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I.

INTRODUCTION

Family is the fundamental unit of society which is entitled for the protection of
state and also the society. One of the primary functions of the family is to produce and
reproduce persons—biologically and socially. Thus, one's experience of one's family
shifts over time.
From the perspective of children, the family is a family of orientation: the family
serves to locate children socially and plays a major role in their enculturation and
socialization. From the point of view of the parent(s), the family is a family of
procreation, the goal of which is to produce and enculturate and socialize children.
However, producing children is not the only function of the family; in societies with a
sexual division of labor, marriage, and the resulting relationship between two people, is
necessary for the formation of an economically productive household.

In a traditional Filipino family, the father is considered the head and the provider
of the family while the mother takes responsibility of the domestic needs and in charge of
the emotional growth and values formation of the children. Children see their mothers as
soft and calm, while they regard their fathers as strong and the most eminent figure in the
family. Another particular trait of Filipinos is their strong respect for elders. Children are
taught from birth how to say “po” and “opo” to teach them as early as possible how to
properly respect their elders. These words are used to show respect to people of older
level. Upon arriving home, conservative families expect children to practice the kissing
of hands or touching their parents' or elder family members’ hand to their foreheads with
the words “mano po” as a sort of greeting.

When Filipinos get sick, they usually find an excuse to evade a visit to the doctor
and rely on other people’s advice instead. One common excuse is financial constraint.
Thus, they find the health opinions of experts in the magazines and newspapers very
useful according to Cabral (2009).
Victoria is a 3rd class municipality in the province of Tarlac, Philippines.
According to the latest census, it has a population of 57,085 people in 10,535 households.
The municipality is located in the Province of Tarlac, geographically located in the
central part of Luzon. The municipality has a total land area of 11,150 hectares, of which
a large portion is used for agricultural activities.
Victoria is politically subdivided into 26 barangays. One of its barangay is
Batang-batang and it is one of the smallest rural areas of Victoria in terms of land area,
about 168. 40 hectares, but its active agricultural activities have contributed and made an
impact on the developmental growth of the town. Comprised by 1, 245 people, some 252
households are engaged with agricultural/ farming activities: 76 households in crop
production; 53 HH heads in livestock production; and, 16 households in agricultural
services. Around 52 household heads depend on their contractual wages, 20 household
heads rely on their regular salaries, while 30 household heads are unemployed. At least
94 household heads have undergone livelihood training.

II.OBJECTIVES:
Nurse Centered

General Objective
To promote health education and to have a good working relationship with the
members of the family

Specific Objectives
1. To identify the health problems within the family
2. To establish rapport to the family
3. To apply effectively the nursing process during the entire home visit
4. To improve skills in the assessment process
Family Centered

General Objective
To enhance the current health status of the family and prevent the occurrence of
diseases through health teachings.

Specific Objectives
1. To impart knowledge regarding their health through health teachings
2. To broaden their knowledge about their health conditions and to encourage
them seek medical advice
3. To be able for them to realize the importance of having a healthy lifestyle and
environment

III. INITIAL DATABASE

A. Family Structure, Characteristics and Dynamics


Name of Relation to Sex Age Civil status
household head
member
Celestino Head Male 75 Married
Collado
Dominga Wife Female 73 Married
Collado
Arnold Gracia Son-in-law Male 30 Married
Elena Gracia Daughter Female 31 Married
Jay Ann Gracia Grand daughter Female 3 Single
James Gracia Grandson Male 2 Single
Jay Gracia Grandson Male 5 mos. Single

Observations:

The Collado family is considered an extended type of family because Mr. and
Mrs. Collado have with them their youngest child. Mr. Celestino Collado, 75 years old, is
the head of the family, making the family patriarchal. He is a farmer in their barangay.
Mrs. Dominga Collado, the wife of Mr. Collado is 73 years old. She spends her time
caring for her grandson and grand daughter. They have 4 children but the youngest was
the one with them who is Elena Gracia. Elena is 31 years old. She tooks all the chores in
the house and also responsible for taking care of her children. Elena has a husband who is
Arnold Gracia. Arnold is a part time farmer in their barangay. He also takes care of their
children when he is not working. They had 3 children namely; Jay Ann, 3 years old,
James, 2 years old and Jay, who is 5 months old.

Mr. Collado is the one also decides about all the problem matters of each family
member and this kind of family is patriarchal. They have harmonious relationship to each
other and the younger members of the family have respect to their brother and sister.
There are no noticeable conflicts between members.

Norms:

There is three basic family systems of the nuclear family which is consists of a
husband, wife, and children; the polygamous family which consists of a husband or wife
and several spouses and their children; In the Philippine setting, the head of the family is
the one who decides regarding on certain situations that the family encounters.

The extended type best describes the Filipino family. A harmonious relationship
among each member must be observed. (Maternal and child care nursing, Vol. 1, 2nd
Edition, Authors: Marcia London, Patricia Ladewig, Jane Ball and Ruth Bindler)

Analysis:

The Collado family is an extended type of family which is common among


Filipinos. I have observed a harmonious relationship between the members of the family.
The children uses “po” and “opo” as a sign of respect to elders. The family is patriarchal
type because the father decides in all the matters of the family.
B. Socio-economic and Cultural Characteristics

OBSERVATION

Mr. Collado works as a farmer in Batang-Batang and earns ₱500 a month.


He and his son-in-law are the one who works in the family. Arnold also earns
₱500 a month in his work as a farmer. Their income is not sufficient to meet all
the basic needs of his family. Mrs. Collado and his daughter, Elena are the one in-
charge of budgeting the family’s income. Mr. and Mrs. Collado were not
able to finish elementary, Arnold didn’t finish high school and Elena is a high
school graduate. Their children are not yet studying so they only stay at their
house. All family members are Catholic according to Elena but are not active.

