Republic of the Philippines

University of Northern Philippines

College of Health Sciences Tamag, Vigan City

In partial Fulfillment On the requirement in the

Subject R.L.E.
in Brgy.Margaay, Narvacan Ilocos Sur

Asistin Family

Presented to:

Mrs. Almira A. Gonzales

Clinical Instructor

Presented by:

Jeremiash N. Dela Cruz

BSN-L-III A

I. INRODUCTION
Family, a fundamental social group in society typically consisting of one or two parents and their children. Basic social unit consisting of persons united by ties of marriage (affinity), "blood" (consanguinity), or adoption and usually representing a single household. Family, basic social group united through bonds of kinship or marriage, present in all societies. Ideally, the family provides its members with protection, companionship, security, and socialization The essence of the family group is the parent-child relationship, whose outlines vary widely among cultures. The structure of the family and the needs that the family fulfills vary from society to society. While some scholars believe this to be the oldest form, others point to the inconclusive prehistorically record and the widespread existence of other forms such as the polygynous family (a husband, two or more wives, and their offspring) and the extended family (including at least parents, married children, and their offspring). The members has specific rule in maintaining life and in cooperation with community. We considered family as the main unit of care in community health care nursing. The family as an institution provides for the rearing and socialization of children, the care of the aged, sick, or disabled, the legitimating of procreation, and the regulation of sexual conduct in addition to supplying basic physical, economic, and emotional security for its members. One of the primary functions of the family is to produce and reproduce persons biologically and socially. From the perspective of children, the family is a family of orientation: the family serves to locate children socially and plays a major role in their enculturation and socialization. From the point of view of the parent(s), the family is a family of procreation, the goal of which is to produce and acculturate and socializes children. A conjugal family includes only the husband, the wife, and unmarried children who are not of age. The most common form of this family is regularly referred to in sociology as a nuclear family. A consanguineal family consists of a parent and his or her children, and other people. A matrilocal family consists of a mother and her children. Generally, these children are her biological offspring, although adoption of children is a practice in nearly every society. This kind of family is common where women have the resources to rear their children by themselves, or where men are more mobile than women.

II. OBJECTIVE

Family case study is a careful and through analysis of the health, social and personal problems in a family. The study will guide the student in giving care needed by the family and help them through:

To conduct a family health assessment.

Careful evaluation of the planning, organization and implementation of all health education programs and activities in the community.

To inform and diagnose different health problem of every family in the community in order to formulate easy and applicable intervention to attain good health.

To identify health problems existing in a particular family and to apply knowledge by interpreting the survey information and in interviews

Helping people attain health through their own efforts.

Assisting each member of the family to identify problems in the community to be aware how to prevent and eliminate through their own way.

To formulate a family care plan and evaluate the outcome of intervention

III. INITIAL DATA BASE

A. Family Structure and Characteristics Name
Ignacio Asistin Anita Asistin

Relationship to the head Head of the family

Age 39 y/o

Sex Male

Civil Status
Married

Occupation Farmer

Address
Brgy. Margaay Narvacan Ilocos Sur Brgy. Margaay Narvacan Ilocos Sur Brgy. Margaay Narvacan Ilocos Sur Brgy.Margaay Narvacan Ilocos Sur

Wife

43 y/o

Female

Married

Farmer

Jenny Rose Asistin Jay-Mar Asistin

Daughter

21 y/o 17 y/o

Female Male

Single

Nurse Student

Single

Son

B. Socio-Cultural Structure
1. Income and Expenses a. Place of work and income Mr. Ignacio Asistin is working as a farmer, the main source of family needs for living; he is also engaged as a driver. Farming is not a permanent way of earning money so the exact amount of monthly income cannot be determined. Mrs. Anita Asistin sometimes working as a farmer who helps her husband in farming

Jenny Rose Asistin is a Registered Nurse currently being a voluntary nurse @ CISDH

Jay-Mar Asistin isa a 1st year College IT(Information Technology) Student Estimated income per month is 3000 pesos

B. Adequate to meet their basic needs Asistin Family is belong to a poor family, most of the time they depend to Mr. Asistin income as a farmer, but still not enough to meet their daily family needs because he is not everyday having an income in their farm. So most of the time they budget their money to only special things they needed. b. Who makes decision about the money and how it is spent Mr. Asistin is the decision maker regarding financial purposes. But instances like choosing food to be serve is decided to all family members. 2. Education attainment of each member of the family Members of the family Ignacio Asistin Anita Asistin Jenny Rose Asistin Jay-Mar Asistin 3. Ethnic background and religious affiliation All member of the family are Filipinos and Roman Catholics Educational Attainment Elementary Graduate High School Graduate College Graduate Undergraduate

