pavino family

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Southern Luzon State UniversityCollege of Allied Medicine

Lucban, QuezonS.Y. 2012-2013

Family Case Study

(Pavino Family)

Submitted to:

Prof. Maria Luisa E. BarrettoProf. Clarissa D. Maguyon

Submitted by:

Roeder Max R. PangramuyenBSN IV Group 7


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Community Health Nursing - Family Case Study

ACKNOWLEDGEMENT

The researcher expresses his sincerest gratitude and profound appreciation to

the special persons for their invaluable support which contributed to the completion and

success of this study.

The researcher particularly extends his thanks to:

Mrs. Maria Luisa Barretto and Mrs. Clarissa Maguyon, the researchers two

dearest clinical instructor during the times of community health nursing, for the support

and motivation, and instilling knowledge regarding the techniques and guidelines for the

completion of the family case study.

The Pavino Family, for allowing the researcher to conduct interview, formulate

nursing care plan and implement the nursing interventions, and active participation in

the completion of the study.

Rural Health Unit of Lucban, to all the BHWs and Midwives for their untiring

support and in helping us in every way that they could. Your services are greatly

appreciated.

Team leader, Coco, group mates -BSN IV Seven upfor showing the support in

finishing this paper.

All the people who extended their support and encouragement and contributed to

the success of this study.


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And above all , to the Holy Trinity, God the Father, God the Son, and God the

Holy Spirit, the researchers fountain of faith hope and love. The source of strength and

good health for the most difficult time, most challenging and most crucial times, for the

blessings, achievements, and successes in the nineteen years of existence, for the

skills and talent, for wisdom and intelligent he had pass through and use in the conduct

of this study and throughout his entire college life.

R.M.R.P.

The Researcher


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DEDICATION

The dedication of this research work is split seven ways: To my parents, Mama and

Papa, thank you for the genes you passed, untiring reminding of the fulfillment of

my dreams, I was able to this research with your utmost support.To my siblings,

Ate Roma, Kuya Rodemar, Roan, and Roentwho serves as my inspiration

to continue this profession.To my cousin, Kuya Izee Mir, one of my closest

cousin, my idol of outstanding leadership and optimistic view of life. To my

WINNER friends, for understanding of my shortcomings as their friend,

and in times of great challenge serve as my motivator To my

groupmates, SEVEN up,for being a part of my nursing life

and push my limits. To Albus Dumbledore, the wisest

fictional character I ever met, one of the source of

the words of wisdom. To Father Almighty,

I will always give Him praise and thanks

for the blessings of skills,

knowledge and

attitude.

R.M.(RoiedXamyen) R.P.The researcher


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TABLE OF CONTENTS

Title Page . . . . . . . . . .

Acknowledgment . . . . . . . . .

Dedication . . . . . . . . . .

Table of Contents . . . . . . . . .

Introduction. . . . . . . . . .

A. Family Case Study Proper

I. Family Data. . . . . . . .

II. Family Members Chart. . . . . .

III. Family Characteristics . . . . .

IV. General Family Relationship . . . .

V. Dietary Habits of the Family . . . .

VI. Source of Family Income . . . . .

VII. Family Health History/ History . . . .

VIII. Felt Needs of the Family . . . . .

IX. Home and Home Environment . . . .

X. Health and Health Practices . . . .

XI. Family Environment . . . . . .

XII. Awareness of Community Organization . . .

B. Identification of the Problems . . . . .

C. Scale for ranking Family health Problem . . . .


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D. List of Identified Problem . . . . . .

E. The List of the Health Problem according to Priority. . .

F. Family Nursing Care Plan . . . . . .

G. Service and Progress Record . . . . .

H. Summary, Conclusions and Recommendations . . .

I. Appendices


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INTRODUCTION

According to Public Health Nursing in the Philippines by Cuevas et. al, (2007)

Health is a right of every human being. Healthy people are a prerequisite to national

development. The DOH uses the life span approach to design programs and assist in

the delivery of health services to specific age groups. It views health care of individuals

within the context of the family. The term family is defined as the basic unit of the

community. All members of the family are empowered to maintain their health status.