Name of Religious Educational Occupation Monthly


Household Affiliation Attainment Income
Member
Celestino Catholic Elementary Farmer P 500
Collado level
Dominga Catholic Elementary N/A N/A
Collado level
Arnold Gracia Catholic High school Farmer P 500
level
Elena Gracia Catholic High school N/A N/A
graduate
Jay Ann Gracia Catholic N/A N/A N/A
James Gracia Catholic N/A N/A N/A
Jay Gracia Catholic N/A N/A N/A

Total monthly ₱ 1000


Household/Family
Income
Total Annual ₱ 12,000
Household/ Family
Income
Annual per Capita ₱ 1714
Income
Total monthly income of the family
Celestino →₱500
Arnold →₱500
Total: ₱1,000
Total Annual/household family income=Total monthly income x 12 months
₱1,000 x 12 months = ₱ 12,000
Total per Capita Income=Total annual family income/ number of the members of the
family ₱12,000/7= ₱1,714.29

Expenses of each family member → ₱ 1,714


─ Monthly income of the family →₱1,000
Total ₱ 714[lacking income of the family]

EXPENSES WEEKLY MONTHLY YEARLY


1. HOUSE
a. Electricity ₱100 ₱1,200
b. Repairs and others
2. FOOD
a. Rice ₱ 1,500.00 ₱18,000
b. Viand (Ulam) ₱300 ₱1,200 ₱14,400
c. Foodstuff
d. Instant Food
3. HYGIENE
a.
Laundry/Dishwashing ₱140 ₱560 ₱6,720
soap
b. Personal (shampoo ₱42 ₱168 ₱2,016
etc.)
4. Education
a. Allowance
b. School Supplies
c. Uniforms
d. School projects
5. EMPLOYED
WORKING
a. Fare
b. Allowance
6.
MISCELLANEOUS
a. Clothes, shoes,
accessories
b. Medicines, Health ₱300 ₱3,600
check -ups
c. Vices( cigarettes, P200 ₱2,400
alcohol)
TOTAL : ₱482 ₱4,028 ₱48,336.00

Norms:
A person’s educational attainment is considered to be the highest level (grade or
degree) of education they have completed. Education also plays a role in income. Median
earnings increase with each level of education. As conveyed in the chart, the highest
degrees, professional and doctoral degrees, make the highest weekly earnings while those
without a high school diploma are financially penalized. Higher levels of education are
associated with better economic and psychological outcomes Education plays a major
role in skill sets for acquiring jobs, as well as specific qualities that stratify people with
higher SES from lower SES. Annette Lareau(2009) speaks on the idea of concerted
cultivation, where middle class parents take an active role in their children’s education
and development by using controlled organized activities and fostering a sense of
entitlement through encouraged discussion. Laureau argues that families with lower
income do not participate in this movement, causing their children to have a sense of
constraint. A division in education attainment is thus born out of these two differences in
child rearing. In theory, lower income families have children who do not succeed to the
levels of the middle income children, who feel entitled, are argumentative, and better
prepared for adult life.
Majority of the Filipinos are Catholics. The Filipinos believe in only one GOD
who is Almighty and omnipotent. Religious practices show concern and love for one’s
neighbors. Among Catholics, the Ten Commandments set the standard of behavior. They
keep images of saints at home and every church has a patron saint.
Analysis:

Mr. Collado and his son-in-law are farmers they earn ₱500 each every month and
their salary is not enough to meet the basic needs of each of the family members.
Sometimes they just lend money from their relatives when in need. The family manages
this problem by planting vegetables on their backyard and they also have several chikens
in their backyard. Despite their financial problem, the family still manages to live
peaceful life. All members of the family are Roman Catholics but are not active
according to Elena.

C. Home and Environment


Observation:
The house of the family Collado is located beside a cockpit arena. The Collado
Family owns a 6.92m x 5.86m house made of wood and other light materials. Their living
space is divided into three parts: bedroom which is divided into two areas, living, and a
kitchen. Their house has three windows measuring 2.18 m x 1.2 two at their bedroom and
one at the living room. Mr. and Mrs. Collado sleeps on a bamboo bed in the bedroom of
one area. The whole family of Elena and Arnold sleeps on the other area of their
bedroom. The family owns furnitures like two wooden chairs, a two bamboo beds, a
radio, a TV but are not working and a small wooden divider. They use firewood for
cooking their food and there is fire hazard because their house is made from light
materials and rusty galvanize iron which can cause accidents especially to children. Near
their kitchen are knives and other sharp materials which are within the children’s reach.
Their source of drinking water is a water pump located two meters from their house.
Their drainage is open. Their toilet is water sealed which is exclusive for the family. It is
located 5 meters in front of their house. Elena stated that their garbage are being collected
by the barangay. Facilities like barangay hall, school, and sari-sari stores are present in
their barangay. The family socializes well within their barangay.
CROWDINGSPACE
STANDARD: (Concepts and Guidelines in COPAR, 1ST Edition, 2005 by Untalan)
Formula: TFA = length x width of the house
Standard: Adults – 3.0 sq. m
Children – 1.5 sq. m
Infant ─ 0
No. of adults in Collado family = 4
No. of children in Collado family = 3

Interpretation of results:
Not overcrowded: TFA is greater than the TSR (total space requirement)
Overcrowded: TSA is greater than TFA

Computations:
Total Floor Area (TFA) =6.92 x 5.86 = 40.55 m2
Total Space Requirement (TSR) = (4) (3.0) + (3) (1.5) = 16.5 m2

VENTILATION:
STANDARD: (Concepts and Guidelines in COPAR, 1ST Edition, 2005 by Untalan)
20% - Satisfactory
18 - 19 % - fair
Below 18 % - poor
Collado House TFA = \40.55sq. m
Collado House Total No. of windows: 3
Formula:
Ventilation= TWO / TFA x 100
TWO: total area of windows by multiplying their length to their width.
TFA: total floor area
Computations:
WO (window openings)
W1= 2.18 m x 1.2 = 2.616
W2= 2.18 m x 1.2 = 2.616
W3= = 2.18 m x 1.2 = 2.616
7.848 m2
Ventilation = TWO/TFA x 100
= 7.848 m2 /40.55sq. m x 100
= 0.143 x 100
= 19.35%
Analysis:
19.35 %< 20% is poor
The result of the total ventilation of the Collado family is poor. There is
occurrence of serious health threat in them especially they have a 5 months old baby.

Norms:

A healthy home is well ventilated, free of pests, toxics, and dangerous gases; dry;
clean; comfortable; and affordable. Good construction and maintenance practices can
achieve these conditions, even in an older home.
Comfortable homes make it unlikely that individuals will unknowingly take
actions that can harm their health. For example, excess cold may cause people to use
stoves and ovens for heating, leading to chronic and perhaps acute exposure to carbon
monoxide. Humidifiers may be installed to relieve an excessively dry environment,
creating extra moisture that can contribute to molds and foster the growth of dust mites,
both of which are asthma triggers.

