PROBLEM LIST

PROBLEM IDENTIFIED Cough and Colds Fall Hazards Improper Garbage Disposal Seizure Cigarette Smoking

DATE IDENTIFIED January 15, 2013 January 14, 2013 January 15, 2013 January 14, 2013 January 14, 2013

DATE EVALUATED January 29, 2013 January 29, 2013 January 29, 2013 January 29, 2013 January 21, 2013

SCORE 4.5 4.1 3.6 4.0 2.2

Prioritization of the Problem

A health problem is a situation or condition which interferes with the promotion and/or maintenance of health and recovery from illness or injury. A health problem becomes a nursing problem when it can be modified through nursing intervention. After data analysis, the nurse encounters a number of health problems which cannot be taken up all at the same time considering the available resources of both the family and the nurse. Considering this situation, the nurse should establish priorities by ranking the identified problems. There are four criteria for determining priorities among health problems. These include: Nature of the problem presented- categorized into health threat, health deficit, and foreseeable crisis; Modifiability of the problem- refers to the probability of success in minimizing, alleviating or totally eradicating the problem through nursing intervention; Preventive potential- refers to the nature and magnitude of future problems that be minimized or totally prevented if intervention is done on the problem under consideration;

Salience- refers to the familys perception and evaluation of the problem in terms of seriousness and urgency of attention needed.

Scale for Ranking Family Health Problems According to Priorities Criteria Nature of the problem presented Scale: health threat- 2 health deficit- 3 foreseeable crisis- 1 Weight 1

Modifiability of the problem Scale: easily modifiable 2 partially modifiable- 1 not modifiable- 0

Preventive potential Scale: high 3 moderate- 2 low- 1

Salience Scale: a serious problem, immediate

attention needed-

a problem but not needing immediate attentionnot a felt problemScoring: Decide on a score for each area. Divide the score by the highest possible score and multiply by the weight. X weight 1 0

Sum up the scores for all criteria. The highest score is 5, equivalent to the total weight.

Cough and Colds Criteria

Computation
3/3x1

Actual Score
1

Justification
It is classified as a health deficit because of the actual alteration in the bodys immune response. Cough and colds signify that there is an ongoing viral and/or bacterial infection in the body, most particularly in the respiratory system, that we often get from the air we breathe in. It is easily modifiable since resources are available and feasible such as the presence of Lagundi plant in the community and the availability of the mother. The possibility of preventing coughs and colds is high because it can be prevented through proper personal hygiene, proper nutrition and environmental sanitation alone. The family is recognizing the problem and needs immediate action because of their observed frequency of visits in

Nature of the problem

Modifiability

2/2x2

Preventive potential

3/ 3x1

Salience

2/2x1

0.5

their children. Total Score: 4.5

Fall Hazard Criteria

Computation
2/3x1

Actual Score
0.6

Justification
It is classified as a health threat since it is conducive to cause an accident. Upon observation, the house is situated at the river bank, without any fence that will serve as a barrier for anyone not to slide off or fall into the deep river just below the bank. It is easily modifiable since resources are available and feasible such as the woods for fencing. The possibility of falling can be prevented if river bank is fenced and if the parents will learn about some preventive measures to prevent accidental falls. The family does not recognize this as a problem or a felt problem.

Nature of the problem

Modifiability

2/2x2

Preventive potential

3/ 3x1

Salience

0/2x1 Total Score:

0 3.6

Improper Garbage Disposal Criteria

Computation
2/3x1

Actual score
0.6

Justification
It is a health threat because the garbage thrown in the river can worsen the problems of flooding, of which during times of floods, the family and the community as well will be ones affected for insect-borne illnesses and clouding and contamination of the water supply. It is easily modifiable since resources are available and feasible in the community such as doing garbage segregation with the use of available sacks/ cellophanes, and woods, and

Nature of the problem

Modifiability

2/2x2

Preventive potential

3/3x1

Salience

1/2x1

0.5

regularly placing their garbage in a sealed sack or cellophane near the road or highway for easier collection by the Barangays Garbage Collectors. The problem can be prevented if there is an appropriate action and compliance to the Barangays waste disposal program from the family. The family recognized this as a problem but does not need immediate action.