Hey must be free from disease or infirmity with no disabilities. In public health

perspective, the health of the family is considered as a whole and not individually.

Moreover the family health office is tasked to operationalize health programs

geared towards the health of the family. It is concerned with the health of the mother

and the unborn, the newborn, infant, child, the adolescent and the youth, the adult men

and women and older persons.

On the other hand according to Community Health Nursing Services in the

Philippines by Niscee.t. al, (2000) , Home visit is a professional face to contact made

by a nurse to the patient of the family to provide necessary health care activities and to

further attain an objective of the agency. It is made to the client or to a responsible

member of the family.

Student nurse as member of health care team and future professionals, are

instruments in reaching the family to obtain holistic health. During home visit planning


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should revolve around the essential needs of the individual and his/her family but

priority should be given to those needs recognized by the family itself. Family case

study as form of home visitation to the family, should take into consideration the

following factors: the physical, psychological, and educational needs of individual and

family; Acceptance of the family for the services offered; the willingness and interest to

cooperate; take into account other health agencies and the number of health personnel

already involved in the care of a specific family; A careful evaluation of past services

given to a family and how this family made use of such nursing services and the Ability

of the patient and his/her family to recognize their own needs, their knowledge of

available resources and their abilities to use these resources on their own accord.As a

student nurse we are entitled to gain the familys trust and confidence, we may look into

more detailed aspects of the household and surroundings and other health

problems/concerns.

Student nurse as member of Public Health Care team have significant role in

ensuring the health of the family. Every effort has to be made to provide packages of

health services to the family for a better and quality life.


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A. FAMILY ASSESSMENT GUIDE

I. FAMILY DATA

The Pavino family is headed by Mr. Medes Pavino natural born of Lucban,

Quezon and currently resides at SitioBurol 32 Barangay TinamnanLucban, Quezon , he

works as a farmer on the lot he rented, as well as he was being hired as harvester

during harvest time.is wife is Mrs. Bernadete Ratio, again a natural born of Lucban,

Quezon, she had no work and act as housewife. The couple had 4 children. Pavino

familys house is situated near a river and they livesamicably on their house that was

made of light materials.

II. FAMILY MEMBERS CHART

Table 1List of Family Members

FamilyMember

Age Sex CivilStatus

Positionin theFamily

Relationshipto the

Family Head

EducationalAttainment

Occupation

MedesPavino

39 M Single Father Head Grade 4 Farmer/ Hiredharvester

BernadeteRatio

34 F Single Mother Wife of headof the family

1s year Highschool

House wife

Russel Ratio 12 M Single 1s child Son Grade 3(schooling)

Student

Rosemarie

Ratio

9 F Single 2ndchild Daughter Grade 3

(schooling)

Student

Diana RoseRatio

4 F Single 3r child Daughter - -

Danica RosePavino

4months

F Single 4thchild Daughter - -


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Table 1 one shows the list of family members of Pavino family. The Pavino family

is a nuclear family composed of Mr. Medes Pavino and his wife Mrs. Bernadette Ratio;

they are not married and had a good relationship for almost 17 years. They were

blessed with one son and 3 daughters. They are considered as patriarchal family since

that Mr. Medes Pavino is the head of the family. Since that Mr. Medes only reached

grade 4, he work only as farmer, the only thing he mastered and Mrs. Bernadette Ratio

is a housewife and took care of her four children. The family belongs to 4Ps or the

Pantawid Pamilyang Pilipino Program. Mrs. Bernadette was given 500 pesos every

month. Russel Ratio is on his 3

rd

grade, he stopped schooling for some years because

of failing grade and absenteeism, and Rosemarie Ratio is classmate of her brother.

They were obliged to go to school because they were supported of 300 pesos each of

the 4Ps, and the condition is that they need to attend school without absent for

continuous support. Diana Rose Ratio is the 3rd child and undernourished and Last

June 2, 2013 Mrs. Ratio gave birth to her last child Danica Rose Pavino, she was the

only one to have the surname of her father and she is now 4 months old. Mr. Pavino is

the only member of Philhealth in the family but the children are already covered.

