I.

INTRODUCTION A. Overview of the family Family is generally considered as the basic unit of care in the community health nursing

for many reasons. It is very important social institution that performs two major function reproduction and socialization. However, it also performs health promoting, health maintaining, and disease- preventing activities. (Maglaya, 2005). In many cases, the family is the focus of decision making of health matters. It is the source of the most solid support and care to its members, particularly to the young, the elderly, the disable and the chronically ill (Cuevas2007). Families are who you love. Our families all look different and it's always been so. A family caregiving unit might consist of a couple; a mother, father and children; a single parent and child; grandparent and grandchildren; a sibling group; a circle of friends; or however that family defines itself. Families are the foundation of society. It's where we come into the world, are nurtured and given the tools to go out into the world, capable and healthyor we aren't. While families have the greatest potential for raising healthy individuals, they can also wound their members in places that will never heal. When families break down and fail to provide the healthy nurturing we need, the effects impact not only our own lives, but also our communities. Though the community is well advancing to become more developed, some issues become overlooked specially in terms of health orientation, importance, and maintenance. Other factors that might have affected the current status of this community is low income due to incompetent educational attainment of the working members of the family which resulted to incomplete basic housing facilities, insufficient family support, inadequate supply of basic needs, and malnutrition of children. Other factors also include poor orientation about hygiene and environmental cleanliness. My subject is a family of four. With respect to the demand of this course, I chose a family that falls under the given criteria in selecting a family. Our area of assignment is at Barangay Canitoan, District 2, Cagayan de Oro City. Considering given factors we gathered from our surveys and assessments, I chose the Tacbobo family to be its subject because they represent 2

the community as a whole in terms of income, lifestyle, beliefs, and practices. Also they have children below 5years old. Information reflected in this study is solely from data gathered during home visits done. The family was informed that data given are purely for the purpose of this study.

B. Objectives This study is well intended to suffice the learning of what this level demands but also the holistic approach of students about the current status of the community and as follows: Assess the common health and environmental problems existing in the family. Describe and explain the existing health related conditions or problems together with the risk factors contributing to their occurrence. Plan the possible course of actions in addressing the identified health and environmental problems of the family. Conduct appropriate health teachings regarding problems identified within the family. Render appropriate nursing actions to solve and alleviate the existing and potential health and environmental problems of the family. To render holistic family centered nursing care by applying all of the best knowledge and skills learned in school in the prevention of the diseases progression and for the promotion of the Familys health and wellness. Furthermore, it is aimed to observing and applying the nursing process in performing all related activities relevant to the success and completion of the study.

a. Scope and Limitation As 4th year nursing students, our study is limited according to the depth of knowledge and training that we have in our level. This study covers a background of the community and a thorough assessment of selected clients for my family care plan. The information that I have gathered are vital yet limited in terms of completeness of information. Gathered data are solely based on a 3day application of nursing process in accordance with subjective and objective information gathered from the client.

II.

Spot Map

Taking Liceo De Cagayan University,as the point of reference, you will ride a jeepney (PUJ) going bulua, it takes about 3km to reach Jollibee (bulua), with a fare of 6.00php, the jeepney bound for bulua passes at persimmon outside Elipe park. The jeepney stops at Jollibee, at the corner; there is an alley of jeepney to reach District 2, Canitoan with a fare of 20.00php. It would take 20-30 minutes to get there, depending on the speed of the vehicle. The jeepney stops at Canitoan Health center near the Canitoan Elementary School. From there, we walked down for about 200 meters to reach our clients house were situated.

B U L U A Going to Canitoan W

N E

C A M P O

PATAG
Legend: ZAYAS
K A U S W A G A N H I W A Y

ABS-CBN BUILDING Cover Court

Jollibee Over Pass

Liceo de Cagayan Multi Cab to Canitoan

SSS Building

CARMEN

N E

Canitoan Highschool

Canitoan elementary School

Going to Pagatpat

Canitoan District 1 A

Going to Bulua

LEGEND:

House

Cemetery

Creek

School

Tree

Church

Coconut

Family household

Health Center 8

III.