The Total Space Requirement for an adult is 3 sq. m. and 1.5 sq. m. for a child.
The shelter must be a concrete, made up of woods that are strong enough and the lot has
been own by the owner. The family members must be has proper places in the room
while sleeping and not over crowded. There is no presence of accidental hazards, clean
water storage and proper food handling. The kitchen must be far away from the comfort
room at least 10 to 15 meters away.
(www.healthhouse.org)

Analysis:

Generally, the house of the Collado family is not well kept. Their things are not
properly placed as it should be. Their clothes are scattered everywhere at the house. The
family lacks adequate storage for food and for their kitchen fascilities. Their open
drainage is a threat of breeding sites of vectors of diseases. Accident hazards such as fire
and injury from sharp materials is present especially to children. They do not manage
their garbage properly even though it is being collected.

D. Health Status of Each Family Member


Observations:
I asked the medical history of the family to indicate their illnesses from Elena. I

asked some question and she did cooperate. She said that her mother has Diabetes and

suffers from rheumatism and arthritis. The head of the family is chain smoker, he

consumes one pack of cigarettes per day. He also suffers from arthritis. Her husband,

Arnold also smokes one pack of cigarette per day. Her first and second child eats poorly

and they are still taking milk using bottles she added. And her youngest child is breastfed

and eats some other foods like biscuits With regards to their food intake habits they

usually eat rice and viand which they buy from the sari-sari store.
Body Mass Index (BMI) – BMI is calculated using the formula below:
Adult: children:
BMI = Weight in Kgs BMI= Weight in Kgs
Height in meters2 Height in cm2

Body Mass Index


Values BMI
< 18.5 Underweight
18.5-24.0 Normal Weight
25-29.9 Overweight
30 and above Obese

Normal Vital signs:


Adult: Children:
Temperature: 36.4-37.4 oC Temperature: 36.4-37.4 oC
Pulse Rate: 60-100 bpm Pulse Rate: Toddler (70-110bpm)
Respiration: 12-20 cpm Respiration: 25-30 cpm
Blood Pressure: 120/80mmHg BloodPressure: 90/50mmHg

Vital signs and BMI of the members of the family

Name Height Weight BMI BMI VITAL SIGNS


(inches) (lbs.) ANALYSIS
RR PR BP Temp.
Celestino 60.63 119.04 22.77 Normal 17 78 140/80 36.4 oC
Collado

Dominga 57.48 110.23 23.46 Normal 21 74 110/70 36.7 oC


Collado
Elena 58.66 119.04 24.32 Normal 18 86 120/80 35.7 oC
Gracia
Jay Ann 28.74 22.04 14.31 Underweight 31 80 37 oC
Gracia
Physical Assessment

Celestino Collado, 75 years old

Date Body parts Technique Normal Findings Findings Interpretation


performed Used
February 10, Hair Inspection Hair is black, brown or Hairs are Normal since
2010 burgundy depending on evenly white hair
the race: hair is evenly distributed, varies with
distributed and covers thin and dry, his age.
the whole scalp (No no lice are
evidences of present and
Alopecia).It may be white in color.
thick or thin, coarse or
smooth. Neither brittle
nor dry.
Scalp Inspection Normal scalp is lighter Scalp is lighter Abnormal
Palpation in color than the in color than due to
complexion. It can be the body color; presence of
moist or oily. No with a dandruff.
presence of scar. Free presence of
from lice, nits and dandruff.
dandruff. No lesions
and also no tenderness
nor masses upon
palpation.
Eyes Inspection EYEBROWS: They are Normal
Eyebrows are symmetrical
symmetrical and in line and evenly
with each other. The distributed.
eyes should be
evenly placed and in
line with each other.
The eyes should not
protrude. The color of
the eyelashes varies on
the race, evenly
distributed, and turned
outward.
Nose Inspection Nose is in the midline, Nose is in the Normal
no discharges. midline, no
Both nares are patent. discharges and
No bone and cartilage moist, airway
deviation noted on is patent. No
palpation. tenderness,
No tenderness noted on masses upon
palpation. palpation and
Nasal septum in the inspection,
mid line and not
perforated. The nasal
mucosa is pinkish to
red in color. (Increased
redness urbanites are
typical of allergy).
No tenderness noted on
palpation of the
paranasal sinuses.

Mouth Inspection Lip color varies with Lips are Abnormal


race; shape and smooth and because of its
symmetry. pale in color. pale color.
Gums should be pink Gums are dark Abnormal
in color, no discharges in color due to because of its
no swelling and has no smoking dark color.
contractions.

Teeth number depends The client has Abnormal


on the age of the 20 numbers of due to
patient; Toddler must teeth. Yellow incomplete
have 30 deciduous in color. number of
teeth; adult must have No swellings teeth and
28 or 30 permanent or color.
teeth. White in color inflammations.
and aligned.

Tongue depends on the


age of the patient; must Light yellow Abnormal
be pink in color, moist in color, with due to tongue
and smooth. No loss teeth and color, loss of
involuntary movements cavities. teeth, and
of muscles. cavities.

Soft palate and hard


palate must pink and Pink in color, Abnormal
moist; no discharges. moist and due to foul
Position of the uvula smooth. Moist odor.
should be at the center. and there are
And no foul odor. no discharges.
Has foul odor.
Ears and Inspection Ear lobes are bean Normal in Abnormal
hearing Palpation shaped, parallel, and appearance, due to
symmetrical. The upper position well presence of
connection of the ear with the excessive
lobe is parallel with the presence of earwax.
outer cantus of the eye. excessive
Skin is same in color as earwax.
in the complexion. No
presence of lesions
upon inspection. The
auricles are has a firm
cartilage on palpation.
The pinna recoils when
folded.
There is no pain or
tenderness on the
palpation of the auricles
and mastoid process.
The ear canal has
normally some
cerumen of inspection.
No discharges or
lesions noted at the ear
canal. On othoscopic
examination the
tympanic membrane
appears flat, translucent
and pearly gray in
color.
Abdomen Inspection Skin color should be Skin color is Normal
Palpation uniform, no lesions, no uniform in
scars, and no venous body color.
engorgement. Contour
maybe flat, rounded or
scaphoid and aortic
pulsation may be
visible. Thin clients
may show peristalsis.
Nail beds Inspection Pinkish finger nail and Bluish in color Abnormal
Palpation toenail beds. There and dirty due to dirty
should be a capillary untrimmed and
refill. capillary refill nails. Poor untrimmed
should return within 1- capillary refill. finger nails
3 seconds. and poor
capillary
refill.
Skin Inspection Skin texture must be Skin is soft Abnormal
soft and smooth, hair is and smooth due to the
evenly distributed and and there’s presence of
no presence of lesion, presence of scars,
wounds, scars and scars, lesions, lesions, and
scabies. and masses at masses at
both feet. both feet.
Neck Inspection No presence of masses, No presence of Normal
Palpation swelling and masses or any
tenderness. No tenderness. No
enlargement of lymph presence of
nodes. Lymph nodes lymph nodes
are not palpable. upon
palpation.
Lower Inspection Extremities must not be Hair is evenly Normal
extremities Palpation paralyzed; hair is distributed and
evenly uniform in
distributed, uniform in color.
color and no presence
of varicose veins.
Upper Inspection No presence of No Normal
extremities Palpation abnormalities. Hair is abnormalities;
evenly distributed, uniform in
uniform in color and no color and hair
presence of lesion. No is evenly
muscle atrophy and distributed.
hypertrophy.