From Left: Mrs. Bernadette Ratio, together with her three daughters;

Danica Rose Rose Pavino, Diana Rose Patio and Rose Marie Patio


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III. FAMILY CHARACTERISTICS

The Pavino family is a simple nuclear type of family composed of couple having four

children. They are considered as patriarchal family since Mr.Pavino is the one who

decides for the family. They are Roman Catholic however there are times that they do

not go to mass as a whole but always tried to pray if unable to attend mass. They live

amicably about their day to day expenses. It was very hard for them to manage the

small income from farming and need to allocate money for the basic needs such as

food.

IV. GENERAL FAMILY RELATIONSHIP

As a family, Pavino family believes on closed family ties. They own an approximately

3.5 by 3.5 m2, bungalow house made of light materials. The couple sleeps of the floor,

as their 4 child shares and sleep on bamboo bed. The familys bonding time were

scheduled during night time as they watch television but was not able to stroll or go out

during weekends due to financial constraint and lot of works. They help each other on

cleaning the house but most of the time Mrs. Ratio is the only one to do the house hold

tasks.


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V. FAMILY DIETARY PRACTICES

However the family experienced financial insufficiency, Mr. and Mrs. Make it to a

point to complete healthy 3 meals per day. Sometimes if they dont have food to eat

they borrow money from Mrs.Pavinos mother on their neighbourhood just to have

something to eat, even the allowance of the 2 child are borrowed from her. Common

breakfast is hot pandesal and coffee, sometimes if Mr.Pavino luckily has enough

money they buy skinless, egg or hotdog and serve it with steam rice. During lunch time,

on week days the 2 first children eat on school @ PEL, most of the times they prepare

vegetables, it is often to have meat, fish or chicken as main dish. Dinner is same as

lunch. Low price food such as noodles, sardines, egg, and dried fish is also served on

their meals due to high price of foods.

VI. SOURCE OF FAMILY INCOME

Table 2

Source of Family Income

Family Member Monthly Income

Medes Pavino Below P 5,000

Mr. MedesPavino is the only one who provides income for the family. He

was a farmer with the lot he rented. He is the one to nourish, to plow, to plant, and to

harvest on the said lot. It was lucky if there aresufficient amount of harvested


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vegetables. Some of the vegetables he plant are tomatoes, eggplant, okra,

stringbeans and palay. He also sometimes is being hired as harvester on the lot of

others. P5,000 and less was the total income of the family thats the reason why they

are belong to 4Ps family and receive total of 1,100 pesos in a month. Sometimes the

family has to borrow money from other relatives just to support the schooling of the two

children and to buy food for their meals.

VII. FAMILY HEALTH STATUS/ HEALTH HISTORY

The couple experienced and had history of asthma when they were child. By this

time Mr. Medes Pavinoonly experienced fatigue after heavy work in the farm. Except

from previous pregnancy Mrs. Bernadette Ratio had not been hospitalized. She only

experienced tiredness after whole day of preparing the children to school, cleaning the

house, taking care of the 2 last children and other house work. As to their children, they

experienced fever, cough, and colds. The first two children experienced asthma attacks

at times; Diana Rose the third child is considered under nourished and currently have

her feeding program on the brgy. Tinamnan. Every month, weight of Diana is being

monitored. The 4 months old Danica Rose only experienced cough and colds. All of the

children were fully immunized children.Though financially scarce they try to keep

themselves healthy by eating lot of vegetables and have check up on the RHU/BHS.

Most of the timethey avail medicine from RHU/BHS, and they also visit hilot/suob as

treatment. Currently the entire family have no major illness or condition that could affect

their health status.


