Name of the patient : Master Gaurav

Age : 5 years
Sex : Male
Address : house no 32
Religion : Hindu
Date of study begin : 8/01/2010
Date of study end : 30/01/2010
Diagnosis :

INTRODUCTION:
Health is a state of physical, mental and social well being and not merely the
absence of any diseases or deformity. If anyone among the family is affected the
whole family is affected. Hence health maintenance in every individual in the family
leads to a happy family. Health of the family plays a vital role in the community it
belongs. It is the responsibility of the health nurse to meet all the serious needs of the
family and community and to take appropriate measure to solve them.
I have selected Master Gaurav’s family for my family care study. The family is
a nuclear family. There are three children in the family. Elder one is 9 years old, the
second one is 7 years and the younger one is 3 years old whom I have selected.
The mother has a lack of knowledge about environmental sanitation, hygiene
etc. The child has dengue and our aim is to educate the mother about environmental
sanitation.

OBJECTIVES:
 To learn the disease prognosis of the child in practical
 To create awareness about hygienic practices and its relation to health.
 To gain insight into the family
 To provide promotive health care to the child who is suffering from chicken pox.
 To improve family coping ability
 To utilize the community health resources.

ABOUT THE DISEASE

DENGUE:

DEFINITION: Dengue is a viral disease .It is transmitted by the infective bite of Aedes
Aegypti mosquito. Man develops disease after 5-6 days of being bitten by an infective
mosquito. It occurs in two forms: Dengue Fever and Dengue Hemorrhagic Fever (DHF)
Dengue Fever is a severe, flu-like illness .Dengue Hemorrhagic Fever (DHF) is a more
severe form of disease, which may cause death. Person suspected of having dengue fever
or DHF must see a doctor at once.
LIFE CYCLE:

DIAGNOSIS:
The main diagnostic features of scabies are
1) Patient complains of Abrupt onset of high fever.
2) Severe frontal headache
3) Pain behind the eyes which worsens with eye movement
4) Loss of sense of taste and appetite
5) Measles-like rash over chest and upper limbs
6) Nausea and vomiting
7) Muscle and joint pains

PERIOD OF COMMUNICABILITY

Infected person with Dengue becomes infective to mosquitoes 6 to 12 hours before the
onset of the disease and remains so upto 3 to 5 days.

FAVOURED BREEDING PLACES

Desert coolers, Drums, Jars, Pots, Buckets, Flower vases, Plant saucers, Tanks, Cisterns,
Bottles, Tins, Tyres, Roof gutters, Refrigerator drip pans, Cement blocks, Cemetery urns,
Bamboo stumps, Coconut shells, Tree holes and many more places where rainwater
collects or is stored.

CONTROL OF DENGUE/ DENGUE HAEMORRHAGIC FEVER

TREATMENT OF DENGUE & DHF

 Prevention is better than cure
 No drug or vaccine is available for the treatment of Dengue/DHF
  The control of Aedes Aegypti mosquito is the only method of choice
 With early detection and proper case management and symptomatic treatment,
mortality can be reduced substantially

VECTOR CONTROL MEASURES

1.PERSONAL PROPHALATIC MEASURES

 Use of mosquito repellent creams, liquids, coils, mats etc.

 Wearing of full sleeve shirts and full pants with socks

 Use of bednets for sleeping infants and young children during day time to prevent
mosquito bite

2. BIOLOGICAL CONTROL
 Use of larvivorous fishes in ornamental tanks, fountains, etc.
 Use of biocides

3. CHEMICAL CONTROL
 Use of chemical larvicides like abate in big breeding containers
 Aerosol space spray during day time

4. ENVIRONMENTAL MANAGEMENT & SOURCE REDUCTION METHODS

 Detection & elimination of mosquito breeding sources

 Management of roof tops, porticos and sunshades
 Proper covering of stored water
 Reliable water supply
 Observation of weekly dry day

5. HEALTH EDUCATION

 Impart knowledge to common people regarding the disease and vector through
various media sources like T.v., Radio, Cinema slides, etc.

6. COMMUNITY PARTICIPATION

 Sensitilizing and involving the community for detection of Aedes breeding places
and their elimination

MANAGEMENT OF DENGUE CASE

 Early reporting of the suspected dengue fever
 Management of dengue fever is symptomatic & supportive
 In dengue shock syndrome, the following treatment is recommended:

 Replacement of plasma losses

 Correction of electrolyte and metabolic disturbances
  Blood transfusion

DO’S AND DON’TS

 Remove water from coolers and other small containers at least once in a week
 Use aerosol during day time to prevent the bites of mosquitoes
 Do not wear clothes that expose arms and legs
 Children should not be allowed to play in shorts and half sleeved clothes
 Use mosquito nets or mosquito repellents while sleeping during day time

