social practices to which it refers. Additionally, universal social

institution refers to a distinctive characteristics of the social life of particular culture and

epochs. Its activity and their effects on the maintenance of the social structure of the society, of

which it is a part, concentrating on biological and demographic features. The structure of the

family varies from society to society. Deist and Greeff (2015), added that family health nursing
is the practice of nursing directed towards maximizing the health and wellbeing of all

individuals within in a family system. It incorporates two views of family, family as a unit of care

and family as a contact. Family health nursing views the family as a system existing within larger

system. Levels of intervention are the individuals the personal, the family system, and the

environmental level. The goals of the family health nursing include optimal functioning for the

individual and for the family as a unit.

 OBJECTIVES OF THE STUDY

General Objectives:

The general objective of this case study is to protect and preserve the health of its

family members, improve their health status and become self-reliant in maintaining their health

through appropriate intervention.

Specific Objectives:

On the completion of this case study, the family members will be able to:

a. Learn how to manage oneself that will optimize health

b. Learn about one’s strengths and weaknesses regarding case presentation and

takes measures to enhance one’s skills and abilities.

c. Recognize the contributing risk factors associated in the development of the

problem.

d. Exhibit mastery and tact in answering relevant questions with positive attitude

towards criticisms and suggestions.

e. Identify the different signs and symptoms that may be manifested by the family

member with diseases.

 INITIAL DATA BASE

A. Family Structure, Characteristics and Dynamics

NAME AGE SEX CIVIL POSITION OCCUPATION EDUCATIONAL

(CODE (Years) STATUS IN THE ATTAINMENT
NAMES FAMILY
JG 41 Male Married Father All around Vocational
Handyman Graduate
MG 43 Female Married Mother OFW High School
Graduate
CG 18 Female Single Eldest Child ------ Grade 10
(ongoing)
ClG 17 Female Single Second ------ Grade 7
Child (ongoing)
NG 14 Male Single Third Child ------- Grade 8
(ongoing)
LG 12 Male Single Fourth Child ------- Grade 6
(ongoing)
HG 9 Female Single Fifth child ------- Grade 2
(ongoing)
AG 7 Female Single Sixth child ------ Grade 2
(ongoing)
LG 5 Male Single Last child ------

Table 1. Guina’s Family Structure, Characteristics and Dynamics

The Guina Family is a nuclear type of family that consist of the father, Mother,

and their children. Their father, Mr. JG who is a tricycle driver and also a Handyman, the

Mother, Mrs. MG who work as OFW in UAE, and all their Children who are in the middle

school, studies in Manaoag National High School, their Eldest, Ms. CG, a Grade 10

student turning Grade 11 the next school year, she said that she stop studying for 2

years because they don’t have enough money to sustain the needs. The second and

third child are in different level because the second child also stops. The other children
 of this family is Elementary and the school they go is Manaoag Central School SPED

Center. They have been living in Manaoag for ___ years. Mrs. MG is from Mangaldan,

Pangasinan and Mr. JG is from Manaoag, Pangasinan. After marriage, they decided in

Manaoag where Mr. JG live since birth. The lot where their house built is owned by her

mother but the house is owned by the couple. In this family, the father is the more

powerful and has the authority. According to Ms. CG said that his father is more

dominant in terms in decision making and disciplining his children because her mother

was in other country.

“Tumigil po ako ng dalawang taon kasi wala kaming pera pangaral at pagtustus

ngpagaaral ko.” “I stop in studying because we don’t have enough money to support

my education and to sustain the needs in school. “ (CG, Eldest child)

“Si papa ko yung may authority sa bahay namin kasi wala naman si mama ditto

kasi nasa ibang siya nagtratrabaho.” “My father is more dominant in terms in decision

making and disciplining us because our mother was in other country to work” (CG,

Eldest child)

A. Socio-Economic and Cultural Characteristics

Mr. JG mentioned that having a low educational background seems to be a big

challenge because he can’t help his children in doing their homework and to get a

proper and stable job. He is a High School Graduate, he finished his study in Manaoag

National High School. He worked as a tricycle driver and and Handyman as a part time

job. In this, he worked as a labour, and this type of job, it has offers a little opportunities
 which he only receives P450 per day. He mentioned also that if there is a holiday, his

children specifically his sons accompanied him in his work to help him. The salary he

gained is enough to sustain the needs of the family like water bill, electric bill, food and

other stuff needed in the House. So, Her Wife, Mrs. MG who worked as a OFW and has a

salary approximately P10 000 per month and it is a big help to the family to sustain the

needs of their children and his husband like allowance, snack, cigarette and other school

supplies.