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VIII. FELT NEEDS

Felt Needs Frequency Rank

Food Always 1

Health Always 2

Education Always 3

Shelter Always 5

Love, Security and Belongingness Always 4

Clothing Sometimes 6

Self-Actualization Seldom 7

Self-Esteem Seldom 8

Among all the needs food is considered as top priority of the Family, they believed

that if they have enough food everyone could function well and have enough energy for

the whole day of work and school. Health is also considered as one of the priorities

sustenance equally since both of them is important in maintaining their holistic self.The

family also values the education of first two children and they do everything just to

encourage these children to finish school for brighter future. Love, security, and

belongingness is also considered as their need because without these they would not

able to act and fulfill their task if they were insufficient with these things. Self-

actualization and self-esteem is seldom considered as need.


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IX. HOME AND ENVIRONMENT

The Pavino Residence is made of mixed but predominantly light materials. It is

bungalow house, approximately 3.5m by 3.5m. The house actually seems worn out,

dusty, messy and full of weeds. The space of house is inadequate for all of them

because the couples had to sleep on the floor as their 4 children were crowded on small

bamboo bed. The small space of sala is also considered as dining area and it is the

space used of couple to sleep at night. The house have electricity but it was faulty.Their

abode is near the river which is a potential breeding site for mosquitoes and it is

surrounded by trees which can be a resting site for rodents, roaches, and flies. The

family own 3 cats which is pusang gala. most of the time kalan de uling was used for

cooking and if luckily they can avail gas tank and used it for cooking. Charcoal and

wood is used as the source of fire in cooking.The family own TV and DVD player and

used use it for their relaxation. The family does not own any other appliances. They do

not own a refrigerator so all their food preparation and left-overs are disposed or

consumed immediately to avoid rotting. They typically prepare exact amount of food so

there will be no leftover to be stored. Sometimes they missed to keep the foods safely

and it was exposed to some insects. Water supply is Level I or communal faucet

system. They ask for their neighbors to let them have water from their faucet and they

will store it in a drum or water container. They covered the water storage carefully and

sometimes they have to boil the water. The family never experiences any water borne

disease like diarrhea. The family doesnt own toilet facility and they only ask their

neighbor specifically mother of Mrs. Bernadette to let them void and share the toilet.

They also segregate garbage, separating biodegradable to non-biodegradable as


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regard to the waste collection policy. The wet rubbishes are thrown in a pit and are

covered with soil while the dry ones are thrown in a specific area where it is collected by

the garbage collectors of Lucban, Quezon.

The Pavino family lives in a clear, uncongested neighborhood. Houses are built far

apart. Houses on their neighborhood are mixed of bamboo and anahaw, stone houses

and some are mixed. In the area, there were also other families that are member of the

4Ps.

Health station in brgy.Tinamnan where far from the house of Pavino family, yet they

walk from their house to health station to avail medical management to their diseases.

Dining Area/ Sala / Bedroom


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X. HEALTH AND HEALTH PRACTICES

For the past few months the family experience common illness such as cough, cold

and fever and the first and second child experienced asthma attacks, Mrs. Bernadette

had her initial interventions then quickly approach the RHU/BHS. Third child Diana

Rose, considered as malnourished was involved in the feeding program of the

barangay.Sometimes the family considered visiting to suob/hilot/ and herbolarios. Often

times Mrs. Bernadette Ratio prepare herbal medicines as it was available on the nearby

Kitchen Area/ Cooking Entrance door

Dining Area


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houses. The family doesnt engage in exercise because they were busy of their other

activities. The children practice hygiene but sometimes they are forgetful of washing

hands, cutting nails, oral care and other hygiene practices. Mrs. Bernadette Ratio, uses

her spare time of talking with her neighbors but never forget to breastfed her 4 months

old daughter.

XI. FAMILY ENVIRONMENT

The Pavino Family resides in Sitio Burol, Barangay Tinamnan, which is quite far

from the National Road. It is far to Barangay Health Station - Wakas, Gulang-Gulangof

Barangay Tinamnan. The house is located near the river, and it seems that there are lot

of plants and trees around them.The church, school, and market were also not

convenient to be visited because the family had to ride jeepney or tricycle to the

poblacion which is often practice. The area is near a river where they wash their clothes

and dishes and sometimes and take a bath. The family were not fully aware of the

environmental hazards around their residence.