C. Environmental Factors
1. Housing The house is concrete made with 4 meters by 4.5 meters in measurement. The distance from neighboring house is approximately 2 meters north, 2meters west. a. Adequacy of living space Uncongested, but has a poor environmental sanitation due to improper

garbage disposal, there is enough space for the whole family members. b. Sleeping Arrangement Measurements of bedrooms 3 by 3 meters. The house has 2 bedrooms and they sleep in the living room due to the father and son watching the TV making the other members join them.

c. Presents of insects and rodents Flies, mosquitoes, cockroaches and some mice present in the house. Those insects can transmit different diseases such dengue and others. d. Adequacy of furniture appliances The family has T.V. set, electric fan, DVD set, radio am/fm e. Presence of accidents and hazards The present of mosquito carrying a disease. Fire hazards because they are using dalikan for cooking their food and pointed fences around their house. f. Food storage and cooking facilities They keep their food in a refrigerator but sometimes they just cover it to prevent invasion of flies. g. Water supply The water resources that they use primarily come through the water district but sometimes through hand pump in their neighborhood. According to Mrs. Asistin they used to boiled their drinking water but sometimes it takes a long time to do the preparations. h. Toilet facilities They are using water sealed toilet. i. Drainage An open drainage, which flows in their backyards and observed a presence of mosquitoes, some flies and presence of unnecessary smell. 2. Kind of Neighborhood The house is located at a near farm theres adequate space from the neighborhood 3. Social and Health Facilities Availability Barangay Turod, Narvacan is situated at the south from their RHU but needs motorized vehicle to arrive at the RHU.

4. Communication and Transportation Facilities

 Asistin Family has cell phone for communication but has no vehicle for transportation

D. Health Assessment of Each Member

1. Medical and Nursing History Indicating Past and Present Significant Illness And Beliefs: Mrs. Anita Asistin normally delivered all of her children in their house. They are only suffering from cough and colds. Mr. Ignacio Asistin is suffering from asthma. The last asthma attack to him was last month. Mr.Ignacio Asistin is also suffering from Hypertension. 2. Nutritional Assessment All of the member of the family have not yet found of any allergic reaction in their body to any particular food. a. Anthropometric Assessment Name Ignacio Asistin Anita Asistin Jenny Rose Asistin Jay-Mar Asistin Age 39 y/o 43 y/o 21 y/o 17 y/o Height 5 5 51 5 5'7" Weight 56 kg 63 kg 51 kg 50 kg

 Cephalocaudal assessment of each member of the family

Body parts Head

Ignacio Asistin
Proportional to body size

Anita Asistin
Proportional to body size

Jenny Rose Asistin

Proportional to body size with good visual acuity pupils equally round and reactive to light

Jay-Mar Asistin
Proportional to body size with good visual acuity pupils equally round and reactive to light -discharges and patent nose With free earlobes and small auricles which are symmetrical able to close and open mouth proportional to body size with normal breath sounds Round abdomen but not flabby with good skin turgor symmetrical

Eyes

with good visual acuity pupils equally round and reactive to light -discharges and patent nose With free earlobes and small auricles which are symmetrical able to close and open mouth proportional to body size heart rate: 99 beats/min Round abdomen but not flabby with good skin turgor symmetrical

with good visual acuity pupils equally round and reactive to light -discharges and patent nose With free earlobes and small auricles which are symmetrical able to close and open mouth proportional to body size with normal breath sounds Round abdomen but not flabby with good skin turgor symmetrical with fine capillary

Nose

-discharges and patent nose With free earlobes and small auricles which are symmetrical

Ears

Mouth

able to close and open mouth proportional to body size with normal breath sounds Round abdomen but not flabby with good skin turgor symmetrical

Neck

Chest

Abdomen

Upper extremities

Nails

with fine capillary

with fine capillary

with fine

on both extremities
Can move freely

on both extremities
Can move freely

on both extremities
Can move freely to

capillary on both extremities

Lower extremities

to its desired range of motion (flexion, extension,

to its desired range of motion (flexion, extension,

Can move freely its desired range of to its desired motion (flexion, range of motion extension, abduction, (flexion,

abduction, adduction)

abduction, adduction)

adduction)

extension, abduction, adduction)

b. Dietary History They eat thrice a day, sometimes with snacks in the morning and the afternoon. They eat anything vegetables, poultry, fruits, rice, fish and meats except for Mr. Ignacio Asistin for he has high blood pressure. Mr. Ignacio Asistin loves to eat meat especially internal organs, it also known to be the cause of her HPN.

c. Eating Habits and Practices Most of the time they eat their meals together.