Mr. JG acknowledged that they doesn’t have any health insurance because they

doesn’t have budget for health insurance due to lack of money. He further include that

they spend her wife’s money to pay all the debts they have when her wife went to other

country. Also, they spend other for their basic needs and also for the vices of Mr. JGlike

alcohol, smoking. Because through he thought that through vices it would help him to

reduce the stress on taking care of the family and because her wife is away from home.

B. Home and Environment

The family resides in an unsanitary area in Brgy. Calaocan, Manaoag, Pangasinan.

Their house is made up of concrete cement, some are wood and light materials and the

roof is made out of steel. The family sleeps separately, there are two rooms in their

house, the children sleeps together in the floor with foam, and their father sleeps in the

other room .The other side of the room is their receiving area where they have a

wooden sofa and half of the receiving are is the dining area where they usually eat. They

usually ate dinner at 8 pm to 9 pm and sleep at around 10 pm - 11 pm after they to the

chores and wakes up at 6 a.m to prepare the foods for breakfast and to prepare the
children to go to school and to go to work. The house is poorly ventilated and there is

inadequate lighting and insufficient water resources because the resources that they

have is the well which is in the back of their house and they have tank which is

connected to it. They have a dirty kitchen outside of their house that’s where breeding

sites of insects occur such as cockroach and rats, they use to cooked with the use of

wood and sometimes gas and inevitable due to open drainage and poor environmental

sanitation. The drainage they have is open where insects lived and there are a lot of

molds in it. Their toilet is located at the side of their house which you will walk, ‘cause it

is far from the house, also they share with all the member of the family and also they

use it as a business every saturday and Sunday if someone needs to pee. The restroom is

made out of some concrete cement and makeshift. The house is along the road, and

located near the church. There is electric supply in the area which they are belong, and

this electric corporation is DECORP. Mr. JG is accountable for buying their daily

necessities and making sure that their money suits their budget. He buys their food in

the public market and budgeted it for that day. He usually cooks processed food and

sometimes if they have extra money he cook meat, vegetable, fish dishes, also they buy

some “lutong ulam” in lunch.

Regarding their sanitation, they doesn’t have non-biodegradable and

biodegradable trash bins. Their garbage is throw in the open pit in their backyard, also

they just burn it. The overall surrounding of the family is unhygienic and the drainage

system is open and the store that is near the house was also unhygienic because they

just do their sanitation in the back of their store. The walls that separated them from
 their neighbours was concrete cement and sawali and the electrical connections are

entangle and hazardous because the stores near the house is connected to the

electricity of Mr. JG.

C. Health Assessment of the Family

History of Past Illness

 Ms. CG had an asthma attack when she is young. She’s not taken in the hospital

because she has a nebulizer in their house but it is limited. She is a premature

baby which she has a weak lungs. She had already taken vitamins for stronger

immunity but wasn’t able to sustain it due to lack of money

 Mr. LG had been taken to the hospital because of the influenza that he has. His

temperature reached until 39.8℃ which may result in convulsion. Later on, he

has been recovered and has vitamins but due to lack of money they stops to

take.

History of Present Illness

 Mr. JG doesn’t have any maintenance to take because he doesn’t have any

diseases, he told that he drinks alcohol more than 8 beers almost every day and

go home at the early morning. He also smoke, and used more than 10 pcs stick

of cigarette a day. Patient denies any recreational drug use, any exercise tough

he feels that he is physically fit because of his heavy work. Patient told that they

used to eat meat and vegetable, sometimes canned goods and “lutong ulam”.
  Mr. LG has a colds for more than 1 week. He used to have influenza in the past

but he take medication for colds. They used to drink cold beverages such as ice

tea, softdrinks and ice water.

D. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

Family Assessment based on Functional Health Pattern

1. Health Perception / Health Management

According to Mr. JG, illness for him is the state in which his activities of daily

living are delayed by some discomfort or pain, moreover, the presence of symptoms of a

particular disease. He thought that illness is something that we need to take care

because it will be the burden to you and to your children. When asked about his present

health condition, he believes he is well and doesn’t have any complication. The patient

claimed consuming more than 10 sticks of cigarettes daily have lived and frequently

drinking of alcohol.

For the family when fever, cough or colds occurred, over-the-counter

medications like biogesic and bioflu is used for treatment or they go to “mang gagamot”

(quack doctors). He also believed in the alternative treatment such as herbal medicine

and alternative modes of treatment such as “hilot” as a first aid.

2. Nutritional-metabolic Pattern
 The family started a day with a cup of coffee and rice but sometimes they skip

breakfast. At lunch and dinner, he cooks food depending on what’s available and

what’s food can their money buy. They are also a fan of using condiments like magic

sarap and other seasoning that

will make their food more favoured. When it comes to oral intake like water them

usually consumes 4-5 glasses of water daily but when they have extra money from

the other sources of income they buy softdrinks and other beverages. The drinking

water that they are drinking is mineral water, they order it from Aqua Best, a

refilling station near the barangay.

3. Elimination Pattern

Mr. JG has normal bowel pattern. He has his bowel movement once a day which

is normal. The appearance of the stool was normal there is no any blood in stool. He

don’t feel any discomfort with his bowel movement. He frequently urinate about 3-

5x a day. The amount and the colour of urine was normal which is marigold, also the

water that he intake is also he amount of urine he will excrete. He don’t feel any

pain and discomfort while he was urinating. Regarding to the family, they state that

they defecate every day and urinate 5 times daily without suffering from painful and

discomfort urination.

4. Activity-exercise Pattern

According to Mr. JG, His job as a Handyman and a tricycle driver , he

memntioned that it is already their form of exercise because he removing debris,

erecting scaffolding, loading and unloading building materials, and assisting with
 operating heavy equipment. And also he drive the whole day. Also, one of the form

of exercise he does is that he prepares the needs of his children when they go to

school. For the children they walking when going home and sometimes walking

when going to school is one form of their exercise. Sometimes, they used their

bicycle when buying foods in the store.

5. Sleep-rest Pattern

The family usually sleep at around 10 p.m. to 11 p.m. after they did the chores

and wakes up at 6 a.m to prepare the foods for breakfast and to prepare the

children to go to school and to go to work. For the children optimally receive

between seven and eight hours of sleep every night and if they need to study they

usually receive seven hours, while for Mr. JG consider six to seven hours of sleep is

good enough also.

6. Cognitive-perceptual Pattern

The family is very cooperative in the interview, hears and answers every

question I ask to them even though it is quite personal. Mr. JG understands the

present condition they have in the family and recognize things happen for a reason.

They are approachable, respectful and open to all the question I have even though

some very private and they allow me to know all of those.

7. Self-Perception/Self Concept
 Mr. JG admitted that he has difficulty in adjusting because he was

separated from her wife for how many years they lived together and it is their

first time to be in Long Distance to each other because she needs to work for the

family. However, doing all things for their children makes him more brave and

give him the best he can for his children and also for her wife. Right now, his

focus is to strive harder for his children’s future and give them the things he

doesn’t experience when he was still young. Also, to show to her wife that he

can take care of his children.

8. Roles and Relationship

Mr. and Mrs. Guina have a hard time in communicating because of the different

time they had. Mr JG wakes up 3 am just to talk to her wife and asked if she is okay.

Sometimes they have misunderstanding and argued in terms of decision making

about financial and other matters that involved the family but in the end they still try

to understand each other and make it up. Mr JG also added that they always

communicate for the betterment of the family and to update what are the things

happen to their children and how their life is. He also said that raising their child is

not easy especially he’s alone, sometimes he needs to be very strict to them special

to her eldest. Furthermore, the children are communicating to their mother, asking

what is happening to her in other country, how she can cope up with the

environment where she’s in.

9. Sexual/Reproductive Health
 Both parents are in long distance but and they didn’t categorize within the

reproductive age. Ms MG stated that after she give birth to his last son she was

ligated and focus on the wellness of the child.