FAMILY PROFILE

Father Name: Age: Sex: Birthdate: Educational Attainment: Religion: Occupation: Height: Weight: Allergies: Rico Tacbobo 35 y/o Male March 4, 1976 Grade Five Roman Catholic Gardener (Pechay) Not taken Not taken No known food and drug allergies

Mother Name: Age: Sex: Birthdate: Educational Attainment: Religion: Occupation: Height: Weight: Allergies: Ma. Luna Tabcbobo 39 y/o Female July 4, 1972 Highschool Graduate Roman Catholic None 54 ft 53.9 kg No known food and drug allergies

1st Daughter Name: Age: Sex: Birthdate: Educational Attainment: Religion: Occupation: Height: Weight: Allergies: Mary Joy Tacbobo 5 y/o Female November 15, 2006 N/A Roman Catholic N/A 64cm 18kg No Known Food and drug allergies

2nd Daughter Name: Age: Sex: Birthdate: Educational Attainment: Religion: Occupation: Height: Weight: Allergies: Rachelle Mae Tacbobo 1 y/o Female August 6, 2010 N/A Roman Catholic N/A 37cm 7.9 kg No Known Food and drug allergies

10

IV.

Family Health History

Head of the Family: Rico Tacbobo Note: Client not home during home visits, data gathered are subjective as verbalized by wife

Mr. Tacbobo has neither previous hospitalization nor blood transfusion with no known food/drug allergies. He is an occasional drinker (drinks alcoholic beverages only in visited occasions for at least 1-2 small bottles per occasion), and smokes at least 10 sticks of cigarette per day making it his past time during his break. He started both smoking and drinking alcoholic beverages when he started working. Previous illnesses experienced include cough and fever. He drinks paracetamol for fever (preferably BIOGESIC) every four hours until he feels relieved, which usually takes at least 2 days. Unfortunately, he disregards giving attention to cough since he considers it a normal condition that will just go away in a few days.

Wife/Mother: Ma. Luna Tacbobo November 15, 2006 She gave birth with her first child through normal spontaneous delivery at the Barangay Canitoan Health Center. August 6, 2010 she gave birth with her second child through normal spontaneous delivery at the Barangay Canitoan Health Center. She has neither undergone blood transfusion nor has any known food/drug allergies. She reported hypertension as a common illness in their family. She used to be an occasional drinker but never tried smoking. Her last pap smear was done before her latest pregnancy, the specific date forgotten. She never practiced self-breast examination. Previous illnesses experienced include cough and fever. Considered as a family regimen, she takes paracetamol for fever (preferably BIOGESIC) every four hours until she feels relieved and usually lasts for 2 days. Same as her husband, she disregards giving attention to cough and considers it normal, which will eventually pass.

11

1st Daughter: Mary Joy Tacbobo Mary Joy has neither previous hospitalization nor blood transfusion. She has no known food/drug allergies. Her water intake is less than required and has not maintained any vitamins or food supplements for the past 5 years. Previous illnesses encountered include cough, and fever. Her mother normally gives her Paracetamol (preferably BIOGESIC cut into half and dilutes it with water) for her fever once every four hours until fever subsides. 2nd Daughter: Rachelle Mae Tacbobo Rachelle Mae has neither previous hospitalization nor blood transfusion. She has no known food/drug allergies. Her water intake is less than required and has not maintained any vitamins or food supplements for the past 5 years. Previous illnesses encountered include cough, and fever. Her mother normally gives her Paracetamol (preferably BIOGESIC cut into half and dilutes it with water) for her fever once every four hours until fever subsides.

