University of Baguio School of Nursing Community Health Nursing in Purok 3, Camp 7 Baguio City

In partial fulfillment of the requirements of the subject in NCEL03 First Semester SY: 2011-2012

Submitted by: NMH 3

August 2011

Table Of contents Acknowledgement Chapter I 1. Introduction 2. Goals and objectives 3. Scope and limitations 4. Barangay profile 5. Health center profile Chapter II 1. Case finding results a. Assessment b. Plan c. Intervention d. Evaluation 2. Prioritization of Problem 3. Intervention 4. Evaluation Chapter III 1. Initial Data base for family a. Family structure, characteristics and dynamics b. Socio-economic and cultural characteristics c. Home and environment d. Health status of each family member e. Values, habits, practices of health promotion, maintenance and disease prevention 2. Presentation of Family Nursing Problems a. Typology of Nursing Problems for the Family a.1. First Level assessment a.2. Second Level assessment b. Prioritization of Family Health Problems c. Family Nursing Care Plan c.1. Health Problem c.2. Family Nursing Problems

c.3. goal of care c.4. objectives of care c.5. intervention plan i. Nursing intervention ii. Method of Nurse-Family contact iii. Resources required Chapter IV: Implementation a. Diagnostic interventions b. Therapeutic interventions c. Educative interventions Chapter V: Evaluation Chapter VI: Conclusion and Recommendation Chapter VII: Appendices a. Insights b. Spot map c. Documentations References a. Books b. Electronic sources c. Others

Acknowledgement We, the NMH 3 of the School of nursing of the University of Baguio acknowledge the people who had helped us to make this case study possible. First and foremost, we would like to thank our Almighty God for giving us good physical, social and mental health that we needed most in making this study. Our heartfelt thanks to our loving parents, who were always there to help us financially, emotionally, and spiritually. Moreover, we wouldnt fail to thank the barangay officials and the staffs at the health center of Camp 7, Baguio City. We are indeed blessed for having a clinical instructor Maam Bacani and Sir Dumaw-il for their friendly advices, their willingness to teach us the proper managements of different clinical set ups and support in the accomplishment of this summary of community activities. We would like to extend our sincerest gratitude to the school of nursing, our level III coordinator, Maam Bahug and to the University of Baguio. Truly, we appreciate this chance for we really learned so many things that sharpened our skills and broadened our knowledge of Nursing Practice, in the aspirations of being effective nurses in the future. Last but not the least; we would also want to thank each other for being cooperative with all the works, for sharing their knowledge and time for the success and completion of this case study. For all the memories we had for the laughter and hardships that we shared thank you.

Chapter I
INTRODUCTION: Community Health Nursing (CHN) is defined as a learned practice discipline with an ultimate goal of contributing, as individuals and in collaboration with other, the promotion of clients optimum level of functioning through teaching and delivery of care (Department of Health, 2000). It acknowledges the influence of social, cultural, economic and political subsystems that impact the dynamic health promotion, disease prevention and health restoration strategies of the community. In this practice, it is the community that is considered as the primary client. A community refers to various groups of people who interact and share certain things such as beliefs, resources, preferences, needs, risk and number of other conditions that may be present and common, affecting the identity of the participants and their degree of adhesion as a group (Wikipedia, 2007). According to Maglaya (2004), the community has a direct influence on the health of the individual, families, and subpopulations and it is at this level where most health service provisions occur. Community health nursing is also a valuable part of the nursing curriculum since such experience provides an effective mean of broadening the students horizon by serving as the actual laboratory for the students. Aside from that, such experience also develops the students responsibility, selfdiscipline, initiative, courtesy and good public relations. Furthermore, community health nursing also brings the community and the school closer together.

Group NMH3 was assigned to have their community exposure at Purok 3, Camp 7 Baguio City under the supervision of our instructor: Dra Bacani and Sir Dumaw-il. A courtesy call and ocular survey was conducted last August 1, 2011 wherein the group completed their spot maps and was oriented to the community. The group was able to meet and interact with some people in the place. Such experience also provided an opportunity for the group to appreciate and have an overview of the Barangay where they will be conducting home visit for the coming duties. In the afternoon after our courtesy call and ocular survey we had the chance to look for the houses assigned to us wherein the group had their personal encounter with the residents. The succeeding home visits happened last August 2 - 3. 60 families, 59 households and 250 individuals took part in the said survey respondents.

Goals of the study: This aims to gather data regarding the health status, health problems and health-related issues and concerns of Purok 3, Camp 7 Baguio City. This data endeavors to offer relevant basis for the assessment, planning and implementation of a quality nursing care to the community. In addition to that, it aspires to assess the awareness and utilization of the residents as to the programs and services offered by the Health Center. It also intends to provide quality community health care through health education and correct information dissemination regarding health. Objectives of the study: To interview and to conduct a survey to a number of households in the community vital for assessment of the health needs of Purok 3, Camp7 Baguio City. To assess the health beliefs and practices of the residents as well as provide correct information regarding family planning, immunization, nutrition, maternal and child care, environmental sanitation and disease prevention. To implement quality nursing interventions like blood pressure reading, and health teaching. To increase the awareness of the community regarding the health programs and services offered by the Barangay Health Center to improve the general health status of the population. To be able to perform Case finding in the community.

SCOPE AND LIMITATION We, University of Baguio section NMH group 3 of BSN III, have been assigned at Purok 3, Camp 7 to research about the health condition of the community. This research has its own barriers and limitations. We are able to cover up a total population of 250, comprising of 60 families, and 59 households. Families which needed support or services were catered. However, we are not able to cover the whole area assigned to us because some families reject and deny our service to them, and others are too busy enough to accommodate to us.