10. Coping Stress

It’s hard for the children and also to Mr. JG to deal with their Long distance

relationship to her wife and to their Mother, because of her wife which is in other

country, drinking alcohol frequently during weekends and also weekdays makes it

easier for him to ease the pain . In regards to the children situation, they’ve been

calling their mother daily to check on her situation. For Mrs. Guina, she cope up with

stress she had in work and homesick by calling her children and talking to them. This

practice of her, it ease the pain and homesick she had.

11. Values/Beliefs Pattern

The family originated from Manaoag, Pangasinan and Mangaldan, Pangasinan.

They are raised as a devoted Catholic Christian. Every Sunday, every Birthday or

Extra time that they have they go to church to pray and give thanks for the things

that given to them. They believe that God has always a Plan to their life why they are

experiencing this kind of challenges and obstacle. They usually pray every night

before sleeping and waking up in the morning, they pray also before eating their

lunch and dinner.

12. Value, Habits, Practices in health Promotion, Maintenance and Disease Prevention

The family practices to sleep early and to have enough rest for them to do and

complete the task for the next day. Mr. JG try to jog if he had time but usually he
 goes to work to gain money. His children usually play during holidays and weekends.

The family uses only fan when sleeping and comforter at night to protect themselves

from mosquitoes and other insects that may harm them. The eldest child mentioned

that not all of them complete the immunization required to them. When they having

flu they just buy over-the-counter drugs because sometimes barangay clinic is

closed. In the family they taking a bath twice a day before they go to school and

before going to bed. They wash their hands after playing but sometimes they forgot

to do it.

CHAPTER IV

FAMILY BACKGROUND

A. Family History

The Guina Family consist of six family member including the father and the

mother. They live in #46 Calaocan, Manaoag Pangasinan. There are four children in the

Famiy of MR. JG where he belong and he is the third among them. Mr. JG mother died

last 2009 because of cancer. His older brother died also because of brain aneurism. His

father is alive and live in Pampanga. Mrs. MG father died because of some illness that

are not prevented immediately. Her mother is alive and well which lived in their

hometown. They are four in the family and she is second child.

B. Socio-Economic and Cultural Characteristics

 Mr. AV mentioned that having a low educational background seems to be an obstacle

for him and his children to get a good job. He finished vocational education and was

forced to work as a construction in his early childhood. He also added that labour job

offers very little opportunities for receiving only P450 per day. His eldest son IV also

works in a different construction site, he is receiving P250 per day. The Victorio’s

monthly income is approximately P7, 500 per month just enough to pay for their

monthly rent, water bill, food, milk allowance, cigarette and transportation.

Mr. AV acknowledged that they doesn’t belong to any health insurance at all and

doesn’t have the budget for health due to lack of money. He further include that they

spends P250 per day to meet their daily basic needs and the rest goes to their vices like

smoking and drinking alcohol, He thought that these vices would help him reduce this

stress from his separation to his wife.

The family resides in an unsanitary area in Brgy. Maria Basa, 04 St. Pacdal Baguio City. Their

house is made up of concrete cement and some are wood and light materials. The family sleeps

together in a wooden bed with foam situated near the entrance door which also serves as their

dining area. They usually ate dinner at 6 pm and sleep very early at around 8 p.m. and wakes up

at 5 a.m to cook for breakfast and get ready to work and for his children to go to school . The

house is poorly ventilated and there is inadequate lighting and water resources. They have a

dirty kitchen outside their house that’s where breeding sites of insects occur and inevitable due

to open drainage and poor environmental sanitation. Their toilet is located at the back of their
house which they share with all the member of the family. There is electric supply in the area

yet Mr. AV is force to make a solar panel in their roof to reduce their expenses and serves as

their main source of light, at night they have this portable light bulb. Ms. OV is accountable for

buying their daily necessities and making sure that their money suits their budget. She buys

their food in the public market. She usually cooks canned goods and processed food and

sometimes if they have extra money hey cook meat and fish dishes.

Regarding their sanitation, they doesn’t have non-biodegradable and biodegradable

trash bins. Their garbage is collected ones a week, every Monday by a garbage truck

collector. The overall surrounding of the family is unhygienic and the drainage system is

open and very proximate to the houses. Only wooden walls separate them from their

neighbours and the electrical connections are entangled and hazardous.