Dominga Collado, 73 years old

Date Body parts Technique Normal Findings Findings Interpretation


performed Used
February 10, Hair Inspection Hair is black, brown or Hairs are not Abnormal
2010 burgundy depending on evenly due to
the race: hair is evenly distributed, uneven
distributed and covers thin and dry, distribution
the whole scalp (No no lice are of hair.
evidences of present and
Alopecia).It may be white in color.
thick or thin, coarse or
smooth. Neither brittle
nor dry.
Scalp Inspection Normal scalp is lighter Scalp is lighter Abnormal
Palpation in color than the in color than due to
complexion. It can be the body color; presence of
moist or oily. No with a dandruff.
presence of scar. Free presence of
from lice, nits and dandruff.
dandruff. No lesions
and also no tenderness
nor masses upon
palpation.
Eyes Inspection EYEBROWS: They are Normal
Eyebrows are symmetrical
symmetrical and in line and evenly
with each other. The distributed.
eyes should be
evenly placed and in
line with each other.
The eyes should not
protrude. The color of
the eyelashes varies on
the race, evenly
distributed, and turned
outward.
Nose Inspection Nose is in the midline, Nose is in the Normal
no discharges. midline, no
Both nares are patent. discharges and
No bone and cartilage moist, airway
deviation noted on is patent. No
palpation. tenderness,
No tenderness noted on masses upon
palpation. palpation and
Nasal septum in the inspection,
mid line and not
perforated. The nasal
mucosa is pinkish to
red in color. (Increased
redness urbanites are
typical of allergy).
No tenderness noted on
palpation of the
paranasal sinuses.

Mouth Inspection Lip color varies with Lips are Abnormal


race; shape and smooth, dry because of its
symmetry. and pale in pale color
color. and dry.

Gums should be pink Gums are dark Abnormal


in color, no discharges in color due to because of its
no swelling and has no smoking dark color.
contractions.

Teeth number depends The client has Abnormal


on the age of the 24 numbers of due to
patient; Toddler must teeth. Yellow incomplete
have 30 deciduous in color. number of
teeth; adult must have No swellings teeth and
28 or 30 permanent or color.
teeth. White in color inflammations.
and aligned.

Tongue depends on the


age of the patient; must Light yellow Abnormal
be pink in color, moist in color, with due to tongue
and smooth. No loss teeth and color, loss of
involuntary movements cavities. teeth, and
of muscles. cavities.

Soft palate and hard


palate must pink and Pink in color, Abnormal
moist; no discharges. moist and due to foul
Position of the uvula smooth. Moist odor.
should be at the center. and there are
And no foul odor. no discharges.
Has foul odor.
Ears and Inspection Ear lobes are bean Normal in Abnormal
hearing Palpation shaped, parallel, and appearance, due to
symmetrical. The upper position well presence of
connection of the ear with the excessive
lobe is parallel with the presence of earwax.
outer cantus of the eye. excessive
Skin is same in color as earwax.
in the complexion. No
presence of lesions
upon inspection. The
auricles are has a firm
cartilage on palpation.
The pinna recoils when
folded.
There is no pain or
tenderness on the
palpation of the auricles
and mastoid process.
The ear canal has
normally some
cerumen of inspection.
No discharges or
lesions noted at the ear
canal. On othoscopic
examination the
tympanic membrane
appears flat, translucent
and pearly gray in
color.
Abdomen Inspection Skin color should be Skin color is Normal
Palpation uniform, no lesions, no uniform in
scars, and no venous body color.
engorgement. Contour
maybe flat, rounded or
scaphoid and aortic
pulsation may be
visible. Thin clients
may show peristalsis.
Nail beds Inspection Pinkish finger nail and Pinkish in Abnormal
Palpation toenail beds. There color, dirty due to dirty
should be a capillary untrimmed and
refill. Capillary refill nails. Good untrimmed
should return within 1- capillary refill. finger nails.
3 seconds.
Skin Inspection Skin texture must be Skin is soft Abnormal
soft and smooth, hair is and smooth due to the
evenly distributed and and there’s presence of
no presence of lesion, presence of scars,
wounds, scars and scars, lesions, lesions, and
scabies. and masses at masses at
both feet. both feet.
Neck Inspection No presence of masses, No presence of Normal
Palpation swelling and masses or any
tenderness. No tenderness. No
enlargement of lymph presence of
nodes. Lymph nodes lymph nodes
are not palpable. upon
palpation.
Lower Inspection Extremities must not be Hair is evenly Normal
extremities Palpation paralyzed; hair is distributed and
evenly uniform in
distributed, uniform in color.
color and no presence
of varicose veins.
Upper Inspection No presence of No Normal
extremities Palpation abnormalities. Hair is abnormalities;
evenly distributed, uniform in
uniform in color and no color and hair
presence of lesion. No is evenly
muscle atrophy and distributed.
hypertrophy.