Surroundings


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XII. AWARENESS OF THE COMMUNITY ORGANIZATION

Since that the family is a member of 4Ps they have slight awareness on the different

programs and activities of barangay Tinamnan. As requested to them for the continuous

support and membership to 4Ps they actively participate on the program that was being

implemented on the barangay. They visit Rural Health Unit especially if they have

diseases because the medications were given to the priority family like them. Mrs.

Bernadette Ratio frequently brought her third child to the feeding program and monthly

weighing and her fourth child to Expanded Program in Immunization. Mrs. Bernadette

Ratio also tried to visit BHS/RHU during mothers class. As a member of 4Ps, Mrs.

Ratio and the rest of the family had been active member of the community and partakes

on the activities.

Front House of Pavino Family


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B. IDENTIFICATION OF THE PROBLEM

PROBLEMS CUES/ DATA FAMILY HEALTH PROBLEM

First Level Second Level

Poor environmentalSanitation

With messy houseWith unwasheddishes

With unfolded clothesWith dust and spider

webs on the ceilingWith garbage on the

front of the house

HealthThreat

Inability to decide whichaction to take from among alist of alternatives

Failure to see benefits(specifically long-term onesof investment in homeenvironment improvement)

House made of Lightmaterials (accidentprone e.g. to fire)

House made ofbamboo and scarpmaterials such as old

aluminium andbroken hollow blocksElectrical Wirings are

not properly arrangedon the ceiling

Cooking inside thehouse using coal andwoods

Foreseeablecrisis

Inability to recognize thepresence of the condition orproblem due to: Denial

about its existence orseverity as a result of fearofconsequences of diagnosisof problem, specifically:a. Economic/cost

implicationsb. Lack of or inadequate

family resources

Cough, Cold, andFever

Most of the childrenhad these conditionslately due to theweather and crowedarea of house(approximately 3.5mby 3.5 m)a. Communicable

because ofinadequate livingspace

HealthDeficit

Inability to provideadequate nursing care tothe sick, vulnerable / at riskmember of the family dueto:a. lack of / inadequate

knowledge and skill incarrying-out necessaryintervention for care

Financial resourcese.g.cost of medicine prescribed

Asthma of 1standsecond child

The childrenexperienced asthmaat times, and theparents had history ofasthma before

HealthDeficit

Inability to provideadequate care to the sick,vulnerable / at risk memberof the family due to:

lack of / inadequateknowledge and skill incarrying-out necessaryintervention for care

Financial resourcese.g.cost of medicine prescribed


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Malnourished 3r

ChildAge in months54Weight 16.8 kilosHeight 118.5 cmWeight not

appropriate for

months in ageThinWith easy fatigability

after playing

HealthDeficit

Lack of/inadequateknowledge about childdevelopment and care

Unable to feed the childwith healthy and nutritious

food due toa. Financial constraintb. Lack of knowledge of

the foods that are notcostly that can used assubstitute

Family Size beyondwhat familyresources cansufficiently provide

Big family size(6 in the family)

ForeseeableCrisis

Inability to make decisionswith respect to takingappropriate health actionsdue to lack of knowledge as

to alternative courses ofaction open to the family

FinancialConstraints / LimitedFinancial Resources

Member of PantawidPamilyang PilipinoProgram

Inadequate MonthlyIncome of parents(almost less thanP5,000. per month)

Big family size(6 in the family)

Household of thefamily finished gradefour level andcurrently working as afarmer

The mother finished1styear high schooland unemployed

ForeseeableCrisis

Inability to provide a homeenvironment conducive tohealth maintenance andpersonal development dueto:

a. lack of skill in carrying outmeasures to improve homeenvironment

b. inadequate family

resources specificallyfinancial constraints/ limitedfinancial resources

Presence ofbreeding sites ofrodents that are

vectors of diseases

House is not beingclean regularly

House is dirty and

slightly dilapidated Has poor sanitation Cockroaches are

seen inside thehouse

HealthThreat

Inability to provide a homeenvironment conducive tohealth maintenance and

personal development dueto:a. lack of / inadequate

knowledge ofimportance of hygieneand sanitation

b. lack of skill in carryingout measures to


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improve homeenvironment

c. inadequate familyresources specificallyfinancial constraints/

limited financialresources

Dangerous pathwayto their house

Their house has anarrow stair, stiff andslippery due topresence of algae.