B. Family Genogram

igure 1. Victorio’s Family Genogram

 CHAPTER V

TYPOLOGY OF NURSING PROBLEM

Wellness potential is a nursing judgment on wellness state or condition based on client’s

performance, current competencies or clinical data but no explicit expression of client desire to

achieve a higher level of state or function in specific area on health promotion and

maintenance.

Data Family Nursing Problem

Subjective data: Tuberculosis as a health deficit
“Nung last akong nagpacheck up sa Health
Center sinabihan ako ni doc na maggagamot Inability to recognize the presence of the
daw ako ng 6 months pero di ko na tinuloy” condition or problem due to:
as uttered by Mr. AV.  Lack of or inadequate knowledge
 Denial about its existence or severity as
Objective data: a result of fear of consequences of
 Coughing for 4 weeks diagnosis of problem, specifically:
 Sudden weight loss  Economic/cost implications
 Having at least 10 cigarette sticks in  Physical consequences
one day
 Prescribed to take 6 months of
 medication
 Diagnosed with Tuberculosis by the
physician referred by the barangay
health worker
Subjective data: Presence Of Cough And Colds as a Health
“Halos apat na linggo na akong uniubo, pati Deficit
narin nga sila UV at AeV; siguro sa lamig na
din kaya di kami gumagaling” as uttered by
Mr. AV. Inability to recognize the presence of the
condition or problem due to:
Objective data:  Denial about its existence or severity as
 Mr. UV and AeV has productive cough a result of fear of consequences of
and colds with rates on both lower diagnosis of problem, specifically:
lobe of the lungs upon auscultation  Attitude/philosophy in life which
hinders recognition/acceptance of a
problem
 Economic/cost implications

Subjective data: Smoking as a health treat

“Nakakaubos ako ng buong pack ng sigarilyo
pero itinigil ko na” as uttered by Mr. AV
Inability to make decisions with respect to
taking appropriate health action due to:
 Failure to comprehend the
nature/magnitude of the
Objective data: problem/condition
 Dark lips due to smoking  Lack of/inadequate knowledge/insight
 Sudden weight loss as to alternative courses of action open
 Pale skin to family members
 Blackening of teeth  Inability to decide which action to take
from among a list of alternatives
 Conflicting opinions among family
members/significant others regarding
action to take
Subjective data: Poor home condition as a health treat
“Simula nung lumipat kami dito ganto na ito,
hindi naming malinisan dahil nga pagdating Inability to provide a home environment
satrabaho pagod na, kakain at tulog na. Sa conducive to health maintenance and
umaga naman maaga ang pasok kaya ganyan personal development due to:
na” as uttered by Mr. AV
 Lack of/inadequate knowledge of

Objective data:
 Family resides in an unsanitary area
 The house is poorly ventilated and
there is inadequate lighting and water
resources
 They have a dirty kitchen outside
their house that’s where breeding
sites of insects occur and inevitable
due to open drainage and poor
environmental sanitation
Subjective data:
“Dito parin kami tumitira kay papa dahil
walang kwenta ung ama niya pinangiinum
niya pera namin. Nahihiya na din ako kay
papa kasi nga dagdag pa kami sa gastuhin at
pangpasikip lnag sa bahay” as uttered by Ms.
OS
Objective data:
 The family sleeps together in a
wooden bed with foam
 Family lives in a small bungalow
house
 Mr. AV and Mr. IV sleep in their sofa
importance of hygiene and sanitation
 Lack of/inadequate knowledge of
preventive measures
 Lack of skill in carrying out measures to
improve home
 Failure to see benefits (specifically long-
term ones of investment in home
environment improvement
Family size beyond what family resources can
adequately provide as a health treat
Inability to provide a home environment
conducive to health maintenance and
personal development due to:
 Inadequate family resources, specifically:
 Financial constraints/limited
financial resources
 Limited physical resources – e.g.
lack of space to construct facility
 CHAPTER VI

PRIORITIZATION OF THE NURSING PROBLEMS

I. Tuberculosis as a health deficit

Criteria Computation Score Justification

1. Nature of the 3/3x1 1 Tuberculosis is a health deficit
Problem
2. Modifiability of 2.5/3x2 1.67 The resources and interventions
the Problem needed to solve the problem are
available to the family
3. Preventive 3/3x1 1 Proper teaching skills promote the well-
Potential being of each family member
4. Salience 2/2x1 1 The problem is seen to be serious, it
needs an urgent medical attention
TOTAL 4.67
II. Presence of cough as a health deficit

