case data commu cont (repaired)
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Far Eastern UniversityManila
Institute of nursing
Brgy. Maytunas, San JuanAUGUST 2, 2011
Passed to:PROF. TAGAPAN
Passed by:
Group28Pea, Elaine Joy J.
Cabigting Clarisse Jane
Patao, Cristian P.
Ramos, Kaylle Marie R.
Santos, Jear P.
Santos, John Carlo B.
Solis, Mikhail M.
Tabago, Girlie Ann S.
Toreja, Mark Joseph S.
Ventura, Kevin Ace R.
COMMUNICABLE
DISEASE
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Villamor, Katrine A.
Villavicencio, Beverly L.
PRIMARY COMPLEXAn introduction
Primary complex
- It is a type of tuberculosis infection that most often occurs in children. The focus of the
initial infection is a small area in the lungs and lymph nodes.
- Primary complex is acquired when someone inhales the tuberculosis germs of an infected
person. The germs are breathed into the lungs and develop into an infection over a period of
one or two months before spreading to the lymph node, according to Pediatric On Call.
- People infected with primary complex often do not demonstrate any symptoms. However,
they may have a cough or swollen lymph nodes. Primary complex is diagnosed with a skin
test.- Ranks 6th in the leading cause of morbidity and mortality in 2002.
- Incidence rate of Primary Complex is 243/ 100,000 population/year.
- Treatment for Primary Complex TB in children is the use Anti-TB medications and
involves other treatment modalities for it not to be active.
- Mode of transmission: Airborne/ Droplet
- Incubation Period: 4-12 weeks, Average of 8 weeks
- Causative Agent: Mycobacterium Tuberculae
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Pathophysiology
Lower
Respiratory
Tract
CachexiaUpper
Respiratory
Tract
Weight Loss
Consumption
of lung tissue
Hemoptysis
Scarring of
the Lungs
Cavitation
Caseous
Necrosis
Fat
Loss
Increased Basal
Metabolic Rate
Recurrent
FeverInflammation
Productive
Cough
Org. is
resistant to
phagocyte d/t
lipid coat,
which makes it
survive
Phagocytosis
Organism: M.
Tuberculae
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II. BIOGRAPHIC DATANAME POSITION IN
THE FAMILY
(relationship to
client)
GENDER AGE BIRTHDAY OCCUPATION MARITAL
STATUS
1. MikhaellaDhayneArongay
Daughter (eldest) Female 4 y/o Feb. 17, 2007 N/A Single
2. ManuelaDeniseArongay
Daughter
(youngest)
Female 3 y/o April 16, 2008 N/A Single
3. MariaChristinaArongay
Mother Female 25
y/o
October 10,
1986
Housewife Married
4. MarlonArongay
Father Male 26
y/o
Feb. 15, 1985 Janitor Married
5. LolitaFrancisco
Grandmother Female 50
y/o
Jan. 8, 1958 Housewife Married
6. DaniloFrancisco
Grandmother Male 51 y/o March 3, 1957 Company Driver Single
7. DexterFrancisco
Uncle Male 20
y/o
Oct. 19, 1991 N/A: studentSingle
8. ChristianFrancisco
Uncle Male 13 y/o July 15, 1998 N/A: student Single
FAMILY PRIMARY DATA:
Active
Infection
occurs
Decrease
Immune
Response
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HOME ADDRESS: Sr. Mariano St. Brgy. Maytunas,San Juan City
RELIGION: Roman CatholicETHNIC GROUP: None
PRIMARY DIALECT: TagalogNATIONALITY: FilipinoHEALTHCARE FINANCE: None
INCOME(monthly estimation) P 7, 000
II.NURSING HISTORY
A.PAST HEALT H HISTORY
The patients history of past health involved her hospitalization when she was 1
week old when she had a bacterial infection (specific disease not recognized);symptoms include appearance of a red mump-like presentation in the left chin. The
said disease was identified by the clients mother as pigsa sa loob; in lay mans term.
According to her, her husband also had the disease when he was a baby. An antibiotic
(specific name of drug not identified) was use in treatment of disease. The client was
confined for one month in hospital in Silang Cavite. (Hospital unspecified by the
mother).