12

V. Father

PRESENT HEALTH STATUS

Name: Rico Tacbobo Mr. Tacbobo is currently not subject to having any present illness. He still drinks alcoholic beverages on varied occasions where he is invited and maintains his personally established quota of cigarette, which are 10 sticks per day. Since the client is not home during our visits, basic information was subjectively relayed by his wife.

Mother Name: Mrs. Tacbobo Ms. Tacbobo is currently not subject to having any present illness. She is open to learning about health maintenance and related practices to protect self and her family.

1st Daughter Name: Mary Joy Tacbobo Immunization: Complete Birth weight: 2.8 kgs BCG: 1st (December 14, 2006) DPT: 1st (January 12, 2007 6 weeks old) 2nd (February 9, 2007 10 weeks old) 3rd (March 24, 2007 14 weeks old) OPV: 1st (December 14, 2006) 2nd (January 12, 2007) 3rd (September 9, 2010) HEPA B: 1st (December 14, 2006) 2nd (January 12, 2007)

13

3rd (September 9, 2010) Measles: April 2, 2011 Vit. A: 10, 000 iu (April 9, 2011)

2nd Daughter Name: Rachelle Mae Tacbobo gi ubo lagi siya, tungod sa panahon guro as verbalized by mother. Immunization: Complete Birth weight: 2.9 kgs BCG: 1st (September 2, 2010) DPT: 1st (October 8, 2010 6 weeks old) 2nd (November 22, 2010 10 weeks old) 3rd (December 19, 2010 14 weeks old) OPV: 1st (September 2, 2010) 2nd (November 22, 2010) 3rd (December 19, 2010) HEPA B: 1st (September 2, 2010) 2nd (November 22, 2010) 3rd (December 19, 2010) Measles: January 6, 2011 Vit. A: 10, 000 iu (April 10, 2011)

14

FAMILYs OVERALL DATA FAMILY PLANNING: Depot medroxyprogesterone acetate (DMPA) SMOKING: Head of the family smokes 10 cigarettes per day ALLERGY: No known food and drug allergies INTAKE OF ALCOHOLIC BEVERAGES: Head of the family drinks occasionally (1-2 bottles per occasion) FOOD USUALLY INCLUDED IN DIET: Rice, vegetables, fish

15

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Date: December 1, 2011 Childs Name: Mary Joy Tacbobo Age: 5 yr old Ht: 64cm Wt: 18kg Temp: 36.8 C ASK: What are the childs problems? Productive cough Initial visit: CHECK FOR GENERAL DANGER SIGNS YES___NO__ NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES ___NO__ For how long? 3 days on and off Count the breaths in one minute. 44 breaths per minute. Fast breathing? No Look for chest indrawing. Look and listen for stridor. None DOES THE CHILD HAVE DIARRHEA? YES_NO___ For how long? __days Look at the young infants general condition. Is the infant: Abnormally sleepy or difficult to awaken Restless or irritable? Look for sunken eyes. Pinch the skin of the abdomen. Does it go back : Very slowly (longer than 2 seconds)? Slowly? DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37C YES__NO___ Decide malaria risk Does the child live in malaria area? Has the child visited/traveled or stayed overnight in a malaria area in the past 4 weeks? If malaria risk, obtain a blood smear. LOOK AND FEEL Look or feel for stiff neck Look for runny nose THEN ASK : For how long has the child had a fever? days. If more than 7 days. Has never been present almost every day? Has the child had measles within the last 3 months? Look for signs of MEASLES Generalized rash and One of these, cough, runny nose, or red eyes. -----------------------------------------------------------------------------------If the child has measles now or within the last 3 months: Look for mouth ulcers If yes, are they deep and extensive? Look for pus draining from the eye. Look for clouding of the cornea. -----------------------------------------------------------------------------------ASSESS DENGUE HEMORRHAGIC FEVER 16

VI.

