\V. PRESENT HEALTH STATUS Name: Stephen Joie Inihao (Father) Mr.

Inihao works as a jeep driver and no chances of assessment and interaction. According to her live- in partner, he has no history of cigarette smoking but is a social drinker. He started to drink alcoholic beverages when he was sixteen years old due to peer pressure and the maximum number of bottle alcohol he could take is 1 bottle a day.

Name: Cherry Mae Dadreganda (Mother) Miss Dadreganda doesnt have any health related problems after conducting an assessment. She has no vices. Height: 50 feet Weight:45 kg Vital Signs Temperature Pulse Rate Respiratory Rate Blood Pressure 1st Visit August 2, 2011 37.3 c 83 bpm 20 cpm 110/70 mmHg 2nd visit August 3, 2011 37 c 86 bpm 20 cpm 110/70 mmHg 3rd Visit August 8, 2011 36.5 c 70 bpm 20 cpm 110/70 mmHg Unkempt hair Presence of Dental Carries Presence of Dental Carries Presence of Dental Carries

EENT: [ ] impaired vision [ ] blind [ ] pain [] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesions [ ] teeth [x] no problem RESPIRATION: [ ] Asymmetric [ ] tachypnea [ ] Apnea [ ] rales [ ] cough [ ] barrel chest [ ] Bradypnea [ ] shallow [ ] ronchi [ ] Sputum [ ] diminished [ ] dyspnea [ ] Orthopnea [ ] labored [ ] wheezing [ ] Pain [ ] cyanotic [x ] No problem CARDIOVASCULAR [ ] Arrhythmia [ ] tachycardia [ ] numbness [ ] Diminished [ ]pulses[ ] edema [ ]fatigue [ ] Irregular [ ] bradycardia [ ] murmur [ ] Tingling [ ] absent pulses [ ] pain [x] no problem GASTRO INTESTINAL TRACT [ ] Obese [ ] distention [ ] mass [ ] Dysphagia [ ] rigidly [ ] pain [x] no problem GENITO-URINARY and GYNE [ ] pain [ ] urine color [ ] vaginal bleeding [ ] hermaturia [ ] discharge [ ] nocturia [x] no problem NEURO [ ] Paralysis [ ] stuporous [ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip [x] no problem MUSCULOSKELETAL and SKIN [ ] Appliance [ ] stiffness [ ] itching [ ] petechiae [ ] Hot [ ] drainage [ ] prosthesis [ ] swelling [ ] Lesion [ ] poor turgor [ ] cool deformity [ ] Wound [ ] rash [ ] skin color [ ] flushed [ ] Atrophy [ ] pain [ ] ecchymosis [ ] Diaphoretic [ ] moist [x] no problem

Untrimmed nails, Untrimmed nails

Untrimmed nails, Untrimmed nails Dirty feet, Dirty Feet

Name: Ceana Therese Inihao (eldest child) Upon assessment, the child was observed to have presence scalp due to head allergy. The mother verbalized that her daughter ate chicken the night before she had the allergies. Height: 32 inches Vital Signs Temperature Pulse Rate Respiratory Rate Weight: 8 kg 1st Visit August 2, 2011 37.3 c 120 bpm 30 cpm 2nd visit August 3, 2011 38.0 c 130 bpm 30 cpm 3rd Visit August 8, 2011 36.5 c 120 bpm 28 cpm

EENT: [ ] impaired vision [ ] blind [ ] pain [ ] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesions [ ] teeth [x] no problem RESPIRATION: [ ] Asymmetric [ ] tachypnea [ ] Apnea [ ] rales [ ] cough [ ] barrel chest [ ] Bradypnea [ ] shallow [ ] ronchi [ ] Sputum [ ] diminished [ ] dyspnea [ ] Orthopnea [ ] labored [ ] wheezing [ ] Pain [ ] cyanotic [x] No problem CARDIOVASCULAR [ ] Arrhythmia [ ] tachycardia [ ] numbness [ ] Diminished [ ] pulses [ ] edema [ ]fatigue [ ] Irregular [ ] bradycardia [ ] murmur [ ] Tingling [ ] absent pulses [ ] pain [x] no problem GASTRO INTESTINAL TRACT [ ] Obese [ ] distention [ ] mass [ ] Dysphagia [ ] rigidly [ ] pain [x] no problem GENITO-URINARY and GYNE [ ] pain [ ] urine color [ ] vaginal bleeding [ ] hermaturia [ ] discharge [ ] nocturia [x] no problem NEURO [ ] Paralysis [ ] stuporous [ ] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip [x] no problem MUSCULOSKELETAL and SKIN [ ] Appliance [ ] stiffness [ ] itching [ ] petechiae [ ] Hot [ ] drainage [ ] prosthesis [ ] swelling [ ] Lesion [ ] poor turgor [ ] cool deformity [ ] Wound [ ] rash [ ] skin color [ ] flushed [ ] Atrophy [ ] pain [ ] ecchymosis [ ] Diaphoretic [ ] moist [x] no problem