A. BARANGAY PROFILE GENERAL INFORMATION 1. Creation (Legal Basis) The construction of Kennon Road by the American soldiers led by Engineer Major Kennon in 1901, not only abridged the distance between Baguio to its neighboring provinces but paved the beginning of cordilleras progress today. This highway stretched its destiny, synonymous to the clustering of Camps to house its workers. Eventually, these camps became permanent settlements. One of these camps became a breath-taking relief of travelers to signal the end of tedious journey to Baguio City and the beginning of busy community now called Camp 7 Barangay. It became a barangay in September 21, 1974, during the incumbency of Mayor Luis L. Lardizabal by virtue of PD Nos. 86, 86-A, 86-B.210 and 557 issued by then President Ferdinand E. Marcos, and signed into law on January 5, 1973. This became a legal basis including other barrios to be declared as Barangay. 2. Geography, Topography and Political Boundaries Next to Irisan Barangay, Barangay Camp 7 is the Second largest Barangay in the City with a total land area of 411.72 hectares. Basically, its terrain is located strategically along mountainous slopes of rolling hills. Because of this natural terrain, erosions and landslide are common problems during the rainy season, causing significant damages to some residential areas. As to its physical characteristics, the soil is partly sandy, clay, clay lime and loom. The water comes from the four (4) rivers from adjacent Barangays converging into that area. In addition, there are no major earthquake faults in the area, thus, in the 1990 major earthquake, no significant damages were reported.

As to boundaries from its adjacent barangays, it has been delineated. To the North, San Vicente and Poliwes Barangays; to the South, Camp 6 barangay and Tuba, Benguet; to the East, Dagsian and Loakan-Liwanag and to the West, Bakakeng Barangay. 3. Political Subdivisions Considering its wide area of jurisdiction, the Barangay Council deemed it necessary to adopt a resolution to subdivide the Barangay into puroks. By virtue of resolution No.60, series of 1997, which was unanimously approved, the barangay was subdivided into seven (7) puroks which comprise of the following sitios; Purok 1 Agpaoa Drive, Carino Subdivision, Woodsgate Subdivision and Binay-an Compound, Assigned kagawad: Kagawad Angelina Ramos Purok 2 Subdivision Sarok, Milo subdivision, Woodsville

Assigned Kagawad: Kagawad Juan Baldo Purok 3 Homestead and Parisas; Purok Leader: Marisa Gayudan Assigned Kagawad: Kagawad Joel Buena Purok 4 Petersville Subdivision, Mary Heights and Lexber Subdivision Assigned Kagawad: Kagawad Jones Lorena Purok 5 Palispis Satellite Market Compound, Pias, Youngland, Amparo Heights,

Assigned kagawad: Kagawad Dennis Dalisdis

Purok 6 Carantes Subdivision, Amistad

Compound,

Monticelilo,

Richgate

Assigned Kagawad: Kagawad Marcelina Pucdo Purok 7 PNP Substation 8, Zigzag road down to City Limit Assigned Kagawad: Kagawad Arthur Alfonso 4. Religion At present, Camp7 is predominantly Roman Catholics, Followed by the growing religious sect of Born Again, Baptists and other Protestant groups, and Iglesia ni Kristo and Jehovahs Witnesses. Camp 7 is a Christian Community where Catholics, Protestants, Born Again, Iglesia ni Kristo and jehovahs witnesses live together in harmony. 5. Language/Dialects predominantly Spoken In spite of the booming Real Estate Development, making Camp 7 as the future center of Trade and Commerce, and gradually changing the constituents character due to the lowland migrants mixed with the settlers and old timer Cordilleras, still the language generally used in this Barangay is Tagalog, Ilocano,Ibaloi, Kankanaey and English. 6. Natural resources Camp 7 is one of the richest barangay in terms of Natural resources. Because of the presence of rivers and trees, natural springs abound. Incidentally, the Baguio Water District has 4 water Pump Stations in this area that supplies about 85 % of the citys water needs. There are also about 6 car wash areas utilizing the free flowing water from natural springs. Aside from the natural springs, drill samples conducted by the foreign based exploration companies indicate the existence of gold or deposits

7. Population 2009 census on the population initiated by the Sangguniang Pambarangay and conducted by a team of nursing student volunteers headed by a kagawad showed that there are 19,041 residents o f camp 7. Homeowners in subdivision were not included because they were not around during the census and volunteers were restricted to enter the subdivision premises. Population (Distribution by age and sex) AGE 0-6 7-17 8-59 60 and up TOTAL ECONOMIC 1. Agriculture, commerce and industry soil in Camp 7 Barangay is conducive to farming .However, there are few areas left for agriculture. Because water supply is abundant, crops grow very healthy. Marketing the produce is not a problem as most of the produced are sold in the Camp 7 satellite market where these are sold for domestic consumptions and for the travelers and tourists going down to the lowlands passing by and through Kennon Road who opt to buy vegetables and pasalubongs like strawberry jams, brooms, Baguio souvenir items and the like rather than in the city. The satellite is busiest when there are special activities in the city like the panagbengnga, PMA graduations and Homecomings, Holy Week and Christmas seasons. The barangay is also a host of some industrial businesses such as: a. PILTEL, DIGITEL, AND SMART power/cell stations b. Batching plant c. Macron condominium d. High point inn hotel e. 3 international colleges MALE 1,243 3,211 5,002 599 10,055 FEMALE 1,228 2,279 5,087 392 8,986 TOTALS 2,471 5,490 10,089 999 19,041

f. g. h. i. j. k. l. m. n. o. p. q. r.

Hardware and construction Supplies Vulcanizing and auto repair shops Water refilling stations Carinderias Silver craft store/outlet Car wash stations Baguio water district pump stations Jeepney and taxi operators Sand and gravel business Industrial warehouse Private water delivery Private dormitories About 200 small sari-sari stores owned by residents to cater the needs of the neighborhood. In addition, for the tourism industry, there are three (3) prominent tourist spots in the vicinity namely, the Lioness Park, Kennon Road View Deck and the well known lions head along Kennon road. Foreign and domestic tourists normally visit these places as they travel along Kennon road.