Aside from this, client was not hospitalized due to any major diseases. Colds,
fever and cough are her common experienced diseases; she had cough and colds last
June 2011 and had just recovered 3 weeks ago, 1st week of July. According to the
mother, the clients experiences common colds and cough every rainy season. She uses
over the counter drug (Solmux kids syrup) in treatment of disease in every
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occurrence. According to her, it is recurrent and the client easily got colds leading to
cough. The client doesnt have a regular check up and was not brought for any
medical assistance in times of coughs or colds.
The clients mother recalled that the client had complete immunizations
including BCG, DPT, OPV, HEPA B. and Measles. She was not been diagnosed of
asthma and is non-diabetic. There had been no accidents or trauma, blood
transfusions, medications or any allergy to foods or drugs. The client did not have any
foreign travel but was able to go to Cavite and Batangas City.
B. HISTORY OF PRESENT ILLNESS
The clients history of the present illness started seven days (July 19, 2011)
prior to interview (July 25, 2011) when she was observed to have a poor appetite.
According to the clients mother, its just this time when she start to observed the
client to have a decreased food intake from approximately 3 servings of rice to 1
serving. The client also experience frequent mood swings, easily irritated and showed
disinterest in food. The client sometimes skips food; specifically, (lunch) during the
interview.
The client was diagnosed skin test positive (primary complex) conducted in
barangay Maytunas health center, San Juan City last July 19, 2011. This is free program
of the barangay; the incident also served as way in client being diagnosed of the
current disease.
The client currently does not yet received any medical assistance in
treatment of the disease. Clients mother do not bring client for any follow up hospital
check-up.
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C. FAMILY HISTORY
Client belongs to a family with paternal history of cancer; N. Francisco (51,
grandmother) and M. Francisco (51, grandmother) both died from ovarian cancer and
maternal history of hypertension, and Clients mother side has a history of asthma,
family members namely H. Francisco (56, grandmother), E. Francisco (49,
grandmother) have asthma. Also, clients father Marlon (26) and uncle D. Francisco
(28) experienced asthmatic symptoms when they were still infants. J.c Francisco
(deceased, uncle) died from pneumonia at 8 month old.
Aside from these, there are No other hereditary -familial diseases noted
such as heart, lung or kidney diseases and diabetes mellitus.
D. DEVELOPMENTAL HISTORY
The patients developmental history compose of her being conceived as
planned and wanted, with regular prenatal check-up, delivered through normal
spontaneous delivery, in full term, experienced an infective disease when she was just
1 week old. The client was breast- fed until 5 months old but was bottle-fed after until
today, 4 yrs. Old. The client started walking at one and a half of age. She had regular
sleep and had good toilet training. There are No signs of strange and separation
anxiety noted in her, there are also No signs of thumb sucking, head banging and nail
biting though there are temper tantrums, fears noted at times during first encounter,
usually to unknown people. The client is playful and is now attending school.
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FAMILY GENOGRAM
(Family members living with the client/with history of disease)
M.C.
A
L.F
50 y/o
D. F
51 y/o
M.A
26 y/o
D.F
20 y/o
C. F
13 y/o
E.F
56
H.F
49
J. F 8mo.
old
N.D
51 y/o
M.D
5I y/o
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LEGEND:
-Female
-Male
-Identified patient
-married
-siblings
-deceased
*NOTE: there are two families living in common house.
III.PATTERNS OF FUNCTIONINGA. FAMILY HEALTH PERCEPTION AND MANAGEMENT
Regarding health, the family consider health important; the mother of the client
defines health as absence of any diseases, and being physically active and well. More
so, according to the mother of the client, health means having proper body grooming,
adequate clothing, proper and balanced nutrition, as well as good home sanitation
and ventilation.
I. Socio-economic and cultural characteristics
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Mr. A. (Father) are the only that has a permanent job in the family. He
earns Php7 000.00/month. The familys expenditures composed of their food, electric
bill, water bill, and schooling of the children, were the prioritized to the least
prioritized.
Mr. A. is the decision-maker of the family. According to Mrs. A, she admitted that her
family has inadequacy to meet their basic necessities which includes food, clothing,
shelter and health services due to insufficient income. When asked about the familys
financial stability, she stated, Kulang talaga, depende talaga kung magkano lang ang
meron sa isang araw. But she said, sina mama, kasi magkasama naman kami ditto,
ang tumutulong sa amin kapag wala na kami makain. Binibigyan nila kami ng pagkain
tulad ng ulam at bigas o share, sa gastos kasi karaniwan share na e. Di na maiwasan
kasi parang isang pamilya na kami, sa desisyon na lang nagkakaiba tapos ayun oo sa
kwarto nga hiwalay.