ROLE OF NURSE:
In most of the cases initial assessment by the medical staff as followed by
nursing staff. Training nursing staff to take case history to prescribe treatment plan
for the benefit of the patient .Nurse should inquire about the personal hygiene,
sanitation, drainage facilities etc, because this factors play a vital role in producing
the disease.
The nurse should give health education regarding the above measures and take
necessary actions to prevent them. The early signs and symptoms should be
reported to the health departments
Follow up:
Advice the persons to attend the follow up clinic with their child and the nurse
assess the progress of the treatment plan. The assessment is based upon:
 weight change
 present clinical manifestation of disease

SOCIO ECONOMIC BACKGROUND:

COMMUNITY SETTING
1. Name of the child : Master Gaurav
2. Name of the district : Avadh
3. Population
Total Population : 2000
Age Groups:
Infants 0-1 years : 150
Children 1-3 years : 50
3-5 years : 50
5-6 years : 100
7-10 years : 250
10 years : 240
10-14 yrs : 550
15-19yrs : 300
Eligible couples : 90
4. Administration :
5. Main caste group : No Specific group
6. Religion : All kinds of religious people live here. i.e. Hindu,
Muslim and Christian but maximum Hindu
7. Occupation : Agriculture, business,
Birth and deaths are recorded in the Corporation facilities available in the area
and distance is 1 Km.
a) Medical Number Distance
Govt. Hospital 1 3km
Private Hospital 2 4km and 5 km
Private practitioner 3
Health Center 1

b) Social Agencies
No Red Cross and lion club
Youth Organization 1-Social service
Sathy Sai Samithi 1 Orphanage

a) Education
1) Preschool
Balwadi 1
Primary 1
2) Secondary
Vidanjali public school 1
3) College 1

Markets 1
Churches 3
Mosques 1
Temples 5
Post office 1

Developmental programme ICDS

SANITATION:
a) Latrine
Type : RCA
Location: outside the house
Excrete disposal
No of public latrine
b) Waste water disposal
c) Refuse disposal
d) Disposal of the death
e) Water supply
: Through septic tank
:4
: Through drainage
: Cleaned daily by corporation
: Grave yard located at the end of the locality
: through corporation

Name Relation Age Sex Education Occupation income

1.Mr. Mahesh Head of 33yrs M 5th std Business 3000/mth
the family

2. Mrs. Ganga Housewife 29yrs F 3rd std Housewife -

3. Master Sidhart Son 9 yrs M 4th std

- -

4. Master Suresh Son 7yrs M 1st std - -

4. Master Gaurav Son 3yrs M - - -

Family and social relationship:
a) Attitude among family members and neighbors:
The attitude among family members and neighbors are very co-
operative. They can understand others feeling attitude towards people
at other community is good
Description of houses
a) Roof : Asbestos
b) Walls : bricks
c) Floors : cement
d) No of rooms
Only two rooms with verandah. One room is used for general purpose and
the other room as kitchen. The verandah is used for washing and cleaning purpose.
e) Lighting : electricity
f) Furniture : only chairs

Storage of foods and water

Food : vessels
Water : Pots, buckets

Water supply
Well 1
Pipe One in verandah

Washing place
Vessels verandah
Bathing area Bathroom
Latrine RCA the drainage system
Excreta Through septic tank

Surroundings
* Neatness and cleanliness : fair
* Kitchen and garden : Fair
* Where animals are kept : no animals

Family health, attitude beliefs and practice in regard to

a) DISEASE:
Cause and Spread:
It is mainly caused by lack of personal hygiene and environmental sanitation.
It mainly spreads through droplet infection and droplet nuclei.
b) Type of medical aid sought:
They seek medical aid from nearby centre and sometimes from government
hospitals
c) Immunization:
He had undergone all immunization as per date
d) Physical defect:
No physical defect
e) Antenatal care
She told that antenatal mother should take good diet. Then only both the
mother and child will be healthy.
 f) New born care
She told that the baby will be given bath after 7 days. She also told that
during bath oil is rubbed into cord and umbilicus to release heat from the body.
g) Infant feeding:
She told that weaning has started after 6 months

PHYSICAL EXAMINATION:
Name: Master Arun Sex Male Age 3 yrs Organ Remarks
Father’s name : Mr, Mahesh Skin Normal
Mother’s name : Mrs ganga Ear Normal
DOB Nose Normal
Birth history : Normal delivery Throat Normal
Birth weight : 2.4 kgs Teeth Normal
Eyes Normal
Bones Normal
Joints Normal
Hair Normal
Heart Normal
lungs Normal

IMMUNIZATION:
Sl Name of the vaccine Scheduled Route of Given Not given
no time of administration
administration
1. BCG At birth Intradermal Yes

Oral polio vaccine At birth up to Oral Yes

2 years
DPT 6,10,14 wks Intramuscular Yes

MMR 9 mths Subcutaneous Yes

Hepatitis 6,10 wks Intramuscular Yes

ANTHROPOMETRIC MEASUREMENTS:
Height 96m
Weight 12kgs
Head circumference 48m
Mid arm circumference 18cm
Chest circumference 48cm