THEN ASK: Has the child had any bleeding from the nose or gums or in the vomitus or stool? No Has the child had black vomitus or black stool? No Has the child had persistent abdominal pain? No Has the child had persistent vomiting? No LOOK AND FEEL: Look for bleeding from nose or gums Look for skin petachiae Feel for cold and clammy extremities Check for capillary refill._2_ seconds. Perform tourniquet test if child is 6 months or older AND has no other signs AND has fever for more than 3 days. DOES THE CHILD HAVE AN EAR PROBLEM? YES__NO__ Is there ear pain? Is there ear discharge? If yes, for how long ___days Look for pus draining from the ear Feel for tender swelling behind the ear. THEN CHECK FOR MALNUTRITION and ANEMIA Look for visible severe wasting. Look for edema of both feet. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? Determine weight for age. Very low? CHECK THE CHILDS IMMUNIZATION STATUS Circle immunizations needed today. ___ ___ ___ ___ BCG DPT1 OPV1 HEP B1 ___ ___ ___ ____ DPT2 OPV2 HEP B2 MEASLES ___ ___ ___ DPT3 OPV3 HEP B3 CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older. Is the child six months of age or older? Yes__No___ Has the child received Vitamin A in the past six months? Yes__No___ ASSESS CHILDS FEEDING If child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old. Do you breastfeed your child? Yes__No___ If Yes, how many times in 24 hours?. Do you breastfeed during the night? Yes_No___ Does the child take any other food or fluids? Yes_No__ If Yes, what food or fluid? lugaw How many times per day? _3__times. What do you use to feed the child? _____spoon________ If very low weight for age: How large are servings? ______________________________ Does the child receive his/her own serving? ____Who feeds the child and how? _______ 17

No ear infection

No anemia and not very low weight

Return for next immunization on:

Completed (date) Vitamin A given Yes __No __ Feeding Problems: Child has no feeding problems

No anemia and not in very low weigh

 During the illness, has the childs feeding change? Yes___No___ If Yes, how? ASSESS CARE FOR DEVELOPMENT: Ask question about how the mother cares for her child. Compare the mothers answers to the Recommendations for Care and Development for childs age. How do you play with your child? How do you communicate with your child? ASSESS OTHER PROBLEMS

Care and development problems

None

18

Date: December 1, 2011 Childs Name: Rachelle Mae Age: 1 yr old Ht: 37cm Wt: 7.9kg. Temp: 36.8 C ASK: What are the childs problems? Productive cough Initial visit: CHECK FOR GENERAL DANGER SIGNS YES___NO__ NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES ___NO__ For how long? 3 days on and off Count the breaths in one minute. 44 breaths per minute. Fast breathing? No Look for chest indrawing. Look and listen for stridor. None DOES THE CHILD HAVE DIARRHEA? YES_NO___ For how long? __days Look at the young infants general condition. Is the infant: Abnormally sleepy or difficult to awaken Restless or irritable? Look for sunken eyes. Pinch the skin of the abdomen. Does it go back : Very slowly (longer than 2 seconds)? Slowly? DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37C YES__NO___ Decide malaria risk Does the child live in malaria area? Has the child visited/traveled or stayed overnight in a malaria area in the past 4 weeks? If malaria risk, obtain a blood smear. LOOK AND FEEL Look or feel for stiff neck Look for runny nose THEN ASK : For how long has the child had a fever? days. If more than 7 days. Has never been present almost every day? Has the child had measles within the last 3 months? Look for signs of MEASLES Generalized rash and One of these, cough, runny nose, or red eyes. -----------------------------------------------------------------------------------If the child has measles now or within the last 3 months: Look for mouth ulcers If yes, are they deep and extensive? Look for pus draining from the eye. Look for clouding of the cornea. -----------------------------------------------------------------------------------ASSESS DENGUE HEMORRHAGIC FEVER THEN ASK: Has the child had any bleeding from the nose or gums or in the 19