Mrs. Ratio alwayscarry her 4

thchild

and increase risk forfall

ForeseeableCrisis

Inability to recognize thepresence of the condition orproblem due to:a. Lack of or inadequate

knowledge and skillsb. Unavailability of

financial support forrenovation or transfer ofplace of living.

Improper foodstorage

The family doesntown refrigerator

Letting the food leftuncover at times

Foods are notproperly kept and letit exposed to insects.

HealthThreat Inability to recognize thepresence of a problem due to: Ignorance of facts


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C. SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMSACCORDING TO PRIORITIES

CRITERIA STANDARD SCORE WEIGHT ACTUALSCORE

1. Nature ofthe Problem

Health DeficitHealth ThreatForeseeable Crisis

321

11

2/31/3

2. Modifiabilityof theproblem

RemovablePartially ModifiableNot Modifiable

210

2210

3. Preventivepotential

HighModerateLow

321

11

2/31/3

4. Salience of

the problem

Needs immediate attention

Does not need immediateattentionNot a problem

2

1

0

1

1

0

Scoring :1. Decide on a score for each of the criteria.2. Divide the score by the highest possible score and multiply by the weight :

( Score / highest score ) x Weight3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the

total weight.


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G. SERVICE AND PROGRESS RECORD

Date ofHome Visit

HealthProblem

Nursing Observation and Action Evaluation ofProgress

First Visit:

September11, 2013

SecondVisit:September17, 2013

Third Visit:October 6,2013

FourthVisit:October 8,2013

Malnourished

3rdchild

Nursing Observations

Age in months54Weight 16.8 kilosHeight 118.5 cmWeight not appropriate for months in

ageThinWith easy fatigability after playingEasily get sick

Nursing Actions

a) Help the family realize theimportance of proper nutrition troughhealth education

b) Impart family to be awareness of thefactors that affects and discussed itmay affect health.

c) Discussed and shared informationabout malnutrition.

d) Encouraged to provide well balancediet and to increase body resistance

e) Encouraged the family to implement

proper food selectionf) Emphasized prevention of sickness

to prevent lessening appetite duringmeals

g) Persuaded family to regularlychecked the weight and height of thechild or bring her to the RHU

On the last visit the

mother verbalizesthat her childcontinuously jointhe feedingprogram ofbarangay

The mother statedcontinuous visit toRHU/BHS forweighing of herchild

She was not toothin at all and gainweight from 16.8kilos to 18.7 kilos

The child looksmore active andplayful

Resolved

First Visit:September11, 2013


Third Visit:October 6,

Asthma of 1s and 2ndchild

Nursing Observations The children experienced asthma at

times, and the parents had history of

asthma before

Nursing Actions

Health teaching given with theimportance of the following:a) Remove house pets such as cats

or dogs

The motherverbalize thatincident of asthma

attacks werelessened for thepast month andshe was able tocarry interventionsgiven to her

Partially Resolved


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2013

FourthVisit:October 8,

2013

b) Maintain cleanliness of the houseby daily dusting and cleaning

c) Maintain normal home humidityd) Reduced exposure of the child to

cold air

e) Maintain childs normal weightf) Take medications as prescribedg) Stressed the importance of

BHS/RHU in terms of medicalmanagement


SecondVisit:

September17, 2013



Poorenvironmentalsanitation

Nursing ObservationsWith messy houseWith unwashed dishesWith unfolded clothesWith dust and spider webs on the

ceiling

With not segregated garbage on thefront of the house

Nursing Actions

a) Assessed house conditionb) Discussed importance of waste

segregationc) Explained the effects of untidy

environment to a healthy livingd) Encouraged the family to utilize

resources like empty rice sacks orcans as garbage containers, makingsure that they are left covered.Pointed out the result of piles ofgarbage settled along the river to thehealth of the people by using wateron the river, adding up to air, landand water pollution.

