Family Case Analysis

DIVINE WORD COLLEGE OF LAOAG SCHOOL OF NURSING

Laoag City

The FAMILY that ties the bond: A FAMILY CASE ANALYSIS

An Assessment of Dimagiba Family of Sitio Nagtataluan Dilanis Pasuquin, Ilocos

Norte

In partial fulfillment of the course requirementsIn NCM 107

Presented by:KATRINA ANNA ALIPIO

MARIE JANE CAGATPRISCILLA MARIE CRUZ

JOHN PAUL EDRAJENNIFER FLORENTINO

SHELLA PASCUAMICHELLE ROBLESMILANO RIKO RUIZ

CLARIE ANNE TALON(BSN IV, GROUP 8)

Presented to:PROF. MARY C. BALINTONAPROF. IMELDA R. CARLOS

PROF. SANCHO A. GARCIA JR.PROF. RIZAL ANGELO GRANDE

DR. GLORIA A. SANCHEZ(MEMBERS OF THE PANEL)

August 19, 2011I. INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

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A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

HOUSEHOLD MEMBERS

RELATIONSHIP TO HEAD

AGE CIVIL STATUS

PLACE OF RESIDENCE

Inocencio Dimagiba Family head 43 years old Married Dilanis Pasuquin, I.N

Inocensia Dimagiba Wife 41 years old Married Dilanis Pasuquin, I.N

Juanita Dimagiba Daughter 18 years old Single Dilanis Pasuquin, I.N

Dionisia Dimagiba Daughter 16 years old Single Dilanis Pasuquin, I.N

Kaimito Dimagiba Son 10 years old Single Dilanis Pasuquin, I.N

Juanito Dimagiba Grandson 10 months. Single Dilanis Pasuquin, I.N

Dimagiba family of 6 members resides in the rural peaceful community of Sitio

Nagtataluan Dilanis Pasuquin, Ilocos Norte. They’ve been residing in the said place for

the past eighteen years.

This family is considered as an extended type of family as to structure, patrilocal

as to place of residence, patrilineal as to descent or lineage and egalitarian as to

exercise of power/authority.

Inocencio, 43 y/o heads the family. He is married to Inocencia, 41 y/o. Their

wedlock was blessed with three children, two girls and one boy.

As the breadwinner of the family, Inocencio works as a tenant farmer. He is

sometimes accompanied by his wife and children to work in the field and earn for their

living. Inocencia on the other hand, monitors the welfare of her children and manages

household chores.

Juanita, 18 y/o is the first child of the family. She got pregnant when she was 17

y/o and gave birth to a baby boy named Juanito who is now 10 months old. Juanita’s

boyfriend left her and went back to his hometown in Pangasinan and never returned not

even once for almost a year as communication between the two also becomes

infrequent. Currently, Juanita and her child are living with the other members of the

family making it an extended one for Juanito requires support from his grandparents in

the absence of his biological father.

The second child of the family is Dionisia, 16 y/o. Like her sister, she is already

dropped in school. In which case, Dionisia who is left nothing to focus on helps her

mother in performing household tasks and sometimes goes with her parents in the field

to contribute manpower.

Kaimito, 10 y/o is the youngest of the children of the family. He is currently a 5 th

grader at Dilanis Elementary School. His usual task at home includes fetching water in

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the deep well that is found several meters away from their house and watches his

nephew when her mother-sister is away from home to help in the field.

The family can be described as patrilocal according to place of residence. They

founded a house near the head’s family house.

As to descent or lineage, the family is categorized as patrilineal and egalitarian

according to power/authority. They both share decisions concerning things about the

family like financial matters (allocation of family budget). However, when it comes to

health care matters Inocencia usually is the one who makes decisions like for instance

what should be done to a sick member.

When asked about how is the communication in the family going on, Inocencio

replied by saying, “Mayat met, uray no adda haan nga pinagkikinaawatan no dadduma

ket maresresolbar met la nga dagos”. (It’s fine, even if there are problems and conflicts

occurring sometimes, we are still able to resolve it in the soonest time). At present,

there is no observable conflict in the family as they display welcoming and wholesome

attitude to each other and as verbalized, “awan met ti agdama nga di mi

pinagkikinaawatan”.(There is no miscommunication between us).

B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

b.1 Income and Expenses

A portion of the family’s income is sourced from the rice field of which Inocencio

has been a tenant for almost 10 years now. He estimated the land area to be half a

hectare that could generate a ballpark figure of 25 sacks of palay/cropping a year. Due

to scarce supply of water in the absence of water irrigation, the family could only plant

rice in the first cropping, usually in the rainy season. Of the 25 sacks of palay, three of

which is given to the owner of the land. To meet the necessary needs and other

demands of the family, they sell 5-8 sacks of palay. In rough calculation of Inocensio,

the 5-8 sacks of palay could give them an additional income of P 4,000.00/year (P

333.33/month). Another source of income of the family is the profit generated by selling

vegetables in the market. Vegetables like squash, sitaw, eggplant, native tomatoes,

daludal, and badbadyuk and fruits like unripe mangoes and cucumber are being sold in

the market every Sundays. “Kadagijay nga bulan nga pinaglaklakok iti natnateng ket

makalako nak met s iti balor P 6,000.00”, as verbalized by Inocencia. For the purpose of

showing the family income in a month, the sum of P 6,000.00 a year (as generated by

selling vegetables and fruits) could yield an income of P 500.00 a month.

The family also raises poultry and livestock. They currently own 3 months old

native pig, 3 grown native chickens and 2 ducks. These animals are also a source of the

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family income. In a year they could usually sell 2 native pigs at around P 8,000.00 and 5

native chickens roughly calculated to generate P 1,300.00. These figures if combined

could give the family earnings of P 9,300.00 a year (P 775.00/month).

When opportunity comes the family grabs it, “no adda oppurtunidad nga agubra

ket agubra kami”, this was verbalized by Inocencio. Four of the family members

(Inocencio, Inocencia, Juanita and Dionisia) go to the field under the heat of the sun to

work and be paid. For a period of ten days, 5am- 5pm with lunch and snack break

provided free and siesta, the members of the family works as planters of garlic and they

are being paid an amount of P 200.00 each a day. Cumulatively, the family gains an

additional income of P 8,000.00 a year (P 666.66/month) through manpower services.

The accumulated family income in a year as stipulated above is P 27,300.00

which similarly means the family has a monthly income of P 2,275.00.

According to NEDA, each individual should at least have P 2,768.60 when the

total monthly income of the family is divided among the total family members, thus

family Dimagiba with 6 members and with a total monthly income of P 2,275.00 can be

considered poor and is unable to sustain all the needs of each family member.

FAMILY MONTHLY INCOME

SOURCE OF INCOME AMOUNT

RICE FIELD P 333.33

VEGETABLE AND FRUIT P 500.00

POULTRY AND LIVESTOCK RAISING P 775.00

WAGE IN GARLIC PLANTING P 666.66

TOTAL AMOUNT P 2, 275.00

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50%

8%

32%

2%8%

Illustrated Monthly Expenses of the Family

FOOD EDUCATION

MISCELLANEOUS ELECTRICITY

TRANSPORTATION

The family monthly income of P 2,275.00 is then broken down to meet their basic

needs. Food is the most important need of a person to survive. The family allots 50

percent of the total income which is equivalent to P 1,137.50. Food expenses include

the following: noodles, canned goods, meats, fish, vegetables and food seasonings.

Eight percent of the income is apportioned to education expenses like miscellaneous

fees (e.g Red Cross ticket, Boy Scout Membership etc.), purchase of school supplies

and daily allowance. The family earmarks approximately 2 % (P 45.50) for electric bills.

Miscellaneous expenses comprise 32% (P 728.00) of the family income. Of these

expenses includes: toiletries (e.g. soap, shampoo, toothpaste, deodorants, cosmetics,

etcetera), clothes, cellphone load, medicines and other family needs. Lastly the

remaining 8% (P 182.00) is rationed for transportation expenses.

As elicit by the group, the income of the family is not adequate enough for their

needs. “Han nga uman anay deta masapsapulan mi, isu nga agin inot kam lattan”,

uttered by Inocencio. (Our earning is not enough to meet our needs). “No dadduma ket

umutang kam pay kadagita karuban tapnu laeng ada masida”, Inocencio disclosed. (We

sometimes borrow an amount to our neighbors just to have something on our table).

“Isu nga pinagsardeng mi payla ta dua nga anak mi iti pinagbasa da ta han nga

agkasya toy kitkitaen mi”, added by Inocencio. (That’s why we decided to end the

schooling of our two daughters because we lack the financial means).

Note: The following are just rough calculations as based from the information provided

by the interviewees.

b.2 Educational Attainment, Ethnic Background, Religious Affiliation

Name of the Family Member Educational Attainment Ethnicity Religious Affiliation

Inocencio Dimagiba Elementary Level Ilocano Roman Catholic

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50%

8%

32%

2%8%

Illustrated Monthly Expenses of the Family

FOOD EDUCATION

MISCELLANEOUS ELECTRICITY

TRANSPORTATION

Inocencia Dimagiba Elementary Level Tagalog Roman Catholic

Juanita Dimagiba High school Level Ilocano Roman Catholic

Dionisia Dimagiba High school Level Ilocano Roman Catholic

Kaimito Dimagiba Elementary Level Ilocano Roman Catholic

Juanito Dimagiba n/a Ilocano Roman Catholic

The family is affiliated to Roman Catholic Church (RCC) and all members except

Inocencia are of Ilocano ethnic background. Inocencio claimed that because of poverty

he wasn’t able to reach even a high school level. Inocencia is of the same educational

attainment like her husband. Juanita didn’t pursue her secondary education because

she got pregnant when she was in 4th year. Her parents then decided not to send her in

school anymore. Dionisia stopped schooling when she was in 3rd year high school. Her

parents can no longer pay for her liabilities in school like tuition fees, books and any

other added fees and more importantly her daily allowance in going to school. Kaimito is

currently on his fifth grade in elementary. He walks almost two kilometers a day to reach

the school and goes home every lunch time. “Narigat iti agpabasa ita nga panpanawen

lalo ket marigrigat kam met lang”, (It is hard for us to send our kids in school especially

that we are just poor) says Inocencio.

