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De La Salle Health Sciences InstituteCollege of Nursing and School of Midwifery

FAMILY NURSING CARE PLAN

Head of the Family: Melchor Aquino Family Members: 4 Address: Villa Isabel, Dasmarinas, CaviteFamily Structure: NuclearPlace of Origin: BicolReligion: Roman CatholicEthnic Group: None

I. Assessment of Family Structures and Dynamics/ Socio-Economic and Cultural CharacteristicsA. Family Structure/ Socio Economic

FAMILY MEMBER

RELATION TO THE

HEAD

SEX BIRTHDATECIVIL

STATUS

HIGHEST EDUC.

COMPLETED

OCCUPATIONMONTHL

Y EARNING

REMARKS

NO. NAME MONTH YEAR

AGE

TYPE OF

WORK

PLACE

1 Melchor Aquino

Head Male June 1976

25 Married

Elementary Graduate

Tricycle Driver

Dasmarinas, Cavite

9,000 php

Well and healthy

2 Linda Aquino

Wife Female

July 1972

3 Married

Elementary Graduate

NA NA NA Well and healthy

3 Regielyn

Aquino

Daughter Female

October

2005

5 Single Kindergarten

NA NA NA Well and Healthy

4 Marite daughter Femal Februar 200 2 Single NA NA NA NA Well and

ss Aquino

e y 6 healthy

A.1 Dominant family members in terms of decision making especially in the aspect of health care: Both of them (Melchor and Linda Aquino)A.2 Presence of any obvious /readily observable conflict between the members of the family: NoneA.3 Adequacy to meet basic necessities (foods, clothing, shelter, etc): YesA.4 Who makes the decision about the money: Melchor AquinoA.5 Membership in any organization: None

B. Home and EnvironmentDate Assessed: March 20, 2010

1. Homea. Ownership: Ownedb. Construction materials used: Lightc. No. of rooms used for sleeping: 1 (one) d. Lighting Facilities: Electrecitye. Ventilation: Goodf. General Sanitary Condition (over all surroundings of house and environment):

The studio typed house is made up of very light wooden materials. The flooring is the same as the flooring outside the house; the walls are not well polished. There were presences of protruding nails in some area of the house. The kitchen utensils (knife, stove, plates) are just beside their bed. Their pails are kept uncovered. Their trash bag is hanged above the uncovered pails.

The surroundings of the house need further improvement. Here are some of our observations. The animals (dogs, cats, chickens)/ pet of their neighbor sometimes roam around inside their house. The house is located beside a pit where they burn all their trashes. The people in the neighbor do also smoke cigars and plays tong-its /cards as their leisure time. The area is very muddy especially when it rains hard. Your sole can barely buried in mud including the presence of very low clothes line that may inflict harm to the community people. Few steps from their house is a canal with a stagnant stream of filthy water and beside it are unending trashes, plastics and animal manures.

2. Drinking water supply

Source: Private Potability: Potable (Mineral water)Distance from the house: Storage: Water dispenser

3. KitchenCooking Facility: Gas StoveSanitary condition:

Their kitchen is located beside their bed. The food that they are preparing are not properly cleansed and covered. They just let their food sit there without any cover at all. Their knives are also somewhat inserted in the spaces on their wooden wall which makes it prone to bacterial infestation. Their utensils were scattered all over the house (floor, beside their pillows, near their slippers). Also their gas stove is within the reach of their children in the house. They also uses a knife in opening canned goods and as we observed, they are having a hard time opening it and resort to manually (by bare hands) lift the half opened tip of the canned goods. After eating, they wash their plates and utensils in the house flooring making it more susceptible in causing different diseases to the family members.

Drainage Facility: None

4. Water Disposala. Refuse and garbage

Container: Open ContainerMethods of Disposal: Open Burning beside their house

b. Toilet Type: Balot SystemDistance from the house: Beside their house; about few steps away; approx 8-10 stepsSanitary Condition:

The sanitation was not well kept. Their excreta were not properly disposed thus posing more chances of spreading diseases and ailments. As we observed, after they urinate or defecate, they tend not to wash their hands and continue on what they are doing. This usual habit will further cause a harmful feedback to their health as well as the people who lives around them. Proper health education must be imposed.