Allergy(wet), allergy (dry), allergy Presence of earwax on both ears Dental carries, Dental carries

Scars, Scars, Scars Untrimmed nails Untrimmed nails Untrimmed nails

Very Low weight for her age: 8 kg 8 kg 8 kg Fever- 38.0 c

Untrimmed nails Untrimmed nails Untrimmed nails

Dirty feet Dirty feet Dirty feet

Name: Rasheed Inihao (youngest child) The baby doesnt have any health related problems after conducting an assessment. Height: 22 inches Vital Signs Temperature Pulse Rate Respiratory Rate Weight:4 kg 1st Visit August 2, 2011 36.5 c 150 bpm 40 cpm 2nd visit August 3, 2011 36.3 c 144 bpm 44 cpm 3rd Visit August 8, 2011 36.3 c 145 bpm 41 cpm

EENT: [ ] impaired vision [ ] blind [ ] pain [] reddened [ ] drainage [ ] gums [ ] hard of hearing [ ] deaf [ ] burning [ ] edema [ ] lesions [ ] teeth [x] no problem RESPIRATION: [ ] Asymmetric [x] tachypnea [ ] Apnea [ ] rales [x] cough [ ] barrel chest [ ] Bradypnea [x] shallow [ ] ronchi [ ] Sputum [ ] diminished [x] dyspnea [ ] Orthopnea [x] labored [ ] wheezing [ ] Pain [ ] cyanotic [x] No problem CARDIOVASCULAR [ ] Arrhythmia [ ] tachycardia [ ] numbness [ ] Diminished [ ] pulses [] edema [x]fatigue [ ] Irregular [ ] bradycardia [ ] murmur [ ] Tingling [ ] absent pulses [ ] pain [x] no problem GASTRO INTESTINAL TRACT [ ] Obese [ ] distention [ ] mass [ ] Dysphagia [ ] rigidly [ ] pain [x] no problem GENITO-URINARY and GYNE [ ] pain [ ] urine color [ ] vaginal bleeding [ ] hermaturia [ ] discharge [ ] nocturia [x] no problem NEURO [ ] Paralysis [ ] stuporous [x] unsteady [ ] seizures [ ] lethargic [ ] comatose [ ] vertigo [ ] tremors [ ] confused [ ] vision [ ] grip [x] no problem MUSCULOSKELETAL and SKIN [ ] Appliance [ ] stiffness [ ] itching [ ] petechiae [ ] Hot [ ] drainage [ ] prosthesis [ ] swelling [ ] Lesion [ ] poor turgor [ ] cool [x] deformity [ ] Wound [ ] rash [ ] skin color [ ] flushed [ ] Atrophy [ ] pain [ ] ecchymosis [ ] Diaphoretic [ ] moist [x] no problem

VI. INTEGRATED MANAGEMENT ON CHILDHOOD ILLNESS (IMCI) Management of the Sick Child Age 2 Months Up to 5 Years
Name:

Ceana Therese Inihao

Age: 1year old

Sex: Female Weight: 8kg Initial visit: August 2, 2011

Temp.: 36.5C

Address: Zone 6- Bulua Cagayan de Oro City Ask: What are the childs problem? Assess:(encircle all signs present)

Follow-up visit: August 2, 3, 8, 2011

CHECK FOR GENERAL DANGER SIGNS NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN VOMITS EVERYTHING CONVULSIONS DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes____ No *For how long? _____days Count the breaths in one minute. _30cpm_Breaths per minute. Fast breathing? Look for chest indrawing Look and listen stridor DOES THE CHILD HAVE DIARRHEA? For how long? Yes No Look at the childs general condition Abnormally sleepy or difficult to awaken? Restless or irritable? Is the blood in the stool? Look for sunken eyes Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly, thirsty? 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 37.5 C or above) Yes No __ Decide Malaria Risk *does the child live in malaria area? GTB *look or feel for stiff neck. *has the child visited a malaria area in the past $ weeks? *look for runny nose If malaria risk, obtain a blood smear. (+) (Pf) (Pv) (-) not done look for signs of measles: *for how long has the child had fever? 1 days If more than 7 days, has fever been present every day? Generalized rash and Has the child had measles within the last 3 months? 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