The family does not belong in any ethnic group. Their religion is Roman
Catholic. They do not engage themselves in any religious affiliation. Mrs. A is unaware
when it comes to the activities of their community. She verbalized, Hindi kasi ako
aktibo sa barangay kasi bago pa lang kami dito, noong febuary lang ganun. Kaya di ko
pa masyadong alam, ke mama ako ngtatanong.
II. Home and Environment
When asked about the condition of their living space, the mother uttered,
mejo masikip, 8 kami dito, pero Ok lang naman Nakakagalaw naman kami ng
maayos. But according to our observation, the land area is approximately 25 square
meters which makes it inadequate for the familys living space. They have two
bedrooms. They sleep separately as a family. They use bed for sleeping.
There are presence of vectors in their home, specifically, mosquitoes and
cockroaches. They do not spray pesticides. They only kill the vectors by means of
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hitting. There are pets like, cat, dog and mini-mice. There is no presence of accident
hazards except to ladder which can be risky for the children.
They do not store food because the moment they buy their food, they
immediately cook it. They usually cook their food by frying and they are fond of eating
fish, fruits and vegetables. But they do drink liquors but only during occasion.
The familys water supply is coming from Maynilad, also their drinking
water. But the children take a mineral water (no brand, according to the mother) that
is being bought to the nearby store. They do not use any method in sanitizing their
drinking water but they see to it that it is covered.
They use a flush-type excreta disposal and is placed inside the house,
privately used by them.
The family relies in the communitys garbage services by means of
collecting garbage and they do not segregate the biodegradable from non-
biodegradable. They leave their garbage uncovered.
They have a blind drainage and it is free lowing.
The family lives in a slum neighbourhood near water bridge where there are
narrow streets.
There are social and health facilities available like basketball courts and
health center in their community however the family seldom uses these facilities.
Although there are also communication and transportation facilities available like
jeepneys and side cars, the family utilize those services when needed.
III. Health status of each family members
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It was mentioned by the mother, that some past illnesses in the family
includes asthma wherein it is mostly on the side of her mother. Cancer was also
common on the relatives on the side of her father.
As of now, the family does perceive indications that they acquired the said
illnesses and disease specifically M.A, the client who is not diagnosed of primary
complex.
The family does not have a regular or annual check-up, there is also no
finances allotted for health. Only in times of disease when they get to see a physician or
bring a family member in a hospital or health center for assistance.
Family experienced several hospitalizations, one major confinement
happened 4 yrs. ago when a family member was confined due to a bacterial infection.
Currently, the family asks assistance from the barangay health center in incidence of
disease (children) like fever from cough/colds.
Family observed importance on hygiene, hand washing. Taking a bath daily,
brushing teeth. None of the family has vices like cigarette smoking and alcohol intake.
In terms of food intake, the family is not able to meet a planned diet. The
family reasoned out that is enough that in a day they are able to eat three times a day.
The amount of food intake depends on their financial capability to buy food for a day.
The family is experiencing stress due to some workload, financial needs,
responsibilities and roles, and misunderstandings, which contribute in some health
risks.
IV. Values, habits, practices on health promotion, maintenance and disease
prevention
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When asked about any practices concerning health issues, the mother
mentioned that her family dont have any beliefs like going to albularyo when theres a
sick member in the family, but she verbalized that, nagamit kami ng oregano ganun,
kunyari may ubo, ok nman e wala naman gumagaling din.
None in the family drink or smoke. According to her, it is because they
already have history of asthma thats why they try to avoid. Hard drinks are only
during occasions. The family sometimes experience difficulty in sleeping due to noise
brought by pets of neighbourhood even their own; she also stated that in some
instance it is because of occasional noise when there are party and celebration but
stated that they are used to it. She and other family members, dont take a nap, she
elaborated, it seldom happen, only when she is too tired or her brother and partner is
too tired of work.
The family usually prefer to be at home and chat, and have it as a form of
family activity. When stressed due to too much work, she stated, itutulog na lang
ganun.
In general health view, the family, In the scale of 1-10, 10 being the highest
and 1 being the lowest, she rated their family as 5, because according to her, her family
is not that healthy for they sometimes acquire diseases and illnesses, particularly the
children, she stated, mga kalahati lang ganun, kasi minsan talaga di naman kami ok, ayun
kapag ngkakasakit iyong mga bata, lalo na kapag tag-ulan.