The house looksmore organizethan before

The clothes werefolded

The dishes were

washedimmediately afteruse

There are stillsome spider websbut lesser innumber thanbefore

There are garbageoutside the housebut it is already

segregated and forcollection

Resolved




Improperwater andfood storage

Nursing Observations The family doesnt own refrigerator Letting the food left uncover at times

Foods are not properly kept and let itexposed to insects.

Water supply are not properlycovered

Nursing Actions

a) Established therapeutic

The foods wereseen covered withplate

The water isproperly stored incontainer withcover

Resolved


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2013


2013

communication with the familyb) Discussed to the family the

possibilities of contaminating thefood if not properly stored.

c) Explained the possible

consequences and compilation thatthey may acquire from contaminatedfood due to improper storage.

d) Encouraged covering food properlywith plates or any available andappropriate cover.


Second

Visit:September17, 2013



2013

Cough, ColdFever

Nursing Observations Most of the children had these

conditions lately due to the weatherand crowed area of house(approximately 3.5m by 3.5 m)

Communicable because ofinadequate living space

Nursing Actions

a) Demonstrated and explainedimportance of tepid sponge ifbody temperature is increased

b) Discussed the use of herbalmedications as resources

c) Demonstrated back rubbing andtapping techniques for cough and

coldsd) Emphasized importance of

adequate ventilatione) Discussed use of herbal

medications as resourcesStressed the importance ofBHS/RHU in terms of medicalmanagement

On the secondand third visit thechildren doesntexperience coughand colds

Mrs. BernadetteRatio verbalizethat she alreadyknowinterventions

On the last day ofvisit the fourthchild had coughand colds

Continuousbreastfeeding

were given andshe was brought oa paediatrician

Partially Resolved

First Visit:September

11, 2013


Third Visit:

Family Sizebeyond what

familyresources cansufficientlyprovide

Nursing ObservationsBig family size

(6 in the family)

Nursing Actions

a) Assessed the mothers knowledgeregarding budgeting

b) Interviewed mother about the currentfamily budget

The family stillborrows money

from otherrelatives at times

Unresolved


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October 6,2013

FourthVisit:

October 8,2013

c) Explained the importance of properbudgeting

d) Encouraged mother to continueutilizing family planning

e) Showed sample budgets appropriate

for the monthly income of the familyf) Gave examples of cheap meals with

high nutritional contentg) Advised the family to use their

money wisely and buy things that areneeded

h) Provided the family with informationregarding different methods inearning extra money such asrecycled papers and bottles

i) Encouraged the family plant

backyard vegetables such asmalunggay, eggplants, etc.

j) Encouraged the family to prioritizedtheir needs from wantsInstructed the family to have a listwhen buying foodsk) Emphasized use of family

planning method




Fourth

Visit:October 8,2013

Presence ofbreeding sitesof rodents and

other insectsthat arevectors ofdiseases

Nursing Observations House is not being clean regularly House is dirty and slightly dilapidated

Has poor sanitation Cockroaches are seen inside the

house With hanging clothes outside the

house

Nursing Actions

a) Assessed the salience of thefamily toward the problem in poorenvironmental sanitation

b) Listened the family mention themeasures they are doing incontrolling rodents andmosquitoes

c) Provided health teachings on theimportance of clean environment

d) Discussed with the family thediseases that these vectors might

Breeding siteswere eliminated as

The house looks

more organizethan before

The clothes werefolded

The dishes werewashedimmediately afteruse

There are stillsome spider websbut lesser in

number thanbeforeThere are garbageoutside the housebut it is alreadysegregated and forcollectionResolved