Elena Gracia, 31 years old

Date Body parts Technique Normal Findings Findings Interpretation


performed Used
February 10, Hair Inspection Hair is black, brown or Hairs are Normal
2010 burgundy depending on evenly
the race: hair is evenly distributed,
distributed and covers black in color
the whole scalp (No thick and dry,
evidences of no lice are
Alopecia).It may be present and
thick or thin, coarse or white in color.
smooth. Neither brittle
nor dry.
Scalp Inspection Normal scalp is lighter Scalp is lighter Abnormal
Palpation in color than the in color than due to
complexion. It can be the body color; presence of
moist or oily. No with a dandruff.
presence of scar. Free presence of
from lice, nits and dandruff.
dandruff. No lesions
and also no tenderness
nor masses upon
palpation.
Eyes Inspection EYEBROWS: They are Normal
Eyebrows are symmetrical
symmetrical and in line and evenly
with each other. The distributed.
eyes should be
evenly placed and in
line with each other.
The eyes should not
protrude. The color of
the eyelashes varies on
the race, evenly
distributed, and turned
outward.
Nose Inspection Nose is in the midline, Nose is in the Normal
no discharges. midline, no
Both nares are patent. discharges and
No bone and cartilage moist, airway
deviation noted on is patent. No
palpation. tenderness,
No tenderness noted on masses upon
palpation. palpation and
Nasal septum in the inspection,
mid line and not
perforated. The nasal
mucosa is pinkish to
red in color. (Increased
redness urbanites are
typical of allergy).
No tenderness noted on
palpation of the
paranasal sinuses.

Mouth Inspection Lip color varies with Lips are Normal


race; shape and smooth and
symmetry. pink in color.

Gums should be pink Gums are pink Normal


in color, no discharges in color, no
no swelling and has no swelling and
contractions. contractions

Teeth number depends The client has Abnormal


on the age of the 25 numbers of due to
patient; Toddler must teeth. Yellow incomplete
have 30 deciduous in color number of
teeth; adult must have No swellings teeth and
28 or 30 permanent or color.
teeth. White in color inflammations.
and aligned.

Tongue depends on the


age of the patient; must Light yellow Abnormal
be pink in color, moist in color, with loss of teeth,
and smooth. No loss teeth and and cavities.
involuntary movements cavities.
of muscles.

Soft palate and hard


palate must pink and Pink in color, Abnormal
moist; no discharges. moist and due to foul
Position of the uvula smooth. Moist odor.
should be at the center. and there are
And no foul odor. no discharges.
Has foul odor.
Ears and Inspection Ear lobes are bean Normal in Abnormal
hearing Palpation shaped, parallel, and appearance, due to
symmetrical. The upper position well presence of
connection of the ear with the excessive
lobe is parallel with the presence of earwax.
outer cantus of the eye. excessive
Skin is same in color as earwax.
in the complexion. No
presence of lesions
upon inspection. The
auricles are has a firm
cartilage on palpation.
The pinna recoils when
folded.
There is no pain or
tenderness on the
palpation of the auricles
and mastoid process.
The ear canal has
normally some
cerumen of inspection.
No discharges or
lesions noted at the ear
canal. On othoscopic
examination the
tympanic membrane
appears flat, translucent
and pearly gray in
color.
Abdomen Inspection Skin color should be Skin color is Normal
Palpation uniform, no lesions, no uniform in
scars, and no venous body color.
engorgement. Contour
maybe flat, rounded or
scaphoid and aortic
pulsation may be
visible. Thin clients
may show peristalsis.
Nail beds Inspection Pinkish finger nail and Pinkish in Abnormal
Palpation toenail beds. There color and dirty due to dirty
should be a capillary untrimmed and
refill. Capillary refill nails. Good untrimmed
should return within 1- capillary refill. finger nails.
3 seconds.
Skin Inspection Skin texture must be Skin is soft Normal
soft and smooth, hair is and smooth
evenly distributed and and no
no presence of lesion, presence of
wounds, scars and lesions,
scabies. wounds, scars
and scabies.
Neck Inspection No presence of masses, No presence of Normal
Palpation swelling and masses or any
tenderness. No tenderness. No
enlargement of lymph presence of
nodes. Lymph nodes lymph nodes
are not palpable. upon
palpation.
Lower Inspection Extremities must not be Hair is evenly Normal
extremities Palpation paralyzed; hair is distributed and
evenly uniform in
distributed, uniform in color.
color and no presence
of varicose veins.
Upper Inspection No presence of No Normal
extremities Palpation abnormalities. Hair is abnormalities;
evenly distributed, uniform in
uniform in color and no color and hair
presence of lesion. No is evenly
muscle atrophy and distributed.
hypertrophy.
Jay Ann Gracia, 3 years old

Date Body parts Technique Normal Findings Findings Interpretation


performed Used
February 10, Hair Inspection Hair is black, brown or Hairs are not Abnormal
2010 burgundy depending on evenly due to very
the race: hair is evenly distributed, dry and thin
distributed and covers black in color hair and not
the whole scalp (No thin and very well
evidences of dry, no lice are distributed.
Alopecia).It may be present and
thick or thin, coarse or white in color.
smooth. Neither brittle
nor dry.
Scalp Inspection Normal scalp is lighter Scalp is lighter Normal
Palpation in color than the in color than
complexion. It can be the body color;
moist or oily. No no presence of
presence of scar. Free dandruff.
from lice, nits and
dandruff. No lesions
and also no tenderness
nor masses upon
palpation.
Eyes Inspection EYEBROWS: They are Normal
Eyebrows are symmetrical
symmetrical and in line and evenly
with each other. The distributed.
eyes should be
evenly placed and in
line with each other.
The eyes should not
protrude. The color of
the eyelashes varies on
the race, evenly
distributed, and turned
outward.
Nose Inspection Nose is in the midline, Nose is in the Normal
no discharges. midline, no
Both nares are patent. discharges and
No bone and cartilage moist, airway
deviation noted on is patent. No
palpation. tenderness,
No tenderness noted on masses upon
palpation. palpation and
Nasal septum in the inspection,
mid line and not
perforated. The nasal
mucosa is pinkish to
red in color. (Increased
redness urbanites are
typical of allergy).
No tenderness noted on
palpation of the
paranasal sinuses.

Mouth Inspection Lip color varies with Lips are Normal


race; shape and smooth and
symmetry. pink in color.

Gums should be pink Gums are pink Normal


in color, no discharges in color, no
no swelling and has no swelling and
contractions. contractions

Teeth number depends The client has Abnormal


on the age of the 20 only due to
patient; Toddler must numbers of incomplete
have 30 deciduous teeth. number of
teeth; adult must have No swellings teeth.
28 or 30 permanent or
teeth. White in color inflammations.
and aligned.