vomitus or stool? No Has the child had black vomitus or black stool? No Has the child had persistent abdominal pain? No Has the child had persistent vomiting? No LOOK AND FEEL: Look for bleeding from nose or gums Look for skin petachiae Feel for cold and clammy extremities Check for capillary refill._2_ seconds. Perform tourniquet test if child is 6 months or older AND has no other signs AND has fever for more than 3 days. DOES THE CHILD HAVE AN EAR PROBLEM? YES__NO__ Is there ear pain? Is there ear discharge? If yes, for how long ___days Look for pus draining from the ear Feel for tender swelling behind the ear. THEN CHECK FOR MALNUTRITION and ANEMIA Look for visible severe wasting. Look for edema of both feet. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? Determine weight for age. Very low? CHECK THE CHILDS IMMUNIZATION STATUS Circle immunizations needed today. ___ ___ ___ ___ BCG DPT1 OPV1 HEP B1 ___ ___ ___ ____ DPT2 OPV2 HEP B2 MEASLES ___ ___ ___ DPT3 OPV3 HEP B3 CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older. Is the child six months of age or older? Yes__No___ Has the child received Vitamin A in the past six months? Yes__No___ ASSESS CHILDS FEEDING If child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old. Do you breastfeed your child? Yes__No___ If Yes, how many times in 24 hours?. Do you breastfeed during the night? Yes_No___ Does the child take any other food or fluids? Yes_No__ If Yes, what food or fluid? lugaw How many times per day? _3__times. What do you use to feed the child? _____spoon________ If very low weight for age: How large are servings? ______________________________ Does the child receive his/her own serving? ____Who feeds the child and how? _______ During the illness, has the childs feeding change? Yes___No___ If Yes, how? 20

No ear infection

No anemia and not very low weight

Return for next immunization on:

Completed (date) Vitamin A given Yes __No __ Feeding Problems: Child has no feeding problems

No anemia and not in very low weigh

ASSESS CARE FOR DEVELOPMENT: Ask question about how the mother cares for her child. Compare the mothers answers to the Recommendations for Care and Development for childs age. How do you play with your child? How do you communicate with your child? ASSESS OTHER PROBLEMS

Care and development problems

None

21

VII.
Housing

DESCRIPTION OF HOME AND ENVIRONMENT

The family owns the house and lot. The house is a single story constructed out of mixed wood and concrete. The space of the house is just sufficient for the four members, theres only one bedroom, the kitchen and living room are in one place, while their comfort room is located outside the house

Kitchen They use firewood in cooking since they find it more affordable. Kitchen is untidy with the presence of unwashed dishes and cluttered utensils. Food is left uncovered and is feasted with flies

Presence of Health Hazards No drainage system, no proper waste disposal. Prominent number of mosquitoes because of stagnant water. Poor sanitary condition, unhealthful nutritional eating practices, presence of breeding sites of vector diseases (mosquitoes, flies, etc.). Water Supply Water is taken from the faucet which the source of water is from Moresco. Currently supplied with mineral water for drinking Sanitary Condition They have poor sanitation, garbage is not properly disposed and is kept inside the house. Pets waste is remained outside the house and is left uncleaned, which causes the prudent smell surrounding their home. Garbage System They do not practice proper segregation of garbage, also they dont have proper disposal and throw it anywhere. Drainage System They dont have drainage system which causes stagnant water. This would be a breeding ground for vectors. Kinds of Neighborhood Insufficient income to supply familys basic needs. Most of them are incompetent educational attainment. Women at a young age already have children 22

VIII.

FAMILY COPING INDEX

Legend: 5 - Complete Competence 3 Moderate Competence 1 No Competence Area

1. Physical independence Ability to move about, get out of bed and perform daily activities.

Rate 5

Justification
The mother can perform daily tasks well at home and functions normally as a mother to her children, while her husband is working which provides their basic needs.

2. Therapeutic competence Includes procedure or treatment prescribed to any disease condition. 3. Knowledge of health condition

The family carried out some but not all of the treatment or procedures being taught.