When family experiences financial crisis they borrow an amount to their

significant others who also leaves in the same community. Inocencio described the

relationship between his family and other families dwelling in the community as mutual

for they learn the value of sharing. “Dakdakami metlang ketdi ti agkakaruba, sino kuma

ngarud pay iti agtitinulong no di da kami metlang basta la ketdi addaan kami”, (Who

else will help other than our neighbors so in turn we help them also as long as our

resources permits) Inocencio puts it.

Inocencio is a member of the Farmers Association in their barangay. This

association is aimed at building unity and cooperation among farmers of different

families. Inocencia actively participates in the endeavors of the community where her

family belongs. One of these activities of the barangay is the so-called Oplan Dalus

where Inocencia and her children go to the barangay roads to participate in cleaning.

She (Inocencia) also participates in the activities of the school where her son is studying

like Brigada Eskwela, feeding program and the like. Inocencia is also a member of the

Women’s Organization that partakes during the town festival and other related activities.

C. HOME AND ENVIRONMENT

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c.1 House Structure

The family house is made up mostly of light materials like lumber, bamboo, ply

wood (sides, foundation and base of the roof) and galvanized iron and ‘pan-aw’ for the

roofing. The house is composed of a bedroom and a dining room. Most of the things of

the family are stocked in the bedroom and in the dining room making the total surface

area of the house reduced. In the absence of cabinets they put their clothes in large

boxes. The structure of the house is enliken to a kubo-kubo. The base of the bedroom is

made up of bamboo sticks and is slightly elevated leaving a hole below it without a trap

allowing entry of mosquitoes, rats, other types of vermin and even snakes. The group

spotted only one small window that measure 1x1 m which is located in the bedroom.

There is as well one door. Adjacent to the bedroom is the dining room where different

cooking materials could be found.

Family Dimagiba legitimately owns the small are of land where their house has

been built as Inocencio inherited it from his late lamented parents.

c.2 Sleeping Arrangement

The children sleep together in the bedroom while the couple sleeps in the small

bed located in the dining area. The family makes use of woven abaca to cover the area

for sleeping. They share pillows and blankets. Juanito, son of Juanita sleeps in a

‘duyan’ every night. He is only the one who uses mosquito net for protection against

mosquito bites. The family usually sleeps at around 9:00-10:00 at night time.

c.3 Presence of Breeding Sites of Vectors of Diseases

The house is a good breeding or resting site for vectors of diseases like

mosquitoes, cockroaches, flies, rodents and other types of vermin because of the pile of

things stocked inside the house. Layers of boxes can be a good place for rodents and

cockroaches to thrive and multiply. In fact, some members of the group even saw

couple of rats and some cockroaches rooming around during the first home visit. The

stocked water in galloons and uncovered pale in the kitchen area can be a convenient

breeding place for mosquitoes. The water being used for cleaning eating utensils flows

directly to a small canal; however the water is left stagnated which gives another

breeding place for mosquitoes. In the backyard, the group observed that there are tall

uncut grasses. Mosquitoes again are given opportunity to live in there because the area

is moist especially in the rainy season. Additionally, tall uncut grasses could also be a

place for snakes to inhabit. As aforementioned, the family is placed at great risk for

different diseases.

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c.4 Presence of Accident Hazards

Through numerous days of home visits the group has identified many accident

hazards. Top of the list is the observable open electrical wiring found in the roof of the

house. This could promote faulty electrical wiring burns. The group also noted the things

stocked just below the roof in the bedroom which is only supported by woods. In case of

environmental calamities like earthquake, the whole thing could collapse and could

cause fatal injury to the family members. ‘Pan-aw’, a grass that has long leaves, is

utilized to cover almost half of the roof of the house. The family uses clay stove and

burning pieces of woods for cooking. With this scenario, the likelihood of burning the

house is likely. Added to the accidental hazards is the looseness of the foundation of

the house. The woods and galvanized iron that makes up the sides of the house are not

properly nailed. These could disintegrate and crumple which could cause physical

injuries to the family members. The group also observed the sharp edged of the rusting

galvanized iron which could lead to physical harm. The roofing of the kitchen is also low.

One member of the group even accidentally bumped his head that caused him minor

head injury. Presence of scattered rusting nails is also seen during the observation. In

the vicinity is a large aged ‘sargwelas’ tree that rests on the roof of the house. When this

tree would breakdown, it could cause physical injuries to the family members.

c.5 Food Storage and Cooking Facilities

The family prepares their food using a clay stove and pieces of wood. The eating

utensils like cups, glass, plates, forks, spoons and ‘sandok’ are left in an open

container. They store their rice grains in a covered biscuit can. The groceries are placed

in a plastic bag and are left hanging in the kitchen area. Their leftovers are covered with

a plate, and sometimes stored it in a casserole and hang above the cooking area or not,

being fed to their pig and chickens.

c.6 Water Supply

The water supply of the family is a deep well which is located almost 500 meters

away from their house. It is being shared by many families who do not own a water

supply facility. As stated by Inocensio, the water facility is being treated by the

authorities concerned to ensure the potability of the water supply. The family fetches

water in the deep well and uses it for drinking, cooking, washing utensils and clothes,

flushing of the toilet bowl and bathing. The water is not being boiled by the family before

drinking for they believe that the water supply is already clean and safe enough for

drinking.

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The family stores piles of water so that they will not be fetching water every now

and then considering the distance of the deep well to their house.

c.7 Toilet Facility

The water-sealed latrine is the toilet facility of the family. It is a pit privy type of

toilet wherein water sealed toilet bowl is placed instead of the simple platform hole.

They share this said facility with another family. It is being surrounded by a trash bag to

ensure privacy. The bowl is left uncovered and there are marks of previous defecation

which may be due to scanty mechanical flushing of the waste. Upon observation, the

toilet facility is odorous and flies are seen all over the area.

c.8 Garbage Disposal, Drainage System

In the backyard of the house is a small garbage pit. They put all their waste there

and burned in the open air once it is already dry. With this, the garbage disposal of the

family can be said to be open burning. The family has an open type of drainage system

which is originally designed to flow directly in the field but due to obstruction in the flow

of water the drainage system is left stagnant.

c.9 Kind of Neighborhood

The family lives in a far flung community. It is approximately 25 minutes ride from

the town proper of the Municipality of Pasuquin. Numerous families could be found here

and houses are diffused. There are some troubles sometimes in the community but

never did the family involved with any of those as claimed.

c.10 Social and Health Facilities

There are several social and health facilities in the community where the family

resides. Of these are the following: an elementary school and a day care center where

most of the children of the community are sent to study; a barangay hall where

assemblies and meetings are being convened; a basketball court adjoined with the

barangay hall where festivities, programs, barangay sports competition, masses are

conducted. There is no barangay health center found in the community. It is however,

with the assigned BHW’s, BNS’s and the lone midwife that sectors the community that

they gain access to some free health care services. The BHW’s monitors the weight of

the young children and together with the Midwife determines who is underweight. They

also help jointly with the BNS in the feeding programs sponsored by different agencies.

The pregnant women in the community are being monitored by the midwife. They are

being administered with necessary vaccinations. The midwife also administers

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immunizations to the young children of the community. The family sometimes consults

the RHU Pasuquin for more serious health conditions where they are given free

checkups and medications.

c.11 Communication and Transportation Facilities

The use of cellular phones serves as the main communication facility of the

family. Juanita has one cellular phone which is being used to communicate to their

relatives and in cases of emergency situations. The family does not own a

transportation facility. They usually ride on a tricycle or jeepney in going to the town

proper.

II. HEALTH STATUS OF FAMILY MEMBERS

A. Inocensio Dimagiba43 years oldCEPHALOCAUDAL PHYSICAL ASSESSMENT

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GENERAL SURVEY

During the assessment, Inocencio was noticed to be unkempt in a light brown

long-sleeved shirt, navy blue pants and a pair of rubber boots. He has a medium body

build, exhibits relaxed and erect posture and coordinated movement. He is conversant,

coherent and oriented to person, place and time. He also exhibits thought association,

moderate pace and has a sense of reality. He has no difficulty recalling past and

present events. He looked exhausted. He stands 164 cm and weighs 65 kg.

VITAL SIGNS FINDINGS

Blood Pressure 130/90 mmHg

Respiratory Rate 25 counts per minute

Pulse Rate (Radial) 75 beats per minute

Body Temperature (Axilla) 37.5 ○C

SKIN

Light brown skin complexion Hypopigmentation spotted in the neck, arms, abdomen and back Abrasions present in both lower arm Intact sensation to touch, pain and temperature

HEAD

Skull & Face

No bruises, nodules and masses noted Symmetrical facial movements and facial features

Hair

No infection/infestation.