Tongue depends on the


age of the patient; must Light yellow Abnormal
be pink in color, moist in color, with due to loss of
and smooth. No loss teeth and teeth, and
involuntary movements cavities. cavities.
of muscles.

Soft palate and hard Pink in color, Abnormal


palate must pink and moist and due to foul
moist; no discharges. smooth. Moist odor.
Position of the uvula and there are
should be at the center. no discharges.
And no foul odor. Has foul odor.
Ears and Inspection Ear lobes are bean Normal in Abnormal
hearing Palpation shaped, parallel, and appearance, due to
symmetrical. The upper position well presence of
connection of the ear with the excessive
lobe is parallel with the presence of earwax.
outer cantus of the eye. excessive
Skin is same in color as earwax.
in the complexion. No
presence of lesions
upon inspection. The
auricles are has a firm
cartilage on palpation.
The pinna recoils when
folded.
There is no pain or
tenderness on the
palpation of the auricles
and mastoid process.
The ear canal has
normally some
cerumen of inspection.
No discharges or
lesions noted at the ear
canal. On othoscopic
examination the
tympanic membrane
appears flat, translucent
and pearly gray in
color.
Abdomen Inspection Skin color should be Skin color is Normal
Palpation uniform, no lesions, no uniform in
scars, and no venous body color.
engorgement. Contour
maybe flat, rounded or
scaphoid and aortic
pulsation may be
visible. Thin clients
may show peristalsis.
Nail beds Inspection Pinkish finger nail and Pinkish in Abnormal
Palpation toenail beds. There color and dirty due to dirty
should be a capillary untrimmed and
refill. Capillary refill nails. Good untrimmed
should return within 1- capillary refill. finger nails.
3 seconds.
Skin Inspection Skin texture must be Skin is soft Normal
soft and smooth, hair is and smooth
evenly distributed and and no
no presence of lesion, presence of
wounds, scars and lesions,
scabies. wounds, scars
and scabies.
Neck Inspection No presence of masses, No presence of Normal
Palpation swelling and masses or any
tenderness. No tenderness. No
enlargement of lymph presence of
nodes. Lymph nodes lymph nodes
are not palpable. upon
palpation.
Lower Inspection Extremities must not be Hair is evenly Normal
extremities Palpation paralyzed; hair is distributed and
evenly uniform in
distributed, uniform in color.
color and no presence
of varicose veins.
Upper Inspection No presence of No Normal
extremities Palpation abnormalities. Hair is abnormalities;
evenly distributed, uniform in
uniform in color and no color and hair
presence of lesion. No is evenly
muscle atrophy and distributed.
hypertrophy.

Norms:

The Department of Education through the Health and Nutrition Center said that the

normal BMI of adults is 18.5-24.9, underweight adults is below 18.5, overweight adults

are 25-29.9 and for obese person is equal and above 30. Body Mass index is a reliable

indicator of a person’s healthy weight.

An adequate food intake consists of a balance of essential nutrients, water,

proteins, carbohydrates, fats, vitamins, minerals.


Analysis:
Based from the information that I have gathered one of the family members is
underweight who is Jay Ann. She did not reach the normal weight as I have used the
formula for computing the BMI. The family are not taking their breakfast. They only eat
two times a day. The family members has normal vital signs except for Mr. Collado, his
BP is high. He said that it is due to stress and he cannot sleep well because of the noise at
the cockpit near them during night. The family has no particular diet because they will
just buy food depends on the money that they have. Mr. Collado and Arnold are smoking
and they consume one pack each per day.

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


Prevention
Observations:
Elena stated that they sometimes go to the health center for medical advice. The
family also uses herbal medicine for remedies. Mr. and Mrs. Collado verbalized that they
were completely immunized. Only her Elena’s husband and his children Jay Ann and Jay
were not completely immunized. The children sleep for 8-10 hours a day. Mr. and Mrs.
Lorenzo only sleeps 5-6 hours a day because they cannot sleep well especially if there
will be games held at the cockpit. All members take a bath once daily. And they use
footwear that serve as their protection.

Norms:
Studies of health practices among Filipino suggest that people
originally from rural areas in the Philippines are more knowledgeable regarding home
remedies, traditional healing techniques, and super natural ailments, whereas those from
urban areas rely more in medical intervention and over the counter drugs. However, in
both urban and rural areas, a variety of indigenous folk practices and modern health care
systems are utilized simultaneously. Among the traditional forms of self-medication are
certain oils or ointments, which serve as “cure-alls” in relaxing, heating and comforting
the muscles or providing relief for dizziness, colds, headaches, sore throats, and so forth.
(Montepio/1986/1987:Vans 1991)

Analysis: The family is not that aware of the health problems that may arise due to their
lifestyle habits like lack of adequate rest and exercise. On the other hand, they are aware
that completing immunizations means prevention of diseases.

Immunization Status of each Family Member

Name Position in the Age Immunization Status


family
Celestino Collado Head 75 Complete
immunization
Dominga Collado Wife 73 Complete
immunization
Arnold Gracia Son-in-law 30 Incomplete
Immunization
Elena Gracia Daughter 31 Complete
Immunization
Jay Ann Gracia Grand daughter 3 Complete
Immunization
James Gracia Grandson 2 Complete
Immunization
Jay Gracia Grandson 5 mos. Incomplete
Immunization

IV. Ranking and Prioritization of Health Problems

Poor Sanitation

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat that needs
immediate attention to
Problem prevent the risk for other
diseases and infections.
Modifiability 2/2x2 2 It is easily modifiable since the
resources of the student nurse
of the problem are available by teaching and
helping the family to clean
their surroundings properly.
Preventive 3/3x1 1 Occurrence of parasites and
diseases may be minimized if
Potential taken action immediately.
Salience of the 2/2x1 1 It needs immediate attention
to prevent the risk for other
Problem diseases.
Total Score 4.67

Improper drainage system

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat that needs
immediate attention in order
Problem prevent breeding sites and to
minimize the risk for other
diseases.
Modifiability 1/2x2 1 Problem is partially modifiable
since covering an open canal
of the problem will require quite financial
expenditure. Presently, the
family’s resources are not
adequate considering other
problems.
Preventive 3/3x1 1 Occurrence of vector breeding
in an open canal with stagnant
Potential water will be prevented
Salience of the 2/2x1 1 The family recognizes it as a
problem that needs immediate
Problem attention to prevent the
breeding of harmful vectors.
Total Score 3.67