Total Score:

4.1

Seizures Criteria

Computation
3/3x1

Actual Score
1

Justification
It is classified as both a health deficit and a health threat because a person of this illness has already had a lifetime predisposition of attacks yet it can be prevented and/or managed with medications. Also, it is a health threat because when this attacks, it may cause fatal injuries to the person. As asked, the child already had 4 episodes of seizure attacks and the most recent was when we had our duty in the area and according to his parents, the attack was sudden and was of longer duration. The problem is partially modifiable because it cannot be totally modified because of the lifetime predisposition of the person who has this disorder, because the problem with seizure is the brain activity itself. A person of this disorder will possess it throughout his lifetime, however, the frequency of attacks and the likelihood of falls, brain injury, airway obstructions and other fatal injuries can be prevented with proper

Nature of the problem

Modifiability

1/2x2

Preventive potential

3/ 3x1

Salience

2/2x1 Total Score:

1 4.0

knowledge and understanding of the seizure precautions. The possibility of preventing or managing this brain activity disorder is high because the likelihood of incidence or occurrences can be managed with proper anti-seizure drugs maintenance, eliminating triggering stimuli and instituting seizure precautions to ensure safety of the child when seizure attaks. The family is recognizing the problem that needs immediate action.

Cigarette Smoking Criteria

Computation
2/3x1

Actual score
0.6

Justification
It is a health threat because this practices or habit precipitates the development of many respiratory and cardiovascular diseases, such as TB, COPD, Stroke, Hypertension, atherosclerosis and the like. It is partially modifiable because cigarette smoking is an addicting practice that is hard to be eliminated in ones system however with strong determination, motivation and family support, it is not impossible. However, it will take time to be eliminated. The problem is moderately preventable if addiction to cigarettes at an earlier time will be achieved. Not a felt problem by the family.

Nature of the problem

Modifiability

1/2x2

Preventive potential Salience

2/3x1

0.6

0/2x1 0 Total Score: 2.2

FAMILY NURSING CARE PLAN

Problem 1: Cough and Colds Date Identified: January 15, 2013 Date Evaluated: January 29, 2013 Family Nursing Problem: Inability to make decisions with respect to taking appropriate health actions due to lack of adequate knowledge or insights as to alternative actions or home remedies open to them. Cues: Subjective: "Ubo, Sip-on mao jud na ang permi na problema sa akong mga anak kay sige ra na sila ug ubhon ug sip-on." Objectives: Youngest son frequently plays outside with soil or anything he finds under the son. Family eats with bare hands most of the time. Facial towel used by the youngest son seen to be left anywhere. Youngest son bites his hand or puts his hand in his mouth oftenly. Home enironment is surrounded with dried leaves and tiny pieces of cut woods. Youngest son is seen to wipe off his mucus in his face. RR: 32 cpm Goal of Care: Short Term: Within 1 hour of nursing care and management, the family will be able to: Develop conscious awareness about their felt health problem of cough and colds. Long Term: Within the two home visits, the family will: Be able to gain knowledge about cough and colds; Will prevent the reoccurrence or frequency of occurrence of the disease in the future. Objectives: Short Term: Within 1 hour of nursing care and management, the family will be able to: Acquire idea and information about the disease including signs and symptoms of the disease, immediate health care assistance, and preventive measures; Enumerate ways on how to prevent occurrence of the disease; Long Term: Within the two home visits, the family will be able to: Utilize resources available in the community in resolving the problem; Demonstrate alternative ways or remedies available at home. Interventions:

 Assess the familys status of personal hygiene. R: Personal hygiene plays a very important role in the transmission of microorganisms that cause cough and colds. Discuss with the family the cases and effects, signs and symptoms, common causes, and complications of cough and cold. R: Understanding the cause, effects, signs and symptoms and complications of cough and colds helps gain participation and involvement of the family in the care f their sick member. Explain the importance of proper food preparation, good nutrition, rest and sleep in strengthening ones resistance against illness, so as to prevent occurrence of cough and colds. R: Strengthened immune system helps the body fight against infection. Cite ways in eliminating the disease and limiting the occurrence of transmission by suggesting course of actions such as: Use of alternative home medications such as Lagundi Syrup, Ginger Tea, Honey and Calamansi Syrup, and Garlic with Honey Tea; R: These home remedies help provide pharmacologic effects without the risks of adverse effects compared to over-the-counter drugs, thereby empowering the family in solving their health problems. Covering mouth of the member with cough and colds when sneezing or coughing; R: Cough and Colds are transferred via droplets thus covering the mouth when coughing or sneezing would help prevent transmission. Proper disposal of nasal or oral discharges. R: To prevent further transmission of the microorganisms through air. Increase fluid intake and have an adequate rest and sleep. R: To replenish fluid loss and to aid in loosening the secretions in the respiratory tract. Demonstrate proper personal and environmental hygiene among all family members such as: Washing hands very often; R: Hand washing is the one of the most effective ways of preventing transfer of microorganisms. Cleaning and/or dusting the house as well as the surroundings to prevent acquiring the disease. R: Dusts, Pollens and allergens are also one of the common causes of cough and colds. Teach the family how to prepare the Lagundi Syrup, its indication and dosage. R: To help the family gain skills on how to remedy cough and colds at home thereby empowering them.