Nails

untrimmed and dirty intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec)

Eyes structures and Visual Acuity no discharge bilateral blinking white sclera pale palpebral conjunctiva positive blinking reflex on corneal sensitivity test PERRLA Coordinated movements Able to read newsprint at 14 inches distance

Ears and Hearing

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Auricles aligned with the outer canthus of the eyes Minimal amount of cerumen observed Good gross hearing acuity (normal tone voice is audible) Able to hear ticking of watch in both ears

Nose and Facial Sinuses

Symmetrical Clear discharge Nasal septum intact and in midline Facial sinuses are not tender

Mouth

Incomplete set of teeth (30 set) Yellowish colored teeth with some dental carries Tongue moves freely Intact gag reflex With moderate breath odor

Neck

Neck muscles equal in size and strength Coordinated, smooth movements with moderate discomfort

Thorax and lungs

Full and symmetric chest expansion Full symmetric anterior chest respiratory excursion No abnormal breath sounds heard over the whole lung fields. Bilateral symmetry of vocal fremitus

Abdomen

Uniform and unblemished skin Audible vowel sounds

Upper Extremities

firm with coordinated movements able to flex and extend without difficulty can resist against pressure

Lower Extremities

able to flex and extend without difficulty or discomfort

can resist against pressure

NUTRITIONAL ASSESSMENT

Height: 164 cmWeight: 65 kilograms

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Asia-Pacific Obesity Guidelines

Underweight < 18.5

Healthy Weight 18.6-22.9

Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0

Formula in computing for BMI

BMI= Weight in Kilograms (Height in meters) 2

= 65 kg (1.64 m) 2

= 65 kg. 2.69

= 24.2 Inocencio likes to eat fatty and salty foods. He mentioned that these foods often

give him the appetite to eat. His diet consists of vegetables like squash, sitaw, daludal,

badbadyuk, eggplant and the like. He eats at least 2 cups of rice every meal time.

Inocencio admitted that he consumes large amount of coffee a day. He drinks 2 cups of

coffee in the morning before going to work, another 2 cups for pm snack and 1 cup at

night time.

Past and Present Health History

Incocensio experienced some common illnesses in the past. In his childhood

years he experienced mumps, measles and chicken pox. These illnesses were treated

non-pharmacologically and use of traditional means. ‘Akot-akot’ (beehive) was utilized

to treat mumps. As believed by old folks, the akot-akot mixed with water and then

applied to the area will bring relief to pain. As a management to measles, his mother

told him to avoid eating salty and fatty foods as these would aggravate his condition.

Eating egg and shrimp was the advice of his late mother to treat chicken pox as these

foods would hasten his recovery from the said condition.

Inocencio can no longer recall if he received all childhood immunizations,

however a mark was seen in his right upper arm.

Way back in the year 2002 when Inocencio was then 35 years old, he was

rushed to GRBASMH and stayed there for 10 days due to a kidney problem.

Unfortunately, he could no longer bring to memory the diagnosis of the doctor that

attended him, the medications that were prescribed and other treatments done,

however he mentioned that he had kidney stones. He didn’t undergo an operation

because according to the doctor the kidney stones can still be eliminated through

medication therapy. The signs and symptoms he experienced include flank pain, pain

upon urination and blood in his urine. After 15 days of hospitalization he was discharged

with medications to take and from then on he longer presents any of the signs and

symptoms stated above.

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Just two months ago while Inocencio was clearing the field of tall grasses he

accidentally wounded his right arm with a sickle. The wound was cleaned with tap water

and protected with a clean piece of cloth before going to RHU Pasuquin. The wound

was cleaned using a solution he could not name. At this moment the wound is already

healed.

Inocensio also experienced headache, fever and cough and colds. These

conditions were treated with periods of long rest and sometimes medications like

Biogesic and Paracetamol both at 500 mg. doses taken until the condition subsides.

To date of the first contact Inocencio has cough and colds. He manages this

health condition by increasing his intake of water. He takes no medication to treat cough

and colds.

ACTIVITY OF DAILY LIVING

Inoncecio wakes up at 5:00 am in preparation for going to the field to work.

Before doing so, he drinks two cups of coffee. He usually works in the field from 5:30

am to 6 pm. Inocencio goes home at around 8 o’clock for his breakfast and then goes

back to the field and continue his work after he has taken a bath. At 11:00 he takes his

lunch and then goes to sleep until 2:00 pm. After the short break he goes to work again

and stops when the sun sets. He eats his dinner together other family members at 7:00

and watches television after. Inocensio usually falls asleep early in the night at around

9:00 pm.

B. Inocencia Dimagiba41 years oldCEPHALOCAUDAL PHYSICAL ASSESSMENT

GENERAL SURVEY

Upon initial visit, Inocencia was neat looking in dark yellow colored floral

sleeveless, maong short and a pair of sleeper. She is moderately thin with relaxed, Page | 14

erect posture and coordinated movement. She has no foul breath odor, however, she

was observed with minimal body odor. There is no obvious sign of illness. She is

cooperative and appropriately responses to situation. Inocencia presents a moderate

pace, thought association and a sense of reality.

SKIN

Light brown skin complexion Intact sensation to touch, pain and temperature Dry Normal skin turgor

Nails


HEAD

Skull, Hair, and Face

normocephalic with frontal, parietal and occipital prominences No bruises, nodules and masses noted No area of loss of hair and no infection/infestation Symmetrical facial movements and facial features

.

Eyes structures and Visual Acuity no discharge observed bilateral blinking lids close symmetrically white sclera pale palpebral conjunctiva pupils in 3 mm diameter illuminated pupils constricts non illuminated pupil constrict positive blinking reflex on corneal sensitivity test PERRLA Coordinated movements in 6 ocular movement Able to read newsprint at 14 inches distance

Ears and Hearing

Auricles aligned with the outer canthus of the eyes Minimal amount of cerumen observed

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Good gross hearing acuity (normal tone voice is audible) Able to hear ticking of watch in both ears


Symmetrical Nasal septum intact and in midline Facial sinuses are not tender

Mouth

Yellowish colored teeth with some dental carries Tongue moves freely Intact gag reflex With moderate breath odor

Neck

Neck muscles equal in size and strength Coordinated, smooth movements without discomfort

Thorax and lungs


Abdomen


Upper Extremities


Lower Extremities



PAST AND PRESENT HEALTH HISTORY

Inocencia has been hospitalized once at GRBASM in the year 2004 due to a liver

problem. She can no longer recall the exact diagnosis of the doctor, the medication she

took and other treatment done to her. She told us that she got the liver problem from

consuming too much alcohol and cigarettes. She could still recall the days wherein she

used to consume a pack of cigar a day. This situation she’d been through that

endangered her life convinced her not to smoke cigarette anymore.

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Inocencia experienced some common childhood diseases like measles, mumps

and chicken pox. These were all treated non-pharmacologically as her mother used

traditional means and cultural beliefs.

Whenever Inocencia experiences headache, she self-medicate with Biogesic 500

mg once for the relief of pain but when there is no money to buy medicine she just treat

it with periods of rest. Cough and colds is managed using OTC drug Carboceistein 500

mg every after meal or when in financial crisis she utilizes yerba buena decoction.

At present, Inocencia has no concerns regarding her health.


Height: 163 cm

Weight: 58 kilograms



= 58 kg (1.63 m) 2

= 58 kg. 2.67

= 21.7

ACTIVITIES OF DAILY LIVING

Inocencia wakes up at 5:00 am, listens over the radio, drinks a cup of coffee and

prepares breakfast. Early in the morning she cleans the house, the back and front yard.

She sometimes helps her husband in the field. She takes her breakfast usually at 6:00

am with her children. Inocencia goes to the nearby houses to have a chat. At 10:30 she

prepares for lunch and then dinner at 5:00. Most of the time, Inocencia is out of the

house to go to the mountains and harvest “badbadyuk” or not clean the small area of

their vegetable plantation. During Sundays, she goes to the market to sell vegetables

fruits and sometimes chicke

C. JUANITA DIMAGIBA18 years oldCEPHALOCAUDAL PHYSICAL ASSESSMENT

GENERAL SURVEY

On initial contact, Juanita was fairly groomed in blue shirt and pantaloons. She

has normal body built with relaxed, erect posture and coordinated movement. She has

no foul breath and body odor. There is no apparent sign of illness as she presents a

healthy appearance. She is cooperative, with appropriate response to situation. She

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Underweight < 18.5


Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0

exhibits understandable speech in moderate pace, shows thought association and has

sense of reality.

SKIN

Light to dark brown skin complexion Hypopigmentation spotted in the neck, arms, abdomen and back Intact sensation to touch, pain and temperature

Nails

intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec)

HEAD

Skull & Face

No bruises, nodules and masses noted Normocephalic Symmetrical facial movements and facial features

Hair

No area of loss of hair and no infection/infestation.


Ears and Hearing



Symmetrical

Page | 18






Nasal septum intact and in midline Facial sinuses are not tender

Mouth


Neck

Neck muscles equal in size and strength Coordinated, smooth movements without discomfort

Thorax and lungs


Abdomen


Upper Extremities


Lower Extremities




Juanita received all her childhood immunizations as validated by her mother. She

experienced some common childhood illness like measles, mumps, and chicken pox.

These were all managed non-pharmacologically and traditional means.

Juanita when she was 10 years old was rushed to the GRBASMH due to dengue

fever. She stayed at the hospital for 5 days. On those five days, Inocencia as she

recalled told us that Juanita received IVF and some medications she could no longer

recall. She was discharged in good condition and fully recovered after numerous days

of discharge from the health facility.