SOCIAL SERVICES 1. Health, Sanitation and Nutrition The barangay has a Health Center building that caters to the health needs of the barangay. It is opened every Wednesdays and sometimes Thursday when the public community doctors are available. The barangay employs 3 Barangay Health Workers, 3 barangay nutrition Scholar, one BNAO and one DHST Volunteer. The health services rendered to the residents are: free vaccinations for kids, OPT, Vit. A for kids and Family Planning lectures for parents, etc. For the Nutrition program, lectures to parents are also given free. Feeding programs are done every now and then. Only 13 kids were found to be malnourished. Through the feeding rendered by private entities, Barangay officials and DSWD, the health of some bad improved.

With regards to sanitation, the city collects the garbages once a week. The residents are taught to segregate at source. Cleanliness are monitored by the Barangay officials. An MRF will soon be established in the near future. 2. Education Through the initiative of the Barangay officials and the DECS-CAR.the elementary school is now complete from kinder to Grade 6. The Barangay Hall has also housed the Day Care which is subsidized by the DSWD. T he educational needs of camp7 children are adequately provided for. 3. Housing The Barangayan hosts several privately owned flashy subdivisions scattered in different puroks mostly owned by affluent individuals mostly foreigners and from Metro Manila. They are as follows: a. Woodsville subdivision (Sarok) b. Milo Subdivision (Sarok) c. Woodsgate subdivision (Binay-an) d. Richgate Subdivision (Amparo) e. Pettersville Subdivision (Monticeilo) f. Perezville Subdivision (Pias) g. Shodang Subdivision (Pias) h. Kalinga Pelota (De Guia) i. Mary Mount (Amparo) j. Lexber (Amparo) k. Monticeilo (Pucdo) l. Fil-Estae (Montecillo) m. Taipan Subdivision at Youngland n. Carino Subdivision (Carino/Agpaoa) o. White Plains (Pias) In this barangay, generally, there is no housing shortage since Camp 7 is an expansion area of the city. Because of the vigilance of the barangay officials, squatting is not

rampant. place.

Professional

squatters

have

not

invaded

the

One of the present problem relative to housing is the unsolved case are pending with the proper authorities. 4. Social welfare The barangay official sees to it that peace and order prevails and that all residents especially the kids and elderly are protected. As of the moment, there is no incidence of child labor and child abuse. The barangay has a strong set of Lupong Tagapamaya who caters to all sorts of cases filed, where complainant and respondents are given equal attention and service. For CY 2008 to CY 2010. There were about 270 various cases filed and settled. Few were certified. During Calamity seasons, the barangay has its own Disaster Brigade who are always ready to extend helps to the needy. Although the brigade is not fully equipped, they are still ready to serve. 5. Sports and recreation There is no open basketball court for sport activities, etc. However, the barangay has always free access to neighboring Barangay like Loakan for free use of their Open Court. The barangay officials are still scouting for a place to build their own Multi-purpose hall. INFRASTRUCTURE 1. Transportation facilities For the non-car owners, PUJs and Taxis are the main transports. PUJ are available from 6:00 a.m to 9:30 p.m 2. Road net works and bridges The main roads at Camp 7 connecting the city proper is fully cemented or asphalted. 3. Electrification and Communication

BENECO lines have reached almost all residential homes of Camp 7. The barangay pays for the bills of street lights. As to communications, air and land lines are available. The PILTEL (PLDT), DIGITEL, GLOBE, SMART, AND SUN communications are being subscribed by the residents. PEACE AND ORDER Camp 7 is generally and relatively peaceful. The BPOC has been performing excellently in maintaining peace and order in the barangay. DEVELOPMENT ADMINISTRATION AND FINANCE 1. Organizational set-up and Development Administration

The Barangay Council meets regularly every first and third Monday of the month for legislative action to discuss various matters and concerns of the barangay. Committees were set to assist the Punong Barangay carry out his job of governance. They are as follows: PB Constancio F. Danao Overall Chair person Kag. Arthur Alfonso Committee on Ways and Means Kag. Angelina Ramos Livelihood, employment, social services cooperatives, women and urban poor Kag. housing Jones M. Lorena Urban Planning, Lands, and

Kag. Marc elino Pucdo Health and Sanitation, ecology and environmental protection, tourism, parks and playground Kag. Dennis Dalisdis Laws, human Rights, justice, Public Protection, and Safety, Peace and order Kag. Juan Baldo Public Works, transportation, traffic legislation Public Utilities,

SK Chairman Jestoni Buena education, culture, youth welfare and Sports development

Support Staff: Ruth Manuel Barangay Treasurer Romel H. Beltran Barangay Secretary With regards to coordination with other adjacent Barangay, closer coordination and cooperation is being done especially on environmental protection and conservation in support of the Citys clean and green program, sports development and disaster brigades. With regards to the locally funded projects, it is always coordinated with the office of the city Mayor and city Engineers. For the National funded projects within the confines of the barangay, are in coordination with the DPWH. For public safety and protection, the presence of Station and Check Point at Zigzag serves as deterrence to crime commission. The barangay closely work with them so with BPOC volunteers and members. 2. Fiscal Management The main sources of barangay income are its IRA and the 10% RTPA share. For the year 2010, the barangay operated on a budget of P 4,340,000.00. For the year 2011, it operated on the budget of P 8,056,264.17. Comparing it with the past 2009 budget, it is clearly seen that it has increased considerably. It is concluded that the budget is sufficient enough to address the needs of the barangay especially in the implantation of its priority projects. MILESTONE AND ACCOMPLISHMENTS The 2010 milestone and accomplishments reflect all the efforts exerted by the Barangay officials and its constituents. Credits are given to all who have contributed one way or the other, specially the Out Going Punong Barangay, Marvin P. Binay-an, which resulted in the following accomplishments:

1. Infrastructures a. Amparo Heights drainage Canal b. Cementing of Pias Road/Drainage Canal c. Cementing of Camp 7 Elementary grounds d. Young Land Drainage Canal e. Asphalting of Lexber, parisas and Sarok roads f. Amistad Drainage Canal g. Flood control near Alos residence h. Walk away railings at Amistad i. And many other miscellaneous infra-projects 2. Livelihoods Programs a. Noodles making b. Longganisa making c. Flower Making d. Tea, soap and wine making e. Garbage recycling (bag and purse making, flowers, keychain, etc.) f. Reflexology and massage g. Cosmetology h. Culinary Arts 3. Others Accomplishments : a. Mass Feeding and Medical missions sponsored by various NGOs/subdivisions b. Organizations of Homeowners and Vendors Associations of Camp 7 c. Solved the long-time Lions Head problem of squatters d. Solved 87% of barangay cases in 2009 and 90% in 2010 e. Organized and activated the barangay BNC f. Improvement of the Day Care Center g. Implemented the garbage policies into zero waste program and waste segregation at source h. Encouraged community serviced i. Census, clean-ups, etc. j. Weekly rice Distribution and other livelihood projects/seminars through Camp 7 Woman KALIPI k. Motivated and strengthen womens organization through Women KALIPI and other NGO organization l. Computer literacy for the lower incomed residents and OSY

m. Installations/Repair/Rehabilitation of streetlights (2009-2010) n. Creation and implementation of Barangay ordinace(2009) 4. Seminars: a. Barangay development Plan b. DOH Sanitation seminar on Dengue and rabies c. Barangay Nutrition Program d. On herbal medicines e. MRF Seminars f. BPOC Seminars g. Red Cross Seminars h. Nutrition Seminars i. Lupon seminars j. Staff Seminars (Punong Barangay, Kagawads, Secretary and Treasurer) k. Day Care Teachers Seminar l. Tanod Seminar m. All DILG seminars n. SK Seminars o. BAFC (Barangay Agriculture and Fishery Council) Seminar 5. SK Activities a. Clean and green program b. Annual Sports fest (Chess and Dart Tournament, tennis, ball games) c. Biking for a cause Contest d. Christmas party for indigent kids of Camp 7

C.Camp 7 Vision and Mission

VISION To be able to see men and women of Camp 7 barangay live a sufficient life after 5 10 years of training and innovations and be able to live a normal life over those crucial times. MISSION To help the men and women of Camp 7 to be sufficient through livelihood trainings and value formation and be able to establish a small scale business and to be a responsible Filipino men and women.

Barangay Organizational Chart

Constancio F. Danao Punong Barangay (Chairman)

Kag. Marcelina Pucdo Co-Chairman

Dolores Dayrit BNAO

Susan Habbiling Yolanda Benlingan Netty Tiyab BNS

Regie Valencia Sanitation

Mary Gene Basinga Health

Barangay Council Members (Kagawads)

Barangay Secretary

Barangay Treasurer

Jestoni Buena SK Chairman (Sports)

PSI Eugune Raymundo Mike Esteban Peace and Order

Annie Marie Bisquera Gilford Ambaked Camp 7 Elementary School

Presley Fernandez Clean and Green (Subdivision Representative)

Dominga De Guzman Womens Kalipi

Narda Facsoy Kate Lohan Day Care Center

Herminia Pascua Senior Citizen

Sheree Nolasco Non-Formal Education (Solo Parenting) Other Supportive programs

PTR. Arvin Villanueva PTCA

Thomas Mendoza Marcelina Pucdo Transportation group

Delio Pasion Carol Pulas Tourism

PTR. Eusebio Tanicala Home Owners Association

Romeo Rongo Environmental Protection

Matthew Bantiyaw Redonia Binayan Religious Sector

Faith Flores Non-Government Education (Private School)

Irene V. Enriquez Youth group

Constituents

B. Health Center Profile a.Health Center Loakan Vision and Mission Mission Health service is tasked as a catalyst towards the promotion and maintenance of health and the prevention of disease. Vision A healthy city sustained through active interaction between Quality oriented, responsive health care services provider and cooperative, self reliant communities.

CLINIC SCHEDULE OF LOAKAN HEALTH CENTER Monday Family Planning Pap Smear Tuesday Consultation of all sick cases Pre-natal, post-natal, immunization 1:00 pm: TB dots Wednesday Community assemblies/satellites clinics: Camp 7-every Wednesday of the month Puliwes-every 3rd Wednesday of the month Camp 8-every 3rd Wednesday of the month San Vicente-every 4th Wednesday of the month Thursday Community assembly/satellite clinics

Camp 8 every 1st Thursday of the month San Vicente every 2nd Thursday of the month Camp 7 every 3rd Thursday of the month Puliwes every 4th Thursday of the month Friday Consultation of all sick cases Pre-natal, post-natal, immunization Dental services 1:00 pm: TB dots

1. General medical and dental service 2. Maternal and child health Family planning(BCG, DPT, HEPB, MEASLES, TT) Prenatal, natal, and post natal care Nutrition service Under SIH care 3. Communicable disease control Tuberculosis control program Dengue control program Rabies control program Leprosy control program STI/ HIV/ control program Control of acute respiratory infection Control of diarrheal diseases 4. Life style related control program Cancer control program Cardiovascular diseases control program Diabetes control program Renal disease control program 5. Environmental health and sanitation program Population program service

Loakan Health Center

Dr. Marie Therese Sumbillo Medical Officer IV

June Macbac Population Program Worker-II

Regina Valencia Sanitation Inspector

Benilda Villanueva Nurse II

Mary Grace Masing Nurse II

Aniceta Cadangen Midwife II

Barangay Health Workers

Nodel Beltrand Camp 7

Fe Abad Camp 7

Manuela Tsilen Camp 8

Dicden Duday San Vicente

Lourdes Addom Loakan Proper

Josie Canuto Loakan Proper

Julie Tubal Liwanag

Sheryl Lee Tak San Vicente

Chapter II Presentation of Data 1. Case finding Result FAMILY ASSESSMENT -Report #1. Stroke difficulties
with activity due to weakness Hemiplegia (rightside) Difficulty resting. Exhibits hypertension reports feelings of hopeless -Identify the medications the patients is taking, discuss to the client and his family how to properly take the medication -Identified the medications the patient is taking, discussed to the client and his family how to properly take the medications

PLAN
-Increase strength and function of affected or compensatory body part -Assess functional ability of impairment

INTERVENTION EVALUATION After Dx:

nursing -Assessed functional ability or impairment interventio n we increased the straight and function of -Begin active/passiv e Range Of Motion to all extremities affected part.