5. Domestic Animals: Yes (dog)

6. Nutrition

a. Food Preferences (general/day): Vegetables and FishesNumber of glasses consumed/day:

Juice: 3-4 glassesWater: 7-8 glassesSoft drink: None

Number of meals/day: 3 meals per day (Breakfast, Lunch and Dinner)Number of Snacks/day: 1 snack per day (mirienda)

b. Ways and means of food preparation (most of the time): Prepared at house

7. Community in Generala. General sanitary condition:

The sanitary condition of the community is poor. There were presences of garbage, animal and human manure, and stagnant water which may cause further injury to the community people if not been properly solved. There was also presence of very low and thin clothes line that is hard to see if you don’t know the place well. It will inflict further injury and harm. There were also scattered broken pieces of glass all over the community area. All in all, this community needs health and sanitary provisions.

b. Housing congestion: There were some part of the community that is over congested and there were some that is not congested.

c. Recreational Facilities: There were no recreational facilities present in the community but instead the community people gathered

under the shade of the tree and plays cards (tong-its) as their recreational activity. Their community is a big play ground for those children who live there.

d. Availability of Health care services/ Distance of house from the nearest health acre facility: The presence of health care services was abundant in their area. The Bucandala 2 Health Center is just 3-4

blocks away from their house in which they can avail a free check-ups, immunization, consultation and free medications. Giving donations is voluntarily done.

8. Other Informationa. Personal Habits (15 years old and above)

Name: Melchor Aquino (33 years old)Personal Habits: Smoking (5 sticks per day) and drinking alcoholic beverages

b. Family Planning: Non-acceptor of any Family planning methods

C. Health Status of Each Family Member:

I. Nursing History: There is presence of significant illness in their family and that is the condition of their 2nd daughter, Ruth Ann

who suffers from meningitis. Ruth Ann is taking Phenobarbital as her maintenance drugs to make her calm. The rest of the family members are well and healthy.

The Alboro Family seeks medical help through hospitals and health centers. They opted not to see an Albularyos or quack doctor to prevent worsening of their family member’s condition.

The family eats a well balanced diet. They eat three times a day with fish and vegetables as their viands. They eat lean and red meats only during weekends so that their limited budget will fit in their daily needs without compromising the health of their family.

II. Developmental Assessment For Infants, Toddlers and Preschoolers (MMDST): We conducted a MMDST to Ruby Alboro’s son, Raven. Raven is a normal 2 years 5months and 5days old child.

There were no signs of delay.

III. Physical Assessment/ Results of Laboratory/ Diagnostic Exam. (Previous or latest) Of Any Family Members.

SYSTEM ROS PEGeneral/Over all health status “ wala naman akong

nararamdamang may masakit o kung anu ano sa katawan ko kahit may UTI ako. Hindi naman kasi malala”

Normal, responsive, oriented to environment

SHEENT “ Hindi kasi ako mahilig mag lotion kaya siguro parang dry ang balat ko”“ Minsan sumasakit ang ulo ko kapag

(+) hedache with 5/10 pain scale(+) normocephalic(+) short hair with equal distribution

sobrang init ng panahon” (+) pupillary reflex(+)symmetrical nose, medium bridged(+) Dry skin

CHEST/LUNG “ Hindi naman ako nahihirapan huminga”

(+) symmetrical chest expansion RR: 18

CARDIO “ Wala naming may sakit sa puso sa pamilya namin”

BP:90/70 PR: 85

ABDOMEN “ Hindi naman sumasakit ang tiyan ko”

(+) symmetrical rounded abdomen

GUT “ Noong dalaga pa ako ay may UTI na ako hanggang ngayon”

Not done

EXTREMITIES “ Payat lang ako pero kaya ko naman gumawa ng mabibigat na gawaing bahay”

Thin long extremitiesEctomorph

SYSTEM ROS PEGeneral/Over all health status “ wala naman akong

nararamdamang may masakit o kung anu ano sa katawan ko kahit may UTI ako. Hindi naman kasi malala”

Normal, responsive, oriented to environment

SHEENT “ Hindi kasi ako mahilig mag lotion kaya siguro parang dry ang balat ko”“ Minsan sumasakit ang ulo ko kapag sobrang init ng panahon”

(+) hedache with 5/10 pain scale(+) normocephalic(+) short hair with equal distribution(+) pupillary reflex(+)symmetrical nose, medium bridged(+) Dry skin

CHEST/LUNG “ Hindi naman ako nahihirapan huminga”

(+) symmetrical chest expansion RR: 18

CARDIO “ Wala naming may sakit sa puso sa pamilya namin”

BP:90/70 PR: 85

ABDOMEN “ Hindi naman sumasakit ang tiyan ko”

(+) symmetrical rounded abdomen

GUT “ Noong dalaga pa ako ay may UTI na ako hanggang ngayon”

Not done

EXTREMITIES “ Payat lang ako pero kaya ko naman gumawa ng mabibigat na gawaing bahay”

Thin long extremitiesEctomorph

SYSTEM ROS PEGeneral/Over all health status >Ruth Ann

-(+) scabies-untidy hair, long untrimmed finger and toe nails.-cannot ambulate- eyes were not symmetrical with each other