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She had given birth to an alive baby via NSD through a ‘partera’ (traditional birth

attendant). Juanito mentioned that she’d been attending prenatal checkups at the RHU

Pasuquin and according to her she received a shot of Tetanus Toxoid vaccine.


Height: 156 cm.Weight: 49 kilograms



= 49 kg (1.56 m) 2

= 49 kg. 2.43

= 20.2


Juanita wakes up at around 5:30 in the morning and breast feed her baby. She

takes her breakfast together with her sibling at 6:00-7:00 am. Sometimes she is

entrusting her baby to her brother or neighbors to help in the field but most of the time

she is left at home to monitor her baby and prepare food in the absence of her mother.

Jaunita takes her breakfast at 11:30- 12:00 and then takes a bath after. She sleeps at

night at around 9:00-10:00.

D. DIONISIA DIMAGIBA16 years oldCEPHALOCAUDAL PHYSICAL ASSESSMENTDate Performed July 24, 2011

General SurveyOn the first day of contact with the family, Juanita was seen in good grooming in

baby blue shirt and shorts. She has normal body built with relaxed, erect posture and

coordinated movement. She has no foul breath and body odor. There is no apparent

sign of illness as she presents a healthy appearance. She is cooperative, with

appropriate response to situation. She exhibits understandable speech in moderate

Page | 20


Underweight < 18.5


Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0

pace, shows thought association and has sense of reality. Likewise, she is oriented to

person, time and place.






SKIN

Light brown skin complexion Intact sensation to touch, pain and temperature

HEAD

Skull & Face

No bruises, nodules and masses noted Symmetrical facial movements and facial features

Hair

No area of loss of hair and no infection/infestation.

Nails

intact epidermis convex curvature no discoloration of the nail beds normal capillary refill (<2-3 sec)


Ears and Hearing

Auricles aligned with the outer canthus of the eyes Good gross hearing acuity (normal tone voice is audible) Able to hear ticking of watch in both ears


Symmetrical Nasal septum intact and in midline Facial sinuses are not tender

Page | 21

Mouth

Tongue moves freely Intact gag reflex With moderate breath odor

Neck

Neck muscles equal in size and strength

Thorax and lungs


Abdomen


Upper Extremities


Lower Extremities




Dionisia received all the childhood immunization as claimed by her mother. She

as well experienced childhood illnesses like mumps, measles, and chicken pox. These

were all managed non-pharmacologically and traditional means. Common illnesses like

headache, fever, cough and colds and dysmenorrhea were all treated

pharmacologically as long as there is a fund to buy medicines.

Dionisia was hospitalized when she was an infant at GRBASMH due to

pneumonia as claimed by her mother. She fully recovered after she was discharged at

the hospital. Way back in 2006, the young Dionisia was beaten by a dog at her left leg.

The area was thoroughly washed with soap and running water and then after she was

Page | 22

brought to RHU Pasuquin. According to Inocencia, her daughter was administered with

an injection of which she is uncertain if it was anti-rabies.


Height: 160 cm. Weight: 48 kilograms



= 48 kg (1.6 m) 2

= 48 kg. 2.56

= 18.8


Dionisia wakes up at 5:30-6:00 in the morning. After taking a cup of coffee she

sometimes goes to the field with the other family members to work. She helps in

performing household chores like sweeping the front and backyard. She takes her

breakfast at 6:00 and takes a bath at 9:00-10:00. Dionisia accompanies her mother and

older sister in washing their clothes. At 11:30 she takes her lunch and then goes to their

neighbor to watch movies or have a chat. Dionisia sleeps at 9:00-10:00 at night time

after watching television.

e. KAIMITO DIMAGIBA10 years oldCEPHALOCAUDAL PHYSICAL ASSESSMENTDate Performed July 24, 2011

GENERAL SURVEYKaimito on the initial contact was observed to be unkempt in yellow t-shirt and

camouflage short. He has thin body build, walks, stands and sits relaxed with erect

posture and coordinated movements. Minimal body and breath odor was observed. He

is cooperative and responds appropriately to situation. He has understandable speech,

in slow pace, exhibits thought association and has sense of reality. On the other hand

he is oriented to time, place and person.

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Underweight < 18.5


Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0






SKIN

dark brown skin complexion Hypopigmentation spotted in the neck, arms, abdomen and back Scratches seen on right leg with scab formation Intact sensation to touch, pain and temperature

Nails


HEAD

Skull & Face

No bruises, nodules and masses noted normocephalic Symmetrical facial movements and facial features

Hair

No area of loss of hair no infection with minimal lice infestation


Ears and Hearing



Symmetrical Nasal septum intact and in midline

Page | 24

Facial sinuses are not tender

Mouth


Neck

Neck muscles equal in size and strength

Thorax and lungs


Abdomen


Upper Extremities


Lower Extremities




Kaimito was hospitalized at GRBASMH when he was an infant due to

pneumonia. Before Inocencia decided to submit her son to the hospital she sought

consultation at RHU Pasuquin first. In there, the infant Kaimito was given medication to

take, however, the condition persist and worsen. It was only that time that Inocencia

rushed Kaimito to the hospital for immediate care. Kaimito was found out to have

pneumonia. Successfully treated and freed from unhealthy condition, he was

discharged after almost 2 weeks.

Kaimito also experienced common childhood illnesses like mumps, measles, and

chicken pox. These were all treated non-pharmacologically and traditional means same

as those aforementioned.

Page | 25


Height: 141 cm. Weight: 34 kilograms



= 34 kg (1.41 m) 2

= 34 kg. 1.98

= 17.2


Kaimito wakes up at 5:30 am. Together with his father, they fetch water in the

deep well early in the morning. At 6:00 he takes his breakfast and then takes a bath in

preparation for school. At around 6:30 he walks to school for 25-30 minutes. At lunch

time he goes home to take his meal and goes back to school for his afternoon class. At

Saturdays and Sundays when her mother-sister goes to the field to work he is the one

who takes care of his nephew. Kaimito is the one who feeds their pig early in the

morning and late in the afternoon. He sleeps at 8:00-9:00 after accomplishing his

assignments.

f. JUANITO DIMAGIBA9 months oldCEPHALOCAUDAL PHYSICAL ASSESSMENTDate Performed July 24, 2011






Page | 26


Underweight < 18.5


Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0

Juanito was never hospitalized due to any disease condition. As stated by her

mother she completed all his immunizations. Currently, to date of first initial contact, he

has cough and cold. There were no interventions done to treat the condition.


Weight: 8 kg.

Age: 9 months old

AGE IN MONS. BELOW NORMAL NORMAL ABOVE NORMALFROM TO

8 6.2 kg 6.3 kg 10.1 kg 10.2 kg

9 6.5 kg 6.6 kg 10.5 kg 10.6 kg

10 6.8 kg 6.9 kg 10.9 kg 11 kg

*source: FNRI User’s Manual, 2003

INTERPRETATION: NORMAL BODY WEIGHT

DEVELOPMENTAL ASSESSMENT

Child’s ProfileDate of Birth: September 16, 2010Date of Test: July 24, 2011

Computation:(Year) (Month) (Day)2011 07 242010 09 16__________________________

AGE 10 8 days

METRO MANILA DEVELOPMENTAL SCREENING TEST

a. PERSONAL-SOCIAL

Action Score Procedure/Result

Smiles responsively

Smiles spontaneously

Regards face

Passed

Passed

Passed

During the test the tester went close to the child and smiled at the baby while playing with him. The child smiled back at him and produced chuckling sound.

The child occasionally smiles with or without stimulation.

The first time the tester came face to face with the child, the child curiously look at her. Child’s vision is good. The child is studying a face with a fixed stare.

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INTERPRETATIONThe child was able to pass the three activities: smiles spontaneously, smiles responsively and regards face. With this, we could conclude that the child has no developmental milestone delay under personal-social criteria.

b. FINE-MOTOR ADAPTIVEAction Score Procedure/Result

Grasp Rattle Passed Procedure:While the child is sitting on his mother’s lap, the tester put the rattle at his palm.

Result:The child instantly grasps the rattle within a few seconds. Ability to hold small object is visible. The child’s thumb opposition is beginning in scooping motion.

Regards cheese curls

Reaches object

Follows 180º

Hands together

Passed

Passed

Passed

Passed

Procedure:A piece of cheese curl was dropped at the mother’s lap while the child is sitting on one lap.Result:The child looked at the cheese curls and tried to get it. It indicates that coordination of eyes and hands is developing.

Procedure:Toys were put to a place 2 feet near the child.Result:The child tried to reach them out and eventually held one toy. This indicates that vision is clear, especially if there is stimulation.

Procedure:The child was lying in supine position. The tester put the red yarn in about 6-8 inches in front of the child and wiggled it to get his attention. Then it was transferred from his left going to his right side in a slow motion.

Result:The child followed the yarn as evidenced by the movement of his eyes as well as his neck on the same manner of movement of the yarn. The tester performed it twice. Presence of eye movement was observed. The child has a strong sense of sight. He was able to follow the moving objects.

Procedure:The tester watched the child to see if he touches his hands together frequently.

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Follows past midline

Follow to midline

Passed

Passed

Result:The child often touches his hand together during the test. This means that the child is developing self-discovery

Procedure:While the child is lying in a supine position, the tester held the red yarn for about 6-8 inches in front of him and moved it slowly from one side in an arc over the middle of the child to the other side.

Result:The child followed the red yarn from his left side to the middle then paused and from the middle to his right side. The child’s eyes followed the yarn. The tester performed it twice. Eye movement was observed. The child’s binocular vision was achieved.