Tx:

Edx:

-discuss and described to the patient and family the benefits of regular exercise

FAMILY
#2. Hyper tension

ASSESSMENT
Elevated Blood Pressure: 140/90 mmHg. Dizziness Blurring of vision Eating of foods that are high in fat, high in cholesterol, and high in sodium content.

PLAN
-the patient will be able to verbalize an

INTERVENTION EVALUATION After Dx:

rendering -assessed vital signs. care, patient and family verbalized understanding on health teachings given.

understanding -assessed of the health dietary teaching done habits and about the lifestyle. condition -assessed the family history of hypertension Tx: -identified the medications the patient is on, discuss how to properly take the medications

and discuss the drug therapy Edx: -discussed and described to the patient the benefits of regular exercise and how regular exercise can improve blood glucose control -review to client the importance of lifestyle modifications in controlling hypertension. and his family

FAMILY
#3. Diabetes Mellitus I

ASSESSMENT
Checked for vital signs With a blood pressure of: 130/90 Checked for lesions. Diagnosed with Diabetes Mellitus I

PLAN
-the patient will be able to verbalize an

INTERVENTION EVALUATION
Dx: -assessed and monitored the After rendering care, patient and family verbalized understanding on health teachings given.

understanding vital signs of the health of the teaching done patient. about the condition Tx: -discussed and described to the patient the diabetic medications that he is using and how to properly take the medications Edx: -discussed and described to the patient the benefits of regular exercise and how regular exercise can

improve blood glucose control. -educated patient regarding actions to take or to do activities regarding the complications of diabetes.

2. Prioritization of Problem
A. STROKE

Stroke Nature of the Problem Modifiability

Formula 3/3 x 1 2/2 x 2

Actual Score 3 2

Computation 3/3 x 1 = 1 2/2 x 2 = 2

Justification It is a health deficit Resources and interventions to solve the problem are available in the family but they do not utilize these resources. The condition is already present and it is difficult to prevent The family recognizes it is a problem not needing immediate attention.

Preventive

3/3 x 1

3/3 x 1 = 1

Salience

2/2 x 1

1/2 x 1 = 0.5

Total:

= 4.5

B. HYPERTENSION

Hypertension

Formula

Actual Score 3

Computation

Justification

Nature of the problem Modifiability

3/3 x 1

3/3 x 1 = 1

It is a health deficit

2/2 x 2

1/2 x 2 = 1

The resources and intervention needed to solve the problem are available to the family. Occurrence of hypertension can be preventable if the patient continues to take his health maintenance. The family recognizes the existence of the problem and need for immediate attention.

Preventive Potential

3/3 x 1

2/3 x 1 = 0.67

Salience

0/2 x 1

2/2 x 1 = 1

Total:

3.67

C. DIABETES

Diabetes

Formula

Actual Score 3

Computation

Justification

Nature of the Problem Modifiability

3/3 x 1

3/3 x 1 = 1

It is a health deficit

2/2 x 2

0/2 x 2 = 0

The resources and intervention needed to solve the problem are available to the family. The possibilities of complications are moderately preventable family will take of the client.

Preventive Potential

3/3 x 1

1/3 x 1 = 0.33

Salience

0/2 x 1

2/2 x 1 = 1

The family recognizes the existence of the problem.

Total:

2.33

Intervention Dx: -determine degree of immobility in relation to suggested scale: 0-completely independent 1-requires use of equipment or device 2-requires help from another person 3-requires help from another person and device 4-dependent -determine diagnosis that contributes to immobility Tx: -assist client reposition self on a regular basis, at least every two hours - Situate the bed so that clients unaffected side is facing the room with the affected side to the wall

Rationale -to assess functional ability

Evaluation
After nursing intervention we increased the straight and function of affected part.

-to identify causative/co ntributing factors -to prevent complication s on the skin integrity of the client -to enable the client to achieve a level of independence by doing ADLs as much as tolerated

Edx: -encourage clients and SOs involvement in decision making as much as possible

-enhances commitment to plan, optimizing outcomes -to promote wellness

-review individual dietary needs.

CHAPTER III Family Nursing Care Plan 1. Initial Data Base for the Family

a. Family Structure and Characteristics The X family is a nuclear type of family, with Mr. Father, 58 years old and living with Ms. Mother, 49 years old. Both are living at #58 Brgy. Upper West Purok 3, Camp 7, Baguio, City, together with their four children. They have six children; four are staying with

them and the two are living in Manila with their own families. The 3rd child, 24 years old and a college graduate. The 4th child, 22 years old and working as a cashier. The 5th child is 19 years of age and he is

in college level. The 6th child, 16 years of age and is also in the college level. The family had been staying in the community since 1961, approximately 50 years. b. Socio- Economic and Cultural Factors Both Mr. Father and Ms. Mother havent finished their college education. Ms Mother is a beautician and owns a small eatery, while Mr. Father was a taxi driver before having this condition. 3rd child and 4th child finished their studies, 4th child have already a job as a cashier. 5th child and 6th child are still in college level. Mr. Father does not have his maintenance for hypertension because of so many expenses. Mr. Father is originally from Baguio, City. They are all Roman, Catholics. Base on the condition of Mr. Father, for him,

God is the only one who can help him with his condition and he doesnt lose hope, Even though they did not attend the mass regularly. Furthermore, the family do not participate activities in Barangay. c. Housing and Environment They own their house including the lot where it stands. The house is made up of woods and concrete. There are 3 rooms in the house: one room is occupied by the couple, another room for the 3rd and 5th child and another room for the 4th and 6th child. The front portion of the house is not cemented and with several potted plants. The area is not a good environment. As for the Drainage system, they have open drainage system which they use for washing their clothes and could be a breeding site for mosquitoes. The floor of the house is seen as an accident hazard because it is quite slippery. As for the water System they are connected to Baguio Water District with no water interruptions experienced. Drinking water is through a refilling station. Containers are not well covered and cleaned. Their toilet is flush type but unsanitary. they are not practicing waste segregation, they disposed garbage at their yards. In terms of the road, it is not cemented and also seen as accident hazards when raining.