The family is aware of their health conditions but does not fully comprehend the disease process.

4. Application of principles of general hygiene Family nutrition and adequate rest and relaxation

They have poor home management, no proper waste disposal and stagnant water which results to a breeding ground for vectors such as flies and mosquitoes.

5. Health attitude The way family feels about health care in general.

The family seems to not worry at all to their poor health conditions especially to their self-hygiene, environmental sanitation and nutrition.

6. Emotional competence Maturity and integrity which the members of the family are able to meet usual stresses and problems of life and to plan for a happy and fruitful living. 7. Family living How well the family members get along with another in an interpersonal relationship. 8. Physical environment Home, community and environment.

The father of the family is working hard for the familys welfare while the mother is at its best to perform her function as a wife and a mother.

The mother of the family we were assessing does the household chores

the

work

The house is in poor condition, windows unscreened, holed roofing, dusty floor, unfold clothes are on the floor and backyard was unclean. The family is able to go to the health center despite of its distance.

9. Use of community facilities. Is concerned with the degree to which the family members know about the wisdom with which they use available community resources for health education and welfare. Use of hospitals, clinic, welfare organization, churches, etc.

23

IX.

SCHEMATIC DIAGRAM

ENVIRONMENT

SOCIAL

BIOLOGICAL

Housing
House is not completely covered Inadequate living space Windows are unscreened Disorganized Poor sanitation

Surroundings

Prominent number of mosquitoes because of stagnant water No proper waste disposal Presence of animal feces

Drainage System
Presence of breeding sites of vector diseases (mosquitoes , flies, etc.) No drainage system Presence of stagnant water

Toilet
No proper cleaning practice Waste on toilet left unclean Located outside their home

Economic
Father earns minimum wage to provide familys basic needs Family size is beyond what family can adequately support

Social
The family is inactive in barangay organizatio ns and community activities Failure to perceive the benefits of health care

Genetic
Family hereditary condition/ disease (HYPERTEN SION) on mothers side

Physical

Youngest is having productive cough Poor hygiene

Health Threats

Stress Points

Health Threat

Health Deficit

24

X.

FAMILY HEALTH CARE PLAN NURSING SYSTEM REVIEW CHART

Name: Rachelle Mae Pulse: 72bpm Temp: 36.7C EENT:
[ ] Impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesion [ ] teeth Asses eyes, ears, nose Throat for abnormality [x ] no problem

Date: December 1, 2011 Height: 37cm Weight: 7.9 kg RR: 46cpm

Unkept hair Productive cough

RESPI:
[ ] asymmetric [ ] tachypnea [ ] apnea [ ]rales[x ] cough[ ]barrel chest [ ]bradypnea[ ] shallow [ ] rhonchi [x ] Sputum [ ] diminished [ ] dyspnea [ ] orthopnea [ ] labored [ ] wheezing [ ] pain [ ] cyanotic Asses resp. rate, rhythm, depth, pattern Breath sounds, comfort [X ] no problem

CARDIO VASCULAR
[ ] arrhythmia [ ] tachycardia [ ] numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ]bradycardia[ ] murmur [] tingling [ ] absent pulses [ ] pain Assess heart sounds, rate, rhythm, pulse, blood Pressure, etc., fluid retention, comfort [X]no problem

Dirty and long nails

GASTRO INTESTINAL TRACT

[ ] obese [ ] distention [ ] mass [ ] dysphagia [ ] rigidity [ ] pain Asses abdomen, bowel habits, swallowing, Bowel sounds, comfort [x]no problem

GENITO-URINARY and GYNE

[ ] pain [ ] urine color [ ] vaginal bleeding [ ]hematuria [ ] discharge[ ]nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge [x ]no problem

NEURO
[] paralysis [ ]stuporous[ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip Assess motor function, sensation, LOC, strength, Grip, galt, coordination, orientation, speech. [X]no problem