Smoking

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat that needs
immediate action because it
Problem may worsen the condition of
the head of the family.
Modifiability 1/2x2 1 The problem is partially
modifiable since the father
of the problem verbalizes that he cannot stop
smoking because its his vice
for long years.
Preventive 3/3x1 1 Susceptibility to other
diseases and infections can be
Potential prevented if smoking is
eliminated
Salience of the 0/2x1 0 The head of the family do not
perceive it as a serious
Problem problem needing immediate
attention.
Total Score 2.67

Accident Hazard

Criteria Computation Actual Score Justification

Nature of the 2/3x1 0.67 It is a health threat that needs


immediate attention/action.
Problem
Modifiability 1/2x2 1 It is partially modifiable since
the resources of the family are
of the problem available.
Preventive 3/3x1 1 Injuries and accidents which
are caused by environmental
Potential hazards may occur but can be
prevented if interventions are
applied.
Salience of the 0/2x1 0 The family do not perceive it
as a serious problem needing
Problem immediate attention
Total Score 2.67

Poor personal hygiene

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat in which
the children may acquire
Problem diseases that may threaten
their health.
Modifiability 2/2x2 2 The problem is easily
modifiable since the resources
of the problem of the student nurse are
available in helping and
teaching the family to
maintain good hygiene.
Preventive 3/3x1 1 Occurrence of diseases and
infection may be minimized if
Potential taken action immediately.
Salience of the 2/2x1 1 It needs immediate attention
to prevent the presence of
Problem infection and other diseases to
children.
Total Score 4.67

Malnutrition

Criteria Computation Actual Score Justification


Nature of the 3/3x1 1 It is a health deficit because it
requires immediate
Problem attention/action.
Modifiability 1/2x2 1 It is partially modifiable since
the family lacks resources due
of the problem to financial problems
Preventive 3/3x1 1 Malnutrition can be prevented
if the children eat variety of
Potential nutritious food everyday and
junk foods.
Salience of the 2/2x1 1 The family perceives it as a
serious problem needing
Problem immediate attention.
Total Score 4

Diabetes

Criteria Computation Actual Score Justification


Nature of the 3/3x1 1 It is a health deficit because it
requires immediate attention.
Problem
Modifiability 2/2x2 2 It is partially modifiable since
the head of the family and his
of the problem wife lacks knowledge on what
measures are to be done in
minimizing the problem and to
lower blood sugar.
Preventive 3/3x1 1 The problem may be
minimized if taken action
Potential immediately.
Salience of the 0/2x1 0 The family does not perceive it
as a serious problem needing
Problem immediate attention.
Total Score 4

Poor lighting and ventilation

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat that needs
immediate attention.
Problem
Modifiability 1/2x2 1 It is partially modifiable since
the family lacks resources due
of the problem to financial problems.
Preventive 3/3x1 1 This problem may be
prevented but it needs
Potential financial assistance.
Salience of the 0/2x1 0 The family do not perceive it
as a serious problem needing
Problem immediate action/attention
Total Score 2.67

Inadequate family resources due to financial problems

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat
Problem
Modifiability 1/2x2 1 It is partially modifiable since
the student nurse has no
of the problem responsibility on it.
Preventive 2/3x1 0.67 This problem may not be
easily modifiable because it
Potential requires more effort among
family members.
Salience of the 2/2x1 1 The family perceives it as a
problem needing immediate
Problem attention/action.
Total Score 3.34
Inadequate knowledge regarding health conditions

Criteria Computation Actual Score Justification


Nature of the 2/3x1 0.67 It is a health threat since the
family ignores their present
Problem health condition and didn’t
take any action on it.
Modifiability 1/2x2 1 It is partially modifiable since
the family has no resources
of the problem like TV and radio to acquire
health in formations.
Preventive 3/3x1 1 Presence of signs and
symptoms may be prevented
Potential if knowledge can be acquired.
Salience of the 0/2x1 0 The family do not perceived it
as a serious problem needing
Problem immediate action/attention.
Total Score 2.67

Ranking and prioritization of health problems

Poor Sanitation 4.67

Poor personal hygiene 4.67


Diabetes 4
Malnutrition 4
Improper drainage system 3.67
Inadequate family resources due to 3.34
financial problems
Smoking 2.67
Accident hazard 2.67
Poor lighting and ventilation 2.67
Inadequate knowledge regarding health 2.67
conditions
Scale for Ranking Health Conditions and Problems According to Priorities
Criteria Weight
• Nature of the condition or problem 1
presented
Scale: wellness state 3
health deficit 3
health threat 2
forseeable crisis 1
• Modifiability of the condition or 2
problem
Scale: easily modifiable 2
partially modifiable 1
not modifiable 0
• Preventive potential 1
Scale: high 3
moderate 2
low 1
• Salience 1
Scale: a condition or problem, 2
needing immediate attention
a condition or problem not 1
needing immediate attention
not perceived as a problem 0
or condition needing change
V. FAMILY NURSING CARE PLANS

INTERVENTION PLAN
Nursing Methods Resources
HEALTH FAMILY GOALS OBJECTIVES
Interventions of Nurse Required
PROBLEM NURSING EVALUATION
family
PROBLEM/S
contact
Poor sanitation Inability to After proper After proper Demonstrate the Home Time and
(health threat) provide a home nursing nursing following: Visit effort of the
environment that interventions interventions 1)discuss with health care
is conducive in the family will the family the family the provider and
maintaining take the should adhered importance of the family
health and necessary the following: environmental Expenses for
personal actions to sanitation to teaching aids
1) should
development due improve and their health and
know
to: maintain the 2)utilize health transportation
the
1) inadequate sanitation of measures of the student
importa
financial their involving the nurse
nce of
resources immediate manipulation or
clean
and lack surroundings elimination of
potable
of space to thr ffg:
construct a)physical threat
water
facility to health are
supply
2) ignorance eliminated by
and
on the improving on
proper
importanc fascilities at
waste
e of home
disposal
proper b)psychological
hygiene 2) throw threat by
and waste working closely
sanitation material with the family
3) lack of s to improve
knowledg properly communication
e
regarding 3) clean

preventive surroun

measures dings to
eliminat
e
breedin
g sites
of pests
4) take a
bath
once or
twice a
day