d. Health Status of each family member Family Member Health Condition Laboratory and Diagnostic test undergone Mr. Father Stroke Diagnosed by his doctor that the left hemisphere of his brain was damaged Ms. Mother 3rd child 4th child 5th child 6th child High Blood amlodipine, acetylcholine Medications Status of treatment

and treatment the

e. Values and Beliefs According to Mr. Father, because of his condition stroke, the members of the family dont care about him, and was not assisted in his activities of daily living. him as a problem. And other member of the family sees

Whenever they encounter problems, they tend to In

disregard those and only make a solution when its getting worst.

addition, for them having a strong faith in God gives them the courage and strength to fight back every unpleasant condition that may take place in their lives.

2. Presentation of Family Nursing Problems a. Typology of Nursing Problems for the Family a.1. First Level assessment I. Potential for enhanced capability I. a. Spiritual well being: even though the family do not attend the mass regularly, they do still believe that God can help them overcome the condition and doesnt lose hope. II. Presence of Health Threats II.a. Presence of Breeding Sites of Vectors: they have water containers that are left uncovered, tires, cans, and other plastic bottles that can be a breeding sites for vectors of diseases. II.b. Poor environmental condition: the family just throw their garbage on their backyard, this compile of garbage can serve as perfect habitat for rats and maggots which later on can be vectors of diseases. III. Presence of Health Deficits III.a. Mr. Father suffers from stroke III.b. Ms. Mother is hypertensive a.2. Second Level assessment I. Failure to utilize community resources for health care due to lack of knowledge regarding the location and health services offered by the health center.

13 AREAS OF ASSESSMENT 1. Psychosocial status

Mr. X is concern about his condition stroke and he could not do anything to prevent it. Mr. X has had history of stroke and hypertension as serious illnesses at age of 53 and 54. He took prescription medicine for these illness and the condition sub side.
2. Mental status and Emotional status

Mr. X is oriented to time, place, and person. He can identify things or names being asked. He can recall sometimes recent and remote memories he experienced. And he is able to read and write and can speak in Tagalog, and Bisaya. He is responsive and answer to the questions being asked.
3. Environmental status

Mr. X is not has a good support of his family. Especially of his wife because his wife is always in her work every day and his children is go to the school that why he needs a good support of his family especially of his condition.
4. Sensory status

He is using sometimes his reading eye glasses due to his blurring vision of his left eye. His hearing ability is sometimes it is not normal when whispering voices. His sense of smell is normal and he can distinguish foul and fresh odor. His lips are dry and pale. His tongue is normal he can taste whatever food he eats. During his bathing Mr. X complains that he did not take a bath everyday because of his condition he did not do it in alone.

5. Motor status

Mr. X gait is slight staggering with weakness on his left body need support when standing up and walking. He is not comfortable with his condition. He finds walking, sitting, or changing positions difficult. Mr. X is perform things alone if he can but in his condition he needs the help or assistance of another person often.
6. Nutritional status

Mr. X is stated that he eat once a day.

7. Elimination status

Mr. X is usually defecates one to two times a day. On Date from morning to 2 pm he did not urinate. And the following days he urinates one time.
8. Fluid and electrolyte status Mr. X drinks 7 to 8 glasses of water every day. 9. Circulatory status

Mr. X pulse is ranging from 71 77 bpm taken from the radial pulse. His BP is 140/100 mmHg.
10.Respiratory status Mr. X respiration is ranging from 20 25 breaths per minute. Nasal flaring is noted and he also uses his accessory muscles sometimes when deep breathing. 11.Temperature status

Mr X. was not febrile with body temp. of 36.3 C.

12.Integumentary status

Mr. X skin is brown in color, wrinkled and dry. He complains of occasional itchiness on his left body and he has a slight edema. His both hand and feet nails are long and the nail beds are pale in color. His hair is thin, fine and gray. His conjunctiva is slightly pale, and sclera is white in color.
13.Comfort and Rest status

Mr. X reports not sleeping well during at night due to his condition. And he usually sleeps two to three hours a day. He sometimes watches television and listening radio. During rest hours he is not able to sleep because due of his condition and aging.

NARRATIVE PATHOPHYSIOLOGY Stroke is an acute focal neurologic deficit caused by a vascular disorder that injures brain tissue. The term brain attack has been promoted to highlight that time-dependent tissue damage occurs and to raise awareness of the need for rapid emergency treatment, similar to that with heart attack. Among the major risk factors for stroke are age, gender, race, heart disease, hypertension, high cholesterol levels, cigarette smoking, prior stroke, and diabetes mellitus. Other risk factors include sickle cell disease, polycythemia, blood dyscrasias, obesity and sedentary lifestyle. The incidence of stroke increases with age, with a 1% per year increased risk for persons 65 to 74 years of age; the incidence of stroke is approximately 19% greater in men than women; and African American have 60% greater risk of death and disability from stroke than do whites. (Essentials of Pathophysiology, 2nd edition by Lippincott Williams & Wilkins; p.840) The Pathophysiology of ischemic strokes is widely known. Ischemic strokes are the most common type of stroke contributing to over 80 percent of stroke cases. Ischemic strokes are caused by blood clots that subsequently deprive parts of the brain from blood flow and oxygen resulting in the death of brain cells and tissue and a stroke.

