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Family Case Presentation. Intern Ongkeko Intern Rogacion Intern Samson. Outline. Index patient (Case) -hx pe, Assessment, Plan (kasama yung sa CAMP)!! Family Assessment Tools Family Identification Composition Social History Community Neighborhood Health history Roles in the family - PowerPoint PPT Presentation
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Family Case PresentationFamily Case PresentationIntern OngkekoIntern Ongkeko
Intern RogacionIntern Rogacion
Intern SamsonIntern Samson
OutlineOutlineIndex patient (Case) -hx pe, Assessment, Plan (kasama yung sa CAMP)!!Index patient (Case) -hx pe, Assessment, Plan (kasama yung sa CAMP)!!
Family Assessment ToolsFamily Assessment Tools
Family IdentificationFamily Identification
CompositionComposition
Social HistorySocial History
Community NeighborhoodCommunity Neighborhood
Health historyHealth history
Roles in the familyRoles in the family
GenogramGenogram
Family life cycle (Stage)Family life cycle (Stage)
APGARAPGAR
Family MapFamily Map
SCREEMSCREEM
Family timelineFamily timeline
Impact of illness on the familyImpact of illness on the family
Rapid community med checkRapid community med check
Individual Health PlanIndividual Health Plan
Family Wellness PlanFamily Wellness Plan
EBM yak!EBM yak!
Index PatientIndex Patient
The patient is J.V. a 30-year old female from Nagsaulay, San The patient is J.V. a 30-year old female from Nagsaulay, San Juan, Batangas. She is a right-handed, Roman Catholic, Juan, Batangas. She is a right-handed, Roman Catholic, housewife.housewife.
Chief Complaint: Referred by BHW for medical check-upChief Complaint: Referred by BHW for medical check-up
History of Present IllnessHistory of Present Illness
Patient Profile: The patient is a non-asthmatic, non-diabetic and Patient Profile: The patient is a non-asthmatic, non-diabetic and non-hypertensive. She was previously diagnosed as a case of non-hypertensive. She was previously diagnosed as a case of polio during childhood.polio during childhood.
During a previous session in the LHC, a BHW asked his patient During a previous session in the LHC, a BHW asked his patient to be seen. Hence this consult.to be seen. Hence this consult.
Review of SystemsReview of SystemsGeneral: (-)fever, (-) weight loss, (-) malaise, (-) anorexia
• Integumentary: (-) easy bruisability, (-) rashes
• HEENT: (-) colds (-) headache, (-) blurring of vision, (-) nasoaural discharge, (-) loss of hearing, (-) dysphagia, (-) dysphonia
• Respiratory: (-) cough, (-) hematemesis, (-) hemoptysis
• Circulatory: (-) easy fatigability, (-) chest pain, (-) palpitations, (-) orthopnea, (-) PND
• Digestive: (-) abdominal pain, (-) nausea/vomiting, (-) diarrhea/constipation
• Urinary System: (-) dysuria, (-) oliguria, (-) hematuria
• Nervous: (-) decreased sensorium, (-) behavioral change, (-)seizures
• MSK: (-) pain, (-) swelling, redness, warmth
Past Medical HistoryPast Medical History
as aboveas above
s/p bitubal ligation (2009)s/p bitubal ligation (2009)
OB-Gyne HistoryOB-Gyne History
Menarche at 13 years old, periods occurring in regular monthly Menarche at 13 years old, periods occurring in regular monthly intervals, lasting for 2-3 days, consuming 2-3 moderately soaked intervals, lasting for 2-3 days, consuming 2-3 moderately soaked cloth pads per day, (-) dysmenorrheacloth pads per day, (-) dysmenorrhea
She is a G4P4 (4004) mother. During her pregnancies, she had She is a G4P4 (4004) mother. During her pregnancies, she had regular PNCU’s c/o the LHC. All her children were FT delivered regular PNCU’s c/o the LHC. All her children were FT delivered via SVD assisted traditional birth attendant without perinatal via SVD assisted traditional birth attendant without perinatal complications.complications.
Family Medical HistoryFamily Medical History
See later slidesSee later slides
No history of DM, hypertension, TB, goiter, cancerNo history of DM, hypertension, TB, goiter, cancer
(+) Osteoporosis - maternal grandmother(+) Osteoporosis - maternal grandmother
No other members with similar problems as the patientNo other members with similar problems as the patient
Personal & Social HistoryPersonal & Social HistoryThe patient is a 30-year old housewife.The patient is a 30-year old housewife.
She was able to reach Grade 1 but is illiterate and has no formal job experience.She was able to reach Grade 1 but is illiterate and has no formal job experience.
No vices (smoking, alcohol, illicit drugs)No vices (smoking, alcohol, illicit drugs)
Usual diet is fishUsual diet is fish
Husband is a fisherman who is presently living with his mother.Husband is a fisherman who is presently living with his mother.
They have four children. The first of whom also lives with her husband’s mother.They have four children. The first of whom also lives with her husband’s mother.
They are first cousins!!They are first cousins!!
They live in a house made of light materials (dried coconut leaves and bamboo)They live in a house made of light materials (dried coconut leaves and bamboo)
Source of water is a public artesian well which is 30m from their homeSource of water is a public artesian well which is 30m from their home
They do not have their own toilet. They use the rest room of their uncle, 15 meters from their home.They do not have their own toilet. They use the rest room of their uncle, 15 meters from their home.