E. Values and Practices on Health Promotion/Maintenance and Disease Prevention

1. Immunization status of the children All children of Asistin Family completed all their immunization. 2. Preventive health services The family goes to RHU whenever they are sick except for cough and colds especially when Mr. Asistin feels that her blood pressure arises. If Mr. Asistin is attacked by her asthma, they have already nebulizer to decrease the occurrence of his diseases. 3. Adequacy of sleep All the member of the family sleeps 8-9 hours a day except for Mrs. Asistin because she has to wake up early to prepare their food especially during school days. Sometimes Mr. Asistin also awakes early in the morning to work to their farm.

4. Exercise Mr. Asistin considers his work as exercise and sometimes if he had time, he is jog and walking along their farm to guard it from birds and insects.

5. Relaxation All of the family watching television especially when Budoy begins and serves as their relaxation.

6. Stress management They just neither sleep nor sit when they feel stress and watching television. If symptoms become worse, they go immediately to the nearest RHU center.

IV. TYPOLOGY OF THE PROBLEM

1. First Level of Assessment 2. a. Presence of health threat: 1) threat of cross infection 2) their supply is not enough all the needs of the family 3) accident hazard such as: Pointed sharp objects like the fence Stagnant water around their home Fire hazards 4) poor environmental sanitation Presence of insects like mosquitoes Improper garbage disposal Unsanitary water

5) unsanitary food handling and preparation Eating with bare hands eating half cooked foods (kilawin) 6) unhealthy lifestyle and personal habits/practices Inadequate rest and sleep of Mr. and Mrs. Amor Self-medication Poor personal hygiene

b. Presence of health deficits: Presence of illness like asthma by Mrs. Anita Asistin and hypertension to Mr. Ignacio Asistin

c. Presence of stress/forceaceable crisis 1. fear of unemployment 2. children going to school

3. Second Level of Assessment

5 Tasks:
a. Inability to recognize the presence of problems due to ignorance, fear of consequences of the diagnosis of the patient; whether it be social or economic: The family cannot recognize some health problems due to ignorance, even though they can recognize other some basic health problems such as fever, hypertension, and colds and cough etc. b. Inability to make decisions with respect to taking appropriate health action The family cannot make decisions what appropriate actions will do regarding health problems due to lack of time because of work, and some negativity in their lifestyle.

c. Inability to provide nursing care to the sick, disabled, dependent, vulnerable at risk member of the family due to: Lack of appropriate knowledge regarding health problems. Inability to recognize the importance and value of health to the family. Lack of community resources. Lack of knowledge regarding the importance of nursing education to the family. d. Inability to provide a home environment which is conducive to health maintenance and personal development due to: Lack of financial resources Inability to provide health mediums and the importance of environmental sanitation through the family. e. Failure to utilize community resources for health care due to: Lack of responsibility through health problems. Unavailability of the family to provide community resources.

V. PRIORITIES OF THE PROBLEM/SCORING

CRITERIA 1. Nature of the problem >health threat 2. Modifiability of the problem >easily modifiable 3. Preventive Potential >high 4. Salience >some problem felt

Presence of Diseases (Asthma and Hypertension)

COMPUTATION 2/3x1 ACTUAL SCORE 0.66 JUSTIFICATION >the problem must need immediate attention because some carry a diseases >the problem can be easily solved >the problem has a very high to be solved >the problem has low chance to be solved

2/2x2

3/3x1 1/2x1

1 0.5 Total: 4.16

Presence of insect (Presence of mosquitoes, cockroaches and mices) CRITERIA 1. Nature of the problem >health threat 2. Modifiability of the problem >easily modifiable 3. Preventive Potential >high 4. Salience >some problem felt Threat of cross infection CRITERIA 1. Nature of the problem >a health threat COMPUTATION 2/3x1 ACTUAL SCORE 0.66 JUSTIFICATION >because there neighbor house are to near to each other, their kids are susceptible to infection >the problem is easily modifiable >the problem has a high chance to be solved >inability to identify the problem COMPUTATION 2/3x1 ACTUAL SCORE 0.66 JUSTIFICATION >the problem must need immediate attention because some carry a diseases >the problem can be easily solved >the problem has a very high to be solved >the problem has low chance to be solved