She said she is not that active in barangay programs and is not aware of any
health services that it offers; its just recently when she started to get involved.
B. CLIENTSNUTRITIONAL-METABOLIC PATTERNAccording to the clients mother, her family eats are prepared by their
mother, wherein, she usually bought it in San Juan public market market and do the
preparation at home, they sometimes just bought cooked food outside. The
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client usually eats breakfast at 9:00 am, take merienda every 9:30 am during their
recess time in school, have his lunch at 12:00-1:00 pm and dinner by 6-7pm.
Breads, biscuits like Fugee bar and other branded biscuits were her favorite
foods. The mother stated that the client does love eating soupy foods like sinigang. She
likes mango and banana. She oftentimes drinks water about 400ml. Of water a day plus
her milk (Alaska) that is 5 oz. (bottled). Not picky in foods but do not eat much
vegetable often. According to the mother, she has a good appetite and can acquire 3-
plates/servings of rice in one sitting. But currently, loses her appetite from three
servings to 1serving of rice, and skip some meals. She doesnt have any food allergy.
The client has four tooth decays.
3-DAY DIET RECALL
C. CLIENTSELIMINATION PATTERNAs verbalized by the mother, the client defecates once every other day,
usually in the morning. According to the description of the mother, the color of the
stool is brown, long oval; sometimes hard. At present the client does not experience
any changes in her stool. The client also defecates by herself when there is an urge to
eliminate.
The client frequently urinate which ranges from 5 to 6 times a day. In the
morning particularly after waking up, the color of the urine is somewhat yellowish but
FAMILY
MEMBER
SATURDAY [JULY
23, 2011]
SUNDAY [JULY 24,
2011]
MONDAY [JULY 24, 2011]
Break
fast
lunch snacks dinner breakfast lunch snack dinner breakfast lunch snack dinner
M.D.A Bread(1 pc.)
Fried
egg(1 pc)
Water(1ml)
Rice(1
serving)
Soup
(1cup)
Water(200ml)
none Pancitcanton
(1
serving)
Water
(200ml)
Rice(2 serving)
Chicken
adobo(1 serving)
water(200ml)
Rice(1
serving)
Chicken
adobo(1
serving)
water(200ml)
non
e
Rice(1
serving)
Dried
fish(1
serving)
water(200ml)
Rice(1 serving)
Ginisang
toge(1 serving)
water(200ml)
Skip
meal
Fugee bar
biscuit(1serving)
water
(200ml)
Puto(1 pc)
Tokwa(3 slices)
Alska
milk(5oz)
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becomes clear in the afternoon. The mother also told that the client stopped using
diaper when she was 2 yrs. old. When there is an urge to urinate, the client
immediately proceeds to the bathroom by herself.
The mother told that the client do expires excessively or too much when
she plays too much.
D. CLIENTSACTIVITY EXERCISE PATTERNThe mother described clients daily activity as routine, after she wakes up;
she eats breakfast and prepares for school. Most of his time, starting from 10:00-12pm
were spent for school where she usually does not interact with her classmates, the
mother stated, tahimik yan si mika eh, tahimik tapos suplada talaga yan, minsan
naglalaro naman yan sa school, malikot din. Most often, after waking up, the client
eats her breakfast, and then takes a bath, after which she will walk for school, then
lunch, play or watch TV again, and then eats her dinner and then sleep.
The client enjoys playing toys, watching television, sometimes, bahay-
bahayan, luto-lutuan and habul-habulan. As verbalized by the mother, the client
spends her time mostly inside the house playing with her toys together with her sister.
Moreover, the client often plays inside the house instead of playing outdoor games
because she prefers playing alone, although she sometimes plays at school.
She does not take nap during the afternoon. The mother stated, kasi, maaga
yan matulog, kaya mahaba naman iyong nagiging tulog niya. The client does not have
any difficulty with regards to body movement but is observed to be moody, and
irritated with some discomfort in affect.
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There are no significant changes in regards with her past and present activity
even though she is encourage for rest at present for she just recovered from flue weeks
ago.