Procedure:While the child is lying in a supine position, the tester places the yarn at about 6-8 inches in front of the child. Then place it from his left side going to the middle.

Result:The child’s eyes followed the yarn. His neck also moved from left to the middle of his body. The tester performed this twice. The child’s binocular vision was achieved.

INTERPRETATION:The examiner performed seven activities under the fine-motor adaptive sector. These are: grasp rattle, regards cheese curls, reaches object, follows 180°, and follows midline and past midline and hands together. The child passed all these seven activities. For this criterion the examiner ruled out no developmental delay.

c. LANGUAGE

Area Score Procedure/Result

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Turns to voice

Squeals

Laughs

Vocalizes not crying

Responds to bell

Passed

Passed

Passed

Passed

Passed

Procedure:As the child was sitting on her mother’s lap, the tester went to his right side and called him by his name.

Result:Upon calling the name of the child he faced the direction of the voice of the examiner.

Procedure:The tester asked the mother if the child already laughs, or produces a squealing sound if he’s overjoyed.

Result:The mother verbalized that her child was able to produce different sounds. The child squeals because of pleasure.

Procedure:The tester asked the mother if the child laughs loud even without being tickled or any stimulation.

Result:The mother positively confirmed that her child lough loud even if her child is alone lying.

Procedure:The tester observed if the child is able to vocalize and producing different sounds.

Result:As the tester proceeded with the test, it was observed that the child can produce sound like “ahh”.

Procedure:The tester rang the bell quietly at the left side of the child where the child could not see it. Then the tester rang again the bell, this time, louder.

Result:The tester rang the bell first at the left side of the child, the child momentarily stopped wiggling. Then the tester rang again the bell, this time more sound was produced, the child moved his head to the direction of the sound produced by the bell. The child has a distinctive hearing awareness. He turns his head toward the direction of the sounds.

INTERPRETATION:The child was able to pass all the activities mentioned above which means he has no developmental delay on this criteria.

d. GROSS MOTOR

Page | 30

Procedure Score Procedure/Result

Bear some weight on legs

Pull to sit

Prone chest up arm support

Rolls over

Sit head steady

Prone head up to 90º

Prone head up 45 º

Passed

Failed

Failed

Passed

Passed

Failed

Passed

Procedure:The tester held the child upright on the mattress.Result:The child stood straight for a few seconds holding his weight on his legs, as the loosen support to the child.

Procedure:The tester put the child in a supine position and slowly pulled him up through his hands.Result:The child’s head hang as he pulled to a sitting position. It means that head lag is still prominent. Muscles of neck are not strong enough to give support to his head while in motion.

Procedure:The child is placed on the mattress in a prone position. The tester observed if the child can lift his head and chest up using arms for support.Result:The child lifted up his head and chest but did not extend his forearm for support. This means that the child cannot rest his torso's weight.

Procedure:The mother was asked if she have observed her child roll from side to side in supine position.Result:The mother confirmed that she have seen her baby roll in bed many times already.

Procedure:The child is placed at his mother’s lap, in a sitting position. The tester counted for a full minute while looking at the child’s head if there is no swaying.Result:The tester observed that the child’s head did not sway. The child’s muscle control is already established. It allows the child for a more visual interaction.

Procedure:The child was positioned lying in his stomach on a mattress and was observed if he can lift his head to make a 90º angle.Result:The child was not able to lift his head and chest to produce a 90º angle. The child’s head is still held facing down-ward.

Procedure:The child was put in a lying position on his stomach and was observed if he can lift his head to make a 45º angle with the table.Result:

Page | 31

The child was able to lift his head and raise his chin from the mattress. His neck muscles can support his head movement up to 45 degrees angle.

INTERPRETATION:The child wasn’t able to perform some of the task which includes: prone head up to 90º, Prone chest up arm support and pull to sit, however this doesn’t mean that he is already developmentally delayed on this criteria. He still have time to achieve all these developmental milestone.

VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND DISEASE PREVENTION.

Page | 32

All the children of the family were all fully immunized as claimed by their mother.

Both the husband and wife are not certain if they received completely all the childhood

immunizations. None of the family members have vices that could trigger different

diseases.

There is adequate rest and sleep among family members. They sleep at around

8:00-10:00 and wake up between 5:00-6:00 which means they get 9 hours of sleep

every day which is adequate enough.

The family seldom observes the use of protective measures. Inocencio uses

rubber boots in going to the field to ensure safety against snake bites, puncture, cuts

and laceration of the feet. He makes use of hat, long-sleeves, and pants to minimize

exposure to UV rays, however he don’t use hand gloves. When other family members

go to the field, the protection that they only use is a hat, long-sleeves and pants.

None of the family members walks barefooted. At night time only Juanito uses

mosquito net, the other members just use blanket to cover up and protect themselves

from mosquito bites.

Inocencia regards and recognizes the importance of health of each family

member, nevertheless because of financial constraints they are unable to buy

medicines so they just resort to rest or sleep to deal with different illnesses. The family

sometimes utilizes herbal plants to treat common illness like cough and cold which is

treated with the use of Yerba Buena decoction. Whenever the condition of a family

member gets worst they seek consultation at the RHU Pasuquin. The family consults a

quack doctor for illnesses they believe were acquired through invisible creatures. They

refer to a ‘manghihilot’ or traditional healer when a family member experiences

stomachache, fainting, severe headache and difficulty of breathing.

Eating vegetables as stated by Inocencia is one of the best practices that could

prevent different diseases as these boosts body resistance against disease. She also

mentioned that she would want to buy Vitamin supplements if only they’ve got financial

reserves.

Page | 33

Page | 34

FAMILY COPING INDEX

CRITERIA/AREAS DESCRIPTION RATE JUSTIFICATION

1. Physical Independence

Concerned with the ability to move about, to get out of bed, to take care of daily grooming, walking

5 The members of the family are able to perform their ADL’s without assistance from others (except in the case of Juanito who is an infant). At present, none of them has disability or debilitating disease.

2. Therapeutic Competence

Includes all of the procedures or treatments prescribed for the care of illness such as giving medication, using appliances (including crutches), dressing, exercises, and relaxation and special diet

3 In cases that a family member is on illness state or experiences common illnesses (headache, cough and colds, fever) and other health condition ( wounds, animal bites), the family has the basic knowledge on how to provide care but they lack understanding of the principles involved. For instance, Inocencia was asked to tell the reason why she uses yerba buena decoction for cough and cold, she only responds by saying, “tapnu maawan toy panateng ko”. (To cure my cough and colds)

3. Knowledge of Health Condition

Concerned with particular condition

3 Reinforcing the above-mentioned in point 2; the family has some general knowledge of the diseases or conditions they encountered but has not grasped the underlying principles of the interventions.

4. Application of Principles of General Hygiene

Concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for the family members

1 Not all members of the family are practicing general principles of hygiene. Because of the distance of water supply, they sometimes don’t take a bath especially Kaimito and Inocencio. The family diet is grossly inadequate or unbalanced. The cooking area was found messy and unorganized and leftovers are just covered with a plate or stored in a casserole. Inocencio works in the farm for long period of time (5:00am-5:00pm).

5. Health Attitudes Concerned with the way the family feels about health care in general including preventive services, care of the ill and the disease and public health measures

3 The family understands and recognizes needs for medical care in times of illness state but due to lack of financial means they just treat their condition with OTC drugs or herbal medicines. In cases of emergency situations, they immediately seek health care like when Inocencia and Inocencio were hospitalized due to liver and kidney problems respectively. The advices of the doctor to them upon discharge from the hospital were all taken into account for their faster recovery. Inocencia no longer smokes cigarette and drinks liquor after she was treated. On the other side, the family lacks the skills in caring for their ill member.

6. Emotional Competence

Has to do with maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life and to plan for happy and fruitful living

5 The members of the family are able to maintain a reasonable degree of emotional calmness when they are troubled. They deal with the problems they encounter with optimism. When Juanita got pregnant, her parents insisted to accept the baby but when she gave birth already, the baby was accepted as a new member of the family even with the absence of his biological father.“No adda gaget a ket awan imposible”, says Inocencio. (Nothing is impossible when there is patience). He added that being poor is not the reason for them to be discouraged to strive hard. The family is hopeful that someday, somehow they will separate bondage to poverty to a higher economic

TYPOLOGY OF NURSING PROBLEMS

CUES/DATA FAMILY NURSING PROBLEM

Objective: Inocencio and Juanito both present signs of cough and colds like clear nasal discharge.Subjective: Inocencio verbalized, “maika 4 nga aldaw na itan nga agpanpanateng nakon, di metla umimbagen.” (This is already the fourth day that I am experiencing cough and colds, it’s not still treated)“Ada makalawas nan nga agpanpanateng toy anak ko, aguyek-uyek suna ken agbutbuteg tapos kanayon nga mariing iti rabii”, uttered by Juanita. “Awan ti tumtumaren nga uray ana nga agas.” (It’s been a week already that my son is experiencing cough and colds, he is not taking in any medication)

First Level Assessment Presence of cough and colds (Inocencio and Juanito) as health deficitSecond Level Assessment

A. Inability to provide adequate nursing care to the sick and vulnerable/at risk-member of the family due to:1. Lack of/inadequate knowledge about the

diseases/health condition (nature, severity, complications, prognosis and management)