Dry Skin Warm to touch

MUSCULOSKELETAL and SKIN

[ ] appliance [ ] stiffness [ ] itching [ ]petechiae [ ] hot [ ] drainage [ ] prosthesis [ ] swelling [ ] lesion [ ] poor turgor [ ] cool [ ] deformity [ ] wound [ ] rash [ ] skin color [ ] flushed [ ] atrophy [ ] pain Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity [x] no problem

25

A. Nursing Management (NCP) Name: Rachelle Mae Tacbobo Nursing diagnosis: Ineffective airway clearance related to accumulation of secretions in the tracheobronchial tree (baby) Desired outcomes/Evaluation: Baby will be able maintain patent airway Interventions 1. Advice mother to feed child per demand with aspiration precaution To prevent possible aspiration Rationale To prevent possible aspiration

2. Advice mother not to let child lie flat on her back to prevent aspiration

3. Give mother health teachings on: a. Keep babys back dry

To prevent complication

b. Never give medications unless prescribed by pediatrician

To prevent possible side effects; medications may not be relevant for age To

c. Provide a well-ventilated and dust-free environment that can set-off cough

promote

rest

and

remove

possible irritants

d. Clean

breasts

before

To promote hygiene

breastfeeding

e. Limit childs activity

To limit oxygen demand

26

B. Actual Nursing Management (FCP)

Family Care plan # 1: Unsanitary waste disposal
HEALTH PROBLEM FAMILY NURSING PROBLEMS GOAL OF CARE OBJECTIVES OF CARE NURSING INTERVENTIONS Unsanitary waste disposal 1. Inability to recognize the possible effects of this heath threat to the health of the family members 2. Inability to make decisions with respect to taking appropriate actions due to lack of knowledge as to alternative courses of action open to the family. After 2 to 3days of Nursing Interventions, the family will decide and take alternative actions on how to properly dispose waste materials After 1 to 2 day(s) Nursing Interventions the family : 1. Can explain the importance of disposing the waste material properly 2. Can enumerate various alternatives on how to dispose waste material properly to prevent any health related problems 3. Will select waste disposal method most convenient and safe for them 1. Broaden the knowledge of the family on the possible effects of improper waste disposal to the family a. Discuss the consequences of failure to take appropriate actions on the problem 2. Discuss with the family the courses of action open to them and the consequences of the health actions on the family. 3. Discuss and analyze with the family the advantages and disadvantages of each alternative/method to encourage better decision-making on the best option given the familys situated possibilities. INTERVENTION PLAN METHOD OF NURSE-FAMILY CONTACT Home Visit RESOURCES REQUIRED Material Resources: Visual aids and pictures on different ways and methods on disposing waste materials Human Resources: Time and effort of both the student nurses and the family Financial Resources: Money for the Student nurses transportation; Money for the printing of the pictures and visual aids

27

Family Care Plan # 2: Improper drainage system

HEALTH PROBLEM FAMILY NURSING PROBLEMS GOAL OF CARE OBJECTIVES OF CARE NURSING INTERVENTIONS 1. Discuss with the After 1 to 2 day(s) family the OF Nursing importance of Intervention the proper drainage family can: system to 1. Identify possible prevent any health problems health related that can be problems acquired if 2. Discuss with the improper family possible drainage system alternatives on is not properly how to solve the addressed. problem that is a 2. Enumerate threat to the possible ways on health of the how to solve the family problem 3. Make proper 3. Explain the referrals to importance of existing agencies proper drainage on how to solve system in relation the problem that to the health of can also affect each family the surrounding member family INTERVENTION PLAN METHOD OF NURSE-FAMILY CONTACT Home Visit RESOURCES REQUIRED

Improper drainage system

1. Inability to recognize the problem as a health threat to the family 2. Inability to decide about taking appropriate actions due to: a. Lack of knowledge on the effects of it in the health of the family members

After 2 to 3 days of Nursing Interventions, the family will take the necessary measures to improve the drainage system

Material Resources: Visual aids and sample materials needed in proper drainage disposal Time and effort of Family and student nurses

Transportation Expense of Student nurses

the

b. Lack of financial resources

28

XI.