There are many factors that can affect the buildup of a blood clot resulting in a stroke. The chance of an ischemic stroke is largely affected by several main factors including: age, family history, systolic blood pressure, smoking, alcohol, myocardial disease, diabetes and atrial fibrillation. In terms of the Pathophysiology of ischemic stroke age and systolic blood pressure are the most influential factors in ischemic strokes. Hemorrhagic strokes are the second most common type of stroke and are caused due to a burst blood vessel either within the brain itself or just outside of it. There are two main types of hemorrhagic strokes each with different Pathophysiology. One type of hemorrhagic stroke is an intracranial hemorrhage. This type occurs within the brain or in the area surrounding the brain. The bleeding in an intracranial hemorrhage occurs directly into the brain and subsequently the surrounding brain can be damaged by the increase pressure imposed by the mass effect of the burst blood vessel. The main causes of hemorrhagic strokes include: systolic blood pressure, age and anticoagulation. High blood pressure is the main cause of both hemorrhagic and ischemic strokes. Some of the less common causes of hemorrhagic strokes include: cranial trauma, tumors, hypertensive hemorrhages and vasculitides all of which can lead to a buildup of blood around the brain causing a hemorrhagic stroke.

b. Prioritization of Family Health Problems 1. STROKE

Stroke Nature of the Problem Modifiability

Formula 3/3 x 1 2/2 x 2

Actual Score 3 2

Computation 3/3 x 1 = 1 2/2 x 2 = 2

Justification It is a health deficit Resources and interventions to solve the problem are available in the family but they do not utilize these resources. The condition is already present and it is difficult to prevent The family recognizes it is a problem not needing immediate attention.

Preventive

3/3 x 1

3/3 x 1 = 1

Salience

2/2 x 1

1/2 x 1 = 0.5

Total:

= 4.5

2. Presence of Breeding Sites of Vectors of Diseases

Presence of Breeding Sites of Vectors of Diseases

Nature of the Problem Modifiability

Formula

Actual Score

Computation

Justification

3/3 x 1 2/2 x 2

2 2

2/3 x 1 = 0.66 2/2 x 2 = 2

Preventive

3/3 x 1

2/3 x 1 = 0.66

Salience

2/2 x 1

1/2 x 1 = 0.5

It is a health threat to the family Resources are available and interventions are possible Communicable diseases transferred by insects and rodents can be prevented The family does not give immediate attention to the presence of the problem

Total:

= 3.82

3. Poor environmental condition related to unsanitary waste disposal

Poor environmental condition related to unsanitary waste disposal

Nature of the Problem Modifiability

Formula

Actual Score

Computation

Justification

3/3 x 1 2/2 x 2

1 2

1/3 x 1 = 0.33 2/2 x 2 = 2

Preventive

3/3 x 1

3/3 x 1 = 1

Salience

2/2 x 1

0/2 x 1 = 0

It serves as a foreseeable crisis to the family. Resources are available and interventions are possible. The problem can be prevented if the family will start to deal with the problem. The family do not perceive the problem as needing an immediate attention.

Total:

3.33

c. Family Nursing Care Plan 1. STROKE Health Problem Family Nursing Problem Goal of care Objectives of Nursing care Intervention Method of FamilyNurse Contact Resources Required

stroke

Inability < Demonstrate After 1 hour < assess to make techniques/behaviors of nursing abilities decision that enable interventions for with resumption of the family performing respect to activities will be able ADLs taking to: < maintain a appropriate a. supportive, heath < maintain skin participate firm action due integrity in problem attitude to: solving of < suggest a. failure faators client to interfering change compretends with position at the nature integration frequently magnitude of atleast of the therapeutic every 2 problem regimen hours. b. lack of < observe knowledge affected side for

Time and effort of the students and family Home visit < expenses for the transportation of the student

color, edema, or other signs of compromised circulation < encourage client to assist with movement and exercises using unaffected extremity to support/move weaker side.

2. Presence of Breeding Sites of Vectors of Diseases

Health Problem Family Nursing Problem Goal of care Objectives of care Nursing Intervention Method of Family -Nurse Contac t Resources Required

Presence of Breeding Sites of Vectors of Diseases

Inability to provide a home environment conducive to health maintenance and personal development due to: a. Ignorance of the importance of hygiene and sanitation. b. Lack of knowledge of regarding preventive measures.

After nursing intervention the family will be able to eradicate the presence of these unwanted sites of vectors causing diseases and therefore will maintain a home environment conducive to health.

After nursing interventio n the family will: a. be aware and be more knowledgeab le about the importance of proper sanitation especially at home; b. be able to eliminate the presence of these breeding sites of vectors c.

1. Discuss the importance and purposes of proper sanitation 2. Cite the causes and effects of the prevalence of these unwanted pests around the home. 3. Suggest alternative s/methods that would eliminate the breeding sites of vectors.

Home visit

> Material Resources: Visual Aids, materials and low-cost supplies needed for demonstratio ns > Time and effort on the part of the nurse and family.

recognize the cause of breeding sites such as to prevent the occurrence of diseases

4. Explore with the family the ways of improving home sanitation considering its limited resources: a. emphasize to the family the proper storage of food that may attract vectors b. instruct all family members to prevent accumulatio n of stagnant water around their home since this is a good breeding place for insects.

3. Poor environmental condition related to unsanitary waste disposal

Health Problem Family Nursing Problem Goal of care Objectives of care Nursing Intervention Method of Family -Nurse Contac t Resources Required

Poor environm ental conditio n related to unsanita ry waste disposal

Inability to provide a home environment conducive to health maintenance and personal development due to: a. Lack of enthusiasm in cleaning up. b. Nonobservance of good hygiene. c. Lack of knowledge on proper waste disposal.

Within three days out of the total number of days of our exposure, the family would understand the importance of proper waste management. Demonstrate or verbalize ways on how to dispose garbage or waste

After nursing interventio ns the family will be able to: a. Comprehend the possible after effects of rodents as well as insects to their health. b. Select the appropriate methods of proper waste disposal that will be easy to

1.Establish Home rapport visit with the family to gain as well as cooperation . 2. Discuss to them the possible effects ofpoor sanitation to health. C.Stress the importance of having a clean environment and the benefits out of doing it.

>Time and efforts of the family and the students nurse. >Money for transportati on

implement and attainable according to availabilit y of resources.