INTERVENTION PLAN
Nursing Methods Resources
HEALTH FAMILY GOALS OBJECTIVES Interventions of Nurse Required
PROBLEM NURSING family EVALUATION
PROBLEM/S contact
Malnutrition 1)inability to After proper After proper 1)monitor VS Home
(health deficit) make nursing nursing and perform Visit Time and
decisions with interventions, interventions, physical effort of the
respect to the family will the family assessment health care
taking alleviate members will: 2) weighed the provider and
appropriate malnutrition 1)be able to children and the family
health due to and have take nutritious computed their Expenses for
lack of taking healthy foods BMI teaching aids
nutritious condition 2)be able to 3)discuss about and
foods and not maintain the the ffg: transportation
eating at the regular dietary a)the of the student
right time patter at the importance of nurse
2)inability to right time taking nutritious Paraphernalia
provide 3)understand food such as
nursing care to about the fruits and
malnourish importance of vegetables
family nutritious foods b)the condition
member due to 4)avoid to take of being
lack of unsanitary or malnourish and
knowledge non nutritious its effect
among the foods 4)instruct them
members to eat in proper
dietary pattern,
eat 3 times a
day at the right
time
5) promote
health teachings
such as the
proper hand
washing before
and after eating

INTERVENTION PLAN
Nursing Methods Resources
HEALTH FAMILY GOALS OBJECTIVES
Interventions of Nurse Required
PROBLEM NURSING EVALUATION
family
PROBLEM/S
contact
Diabetes Inability to do After proper After proper Demonstrate the Home Time and
(health deficit) the activities nursing nursing ffg: Visit effort of the
that may interventions, interventions, 1)provide health care
prevent the the family will the family information of provider and
occurrence of know the members will how such the family
the importance of be able to: activities like Expenses for
complications the betterment 1)understand of eating verity of teaching aids
of the problem of the disease the taught foods is bad and
measures to 2) giving health transportation
minimize the teachings on of the student
problem how to prevent nurse
2)avoid the complications
intake of sweet Encouraging the
foods that may mother and
contribute to of father to do
having high activities like
blood sugar exercising and
30seek medical have enough
advice when rest and sleep to
complications minimize the
occur problem

INTERVENTION PLAN
Nursing Methods Resources
HEALTH FAMILY GOALS OBJECTIVES
Interventions of Nurse Required
PROBLEM NURSING EVALUATION
family
PROBLEM/S
contact
Improper drainage Inability to After proper After proper Demonstrate the Home Time and
system provide a nursing nursing ffg: Visit effort of the
(health threat) home interventions, interventions, 1)cleaning the health care
environment the family will the family will open canal daily provider and
conducive to be able to: be able to: to stop breeding the family
health 1)recognize the 1)Demonstrate sites Expenses for
maintenance presence of the the ffg: 2)replacing all teaching aids
and personal problem by a) cleaning the the materials and
development doing a specific open canal that can be transportation
due to ignoring action such as daily possible of the student
the problem cleaning the b)avoiding breeding sites of nurse
open canal and throwing waste insects such as
avoiding on it open tires with
throwing waste stagnant water
on it
3) Proper
arranging of
home materials
such as
containers
having stock
water to
maintain a clean
surrounding.

INTERVENTION PLAN
Nursing Methods Resources
HEALTH FAMILY GOALS OBJECTIVES
Interventions of Nurse Required
PROBLEM NURSING EVALUATION
family
PROBLEM/S
contact
Smoking Inability to After proper After proper Demonstrate Home Time and
(health threat) refuse to nursing nursing the ffg: Visit effort of the
smoking of the interventions, interventions, 1encourage the health care
head of the the father will the father will father not to provider and
family that may be able to: be able to: smoke because the family
lead to serious 1) realize that 1)realize the smoking is not Expenses for
problems such smiking is very importance of only dangerous teaching aids
as TB, cancer. dangerous to not smoking for him but also and
Emphysema,and him for those who transportation
other heart takes the second of the student
ailments hand smoke nurse
2)teaching the
father the
proper mouth
hygiene

INTERVENTION PLAN
Nursing Methods Resources
HEALTH FAMILY GOALS OBJECTIVES
Interventions of Nurse Required
PROBLEM NURSING EVALUATION
family
PROBLEM/S
contact
Poor personal hygiene Inability to After proper After proper Demonstrate the Home Time and
among the maintain a nursing nursing ffg: Visit effort of the
children good hygiene interventions, interventions, 1)discuss to the health care
family the
(health threat) due to: the family will the father will provider and
importance of
1) lack of be able to: be able to: maintaining the family
good hygiene
assistance of 1)take the 1)demonstrate Expenses for
2)helping the
the mother necessary the proper way mother in teaching aids
bathing the
2)lack of action to of bathing the and
children
knowledge in improve and children 3)instructing the transportation
mother the
maintaining maintaingood 2) maintain the of the student
proper way in
good hygiene hygiene among cleanliness of maintaining the nurse
cleanliness of
3) the children the children
her children
paraphernalias
VI. Conclusion

The family cooperated well during interventions with the student nurse and we have a good working relationship. The family
in return responded well to the interventions done to them. The family are now knowledgeable with the problems in their home and to
themselves because of the student nurse who imparted knowledge to them.

VII. Recommendations
The student nurses exposed in the community play an important role in the life of a family. They will be the ones who will lead
the path towards the family’s improvement in terms of health.
As a student nurse, I recommend the following to the Collado family:
1.) The family must be conscious about their health.
2.) The family must give more attention to their hygiene.
3.) The family must know how to have a good and healthy environment in order to prevent the occurrence of diseases that
may trigger their health.

VIII. Learning Derived


In doing this family case study, I learned a lot of different ways of living. I also appreciated the Collado family because they
don’t hesitate to entertain and welcome me even though I am a stranger to them. I will not forget this community exposure because of
the people living there, they are very friendly and kind to us.
X. Bibliography

A. Books

Araseli & Maglaya., Nursing Practice in the Community

Estes, M.E., Health Assessment and Physical Examination (3rd Edition).

Potts & Mandleco., Pediatric Nursing

B. Websites

http://www.livinginthephilippines.com/style12.html

Wikepedia.org

www. Census.gov.ph

www.google.com

www.healthhouse.org

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