7
DAY ACTIVITY DIARY
FAMILY
MEMBERS
TIME IN
A DAY
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
M.D.A
9:00-10:00
noon
Eat breakfast,
take a bath,
prepare for
school
Eat breakfast,
take a bath,
prepare for
school
Eat breakfast,
take a bath,
prepare for
school
Eat breakfast,
take a bath,
prepare for
school
Eat
breakfast,
take a bath,
prepare
for school
Eat breakfast,
take a bath,
prepare for
school
Eat breakfast,
take a bath,
prepare for
school
10:00-
12:00pm
In school
(activity
depend on
school
activity)
In school
(activity
depend on
school
activity)
In school
(activity depend
on school activity)
In school
(activity depend
on school
activity)
In school
(activity
depend on
school
activity)
In school
(activity
depend on
school
activity)
In school
(activity
depend on
school activity)
12:00-
6:00pm
Eat lunch,
brush teeth
watch TV,
play with
sibling
Eat lunch,
brush teeth
watch TV,
play with
sibling
Eat lunch, brush
teeth watch TV,
play with sibling
Eat lunch, brush
teeth watch
TV, play with
sibling
Eat lunch,
brush teeth
watch TV,
play with
sibling
Eat lunch,
brush teeth
watch TV, play
with sibling
Eat lunch,
brush teeth
watch TV, play
with sibling
6:00-
7:00pm
Eat dinner,
watch TV,brush teeth,
drink milk
Eat dinner,
watch TV,brush teeth,
drink milk
Eat dinner, watch
TV, brush teeth,drink milk
Eat dinner,
watch TV, brushteeth, drink
milk
Eat dinner,
watch TV,brush
teeth, drink
milk
Eat dinner,
watch TV,brush teeth,
drink milk
Eat dinner,
watch TV,brush teeth,
drink milk
7:00-
9:00am
Rest/sleep Rest/sleep Rest/sleep Rest/sleep Rest/sleep Rest/sleep Rest/sleep
E. CLIENTSSLEEP AND REST PATTERNAccording to the mother, the client usually has an average sleep 6 to 7
hours a day, from 7:00 or sometimes 8:00pm up to 9:00 in the morning. The client
usually wakes up at 9:00 for school. She does not take nap in the afternoon. The client
sleeps early at night because she does not have any nap in the afternoon. Before going
to sleep, the client drinks a bottle of milk 5 oz. According to the mother, the client is
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usually satisfied with sleep she has. The client has no problem with the sleeping
environment.
The client has no significant or notable changes between her past and
present activities prior to her sleeping pattern.
F. CLIENTSHYGIENEWith regards to personal cleanliness and hygiene, the client takes a bath
once a day every morning at 9:00am before going to school, She sometimes have her
mother to assists him but she can do the activity alone. Aside from it, she washes his
face before going to sleep; Brushes her teeth after eating meals. The client has no noted
itching, scratching, unfix hair and clothing.
IV. PHYSICAL ASSESSMENTVITAL SIGNS NORMS ACTUAL
FINDINGS
ANALYSIS
Client functional pattern(Disease-focused)
Adl Before During1.nutrition Seldom Eats vegetables and fruits, but like
protein rich like egg and sea food like fish.With good appetite, approximately 3servings of rice per meal.
Poor appetite with decreased interest, (from3-1 serving of rice). Skip meals, notconsistent in attending meals in mealtimes.
2.elimination Voids urine 5-6 times a day with anestimation of 250-300cc per void of clearyellow urine.
Defecates once every other day a day anddescribes it as bulky with aroma and fromcolor light brown to yellowish brown. Herstool is many sometimes few depending onwhat she ate.
No change in bladder and bowel pattern.
3.exercise Exercises done through play, usually aroundthe house with her sibling.
With the same play pattern but is in Needof rest due to recent recovery from a diseasecondition. (Flue)
4.hygiene Takes a bath daily and brushes her teeththrice daily.
The same practice is maintained.
6.sleep & rest Sleeps for 10-12hrs. Do not take nap duringnoontime. Sleeping time is from 7pm to9am.
No observed change in the usual sleep andrest pattern.