ACTUAL IMPLEMENTATION

Day 1 (December 1, 2011) During our ocular survey, I was end up with the Tacbobo family, which fit the criteria for conducting a study. I then introduced myself and stated the purpose of my visit. Fortunately the mother was so helpful in permitting me to carry on. There are four members of the household, but only the mother and her youngest child was home during that time. Upon assessment, I found out that the youngest child was having a productive cough for three days already. With the limited time, I focused on imparting health teachings with emphasis on improving nutrition and increasing fluid intake as tolerated.

Day 2 (December 10, 2011) During the second day of visit, we focused to the youngest child who was still having a productive cough. I encouraged the mother to have her daughter checked up the health center. Since the family prefers herbal medicines than pharmacologic prescriptions, I encouraged the mother to make boiled Lagundi to treat her childs cough. After the visit, the mother was able to verbalize the proper preparation of Lagundi and enumerate the ways on preventing recurrence of cough.

Day 3 (January 7) The 3rd day of visit was our last visit. I now worked on our family profiling. We focused on giving health teachings with emphasis on the services given by their health center and encouraged her to visit and make use of those services. I also included recommendations on their diet and exercise to improve their familys health status, and thus promote wellbeing.

29

XII.

RECOMMENDATION

MEDICATIONS Instructed the clients to:

Never do self-medication, take only medications prescribed by physician with its corresponding dose and frequency as ordered

EXERCISE Instructed clients to:

Include exercise such as brisk walking, and stretching as part of their daily activity to promote wellness, proper blood circulation, and revive energy

TREATMENT Taught client about:

How to make homemade boiled lagundi as a treatment for cough Closely monitor BP since hypertension is a heredo-familial disease Visit the health center to be able to avail of the services rendered

DIET Instructed the clients to

Eat food rich in protein, vitamins and minerals (meat, soya, vegetables, and fruits) for a stronger immune system

Plant MACKS-P outside their house to make vegetables accessible and can be surely included in their diet

Increase fluid intake by drinking 8-10 glasses per day Refrain from drinking soft drinks and eating junk foods

30

XIII.

EVALUATION

I was grateful enough that the chosen family was very cooperative and that I was able to do task well and imparted knowledge to them. Although the period covered for our exposure is inadequate or really in short time because of the disaster that happened in Cagayan de Oro City made by the typhoon Sendong. Nurse plays a vital role in the community to render service, assess to those who are in need, give health teachings and encouragement. I admit that the family who is subject for my case study made all things possible for me to learn what I need to know and what Ive supposed to gain in the field of community nursing.

31

XIV.

BIBLIOGRAPHY

BOOKS:

Clark DH, Casals J (1965) Arboviruses, Group B. In: Horsfall FL, Tamm I, eds. Viral and rickettsial infections of man. Philadelphia, Lippincott, pp. 606 658.

Craven RB (1991) Flaviviruses. In: Belshe RB ed. Textbook of human virology, 2nd ed., St. Louis, MO, Mosby-Year Book, Inc. pp. 633662. Doenges, M. et al (2004). Nurses Pocket Guide Diagnoses, Interventions, and Rationales. 9th Edition. FA Davis. Karch, Amy M. (2007). 2007 Lippincotts Nursing Drug Guide. Lippincott Williams and Wilkins

INTERNET:

http://www.doh.gov.ph/kp/statistics/morbidity http://www.chp.edu/CHP/P03060 http://kidshealth.org/parent/nutrition_fit/fitness/exercise.html# http://www.fitnessforkids.org/1-12_yearsprogram.html

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