YES

NO

No Pneumonia: Cough or Cold No dehydration

Fever: 38.0 c

Decide Dengue Risk: YES________ NO If Dengue risk, then ask: *has the child had any bleeding from the nose or gums look for bleeding from nose or gums Or In the vomitus or stools? Look for skin petechiae Has the child had black vomitus or black stool? feel for cold and clammy extremities. Has the child had abdominal pain? Check capillary refill.____seconds Has the child been vomiting? Perform tourniquet test if the child is 6 Months and has fever for more than 3 Days. DOES THE CHILD HAVE AN EAR PROBLEM? Yes_____ No *is there ear pain? *look for pus draining form the ear *is there ear discharge? *feel for tender swelling behind the ear If Yes, for how long?______days THEN CHECK FOR MALNUTRITION AND ENEMA Look for visible severe wasting. Look for edema of both feet Look for palmer pallor. Severe pal mar pallor? Some palmar pallor? Determine weight for age 8kg Very low? CHECK THE CHILDS IMMUNIZATIONZATION STATUS Encircle Immunizations needed today BCG DPT1 OPV 1 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 the child has ANEMIA or very LOW WEIGHT or iess than 2 years old. *do you breastfeed your? Yes No If yes, how many times in24 hours? 6x_times. Do you breastfeed during the night? Yes No *does uPD6b Does the child takes any other food or fluids? Yes No If Yes, what food or fluids? Water, taho, rice and juices

No ear infection No anemia and not very low weight

Return for next Immunization on: Fully Immunized DATE Vitamin A needed today Yes No_____ Feeding Problem No feeding problem

How many times per day? 3x_times. What do you use to feed the child? _spoon and hands sometimes If very low weight for age. How large are servings? ___________________ Does the child receive his/her own serving? No Who feeds the child and how? Mother through assisting with the use of utensils *During the illness, has the childs feeding changed? Yes______ No If Yes, how? ASSESS OTHER PROBLEMS: None

VII. HOME AND ENVIRONMENT 1.) Home The family doesnt own the house where they presently live but were just living along with the Miss Dadregandas mother. She gave them one small room for the four of them. It was made up of hard materials, hollow block but doesnt have finishing that it looks darks inside during daytime and dirty. It was inadequate for the family members since living room, bedroom and kitchen where too small for the number of household living in the house and was only confine in 30- 40 square meters only and approximately a half meter away from its nearest house. Fluorescence was the source of light of the family. The roof was too low, thus it makes the house hazardous and prone to injury head injury. The house was clean inside but dark and things were disorganized. Clothes were not properly arranged in their improvised cabinet.

2.) Water Supply The source of the familys drinking water was aquasoft mineral water.

3.) Toilet Facilities The family uses pour flush water-sealed toilet. The said toilet was owned by Miss Dadregandas mother and it was shared by three families including them. It was only located inside their house. Its toilet facility was unsanitary. It was a risks for using especially for the very young children. 4.) Kitchen and Cooking Facilities Kitchen was located inside the house. The family used fire woods for cooking. The sanitation in the kitchen was good since it was cleaned and organized. Health threat was noted due to smoke production which can be inhaled by every member of the family. 5.) Garbage Disposal The family uses open burning as their method of garbage disposal and it can be health and environmental hazards but sometimes they brought it near the street for the collection schedule, 50-60 meters away from their house. They put their garbage in plastic cellophane before it was burned or carried for the garbage truck. 6.) Drainage System The family doesnt have a drainage system around their house. The water will flow directly into the ground. 7.) Domestic Animals The members of the family did not owned any domestic animals but there was a dog that they fed. Now, the dog stays longer in their house during daytime. The dog was untidy and the eldest loved to pet the dog. 8.) Neighborhood The neighbors were kind and helpful. They have relatives living near approximately a half meter away from their house. 9.) Community Facilities Health and Social Facilities were not readily available for the family. They had gone to the health center of Bulua but less entertained and referred to the hospital. The mother brought her children to Dr. Lasdoces Clinic at Iponan for consultations if there were problems noted. The Clinic was approximately 5 kilometers away from their residence.