>Raven-(+)scabies-(+)lice-long and untrimmed finger and toe nails

(+) scabies(+)lice(+)dry skin

>Ruby -long and untrimmed finger and toe nails-(+)lice

SHEENTCHEST/LUNG

CARDIOABDOMEN

GUTEXTREMITIES (+) scabies

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

1. Immunization status of Family Members:

NAME AGE BCG HEP B VAC OPV DPT Vit A M VAC

REMARKS

1 2 3 1 2 1 2 3Melchor Aquino

33 years old

Fully immunized

Linda Aquino

38 years old

Fully immunized

Regeilyn Aquino

5years old

Fully immunized

Maritess Aquino

4 years old

Fully immunized

2. Healthy Lifestyle Practices: No Specify: Smoking

3. Adequacy of Rest and sleep: Yes How many hours: 6 hours

4. Relaxation: YesSpecify: playing tong-its, chit chats, sleeping

5. Use of protective measures: Mosquito net and footware

II. Problem Sheet

Health Condition and Problems Cues/Data Family Nursing Intervention1. Scabies as health deficit (+)scabies on the lower extremities

(+) itchiness and pruritus on the lower extremities

>Health Teaching about proper hygiene>Application of Calamine lotion or Acapulco ointment as an alternative.>instruct the mother to wash and change clothes, beddings and linens.>implementing sanitation measures.

2. Improper sanitation -presence of trashes,plastics, animals and human manures.-burning of garbage.-presence of stagnant and filthy water-presence of flies, rodents and cockroaches-presence of foul odor.

>instruct the client in proper waste disposal >proper health teaching about the adverse effects of burning trashes in human body.>eliminate stagnant and filthy water>promote segregation and recycling

3. Smoking as Health Threat -5 sticks of cigarettes per day(+) dark lips(+) Shortness of Breath

>explain the health hazards of smoking and its complications.>limit the no. of sticks per day.

(+) sore throat in the morning(+)Headache(+) nausea and vomiting

>proper positioning >instruct the client to stay away from any of the family members if he cannot cease from smoking.

4. Unsafe living space for the children

-presence of danger hazards around the area (protruding nails, broken pieces of glasses, sharp objects kept unattended, stove within the reach of children, high bed without railings to protect the child if sleeping/playing, house made from very light wooden materials, usage of gas lamp at night)

>instruct the client to hammer all the protruding nails to avoid accidents.>discuss the possible complications of tetanus.>instruct the client to keep away those sharp objects from reach of children.>find alternative ways to avoid children from falling out of bed (eg. They can use their pillows as a barricade or better do not let the children unattended.)>instruct the client to put away the gas lamp from flammable materials (papers, clothes,linens)

5. Improper hygiene -presence of parasitic hair lice-long, untrimmed finger and toe nails-dirty feet and hands -presence of foul odor-untidy hair-(+) scabies on the lower extremities-does not take a bathe everyday-dirty and soiled garments and undergarments

>instruct the client on how to eradicate the presence of parasitic hair lice by taking a bathe everyday and use a fine toothed comb to suffice the eradication process.>instruct the client on proper handwashing>the client can apply deodorant or tawas to avoid having such odor.>application of calamine lotion or Acapulco ointment in treating the scabies.>instruct the client to wash their clothes properly using an antibacterial

detergent and let it dry under the heat of sun.

III. Prioritization of Nursing problem

A. Case Illustration on Priority Setting

Scabies as health deficit

Criteria Computation Actual Score Justification1. Nature of the

problem3/3 x 1 1 It is a health deficit that

requires immediate attention and adequate management to reduce likelihood of transfer of the disease to the rest of the family members.

2. Modifiability of the condition or problem

1/2 x 2 1 The family has inadequate sources to solve the problem. Inadequacy of living space is barrier to achieve good personal hygiene, which is important in the management and prevention of scabies.

3. Preventive potential 3/3 x 1 1 The spread of scabies to other family members is reduced or not eliminated if the problem is managed properly as soon as possible.

4. Salience of the problem

1/2 x 1 1/2 The family recognizes it as a health problem.

Total Score 3 1/2

Improper sanitation


problem2/3 x 1 2/3 It is a health threat that

requires immediate solution to reduce the spread of different diseases and ailments.


2/2 x 2 2 The family has adequate resources to resolve the said problem. Motivation must be implemented among members of the family.

3. Preventive potential 3/3 x 1 1 The presence of filthy surroundings will create further harm and infections therefore the problem should be managed as soon as possible.


0/2 x 1 0 It is not a felt problem.

Total Score 3 2/3

Smoking as health threat


problem3/3 x 1 1 It is a health threat that

requires immediate attention and adequate management to prevent the possible complications of smoking to the client and to its member.


2/2 x 2 2 They are fully equipped with knowledge of possible adverse effects of smoking in to their body.

3. Preventive potential 3/3 x 1 1 The effects of possible complications will be prevented if it is properly managed as soon as possible.