Criteria Computation Score Justification

1. Nature of the 2.5/3x1 0.83 Cough and is a health deficit
III. Problem
Smoking as a health treat
2. Modifiability of 2.25/3x2 1.5 Cough is partially modifiable.
the Problem Treatment and appropriate
interventions are very obtainable to
manage the problem.
3. Preventive 3/3x1 1 Proper teaching skills promote the well-
Potential being of each family member
4. Salience 2/2x1 1 The problem is seen to be stern, it
needs medical attention.
TOTAL 4.33

Criteria Computation Score Justification

1. Nature of the 2/3x1 1 Smoking is a health treat
Problem
2. Modifiability of 1/3x2 0.67 Smoking is easily modifiable. Avoidance
the Problem of cigarette and alternative activities
can obtainable to manage the problem.
3. Preventive 3/3x1 1 Current knowledge, interventions and
Potential resources are available to solve the
problem
4. Salience 3/2x1 1 Mr. AV recognize it as a serious
problem and needs immediate action
TOTAL 3.67

IV. Poor home condition as a health threat

Criteria Computation Score Justification

1. Nature of the 2/3x1 0.67 Poor sanitation is a health threat
Problem
2. Modifiability of 2/3x2 1.33 The problem is easily modifiable since
the Problem resources are available; the family can
be educated regarding proper ways of
sanitation
3. Preventive 2/3x1 0.67 Susceptibility to possible diseases and
 Potential infection can be prevented if poor
sanitation is eliminated
4. Salience 2/2x1 1 The family recognizes it as a problem
that needs continuous action
TOTAL 2.67

V. Family size beyond what family resources can adequately provide as a health treat

Criteria Computation Score Justification

1. Nature of the 2/3x1 0.67 Inadequate living space is a health treat
Problem
2. Modifiability of 1/3x2 0.67 Inadequate living space is easily
the Problem modifiable by increasing the living
space require is quite a financial
expenditure
3. Preventive 1/3x1 0.33 Increasing the living space will allow
Potential more amenities to be utilized.
4. Salience 0/2x1 0 It is not a felt problem
TOTAL 1.87

PRIORITAZATION OF PROBLEMS

PROBLEMS SCORES
1. Tuberculosis as a health deficit 4.67
2. Presence of cough as a health deficit 4.33
3. Smoking as a health treat 3.67
4. Poor home condition as a health treat 2.67
5. Family size beyond what family resources can 1.87
adequately provide as a health treat
CHAPTER VII
 COMPREHENSIVE PATHOPHYSIOLOGY

Pathophysiology of Asthma

According to Morris, MJ, et al (2019),Asthma is a common chronic disease worldwide

and affects approximately 26 million persons in the United States. It is the most common

chronic disease in childhood, affecting an estimated 7 million children. The pathophysiology of

asthma is complex and involves airway inflammation, intermittent airflow obstruction, and

bronchial hyperresponsiveness.

The underlying pathophysiology in asthma is reversible and diffuse airway inflammation that
leads to airway narrowing. (Belleza, M(2017))

 Activation. When the mast cells are activated, it releases several chemicals

called mediators.
  Perpetuation.These chemicals perpetuate the inflammatory response, causing
increased blood flow, vasoconstriction,, fluid leak from the vasculature, attraction of
white blood cells to the area, and bronchoconstriction.
 Bronchoconstriction. Acute bronchoconstriction due to allergens results from
a release of mediators from mast cells that directly contract the airway.
 Progression. As asthma becomes more persistent, the inflammation progresses and
other factors may be involved in the airflow limitation.

Pathophysiology of Flu

Influenza is an acute disease that targets the upper respiratory tract and causes

inflammation of the upper respiratory tree and trachea. The acute symptoms persist for seven

to ten days, and the disease is self-limited in most healthy individuals. The immune reaction to

the viral infection and the interferon response are responsible for the viral syndrome that

includes high fever, coryza, and body aches. High-risk groups who have chronic lung diseases,

cardiac disease, and pregnancy are more prone to severe complications such as primary viral

pneumonia, secondary bacterial pneumonia, hemorrhagic bronchitis, and death. These severe

complications can develop in as little as 48 hours from the beginning of symptoms. The virus

replicates in the upper and lower respiratory passages starting from the time of inoculation and

peaking after 48 hours, on average.