2. Lack of/inadequate knowledge about child development and care

3. Inadequate family resources for care, specially financial constraints

B. Inability to provide a home environment conducive to health maintenance and personal development due to:1. Inadequate knowledge of importance of

hygiene and sanitation2. Inadequate knowledge of preventive

measures

Objective: The family’s total monthly income is P 2,275.00 which is broken down to meet the basic needs of the family. According to NEDA, each individual should at least have P 2768.60 when the total monthly income of the family is divided among the total family members, thus family Dimagiba with 6 members and with a total monthly income of P 2,275.00 and each member having a share of P 379.00 a month can be considered poor.Subjective: Inocencio was noted saying, “haan umanay detoy makitkitaan mi para kadagiti masapsapul toy pamilya mi.” (Our income is not enough for our needs) “No ada masakit ket iyan anos lattan iti agpalaing iti uneg ti balay ta

First Level AssessmentFamily size beyond what family resources can adequately provide as a health threatSecond Level Assessment

A. Inability to make decisions with respect to taking appropriate health action due to:1. Inaccessibility of appropriate resources

for care, specifically cost constraints or economic/ financial inaccessibility

Page | 35

awan met pagpachec up kas kada igatang iti ag-agas”, he added. (If someone experiences illness, he just stays inside the house and rest for we could not afford to pay for checkup or buy medicines)

Objective: On observation of the house structure, the group noticed many accidental hazards. To name a few, they are the presence of rusting sharp edges of galvanized iron located in the front door and sides of the house, use of “pan-aw” for the house roofing which could cause fire, faulty electrical wiring, and presence of piles of things stocked in the base of the roof, scattered rusting nails.Subjective: not available

First Level Assessment:Accident Hazards like rusting sharp edges of galvanized iron, fire hazards and fall hazards as health threatSecond Level Assessment

A. Inability to provide a home environment conducive to health maintenance and personal development due to:1. Inadequate family resources, specifically

limited financial resources and limited physical resources (lack of space to construct facility)

2. Failure to see benefits of investment in home environment improvement

3. Lack of skill in carrying out measures to improve home environment

Objective: Juanita got pregnant when she was 16 years old. Her boyfriend left her and it’s been a year already that he didn’t show up and there is already limited communication between them. With this, at her young age she is already taking care of her baby who will be turning a year old. She is pressed with the responsibility to care for her child even if she lacks the knowledge to carry out those actions.Subjective: “No dadduma ket ni pay mamang ko iti magal alaga kadeta anak kon ta jak met unay amo pay ngamin manong ngem makasursuro nak met ketdin ah, (It is sometimes my mother who takes care of my child because I don’t fully know how to take care of himbut I’m learning though) verbalized by Juanita. “Uray kuma met umay lata bumisita suna (Boyfriend) ta umay na met kitan no kasano iti plastar mi nga agina ditoy yen, jak amo no panindigan na pay toy anak mi no saanen ta nabayag met nga han nga nagparangen ken jak pay unay makonkontak sunan,” (I hope he will come to visit us) she added.

First Level AssessmentPresence of stress-provoking factors like strained marital relationship as a health threatSecond Level Assessment

A. Inability to provide a home environment conducive to personal development due to1. Ineffective communication patterns

within the family2. Lack of supportive relationship among

family members3. Negative attitude/philosophy in life which

is not conducive to personal development

4. Lack of competencies in relating to each other for mutual growth and maturation

Objective: Each individual must have at least a share of 3.5x3.5 m if the total floor area is divided by the number of family members. In the appraisal of the group, it has been found out that the

First Level AssessmentPoor home/environmental condition: inadequate living space as a health threatSecond Level Assessment

A. Inability to make decisions with respect to Page | 36

circumference of the house is 5.26x4.14 m. far enough to meet the standard floor area to be occupied by each member.Subjective: “No kunkunaek ah ket haan nga umanay detoy espasyon iti balay me, a kas makita yo met nailet ken adut gamit nga nakapaigid ken haan kam pay ketdi unay makakuti-kuti dita unay isu nga alwadan yo no baka maitumeg kayo,” (The space of our house is not adequate enough to accommodate us all and our movement is limited) verbalized by Inocencio.

taking appropriate health action due to:1. Low salience of the problem2. Inaccessibility of appropriate resources,

specifically cost constraints

Objective: There is no available food storage like refrigerator or flies resistance coverings.Subjective: “Awan iti nasayaat nga pagipanan mi dagita mabatbati nga magmakan para iti sumarno, kaluban mi nukwa iti pinggan wenno ipan iti uneg iti kaserola tapnu haan nga mabangles,” (We don’t have proper storage for food, we usually cover it with place or put it inside a casserole) as verbalized by Inocencio.

First Level AssessmentPoor home/environmental condition/sanitation: lack of food storage facilities as a health threatSecond Level Assessment

A. Inability to provide a home environment conducive to health maintenance due to:1. Inadequate family financial resources2. Inadequate knowledge of importance of

sanitation

Objective: On observation of the home and environmental condition, there were presence of vermin like cockroaches, flies and rodents.Subjective: “Ada da latta ipes kada kabkabalay, ta adu met ngamin nakatambak nga gamit ditoy balay mi”,(There are cockroaches and rats because we’ve got many things sticked inside our house) says Inocencio.

First Level AssessmentPoor home/environmental condition/sanitation: presence of breeding or resting sites of vector of diseases (e.g mosquitoes, flies, cockroaches, rodents etc. as a health threatSecond Level Assessment

A. Inability to provide a home environment conducive to health maintenance due to:1. Inadequate family financial resources2. Inadequate knowledge of importance of

maintaining proper environmental condition

Objective: The garbage disposal being used by the family is an open pit system that measures 1x1 m circumference and less than foot deep that is overflowing which could attract flies that carry different microorganisms and eventually cause different diseases.Subjective: “Deta ada dita likod mi nga nakali iti agdama nga pagibelbelengan mi iti basbasura mi”, (We’ve got pit behind out house where we dumped all solid waste) says Inocencio.

First Level AssessmentPoor home/environmental condition/sanitation: improper garbage disposal as a health threatSecond Level Assessment

A. Inability to provide a home environment conducive to health maintenance due to:1. Failure to see benefits of investment in

home environment improvement2. Inadequate knowledge of importance of

sanitation

Objective: A small canal of approximately 10 inches wide and 5 inches deep is the drainage system that the family has. There were obstructions seen like leaves, rocks and plastics that impedes the flow of water and leaves it stagnated. The water is also overflowing.

First Level AssessmentPoor home/environmental condition/sanitation: Improper Drainage System as a health threatSecond Level Assessment


Page | 37

Subjective: not available home environment improvement2. Inadequate knowledge of importance of

sanitation3. Inadequate family financial resources

Objective: The house has only one source of lighting. It’s an incandescent bulb of 15 watts that lights up the whole house at night time. There is as well one small window that measures 1x1 m, which is located in the bedroom.Subjective: not available

First Level AssessmentPoor home/environmental condition/sanitation: poor lighting and ventilation as a health threatSecond Level Assessment


home environment improvement2. Inadequate family financial resources

Objective: The cooking area is messy and disorganized. The eating utensils and cooking facilities are held in a place uncovered.Subjective: “Haan unay naplastar detoy paglunglungan mi ata kurang iti espasyon ken awan pay ketdi igatang iti pagyanan dagita pingpingganen”, (Our eating and utensils are not properly placed because of financial problem) verbalized by Inocencia.

First Level AssessmentUnsanitary food handling and preparation as a health threatSecond Level Assessment

A. Inability to provide a home environment conducive to health maintenance due to:1. Inadequate knowledge of importance of

sanitation2. Cost constraints.

Objective: Some members of the family have been found out to be on somewhat unpleasant personal hygiene. Presence of long untrimmed and dirty fingernails, moderate breath and body odor were observed along with lice infestation. These objective cues could indicate poor personal hygiene.Subjective: “Narigat iti danum ditoy ayan mi ta adayo iti pagsakduan, isu nga haan kam malimlimitaran lang iti panagusar mi iti danum,” (Our water supply is away from our house, so our use of water is limited) stated by Inocencia.

First Level AssessmentUnhealthy lifestyle and personal habits/practices: poor personal hygiene as a health threatSecond Level Assessment

A. Inability to recognize the presence of the problem due to:1. Lack of knowledge about the benefits of

proper personal hygiene2. Attitude in life which hinders recognition

of the problemObjective: not availableSubjective: “Agag-agas kami iti Paracetamol no adda gurigor ken Biogesic no para iti sakit iti ulo, ngem han unay kanayon ta awan met igatang no dadduman,” (We are self-medicating with Paracetamol for fever and Biogesic for headache but we sometimes cannot avail these medicines) verbalized by Inocencia.

First Level AssessmentUnhealthy lifestyle and personal habits/practices: self-medication as a health threatSecond Level of Assessment

A. Failure to utilize community resources for health care due to:1. Lack of knowledge of community

resources for health care2. Unavailability of required care due to

physical inaccessibilityB. Inability to make decisions with respect to

taking appropriate health action due to:1. Failure to comprehend the nature of the

health problemObjective: The family has one mini mosquito net which is good for Juanito’s use.Subjective: “Di kami agususar iti mosketero deta lang apokok ah iti agusar tapnu haan nga kagaten iti lamlamok,” (We are not using mosquito

First Level Assessment Unhealthy lifestyle and personal habits/practices: non-use of self-protection measures (mosquito nets) as a health threatSecond Level of Assessment

A. Inability to provide a home environment conducive to health maintenance due to:

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net, only my grandson uses it) verbalized by Inocencio.