CHAPTER IV: IMPLEMENTATION

University of baguio section NMH group 3 of BSN III have been working together to implement community health nursing to Purok 3, Camp 7. We go to the area assigned to us and do home visits, by doing so, we collected data and information about the people, the families, and lastly the community to pinpoint presence of health deficits, wellness condition, health threats, and future risks of Purok 3, Camp 7. We do our ocular survey of the barangay and come up with our spot map. We done some nursing interventions to some members of the families in the barangay who needs nursing interventions. we are able to establish and promote to the people of the community about healthy lifestyle, signs and symptoms of a disease, prevention and management of diseases, the importance

of immunization, and inform the about the advantage of having a regular check up at their health center.

CHAPTER V: EVALUATION The group NMH 3 was able to do ocular survey and make a spot map in the area assigned to us specifically Purok 3, Camp 7 Baguio city. The group was also able to conduct surveys in the barangay in order to gather information regarding health conditions of the families living on the barangay. Out of the 60 families, 59 households and 250

individuals that we are able to survey in the barangay, we were

able to find three case of diseases that needs some medical attentions which mainly are stroke, hypertension, and diabetes mellitus, and have chosen the family with stroke to be in the groups case study, which also has the highest level of priority based from the four level of prioritization. The group was able to come up with appropriate nursing interventions to the family we have chosen which includes health teachings such as disease process, prevention, management, proper garbage disposal and preventive measures on vector control. The families were able to comply with the health teachings rendered by the group; they have increased awareness regarding the different health programs and services offered by the Department of health thru the Barangay Health Center.

CHAPTER VI: CONCLUSION AND RECOMMENDATIONS

Having a community duty serves as a good training for us student nurses, in rendering primary health care for our clients. It develops our skills, enhance our knowledge and improve our attitudes in dealing about the real situation which happens in a community. As a health care provider we adjust and adopt the different cultures and beliefs. We had encountered. We need to respect whatever culture our clients have. We need to understand individual differences especially when dealing with health related issues. We have also noticed that not all of them are aware on the programs and health services that are being provided by the health center. During this community exposure, we have to broaden our minds about the importance of information dissemination about health management. Through home visits, we realized that it is very essential to offer the services in the community to point out the importance of primary health care and utilization of resources in the community. We can say that our community exposure was a success. We have been able to know and realized the fun but challenging life of the nursing profession.

We, the nursing students of University of Baguio section NMH group 3, were exposed to Purok 3, Camp 7 for our Community Health Nursing experience. Through our experiences and observations in the community we were assigned to, we came up with the following recommendations.

To the Barangay officials: To conduct regular meetings focusing on social welfare and programs of the community. To protect the residents from crimes and diseases by implementing safety programs. To promote environmental sanitation by administering programs that will emphasized on proper dispose garbage and waste materials.

To the Health Center: To conduct more seminars and trainings responding to the identified health needs of the community particularly highlighting the importance of hand washing and proper hygiene to minimize the spread of cough and colds. To conduct more seminars and trainings on the importance of healthy life style. To conduct more seminars and trainings on herbal medicine preparation.

To the Students: To be effective health care provider by being a good model in promoting health status of the people in the community. To continue rendering service to the community with humility and dedication.

CHAPTER VII: LEARNING INSIGHTS

These past few days in exposure to the community, we were able to learn a lot even though it was short in time. We learned to establish a good and friendly relationship to other people by interviewing and interacting to the needs which we could render to them. Patience is a must when interviewing because in handling some situations like knocking at some houses they didnt attempt to open doors maybe because they were busy with their personal matters. Because of this we also learned to respect, Respect for their decisions if they are not available at the moment of interview. We learned to appreciate the importance of proper communication skills in application to Community Health Nursing. With the teamwork of the group and with enough courage and determination we have fulfilled our task in the community. Another important thing we have learned is to cherish the moments that we experienced during and after the community, because this experience can greatly influence us in becoming a good and ideal nurse someday.

SUMMARY OF ACTIVITIES Monday ( August 1, 2011) 7:00 7:30 assembly time at front of Danes 7:30 8:00 jeepney ride going to the Health center of Loakan 8:00 9:00 courtesy call 9:00 10:30 ocular survey of the areas and spot map 10:30 11:00 a walk going to Barangay Camp 7 11:00 12:00 courtesy call in the Barangay Hall 12:00 1:00 the groups had their lunch break 1:00 1:30 a walk going to the areas assigned to our group 1:30 3:30 ocular survey and spot mapping of the area assigned to us 3:30 4:00 group meeting with our clinical instructor Tuesday (August 2, 2011) 7:00 7:30 assembly time at front of KFC lower session 7:30 8:00 jeepney ride going to Purok 3, Camp 7 8:00 12:00 home visits 12:00 1:00 Lunch Break 1:00 3:30 home visits

3:30 4:00 - group meeting with our clinical instructor Wednesday (August 3, 2011) 8:00 10:00 - group meeting for collation of data 10:00 12:00 - group meeting with our clinical instructor 12:00 1:00 lunch break 1:00 4:00 Return Demonstration on Bag technique Monday (August 8, 2011) 7:00 7:30 assembly time at front of KFC lower session 7:30 8:00 jeepney ride going to Purok 3, Camp 7 8:00 9:00 - group meeting with our clinical instructor 9:00 11:30 assessment of our case and follow up of unsurveyed households. 11:30 12:30 going from Purok 3, Camp 7 to University of Baguio 12:30 1:30 Lunch Break 1:30 3:30 started working on our book 3:30 4:00 - group meeting with our clinical instructor Tuesday (August 9, 2011) 8:00 11:00 working on our book 11:00 12:00 Lunch Break

12:00 3:30 working on our book 3:30 4:00 - group meeting with our clinical instructor Wednesday (August 10, 2011) 8:00 10:00 started preparing for the Case presentation 10:00 12:00 Case presentation 12:00 1:00 Lunch Break 1:00 4:00 Case presentation 4:00 5:00 Rotational Exam

DOCUMENTATION