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Body Temparature Oral- 36.5 degrees
Celsius- 37.5 degrees
Celsius- normal range
* Kozier and Erbs,
Fundamentals of
Nursing, page 529
Axillary
temperature-
36.60 C
Normal
Pulse Rate Pulse Average( and
ranges)
Adults- 75(60-100 bpm)
Children -100 (70-130)
*Kozier and Erbs,Fundamentals of
Nursing, page 538
110bpm Above Normal
Respiratory Rate Respirations Average(
and ranges)
Children-
(15-30cpm)
*kozier and Erbs,Fundamentals Of
Nursing, Page 538
23cpm Above Normal
Blood Pressure Classification of blood
pressure
Normal- systolic BP MM
HG
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* Kozier and Erbs,
Fundamentals of
Nursing, page 529
Weight N: 15-35kg
* Kozier and Erbs,
Fundamentals of
Nursing, page 529
12kg Below Normal
VITAL SIGNS NORMS ACTUAL
FINDINGS
ANALYSIS
General Survey
A. Body built, height,
and weight in relation to
the clients age, lifestyle
and health
Proportionate, varies
with lifestyle
* Kozier and Erbs,
Fundamentals of
Nursing, page 572
Ectomorph. Normal
B. Posture and gait,
sitting, and walking
Relaxed, erect posture:
coordinated movement
*Kozier and Erbs,
Fundamentals of
Nursing, page 572
The client is lying
on bed, conscious
and coherent
Normal
C. Overall hygiene and
grooming
clean, neat
*Kozier and Erbs,
Fundamentals of
Nursing, page 572
Her clothes and
she appears neatand clean.
Normal
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D. Body and Breath odor No body odor or minor
odor relative to work or
exercise: no breath odor
No body odor and
breath odor
Normal
E. Signs of distress( in
posture or facial
expression)
No distress
*Kozier and Erbs,
Fundamentals of
Nursing, page 572
Client is irritable
and less
cooperative due to
anxiety at first,
and cooperates
later when
rapport is done.
Normal
F. Obvious signs of
health or illness
Healthy appearance
*Kozier and Erbs,
Fundamentals of
Nursing, page 572
The client is
healthy in
appearance.Though in BST,
she have positive
outlook towards
her condition.
Normal
G. Attitude Cooperative, able to
follow instructions
*Kozier and Erbs,
Fundamentals ofNursing, page 572
She is
uncooperative
and unable to
follow
instructions and
resists to be
examined at first
due to anxiety.
Not Normal
H.Affect/mood(appropri
ateness of the clients
response
Appropriate to situation
*Kozier and Erbs,
Fundamentals ofNursing, page 572
The Clients mood
is not appropriate
to situation.
Not Normal
I. Quantity and quality
of speech
Understandable,
moderate pace.
*Kozier and Erbs,
She has a clear
voice,
understandable,
and moderate
Normal
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Fundamentals of
Nursing, page 572
pace.
J. Relevance and
organization of thought
Logical sequence: makes
sense: has sense of
reality
Thought association
*Kozier and Erbs,
Fundamentals of
Nursing, page 572
N/A. N/A
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V. ECOLOGIC MODEL
Ecologic Model
Hypothesis
- Primary Complex TB
- Exposure to PTB either in
either community or at
home.
Age: 4y/o, Nationality: Filipino,
Sex: Female
-History of Primary Complex
Tuberculosis
-Mycobacterium
Tuberculosis
Agent Environment
Host
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The occurrence of Primary Complex TB is attributed to clients exposure to PTB
carriers and pathogen and immunosuppression due to the environment of the client at
her home.
A. Predisposing Factors
1. Host
Age: 4 y/o Sex: Female Nationality: Filipino
2. Agent
Mechanical: Mycobacterium is passed and acquired throughrespiratory secretions/droplets which transmit during sneezing,coughing, and talking.
Chemical: Substance Abuse, Smoking, and Alcohol Biologic: Mycobacterium Tuberculosis is a rod shaped, aerobic
bacteria that is resistant to destruction and can persist necrotic and
calcified lesions for prolonged periods and remain capable of
reinstating growth.
3. Environment
Physical: Possible contact to person with PTB
Socio-Economic: Exposure with persons with PTB either incommunity or at home.
Analysis:
Occurrence of Pulmonary Tuberculosis is caused by contact to carriers of
pathogen, confined living condition. Past Health History of PTB may affect the
development of the condition.
Conclusion and Recommendation:
We therefore conclude Tuberculosis is a chronic granulomatous infection that
usually affects the pulmonary system but may also invade other organs and tissues. The
incidence is highest in crowded, poverty-stricken settings. It spreads from one person to
another by airborne transmission. An infected person releases droplet nuclei through
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talking, coughing, sneezing, laughing or singing. Larger droplet nuclei; smaller droplets
remain suspended in the air and are inhaled by susceptible persons. Risk factors for TB
are close contact with someone who has active TB, immune compromised status,
substance abuse, inadequate health care, pre-existing medical condition,
institutionalization, living in crowded, substandard housing and caring for TB patients. Inthe case of the patient, the substandard / crowded housing, contact with active TB and
immune compromised status are the factors that have contributed to the development of
the disease.