1. Failure to comprehend the nature of the health problem

2. Lack of knowledge as to alternative courses of action open to them

3. Cost constraints of appropriate resources

4. Failure to see the benefits of investment in home condition improvement

5. Inadequate knowledge of preventive measures

PROBLEM IDENTIFICATION

Problem # 1. Presence of COUGH AND COLDS (Inocencio and Juanito) as a health deficit

CRITERIA COMPUTATION ACTUAL

SCORE

JUSTIFICATION

A. Nature of the problem

3/3 x 1 1 It is a health deficit that affects the normal functioning of the individual concerned that also requires immediate attention and adequate management to reduce the likelihood of transfer to the other members of the family.

B. Modifiability of the problem

2/2 x 2 2 The problem is easily modifiable because: Current Knowledge

The family recognizes the presence of the health condition and the need for the the family member affected to be properly taken cared of AEB the verbalization of the problem by Inocencia and Juanita

Resources of the FamilyThe family has necessary resources to make a particular intervention to the problem since they have and are knowledgeable of the use of herbal medicines useful for treating the cough and colds like yerba buena which is planted beside their house.

Resources of the NursesKnowledge and time of the student nurses are available to establish awareness and recognition of the problem. Also, they have proper know-how to perform independent nursing intervention to help treat the condition.

Resources of the CommunityThe community resources are also available to assist the family in terms of consulting about the disease condition like RHU Pasuquin and the BHW’s.

C. Preventive

Potential

2/3 x1 0.67 The problem is moderately preventable because: The family recognizes it as a problem.

Awareness is highly necessary to implement the plan of action in treating the condition.

Knowledge, skills and time of the student nurses adds up to the preventive potential.

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They could give the family health teachings on how to manage this illness.

However: The family lacks the financial means to avail

medicine in curing the illness. Health facilities are from their place.

D. Salience 2/2 x 1 1 The family recognizes the need to make necessary interventions especially for Juanito. AEB Juanito, “innak kuma ngarud ipacheckup isunan ket kumarkaro ngamin toy kondisyon na nammuna ket no ubing nababa iti resistansya na.”

TOTAL SCORE 4.67

PROBLEM #2. Family size beyond what the family resources can adequatelyprovide as a health threat

CRITERIA COMPUTATION ACTUAL SORE

JUSTIFICATION

A. Nature of the Problem

2/3 x 1 .67 This problem becomes a health threat because the family can’t sustain the health needs of a sick member like provision of medications and access to health care facilities in the presence of another problem which is inadequate family income.


1/2x 2 1 The problem is not modifiable because: Current knowledge

The family recognizes this as a problem. AEB by Inocensio, their income is not enough to meet their needs, “pagkaskasyaen mi laengen detoy kapiranggot nga kita mi ta nammuna ket adu ka mi ditoy pamilya mi,” he added. “Awan pay ketdi iti igatang ti ag-agas no ada agkasakit kanyamin, uray kuma agas lang toy apokok,”

Resources of the familyThe family lacks the financial means to support and give the needs of the family, like food, health care, and conducive home environment.

Resources of the Student NursesThe student nurses have the knowledge, skills and time to teach the family some relevant alternatives for nursing health care which are economically wise like the use of common herbal medicines.

Resources of the CommunityThere are available facilities in the community that offers free medicines and health checkups.

C. Preventive potential

1/3 x 1 0.33 The problem has low preventive potential because: The sources of income are scarce and often

unstable. They can’t avail health care services because

of their low income. The income of the family is not enough to

meet all their basic needs and health needs.D. Salience 2/2 x 1 1 The family perceived this as a problem specially in

providing adequate care for both well and ill member but regards it as not needing immediate attention.

TOTAL SCORE 3Page | 40

Problem #3 Accident hazards like rusting sharp edges of galvanized iron,fire hazards and fall hazards as health threat


JUSTIFICATION


2/3 x 1 0.67 The problem is a health threat.


1/2 X 2 1 The problem is partially modifiable because: Current Knowledge:

The family recognizes the presence of the different accidental hazards but they knew that modification of these things would cost them an amount.

Resources of the family:Financial and physical resources are obviously not the asset of the family which are necessary to eliminate these accidental hazards but when it comes to manpower, it is fair enough to make some modifications especially to those hazards that don’t require some money to be shelled out.

Resources of the student nurses:Knowledge, time and skills of the student nurses could help in the modification of the problem. They could empower the family to act on eliminating these hazards by merely educating them the ill-effects on them.

Resources of the community:There are no available resources of the family that could help them solve this problem.


2/3 x 1 0.67 The likelihood of modifying the home environment is increased by the awareness of the family of the existing problem but unfortunately, they cannot totally eliminate all the accidental hazards, for some modification needs money to successfully carry out actions. Through their time and effort these accidental hazards could be eliminated and prevent future accidents.

D. Salience 2/2 x 1 1 The family perceives it as a serious problem that may endanger their lives and may cause injuries to them.

TOTAL SCORE 3.34

Problem #4 Presence of stressprovoking factors like strained marital relationship as a foreseeable crisis


JUSTIFICATION


1/3 x 1 0.33 This problem is a foreseeable crisis that may affect the everyday life Juanita and could encroach on the family as a whole.


1/2 x 2 1 The problem has a partial modifiability because: Current Knowledge

Juanita and her family are aware that this is a problem that could affect most specially the baby because he (Juanito) is growing up and he has an increasing need.

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Resources of the family:There is little family resources that could help sustain and support the needs of the child.

Resources of the student nurses:Presence and time for motivation are the resources of the student nurses available.

Resources of the community:There are no available community resources that could solve this problem.


1/3 x 1 .33 There is a low preventive potential for this problem because:

Juanita is still young to assume mother roles in the absence of her boyfriend.

The family lacks the financial means to support the needs of an additional member.

There are already many effects of her early pregnancy like dropping in school.

Most likely there will be less opportunity for her to find a stable job so that she could give the needs of her child.

D. Salience 0/2 x 1 0 Juanita denied this as an occurring problem and her family does the same.

TOTAL SCORE 1.66

Problem #5 Poor home/environmental condition/sanitation: inadequate living space as a health threat


JUSTIFICATION


2/3 x 1 0.67 This is a health threat.


0/2 x 2 0 This is not a modifiable problem because: Current Knowledge and Resources of the

family:They acknowledge this as a problem but financial, physical and manpower resources makes this problem impossible to modify at this very moment.

Resources of the student nurses:The student nurses could only give their time in planning for the rearrangement of the things stocked in the house but cannot actually solve the problem because 3.5x3.5 m is required for every member to have an adequate space inside the house.

Resources of the community:There are no available resources of the community that could help solve this problem.


1/3 x 1 0.33 There is low preventive potential for this problem because:

The family lacks the financial means to improve the living space for each member.

D. Salience 1/2 x 1 0.5 The family perceives this as a problem that doesn’t need immediate attention or solution for this is not a priority for them to solve.

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TOTAL SCORE 1.5

Problem #6 Poor home/environmental condition/sanitation: lack of food storage facilities as a health threat


JUSTIFICATION


2/3 x 1 0.67 This is a health threat because the family is at risk to different diseases like diarrhea and poisoning.


1/2 x 2 1 There is a partial modifiability for this problem because:

Current KnowledgeThe family recognizes this as a problem but not aware of the different illness they could get from improper food storage.

Resources of the familyThere is little available financial resource of the family.

Resources of the student nursesTime, knowledge of the ill effects of improper food storage and assistance are the available resources the student nurses have.

Resources of the communityThere are no community resources that could help this problem


2/3 x 1 0.67 The is a moderate preventive potential for this problem because:

Knowledge of the family will be increased with the health education of the student nurses.

Of the high modifiability of the problem. Practice of proper food storage could prevent

different diseases.D. Salience 1/2 x 1 0.5 The family recognizes this as a problem but thinks it

does not need immediate attention.TOTAL SCORE 2.84

Problem #7 Poor home/environmental condition/sanitation: presence of breeding or resting sites of vector of diseases (e.g. mosquitoes, flies, cockroaches, rodents, snake etc. as a health threat


JUSTIFICATION


2/3 x 1 0.67 This problem is a health threat because the family is predisposed to different nonfatal as well as fatal diseases when they come in contact with these vectors.


1/2 x 2 1 The problem is partially modifiable because: Current Knowledge

The family recognizes the problem and is aware of the presence of these vectors of diseases.

Resources of the family:There are no available financial resources but family gets an advantage in both physical and manpower means.

Resources of the student nurses:Time, knowledge and assistance are the things that

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could be contributed by the student nurses to resolve the problem.

Resources of the community:There are no available resources that could help in solving the problem.


3/3 X 1 1 There is a high preventive potential for this problem because:

Once actions are taken the likelihood of contracting different vector-borne diseases will be reduced.

D. Salience 2/2 x 1 1 The family understands the seriousness of the problem for they’ve come in contact already with all the vectors stated above and acknowledges the negative impact of these to their health and safety.

TOTAL SCORE 4.67

Problem #8 Poor home/environmental condition/sanitation: improper garbage disposal as a health threat


JUSTIFICATION


2/3 x 1 0.67 This is a health threat for the family different insects thrive in garbage that carries microorganism that causes different diseases


2/2 x 2 2 The problem has a high modifiability because : Current Knowledge

The family has the knowledge on the problem and understands the different effects of improper garbage disposal to health.

Resources of the familyPhysical and manpower resources are available.

Resources of the student nursesTime, knowledge and assistance are what the student nurses could contribute to modify the problem.

Resources of the communityThere is no needed assistance from the community to carry out action in solving this problem.