2/2x2

3/3x1 1/2x1

1 0.5 Total: 4.16

2. Modifiability of the problem >partially modifiable 3. Preventive Potential >high 4. Salience >some felt

2/2x1 3/3x1 1/2x1

1 1 0.5 Total: 3.16

Stress provoking factors(unemployment, children going to school)

CRITERIA 1. Nature of the problem > health threat 2. Modifiability of the problem > not modifiable 3.Preventive Potential > high COMPUTATION 2/3x1 ACTUAL SCORE 0.66 JUSTIFICATION >the problem needs immediate attention because stress lead to hypertension of Mr. Ignacio Asistin. >the problem has low possibility of prevention >the problem has a high possibility to be solved since Mr. Ignacio Asistin drink only sometimes >the problem needs immediate attention

0/2x2 3/3x1

0 1

4. Salience > problem not need immediate attention

1/2x1

0.5

Total: 2.16 Presence of accident hazards(pointed fences, scattered broken glasses) CRITERIA Nature of the problem -health threat Modifiability if the problem -easily modifiable Preventive potentials -high Salience -problem but not needing immediate attention Legend: Nature of the problem Health Threat =2 Health Deficit = 3 Foreseeable crisis = 1 Modifiability of the problem Easily modifiable = 2 Partially modifiable = 1 Not modifiable = 0 Preventive Potentials High = 3 Moderate = 2 Low = 1 1 2 1 COMPUTATION 2/3x1 2/2x 2 3/3x 1 1/2x 1 ACTUAL SCORE 0.66 2 1 0.5 JUSTIFICATION The family is prone to accident Can be prevented by organizing what he had used after fishing They just need to be organized They used to put the fishing equipments anywhere.

Total; 4.16

Salience

Serious problem needing immediate attention = 2

Problem but not needing immediate attention = 1 Not felt as a problem = 0

Prioritization of Problems:

1. Presence of Diseases 2. Presence of insect 3. Threat of cross infection 4. Stress provoking factors 5. Presence of accident hazards

VI. FAMILY NURSING CARE PLAN

Health Problems 1. accident hazard such as: pointed sharp objects like the fence unsafe water fire hazards > lack of knowledge regarding hazardous accident > unavailability to provide solution of the problem Family Nursing Goal of Care Problems > unable to identify the presence of the problem >After a nursing intervention, the family will now be able the appropriate action on how to prevent and eliminate the problem involve > After rendering a nursing intervention the provide solution to the problem >inform the family that using the dalikan can cause fire hazard if it is not use properly and must be not to near to the house >Encourage the family the importance of Objectives of the Care Intervention Measure Method of Nurse- Resources Required Family Contact >home visit >observation of the surroundings. >nurse-family interaction >time and effort of the nurse and family to discuss the problem >expenses for the transportation of the nurse

> After a nursing intervention, the family will keep all the pointed sharp objects on proper place

>Inform the family the proper preventive measure on how to manage the accidental hazards to the family

family will be give time to environmental sanitation

3. poor environmental sanitation inadequate living space presence of insects like mosquitoes improper garbage disposal unsanitary water

> a wider space is needed for the family for them to provide and implement the proper garbage waste disposal > insufficiency of knowledge regarding different diseases that may give when the environment has present of rodent insects

>After nursing care intervention , the family will give much time to clean and proper garbage waste disposal

>After nursing care intervention, the family will be able to throw their garbage in appropriate place, and know the importance of a clean environment

>imparting knowledge on how to segregate the garbage, cleaning the surrounding to eliminate the different disease infecting to their family >advising to boil first the water they are drinking to avoid diarrhea and other.

>home visit

>effort of studying the problem >nurse-family interaction >expenses for the transportation of the nurse >observation of the surrounding

VII. RECOMMENDATIONS
The family should know what symptoms they need to report to physician and when to seek immediate assistance specially now that they are old and many problem and complication may arise. The family should be aware regarding different problems may encounter to be easily solved and should learn the basic principles on a healthy environment. Inform the client to obtain a clean, organize and healthy environment to avoid such infectious diseases. Inform the client to obtain a clean, organize and healthy environment to avoid such infectious diseases. The environment where the family was living should be improved for better health, Able to know the different nature of the problem to apply a proper solution of the problem. They should work hand-in-hand in cleaning their surroundings.