For virulence, both neuraminidase and hemagglutinin are vital as they are the key

targets by the neutralizing antibodies. Hemagglutinin adheres to the epithelial cells in the

respiratory tract allowing for the progression of the infection. Neuraminidase cleaves the bond
that holds the virus together and helps to spread the virions. Their H and N proteins identify

influenza viruses.

An important aspect of influenza A virus is that it is a genetically labile virus with a high

rate of mutations. This results in major changes in antigenic and functional proteins. ( Boktor, S.
and  Hafner, J (2019))
 CHAPTER VIII

FAMILY NURSING CARE PLAN

 CHAPTER IX

COMPREHENSIVE FILE OF THE FAMILY HEALTH INTERVENTIONS

After diagnoses are established by the nurse and client, the relationship moves into the

planning phase of the nursing process (Clemen-Stone et al., 2007). In this phase client centered

goals and objectives are formulated and interventions are identified. A goal is defined as a

"broad desired outcome toward which behavior is directed" and an objective "delineates client

behaviors which reflect that a goal has been reached". The interventions are activities to be

carried out by the client, community health nurse, or other professional to help reach the

identified goal. Clemen-Stone et ale (2007) set forth three main principles to be considered in

the planning process: "(1) individualization of client care plans; (2) active client participation;

and (3) the client's right to self-determination". Therefore, since each client has unique needs,

the client must be actively involved in mutual goal setting with the nurse. According to Twinn

(2011) this philosophy of practitioner forming a partnership with the client is quite different

from the traditional health care paradigm in which "practitioners generally work with clients in

a directive manner". However, it is sometimes appropriate for the community health nurse to

develop a nurse centered goal. This would be appropriate if the nurse identifies a problem that

the family is not aware of and determines by professional judgment that it is necessary to

increase the family's awareness of the problem.

 Certain interventions must be implemented by the nurse throughout the relationship in

order to prepare the family for termination. These include:

1. Stating the termination date, if known, in the beginning of the relationship and

throughout consecutive meetings

2. Discussing thoughts and feelings about termination prior to the last meeting

3. Identifying signs of separation anxiety in the family and personally

4. Encouraging the family to compare past separations with the present one

5. Promoting the family's evaluating and summarizing the relationship in terms of its

goals, expectations, satisfactions, and dissatisfactions

CHAPTER X

CONCLUSIONS AND RECOMMENDATIONS

The area is congested, there are around 20 families in a compound who is expose to

several health hazards like poor environmental sanitation, open drainage system and

inadequate living space. The house has no enough lighting and ventilation. They manage to stay

there for two years without inadequate water supply and no private toilet facility. Their house
is considered to be a make shift type of house and has insufficient living space. The wooden bed

found near the main door serves as the living room area leaving a small space for kitchen.

Family needs more orientation and information regarding health issues. They should

value or prioritize their health above all. The importance of prenatal check-up and malnutrition

should be given emphasis to ensure the development of the baby. Inadequate living space and

poor environmental sanitation seems to be a threat to the family s health. Promotion of health,

prevention of diseases together with simple treatment and rehabilitation would alleviate their

health status and conditions. It will correspondingly enable to achieve integration within the

family and to promote health education and active participation in terms of general and distinct

health necessities.
 CHAPTER XI

REFERENCES

Alice Petiprin(2006). FAMILY NURSING. Retrieved from https://nursing-theory.org/theories-

and-models/family-nursing.php

Mengistu, D. and Misganaw, E.(2006).Community Health Nursing. Retrieved from

https://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/nursi

ng_students/comm_hlth_nsg_final.pdf

Friedemann ML(1989). The concept of family nursing. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/2715522

Morris, MJ, et al (2019).Asthma. Retrieved from

https://emedicine.medscape.com/article/296301-overview

Belleza, M(2017). Asthma. Retrieved from

https://nurseslabs.com/asthma/#Pathophysiology

Boktor, S. and  Hafner, J (2019). Influenza. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK459363/

Baumbusch (2014)
Deist and Greeff (2015