Physical ExamPhysical ExamGeneral Survey:
• Awake, conscious, coherent, not in cardiorespiratory distress
• Vital Signs:
• BP 110/70
• HR 88 bpm
• RR 19 bpm
• Temp 37.0°C
• Anthropometrics
• Height: 152 cm
• HEENT
• Pink conjunctivae, anicteric sclerae, no cervical lymphadenopathy, (-) neck vein engorgement, no anterior neck mass, no nasal or aural discharge, (-) tonsillopharyngeal congestion, (+) visible cerumen
• Chest/Lungs:
• Equal chest expansion, clear breath sounds, no rales/wheeze/crackles
• CVS:
• Adynamic precordium, (-) heaves/thrills, Apex beat at 5th ICS L MCL, (-)murmurs
• Abdomen:
• Flat, soft, not distended, (+) postsurgical scar normoactive bowel sounds, (-) masses/tenderness
• Skin/Extremities:
• Full and equal pulses, pink nailbeds, dry skin with good skin turgor, (-) edema/cyanosis/clubbing, capillary refill time < 2 seconds, No atrophy
• True Leg Length: R: 31in L: 30in
• Neurologic:
• GSC 15, oriented to time, place, and person; intact cranial nerves I-XII (decreased hearing acuity, AS), no sensory deficits, 5/5 motor strength on all extremities, +2 deep tendon reflexes, no babinski reflex, no cerebellar signs
• OPHTHA:
• VA: OD: can read fine print; OS: counting fingers at 3 feet
• (+) leukocoria OS, pupils equally brisk and reactive to light; full EOMs, (+) visual field defects in inferonasal quadrant, OS
AssessmentAssessment
Congenital cataract, etiology?Congenital cataract, etiology?
Polio (EDIT ME!!!!!!!)Polio (EDIT ME!!!!!!!)
ASSESSMENT FROM CAMPASSESSMENT FROM CAMP
s/p bitubal ligation (2009)s/p bitubal ligation (2009)
PLANPLAN
PLAN FROM CAMPPLAN FROM CAMP
Diet as toleratedDiet as tolerated
Wear thicker slippers on the leftWear thicker slippers on the left
Advised on ophthalmologist consultAdvised on ophthalmologist consult
Daily bath and oral hygieneDaily bath and oral hygiene
Maintain a clean home and surroundingsMaintain a clean home and surroundings
Family IdentificationFamily Identification
Insert PicInsert Pic
Family IdentificationFamily Identification
Jocelyn-motherJocelyn-mother
Alberto-fatherAlberto-father
Jema Rose- eldestJema Rose- eldest
John Carlo- secondJohn Carlo- second
John Lloyd- thirdJohn Lloyd- third
Anika- youngestAnika- youngest
Family IdentificationFamily Identification
Community NeighborhoodCommunity Neighborhood
Look at Chionglo’s community updateLook at Chionglo’s community update
Family IdentificationFamily Identification
Social HistorySocial History
JV was originally from Bicol and transferred to San Juan, JV was originally from Bicol and transferred to San Juan, Batangas when she was 22 years old. Batangas when she was 22 years old.
JV and Alberto are first cousins. Their fathers are brothers. The JV and Alberto are first cousins. Their fathers are brothers. The family is still hesitant to talk about the history of JV’s family.family is still hesitant to talk about the history of JV’s family.
Health HistoryHealth History
Roles in the FamilyRoles in the Family
Breadwinner- AlbertoBreadwinner- Alberto
Decision-maker- LiliaDecision-maker- Lilia
Handles budget- Alberto/LiliaHandles budget- Alberto/Lilia
Disciplinarian- JVDisciplinarian- JV
Primary Caregiver- LiliaPrimary Caregiver- Lilia
GenogramGenogram
Family Life Cycle StageFamily Life Cycle Stage
Family with Young ChildrenFamily with Young Children
Family APGARFamily APGAR
JVJV
Family APGARFamily APGAR
AntonioAntonio
Family APGARFamily APGAR
LilibethLilibeth
SCREEMSCREEM
AspectAspect ResourceResource PathologyPathology
SocialSocial
All their neighbors are All their neighbors are their relatives and help their relatives and help them when they are in them when they are in
needneed
She is looked upon as She is looked upon as kulang sa kulang sa bait. bait. And she is regarded as a And she is regarded as a
burden to the family.burden to the family.
CultureCulture
SCREEMSCREEM
ReligiousReligious
EducationalEducational
EconomicEconomic
SCREEMSCREEM
MedicalMedical
Family TimelineFamily Timeline
WADAHECK!!!!WADAHECK!!!!
Impact of Illness on the FamilyImpact of Illness on the Family
Rapid Community Medicine Rapid Community Medicine CheckCheck
INDIVIDUAL HEALTH PLANSINDIVIDUAL HEALTH PLANS
FAMILY WELLNESS PLANFAMILY WELLNESS PLAN
JOURNAL APPRAISALJOURNAL APPRAISAL
DILEMMADILEMMA
PopulationPopulation Polio patients with leg length Polio patients with leg length discrepancydiscrepancy
InterventionIntervention
OutcomeOutcome
MethodologyMethodology