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causee) Encourage the family to clean

every corner of their houseincluding the outside of theirhouse

f) Instructed them to remove anystagnant water

g) Instructed the family to removethe junks surrounding their house

h) Instructed the family to removethe hanging clothes inside thehouse

i) Encouraged the family to sleepwith a mosquito net

j) Encourage the family to makeuse of cheap pesticides like chalk

pesticidesk) Encourage the family to clean the

house and the surroundingfrequently


SecondVisit:September

17, 2013



Dangerouspathwaygoing to theirHouse

Nursing Observations Their house has a narrow stair, stiff

and slippery due to presence ofalgae.

Mrs. Ratio always carry her 4thchildand increase risk for fall

Nursing Actions

a) Assessed the knowledge of the familyregarding the safety precautions.

b) Encouraged to have handles at thestairs.

c) Stressed importance of removingalgae to stones of the stairs

d) Instructed children to avoid runningdown the stairs.

The pathway stilllooks the samebut algae werelessened

Mr. Pavino isplanning to putcement and

reconstruct thestair

Partially Resolved

First Visit:

September11, 2013


Financial

Constraints /LimitedFinancialResources

Nursing Observations

Member of Pantawid PamilyangPilipino Program

Inadequate Monthly Income of parents(almost less than P5,000. per month)

Big family size(6 in the family)Household of the family finished grade

four level and currently working as a

The Family still

borrows moneyfrom other relativebut only on themost importantsituations

Still member of4Ps

Unresolved


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Fourth

Visit:October 8,2013

farmerThe mother finished 1styear high

school and unemployed

Nursing Actions

a) Encouraged to search for jobsaccording to their skills.

b) Emphasized the importance ofincome as means of satisfying theneeds of the family.

c) Explained ways and give informationregarding government agency hiring.

d) Encouraged to actively participate onthe programs being implemented by4Ps




2013


Fire hazardsdue to housemade up oflight materials

Nursing ObservationsHouse made of bamboo and scarp

materials such as old aluminium andbroken hollow blocks

Electrical Wirings are not properlyarranged on the ceiling

Cooking inside the house using coaland woods

Nursing Actions

a) Discussed the importance of

preventing fireb) Explained the possible life threatening

effects of fire to the family and itsdestructing effects

c) instructed to keep out fire once not inuse pour water onto the fire flame orwith wet blanket dispose fire ambersafter use and keep it away fromchildren

d) Instructed to cook far from the houseif uses coal

e) assign a responsible member of thefamily to cook

f) prepare water to keep out fire in caseof emergency teach techniques onhow to safely escape fire

The tools used forcooking such askalan de ulingwere broughtoutside the house

Wirings are stillnot arrange

Partially Resolved


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H. SUMMARY, CONCLUSION, AND RECOMMENDATIONS

Summary

This case study was done to assess the Pavino Family. History taking were done

at the visit visits and noted the following: Family Data, Family Members Chart, Family

Characteristics, General Family Relationship, Dietary Habits of the Family, Source of

Family Income, Family Health History, Felt Needs of the Family and assessed the

Home and Home Environment, Health and Health Practices, Family Environment, and

Awareness of Community Organization. After that the researcher was able to identify

problems, rank them according to priority and able to formulate nursing care plan for the

family. On the second and third visit the researcher implemented the different

interventions for each problem identified. The family cooperates to the researcher by

doing the health educations and instructions given to them. There is seen improvement

on family health status and environment, but still financial problems were there. On the

last visit, it was seen that some of the problems were resolved, others partially resolved

and commonly the problems related to financial status is unresolved.

Conclusions

Home Visitation and Formulation of nursing care plan for the family had a big

impact to bring the family on the state of wellness. Even though there were problems

that are unresolved it is very important to do continuous health education and visits. It is

also important to encourage each family member to act, intervene and manage their on

health as well as environment. A healthy family creates a healthy community and each

member of the family has significant role to attain optimum health.


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Recommendations

Based on the findings of the study, the following recommendations were made:


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pavino family

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