XI. ACTUAL IMPLEMENTATION

WEEK I y y y Look for family to care for in our CHN exposure Chose the Inihao Family for the care study Established rapport with the family and explained to them the purpose of the visit until 2 weeks of duty y Initial interview with the family regarding the family s health and its history

Day 1 august.2,2011 We were able to find a family for the family case study. they were chosen because they suited to the criteria and as we observed they needed health care attention. We ve introduced ourselves to them, and also explained our purpose of coming to them and asked permission to Mrs. inihao that they were the chosen family to be cared of and we ll be going to visit up to next week. We ve established rapport so that by the next visit there will be no hesitation to both parties. During in the interaction we observe that there is a problem in this family as we go on we observe that the family has no proper hygiene in terms of physical like dry skin, untrimmed finger nails, dry hair and dirty feet and we also observe the scalp infection of her daughter. we ve started to take the family s profile and health history. And assessed and have physical examination to the member of the family, but not all of them because the father was at work at that time. Only Mrs. inihao and her daughter were in the house during that time. We ve interviewed them to know what were there perception regarding health. Other than that, we ve started to scale their family coping index and asked their main problem in the community. We look in their surroundings we observe that the area was so unsanitary/unclean which can affect in their health.

Day 2 august.3, 2011 During the 2nd visit we ve had gathered all the needed or lacking data s and assessment. And had documentation each of the family members, their main problems in their house and specially their environment we also observed that the medication container was not properly put in place in her daughter keep play with it.. We ve trimmed the fingernails of the children and instructed the mother regarding proper hygiene. And also assessed the father taking vital signs and assessed his physical appearance; he has dirty fingernails and appears a hardworking person to sustain the needs of the family. . We also gathered our data and had documentation. We also gave those nursing interventions and health teachings to the family to help them improve their lifestyle And Imparted some information about herbal plants which could help to treat some illnesses

Day 3 , august.8, 2011 During our 3rd visit and last day of visit, we assessed the health condition of the family members Discussed to the family members the importance of maintaining a safe home which is conducive for growth and development and free from hazards because it was observed that there are accident hazards in the family s house such as unhammered nails. And also we invited the family to join with our Culminating on august 8 2011 9am we gave some foods to the family and a token for being so nice, approachable and for being cooperative to our activity. And also the family thanks us for helping them to solve their problem and for imparting them some health teachings

XII. RECOMMENDATION

When we had our home visits at the inihao Family, We ve observed that they didn t practiced proper hygiene and do not take a bath daily. So we ve instructed them to take a bath daily and had a proper hygiene to avoid illness. We ve also observed that their dirty kitchen outside the house was prone to accident. Children may play near the kitchen and may accidentally get the fire and we also teach the family to properly label the medication container supply. So we ve instructed the mother to avoid the children from playing near the dirty kitchen and also to hammer well the unhammered nails in their wall. And also we advised them to eat vegetables or any nutritious food and minimize eating dried fish to prevent them from getting any illnesses like UTI and hypertension.

XIII. EVALUATION At the end of 3 days of CHN Exposure, the family benefited from the interventions and health teaching that were given to them. Interventions that were community based were given to treat the health deficit and health threat to the family. And also, health teachings were given as a prevention, promotion and maintenance of health. The main problem of the family was poor home and environmental condition, and the scalp infection of her daughter ,accident hazard and unhealthful nutritional habits which was a health threat. Through the management of the students, they were able to identify their needs, and able to determine what ways to or methods to meet their needs. The family was able to learn some health teachings regarding nutrition and how to maintain it. Planting was encouraged to the family so that they can have some other source of nutritious foods. And also they learn the simple way of healing certain illness using available recourses in the community and understand the importance of good hygiene and cleanliness. The family was able to learn about it and tried to make ways on how to meet these health teachings that is very vital to life and health. The process of making this care study entails a lot of critical thinking and research work. Its understanding is somewhat crucial as student nurses who are still novice in this field of nursing research but it will make us enhance our skills and knowledge, boost our ego and provide a positive outlook of becoming good nurse in the near future.

XV.

Appendices

Pagtugot sa Pamilya

Ako si Mr. / Mrs.___________________________ nagapuyo sa Zone 1, Baikingon nagatugot na kami paga apilon sa usa ka pagtulun-an sa mga estudyante sa Liceo de Cagayan University mahitungod sa among pamilya sulod sa upat ka semana. Lakip niini ang pagkuha ug mga litrato sa tagsa tagsa na myembro sa pamilya ug sa panimalay.

____________________________ pangalan Lagda Ibabaw sa

XIV. BIBLIOGRAPHY

Community Health Nursing Service Section, National League of Philippine Government Nurses, Inc., Community Health Nursing Services in the Philippines, 9 Maglaya, Arceli, Nursing Practice in the Community, 4th Ed. Argonanta Corporation, Marikina City, Philippines, 2004. Kozier et al, Fundamentals of Nursing, 5th Ed. Pearson Education Asia Ptc. Ltd., Singapore, 2002. Lippincott et al, Manual of Nursing Practice, 7th Ed. Philippines Edition. Gopson Papers Ltd, Noida, India, 2001. Integrated Management of Childhood Illness, Department of Health