3/3 x 1 1 There is a high preventive potential for future problems because:

Proper garbage disposal could minimize the transmission of microorganism from vectors of diseases to human

D. Salience 1/2 x 1 0.5 The problem perceives the problem as not a serious one and not needing attention however it is still a recognize problem.

TOTAL SCORE 4.17

Problem #9 Poor home/environmental condition/sanitation: Improper Drainage System as a health threat


JUSTIFICATION


2/3 X 1 0.67 Not flowing water form canal is a good place for mosquito to multiply and with this the family is

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placed on health threat.B. Modifiability of the problem

2/2 x 2 2 There is a high modifiability for the problem because:

Current KnowledgeThe family acknowledges the problem and the effects of it on their health.

Resources of the familyPhysical and manpower resources are the available to carry out plan of action in solving this problem.

Resources of the student nursesKnowledge, time and assistance are available to help the family carry proper actions.

Resources of the community:There are no needed community resources for this situation.


3/3 x 1 1 The is a high preventive potential for future problems because:

As the drainage system will be fixed to an ideal one different diseases caused by mosquito bites could be minimize.

D. Salience 2/2 x 1 1 The family perceives this as a serious problem that needs immediate attention.

TOTAL SCORE 4.67

Problem #10 Poor home/environmental condition/sanitation: poor lighting and ventilation as a health threat


JUSTIFICATION


2/3 X 1 0.67 This is a health threat because the family is placed at risk for accidental banging their heads especially at night time and fresh air could not enter the house in the presence of only one small window.


0/2 x 2 0 The problem is not modifiable: Current Knowledge

The family doesn’t recognize the two as existing problems.

Resources of the familyThere are only physical and manpower resources to treat this problem.

Resources of the student nursesKnowledge and time are available on the side of the student nurses.

Resources of the communityNo available community assistance for this problem.


1/3 x 1 0.33 Good lighting is beneficial for the family members so that they could clearly see what they are doing at night and for good ventilation, so that there is a good exchange of gases but since the problem is not modifiable the preventive potential is low.

D. Salience 0/2 x 1 0 Not a felt problem/needTOTAL SCORE 1

Problem #11 Unsanitary food handling and preparation as a health threat

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JUSTIFICATION


2/3 x 1 0.67 This is a health threat to the family since different microorganism from improper food handling and preparation could cause different diseases.


1/2 x 2 1 The problem is moderate modifiable because: Current Knowledge

The family doesn’t recognize the problem on unsanitary food handling and preparation but admits that because their eating and cooking utensils are not stored properly it could somehow affect the food they eat.

Resources of the familyThe family lacks the financial means to purchase storage of eating utensils but they have both physical and manpower resources which could be utilized in properly cleaning the cooking and eating utensils.

Resources of the student nursesTime and knowledge in imparting health teachings could be utilized by the student nurses.

Resources of the communityThere is no available resources/assistance of the community to solve this problem.


2/3 X 1 0.67 There is moderate preventive potential for future problems to occur because:

The modifiability of the problem is fair Actions to implement sanitary food handling

and preparation could ensure food safety and minimize diseases.

D. Salience 1/2 x 1 0.5 This is perceived by the family as a problem but thinks that it is not a needing an immediate attention.

TOTAL SCORE 2.84

Problem #12 Unhealthy lifestyle and personal habits/practices: poor personal hygiene as a health threat


JUSTIFICATION


2/3 X 1 0.67 This is a health threat.


3/3 x 2 2 This is an easily modifiable problem because: Current Knowledge

The family has knowledge in the unhealthy personal hygiene practices and their effects on health.

Resources of the familyPhysical resources are available to solve the problem.

Resources of the student nursesTime for health teaching and assistance in carrying out action are available.

Resources of the communityThe water supply from the deep well being shared by many households could be utilized for their bath.

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2/2 x 1 1 There is a high preventive potential for future problems to occur considering the modifiability of the problem. Good hygiene is beneficial to the family member for it brings a sense of well-being.

D. Salience 0 0 No available dataTOTAL SCORE 3.67

Problem #13 Unhealthy lifestyle and personal habits/practices: selfmedication as a health threat


JUSTIFICATION


2/3 x 1 0.67 This is a health threat for the family members could take in the wrong medication for a certain disease/illness.


1/2 x 2 1 The problem is moderately modifiable because: Current Knowledge

The family members don’t recognize the negative effects of self-medication.

Resources of the familyThe family lacks the financial means in for consultation in a health care facility.

Resources of the student nurses Time, knowledge and skills are available on in making changes to the wrong actions of the family.

Resources of the communityThere are available community resources like the RHU.


1/3 x 1 0.33 There is a low preventive potential for future problems to happen for the family don’t recognize the problem as well as resources are limited.

D. Salience 0/2 x1 0 The family perceives this as not a problem.TOTAL SCORE 2.0

Problem #14 Unhealthy lifestyle and personal habits/practices: nonuse of self-protection measures (mosquito nets) as a health threat


JUSTIFICATION


2/3 X 1 0.67 This is health threat because mosquito bites could cause deceases like DF, DHF, Malaria etc.


1/2 x 2 1 The problem is moderately modifiable because: Current Knowledge

The family has knowledge on the problem. Resources of the family

The family is deficient in terms of financial and physical resources to stamp out the problem.

Resources of the student nursesThe students could impart their knowledge about the effects of mosquito bites on human which is necessary for the family to make prompt action.

Resources of the communityFogging is available which is done every rainy

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season or if there is an outbreak.C. Preventive potential

3/3 x 1 1 The problem has a high preventive potential because:

Problems on mosquito bites could be minimize if speedy action is discharged.

The family recognizes that the problem is in existence

D. Salience 2/2 x 1 1 It was perceived by the family that the problem needs immediate attention upon knowing that there are many cases of Dengue in Ilocos Norte.

TOTAL SCORE 3.67PROBLEM IDENTIFIED SCORE RANK

I. Presence of cough and colds (Inocencia and Juanito) as

health deficit

4.67 1st

II. Poor home/environmental condition/sanitation: presence of

breeding or resting sites of vector of diseases (e.g.

mosquitoes, flies, cockroaches, rodents, snake etc. as a

health threat

4.67 1st

III. Poor home/environmental condition/sanitation: Improper

Drainage System as a health threat

4.67 1st

IV. Poor home/environmental condition/sanitation: improper

garbage disposal as a health threat

4.17 2nd

V. Unhealthy lifestyle and personal habits/practices: poor

personal hygiene as a health threat

3.67 3rd

VI. Unhealthy lifestyle and personal habits/practices: non-use of

self-protection measures (mosquito nets) as a health threat

3.67 3rd

VII. Accident hazards like rusting sharp edges of galvanized iron,

fire hazards and fall hazards as health threat

3.34 4th

VIII. Family size beyond what the family resources can

adequately provide as a health threat

3.0 5th

IX. Poor home/environmental condition/sanitation: lack of food

storage facilities as a health threat

2.84 6th

X. Unsanitary food handling and preparation as a health threat 2.84 6th

XI. Unhealthy lifestyle and personal habits/practices: self-

medication as a health threat

2.0 7th

XII. Presence of stress-provoking factors like strained marital

relationship as a health threat

1.66 8th

XIII. Poor home/environmental condition/sanitation: inadequate

living space as a health threat

1.5 9th

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XIV. Poor home/environmental condition/sanitation: poor lighting

and ventilation as a health threat

1 10th

SUMMARY, EVALUATION AND RECOMMENDATION

The subject of this family case analysis is the Dimagiba Family who is residing at

the peaceful community of Sitio Nagtataluan Barangay Dilanis of the Municipality of

Pasuquin. This is family is composed of 6 members and is considered as extended as

to structure, patrilocal as to place of residence, patrilinear as to decent or lineage and

egalitarian as to exercise of power/authority.

The family has an overall monthly income of P 2,275.00 which is sourced from

the selling rice, vegetables and fruits, raising poultry and livestock and salary from

planting garlic. The amount is then distributed to meet the demands of the family.

On observation of the home and environment through numerous days of home

visit, the group has found out many problems. Alongside with the accidental hazards

like presence of rusting sharp edges of galvanize iron, scattered rusting nails, fire and

fall hazards, presence of breeding sites of vectors of diseases were also spotted. The

family utilizes a uncovered deep well located meters away from their house as their

water supply. Moreover, water-sealed latrine of pit privy type is the family’s toilet facility

which is being shared with other families. The family makes use of a small pit of 1x1

meter wide and less than a foot deep as their form of garbage disposal.

There are available community resources like RHU which will take almost 25

minutes ride an elementary and preschool center and barangay hall.

On problem identification, the group has determined 14 family nursing problems.

Arranged according to priority, these are the following: presence of cough and colds

(Inocencio and Juanito) as health deficit, poor home/environmental condition/sanitation:

presence of breeding or resting sites of vectors of diseases (e.g mosquito, flies,

cockroaches, rodents and snake as s health threat, poor home environmental

condition/sanitation: improper drainage system as a health and improper garbage

disposal as a health threat, unhealthy lifestyle and personal habits/practices: poor

personal hygiene, non-use of self-protection measures (mosquito nets) as health threat,

family size beyond what the family resources can adequately provide as a health threat, Page | 49

lack of food storage facilities as a health threat, unsanitary food handling and

preparation as a health threat, self-medication as a health threat and presence of

stress-provoking factors like strained marital relationship as a health threat, inadequate

living space and poor lighting and ventilation as health threats. These problems were

made known to the family and interventions were done.

SPOT MAP

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Documents

Family Case Analysis