As a Student Nurse we recommend a vital role in caring for patients with TB and
family, which includes Assessment of the patients ability to continue therapy at home.
The nurse instructs the patient and family about infection control procedures, such as
proper disposal of tissues, covering the mouth during coughing and hand hygiene.
Assessment of the patients adherence to the medication regimen is imperative because of
the risk of developing resistant strains of TB if treatment is not followed faithfully.(Smetltzer and Bare. Brunner and suddharts Textbook of Medical-Surgical
Nursing 10th Edition. p.532-53, 539)
VI. PROBLEM IDENTIFICATION/PRIORITIZATIONA. CLIENT FOCUSED
PROBLEM RANK JUSTIFICATION
Imbalanced nutrition:
less than body
requirements
1 According to Maslows Hierarchy of need, nourishment is under
the physiologic need. This is the first and primary need of an
individual. Since the patient is a child with communicable disease
nutrition is a very important factor in order to enhance immune
system to fight for infections.
Susceptibility to other diseases or infections can be prevented if
malnutrition is eliminated.
Risk for infection
related to
compromised immune
2 According to Maslows Hierarchy of needs, this will fall under
physiological needs for it will affect the health of the client thus
addressing would prevent further infection. Physiological needs
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system are the most basic needs that are vital to survival.
Patients susceptibility to infection because of compromised
immune system can lead to more disturbing situation thus giving
importance to this and giving proper intervention will contribute
to improved recovery and well being.
Anxiety 3 According to Maslows Hierarchy of needs, this will fall under
esteem needs which include anxiety for it is considered as
deviation of personal worth. Anxiety arises to children when they
seem that something is wrong with them.
A. FAMILY FOCUS
Threat of cross infection from a communicable disease
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
Nature of the Problem 2/3 x 1 2/3 It is a health threat that neededimmediate attention andmanagement to eliminate possible
worsening of the problem.
Modifiability of theproblem
2/2 x 2 2 The problem is modifiable becausethe resources are available to thenurses to increase familysperception and knowledge of theexisting problem and also nursescan help the family in hygiene andsanitation and management of thefamily member withcommunicable disease.
Preventive Potential 3/3 x 1 1 Prevention of the cross infectionfrom a communicable disease will:
a. Reduces chances thatother family member willbe susceptible to thedisease
b. Decreases the likelihoodof the family in acquiringother diseases
Salience of the Problem 0/2 x 1 0 It is not felt as a problem
TOTAL SCORE: 3 2/3
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Primary Complex
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
Nature of the Problem 3/3 x 1 1 It is a health deficit that requiresimmediate attention and adequatemanagement to reduce theincidence of transmission of thedisease to the rest of the family.
Modifiability of the
problem
1/2 x 2 1 The problem is partiallymodifiable because the family doesnot have adequate resources tosolve the problem. Limitedfinancial resources and lack of
knowledge which is important inpreventing or managing theproblem but nurses can providehealth teaching about the propermanagement and prevention ofthe disease.
Preventive Potential 3/3 x 1 1 Transmission of infection to otherfamily can be prevented oreliminated if the problem ismanaged adequately.
Salience of the Problem 2/2 x 1 1 The family recognizes it as aproblem. They consulted the
problem to the health center. Andfrequently ask questions of what isthe proper health action to do.
TOTAL SCORE: 4
Inadequate living space
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
Nature of the Problem 2/3 x 1 2/3 It is a health threat that neededattention because it may increasespread or transferability ofinfection or diseases
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Modifiability of the
problem
0 0 The familys resources arepresently not adequateconsidering that they have otherproblems that for them should bethe priority of finances.
Preventive Potential 3/3 x 1 1 Increasing the living space will:a. Reduces possibility of
transferability ofcommunicable disease.
b. Provide for privacy tomembers.
Salience of the
Problem
0/2 x 1 0 It is not felt as a problem
TOTAL SCORE: 1 2/3
The Prioritized Health ProblemsThe list of health condition or problems ranked according to priorities is presented:
1. Primary Complex 42. Threat of cross infection from communicable disease 3 2/33. Inadequate living space 1 2/3
VII. NURSING CARE PLANA. CLIENT FOCUSEDB. FAMILY FOCUSED
VIII. FAMILY HEALTH TEACHING PLAN*(See tables below)
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