Name of the mother : Mrs Ganga

Age : 29yrs

Physical Examination
General Appearance : neat and tidy
 Body built : moderate
Head : normal
Hairs and scalp : black with dandruff
Eyes : normal
Ears : normal
Nose and sinus : normal
Mouth / throat : normal
Neck : normal
Chest : normal
Abdomen : normal
Extremities : normal
Respiratory system : normal
Cardio vascular system : normal
Gastro system : normal
Temperature : 98.6 F
Pulse : 82/min
Respiration : 24 beats/ min
Name of the child: Master Gaurav

Nutritional Assesment:
Food Items Ingredients Qty CHO PRO FAT CAL IRON K.Cal
Milk Milk, sugar 100ml+ 4 3.2 4 0.12 65
1 tsp 2.5 10

Idly 2 idlys m.size 2 20 1.6 85

+3tsp 1.5 30
Sugar Sugar

100ml+1 4 3.2 4 0.12 65

Milk Milk, sugar tsp 2.5 10

Cooked rice Cooked rice, 100mg 15 1.6 170

green leaves 25gm 2.4 1.5 17.5
Veg 17
Dal 5gm 3 1.12 30
Oil 1tsp - - 3

Milk Milk, sugar 100ml+ 4 3.2 4 0.12 65

1tsp 2.5 10

255
Cooked rice Cooked rice 150mg 22.5 2.4 17.5
Dal 25mg 2.4 1.5 17
Veg 5mg 3 1.12 30
Oil 1tsp - -

Sambhar Dal 25mg 15 1.5

Oil 5mg 2.4 1.12 3
Veg 1tsp 3 -
Biscuit biscuit 2 14 1 96

21.44gm 990kcal
Summary of Nutritional Status
Name: Master Arun Sex: Male
Age 3years Weight 12kgs
Sl Food constituents Normal value Client value Deficient
no
1. Protein 23g 21.44gm 1.56gm
2. Calories 1300kcal 990kcal 310 kcal

Name : Mrs. Maya Sex: Female

Age 29yrs weight 48kgs

S. Food constituents Normal value Client value Deficient

no
1. Protein 45gm 55.90gm -

2. Calories 2200kcal 2064.5kcal 135.5kcal

Name : Master Arun

Classification : Toddler
Problem : Itching and irritation due to disease condition

Non behavioral factors

Personal-Developmental period Environmental-unhygienic environmental
practice
Behavioral factor
Drinking unboiled water
Knowledge
Lack of knowledge about treatment

Beliefs and customs

Mother believes that the irritation is
due to local allergic reaction and it will
subside slowly

Problem : Malnutrition related to less intake due to disease condition

Non behavioral factors
Personal- poor intake of food due to Environmental factors due to the disease
disease condition the child is suffering from malnutrition

Behavioral factors-keeping thumb in

mouth causes infection’
Knowledge
Lack of knowledge about nutritious and
high calorie diet.

Reinforcing factors
Encouragement from the student nurse
to give nutritious and high calorie diet
prevent malnutrition

Name : Master Arun Age 3yrs

Sex : Male Diagnosis: scabies
Sl Potential problem Level of Health Treatment Reason for
no prevention status closing
1. Scabies Secondary Improved Completed Problem
solved

2. Itching and Secondary Improved Completed Problem

irritation solved

3 Malnutrition Secondary improved completed Problem

solved

Name : Master Arun

Classification : toddler
Problem: knowledge deficit regarding environmental sanitation and hygienic practices
Objective: To gain knowledge about hygienic practices
Non behavioral factors
Personal factor Placing the well I the open space without
lid over it.
Developmental period
Behavioral factors: mother is not looking Placing objects on the floor that makes
after the child properly the baby to keep in the mouth
The child is keeping thing in the mouth

Knowledge:
Lack of knowledge regarding
environmental sanitation

Beliefs and customs

Values: mother values the household
work to be important than giving care to
the child

SUMMARY:
The family that I selected for my care study is a sociable and co-operating
family. Through my care study I identified many problems in the family. I was able to
establish good rapport with the family through out my care study period. I came to
know about the nutritional status, economic status, educational status and their other
activities regarding environmental sanitation and hygienic practices.
Because of the poor environmental sanitation and personal hygiene the child was
suffering from scabies. I educated the mother regarding the environmental sanitation,
hygienic practice and about the treatment plan.
This experience helped me to know all about the family and community.
After care the child has improved a lot in both nutrition and physical status

OBJECTIVES ACHIEVED:
1) The problem of recurrent itching is controlled
 2) Educate the mother regarding the healthy life style and importance of personal
hygiene.

OBJECTIVES TO BE ACHIEVED:
Maintenance of child health status for ever.

BIBLIOGRAPHY:
1) K.Park Text book of social and preventive medicine page 148-150
2) BT Basavanthappa community health nursing page 121-126

ACHARYA COLLEGE OF NURSING

CHOLANAGAR, R.T.NAGAR BANGALORE.
 PAEDIATRIC NURSING

FAMILY CARE STUDY

M.Sc. NURSING PROGRAMME

Submitted to: Submitted by:

Prof Deepesh Joshi
HOD Paediatric Nursing 1st Year M.Sc. nursing
Acharya College of Nursing Acharya College of Nursing
Bangalore. Bangalore.