2/2 x 1 1

Total Score 5

Unsafe living space for the children


problem1/3 x 1 1/3 It is a foreseeable crisis

that requires least attention because its consequences were not yet felt by the family

member.2. Modifiability of the

condition or problem2/2 x 2 2 The family is fully

equipped with man power and physical resources to solve this dilemma.

3. Preventive potential 3/3 x 1 1 The effects of possible harm of this problem will be reduced if proper management will be applied on this specific problem.



Total Score 3 1/3

Improper hygiene


problem3/3 x 1 1 The client desired to

sustain and maintain high level of wellness.


0/2 x 2 0 The family is not capable or not fully equipped with knowledge about maintaining proper personal hygiene.

3. Preventive potential 3/3 x 1 1 The effects of possible harm of this infectious problem will be reduced if proper health education and preventive measures are done.



Total Score 3

The Prioritized Health Problem:

The list of Health problems ranked according to priorities presented:

Smoking as Health Threat 5Improper sanitation 3 2/3Scabies as Health Deficit 3 1/2Unsafe living space for the children 3 1/3Improper hygiene 3

IV. Family Nursing Care Plan

Health Problems

Family Nursing

Problems

Objectives Of Care

Plan Of Intervention Evaluation Plan

Nursing Interventions

Methods Or Tools

Resources Required

Outcome Criteria/

Indicators1. Smoking

as Health Threat

>inability to recognize the presence of possible danger signs of smoking.>inability to decide about taking

After the nursing interventions, the client will reduce the number of sticks of cigarette consumption

Discuss:>The consequences of habitual smoking.>the effects of habitual smoking.>the effects of

Home Visit Visual aids

Time and effort of the nurse and the family.

Goal Partially Met

The client was able to name some complications of smoking like lung cancer,

2. Improper Sanitation

3. Scabies as Health

appropriate action due to failure to comprehend the scope of the problem.

>Inability to recognize the presence of possible harm of filthy environment.>inability to use the resources wisely.>inability to decide about taking appropriate action due to failure to comprehend to the scope of the problem.

per day.

After the nursing interventions, the client will be able to name some of the complications being brought about by habitual smoking.

After the nursing interventions, the presence of health hazards around the vicinity of the house will be lessen or not totally reduced.

After the nursing intervention,

habitual smoking to the second hand smokers.

Discuss:>the deleterious effects of having a filthy and dirty environment.>health importance of living in a clean environment.

Home Visit

Home Visit

Time and effort of the nurse and the family.

Time and effort of the nurse

chronic bronchitis and heart failure. But he was not able to lessen the number of cigarette consumption per day.

Goal Met

The presence of health hazards that can inflict harm to the family was lessened. Proper precautionary measures are applied to possible harm in the environment.

Deficit

>inability to provide adequate nursing care due to lack of knowledge due to the condition; inadequate knowledge of the nature and extent of nursing care needed.>inadequate family resources.

the client will know the value of having clean and safe environment for the growth of their children.

After the nursing interventions, the scabies of the client will lessen its severity.

>discuss the family with possible ways of providing adequate treatment of scabies utilizing less expensive alternative drugs. (Acapulco ointment/soap)>emphasize the importance of personal hygiene and proper washing of clothes and beddings in the management of scabies.>explore with the family of possible ways of implementing measures in eliminating the

and the family.

Goal Not Met

Because of the insufficient time of home visiting, the chance of monitoring daily improvement on the status of the client with scabies were not done but proper techniques and methods on how to treat the disease are carefully taught.

mite that causes scabies.

V. Summary of Last Day of Home Visit

Upon arrival, we suggested to clean the surroundings. Since morning is their usual cleaning routine, we helped them to cover up protruding nails in their house. We kept the sharp objects away from the reach of children. The gas lamps are also kept away from flammable materials to avoid accidents. They were not able to put a steady railings/barrier to the bedside but they have agreed to put pillows as barriers while the children are sleeping or playing.

After a few hours of thorough cleaning, the husband arrives. We conducted health teaching to avoid possible complications about habitual smoking. Father agreed to try lowering the number of cigarette sticks per day. We also instructed the father to stay a way from the family members especially the children who are candidates as the second hand smokers and could acquire lung and other problems. The presence of scabies is a possible threat to the whole family, so we brought Acapulco leaves for them to utilize it and make an Acapulco soap/ointment as an alternative medication for the scabies of the children. We taught them the ways and methods on how to prepare an Acapulco and use it as a soap and topical application. We encourage the children to take a bathe first before applying the said ointment/soap to maximize its potential effects. The Acapulco soap/ointment will sit for about 10 minutes before rinsing it with clean running water. We advised the family to frequently consult their doctor of go the nearest Health Center for their check ups. We told them that free medications are available and given in the center since they are not fully aware of it. After all these fully loaded information that we said to our family, a pleasing and light feeling came in to us because we were able to help people from the community. Well done!

VI. Photo Documentation

Documents

FNCP - destura