 Provide information on the health centers in the vicinity for immediate care assistance. R: To give the family knowledge about the presence of available health services. Evaluate the family. R: To assess the effectiveness of the care provided. Evaluation: Short Term: Goal met. After 45 minutes of nursing care and management, the family was able to show understanding on the nature of the disease process, their signs and symptoms, common causes and alternative ways or home remedies as evidenced by the mother's verbalization of: "Oo, nakasabot nako nganong magkasipon ug ubo sila, kasagaran diay hinungdan kay virus. Nakat-unan pud nako na maayo jud na maghugas ug kamot permi, unya kung naay ubhon o sip-on sa amu dapat manampong para dili makatakod. Dili pud diay maayo ng mupalit ug tambal labina antibiotic sa tindahan o parmasya, mas maayo pa diay ug maghilada o magbuhat ug halada, paimnon ug dugos akong mga anak." Long Term: Goal met. After the first home visit, the family was able to utilize resources available in the community in resolving the cough and colds such as garlic, Lagundi leaves and honey, doing frequent handwashing as observed and maintaining cleanliness of their home environment and the family was able to demonstrate active participation during the Structured health teachings about cough and colds and the actual demonstration on how to make the lagundi syrup.

Problem 2: Improper Garbage Disposal Date Identified: January 15, 2013 Date Evaluated: January 29, 2013 Family Nursing Problem: Inability to provide a home environment conducive to health maintenance and personal development due to inadequate knowledge of importance of hygiene and sanitation and lack of skill in carrying out measures to improve home environment. Cues: Subjective: Naa man mi saku peru dili lage matarung ug labay, usahay magsagulsagul na. Usahay pud malabug namu sa kilid sa suba. Unsahay pud among sunugon. Objectives: Presence of plastics and wrappers on the riverside-at the back of their house.

Improper garbage segregation-only 1 container with assorted garbage/trash Presence of decomposing leaves and pieces of broken firewood contained in an open area Presence of compost pit full of mixed trash and already covered with soil. Residus from washed dishes are thrown directly to the river. G0al 0f care: After nursing interventions, the family will be able t0 attain a much conducive environment for health by d0ing and maintaining proper garbage disposal. Objectives: Within 4 hours of nursing interventions, the family will be able t0: Recognize the vitality 0f proper garbage disposal; Determine the possible disadvantages 0f throwing the garbage anywhere; Build a set 0f garbage containers that separate the recyclables, non-biodegradables and biodegradables; Identify 0ther alternatives and methods that observe proper waste disposal and sanitation. Interventions: Assess with the family the existing problem including the effects 0f such problem t0 the family. Rationale: Identifies what level d0es the family considers it as a health problem. Ask the family h0w long d0es the members practice the current disposing act and ask also the family any alternatives they applied previously t0 address such problem. Rationale: Determines how the family responded t0 address the problem. Discuss to the family membes the importance of proper garbage disposal 0n the familys health emphasizing its advantages and benefits. Rationale: Relating it directly to health can help encourage the family address the problem. Encourage the family that they can still address the problem with their willingness and help them think about the alternatives or available opti0ns. Rationale: Positive attitude toward the problem can encourage the family do the necessary actions. Help the family modify and manipulate the available resources and help them think on h0w to create an alternative that consumes readily available resources. Rationale: Empowers the family to decide for their own and help them realize the said alternatives successfully. Help the family builds an alternative waste segregation system and help them identify and secure the needed resources. Rationale: Empowers the family t act for their own welfare. Segregation system provides a simple but effective waste segregation and disposal. Instruct the family members on h0w to maintain such system and encourage the family to religiously dispose all their garbage to the garbage truck as scheduled. Rationale: Doing such, cleanliness will be maintained and it provides a hassle-free way t0 the family since they d0nt need t0 worry if the container is already full. Evaluation:

Objectives: Goal Met. After 4 hours of nursing interventions, the family was able to recognize the importance of proper garbage disposal, and the possible disadvantages of improper the improper way as evidenced by Mrs. X verbalization of: "Lage Ma'am, Sir, kanang dautan man jud ang dala anang dili sakto na paglabog sa basura pero tungod kay wala mi saktong basurahan pud mao tapulan mi mulabog sa among basura sa saktong lugar o pamaagi. Pero karon, paninguhaon namu na mautro na na kinaiya kay sa amo ra man gihapon balik ang dautan na resulta ana", and the family was also able to partake great effort and active involvement and compliance in the garbage segragation as evidenced by the presence of garbage containers that separate the recyclables from biodegradables and the non-biodegrables, and by their affirmation that they will submit their garbage whenever containers were full to be collected by the Barangay Garbage Collectors.

Problem 3: Seizure Date Identified: January 14, 2013 Date Evaluated: January 29, 2013 Family Nursing Problem: Inability to manage the condition due to the lack of knowledge regarding its management and care. Cues: Subjective: Nag-convulsion na siya bag-o pa lang adtong naa bitaw mo, pagkahapon ato. Ikaupat na to niya pagconvulsion sukad pagkabata. Ang mga una kay tungod man daw sa UTI. Objectives: The youngest child had fever at 38 degrees Celsius after he had convulsive episodes. (Assessed upon Check up at ADNPH). The house had two narrow wooden stairs without hand grip. The House is located at the river bank. The child is observed to be wandering and playing around without supervision. The child is very hyperactive at play. Goal of Care: Within 4 hours of nursing interventions, the family must be equipped with the necessary knowledge they need in dealing with the situation. Objectives: Within 4 hours of nursing interventions, the family: Will be able identify the cause and effect of the disease. Know the appropriate intervention to make during seizure episodes. Interventions: 1. Establish rapport.

Rationale: Rapport is vital to a trusting nurse-family relationship. 2. Prepare the necessary equipments needed. Rationale: To organize work and save time for more important things. 3. Inform the family about the visit. Rationale: To facilitate provision of care in the familys convenience to help gain cooperation. 4. Analyze with the family the problems measles and cough. Rationale: To help family understand the nature and cause of the disease. 5. Health education about the diseases and its management through a structured health teaching. Rationale: Lack of sleep, flashing lights and prolonged television viewing may increase brain activity that may cause potential seizure activity. 6. Explore with the patient the various stimuli that may precipitate seizure activity and enumerate to the family the danger signs they need to watch out for namely: > Unusual smells, tastes, or feelings > Unusual experiences 'out-of-body' sensations; feeling detached; body looks or feels different; situations or people look unexpectedly familiar or strange > Feeling spacey, 'fuzzy', or confused > Jerking movements of an arm, leg, or body > Tingling, numbness or feelings of electricity in part of the body > Headaches > Unexplained confusion, sleepiness, weakness > Losing control of urine or stool unexpectedly Rationale: Enables the patient to protect self from injury. Family will in turn know what to watch out for to their child. 7. Discuss with the family the appropriate courses of action. * Maintain strict bed rest if prodromal signs or aura experienced. Rationale: Patient may feel restless to ambulate or even defecate during aural phase, that inadvertently removing self from safe environment and easy observation. * Turn head to side or suction airway as indicated. Insert plastic bite block only if jaw are relaxed. Rationale: Help maintain airway and reduces risk of oral trauma but should not be forced or inserted when teeth are clenched because dental or soft-tissue may damage. * Cradle head, place on soft area, or assist to floor if out of bed. Rationale: Gentle guiding of extremities reduces risk of physical injury when patient lacks voluntary muscle control. * Reorient patient following seizure activity. Rationale: Patient may be confused, disoriented after seizure and need help to regain control and alleviate anxiety.

Evaluation: Goal Met. After 3 hours of nursing interventions, the family was able to identify the cause and effect of the disease and know the appropriate interventions to make during seizure episodes, as evidenced by Mrs. X's verbalization of: " Ahh mao ba Ma'am, seizure diay ang tawag ana, diili lang diay siguru simple na convulsion lang nuh kay kadaghan naman nahitabo sa iya. Dapat jud diay todo bantay mi ani niya kay basin atakehon siya unya wala'y makatabang... Kabalo na mi unsaon amu buhaton pag-atakehon siya, ang dapat namu siguruon ang iyang ulo, unya kanang dili sya mabuntak o mabagok, ug dapat sa pagmata niya i.orrient namu siya."