rle community

8/13/2019 RLE Community

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Name: Antoniette C. Dumdumaya CI: Mrs. Vivian S. Bartolome RN MN

Year/Section: 3K Area: Canelar Health Center

Date: February 14-16/21-23, 2013 Rotation: 4

Terminal Performance Objective:

Acquisition, application and demonstration of proper skills, correct knowledge, right

attitude and values in providing basic health services for beginning professional practice in

Canelar Health Center for clients with problems in inflammatory and immunologic

response, and perception and coordination, as well as problems in maladaptive patterns of

behavior with emphasis on the health promotion and prevention of diseases with

consideration on ethico-legal aspect of nursing practice integrating the eleven key areas of

nursing responsibilities.

Enabling Objectives:

At the end of 48 hours of R.L.E, I will be able to:

1. Orient myself with the physical set-up of the area assigned.


2/18

PLAN OF ACTIVITIES

February 14, 2014-Thursday

TIME ACTIVITIES REMARKS

7:00-7:15

7:15-8:00

8:00-10:00

10:00-10:15

10:15-12:00

12:00-12:30

12:30-2:00

2:00-2:30

2:30-2:45

Arrived at Canelar Health Center andsigned in with CI.

Pre-Conference

Orientation and familiarization of thephysical set-up of the area and members ofthe health care team.

SNACK

Interaction with client through home visits.

LUNCH BREAK

Discussion with CI on informationobtained.

Post Conference

Aft C

students signed in with CI

CI discuss about area andmembers of the health care team

CI oriented student

Student took their snack

Student made home visit.

Student took their lunch.

Students discussed with CI

CI discuss about task fortomorrow


3/18

PLAN OF ACTIVITIES

February 16, 2013-Saturday


7:00-7:15

7:15-8:00

8:00-11:00

11:00-12:00

12:00-2:00

2:00-2:30

2:30-2:45

2:45-3:00

Arrived at Canelar Health Center and signed inwith CI.

Pre-Conference

Joined Dengue Zero Motorcade

SNACK/LUNCH BREAK

Discussion with CI on information obtained.

Post Conference

After Care

Signed out/Dismissal


CI discuss task for today

Student joined Dengue ZeroMotorcade.


Student discussed with CI




Student cleaned area andsigned out


4/18

PLAN OF ACTIVITIES

February 22, 2013-Friday


7:00-7:15

7:15-8:00

8:00-12:00

12:00-11:00

11:00-11:30

11:30-12:30

12:30-2:00

2:00-2:30

2:30-2:45

2 45 3 00

Arrived at Canelar Health Center andsigned in with CI.

Pre-Conference

Performed Health Teaching at community

SNACK

Travel time from community back to thehealth center

LUNCH BREAK

Discussion with CI on informationobtained.

Post Conference

After Care


CI discuss task for today

Student discussed health teachingon identified problems.


Student returned to Health Centerbase.




Student cleaned area and signed


5/18

INITIAL DATA BASE

A. FAMILY STRUCTURES, CHARACTERISTICS AND DYNAMIC

FAMILY DATA

Respondent Profile:

Name : Rosie RiveroAge : 52 years old

Sex : Female

Address : Purok IX, Canelar Moret Zamboanga City

Birth Place : Siocon, RT Lim, Zamboanga Sibugay Province

Birth of Date : December 4, 1959

Occupation : Housewife

Civil Status : Married

Nationality : Filipino

Number of Children : Four (4)

Educational Attainment : Elementary Level (Grade Six)

Name of Husband : Mr. Abner Rivero (deceased)

Length of Residency : 13 Years


6/18

The Rivero family resides at Purok IX, Canelar Moret, Zamboanga City. They are a nuclear

type of family that has six members. The respondent Mrs. Rivero, 52 years old, born on December

4, 1959 was originally from Siocon Province, she has just became a widow. She states that her

husband just passed away last month of January 13, 2013. They own the house the live in but not

the lot. They have their own electric connection but buy their water from neighbors, the main

source being the Zamboanga water district. Mrs. Rivero has four children, three boys and a girl.

They are all grownups and can take care of themselves her responsibility has gone down to only

guide them in whatever decision they make understanding that her children has their own life to

lead. She still cook for the family and do housework but most of the time she is alone in the house.

Mrs. Rivero is still grieving for the lost of her husband. Her husband used to be the breadwinner ofthe family; he was a vendor of mangoes and a responsible husband to their four children. Now

that his husband is gone, expenses in the house, especially the food and other basic needs are

shared by her two sons who work in a construction and Mrs. Rivero herself by accepting laundry

services from neighbors.

The familys primary dialect is chavacano but they also speak bisaya and tagalog. Only two

of her children are presently in school. Both children are being sponsored by the community as

barangay scholar because they belong to an indigent group of family. Mrs Rivero has four children.

Her eldest and second son works in a construction they are Marlon Rivero, 24 years old and

Maximiano Rivero, 21years old. The third is Analiza Rivero who is now 18 years of age and on her

fourth year in high school. Her youngest son who is a 16 year old is on his sixth grade in

elementary. They have to stop school thats why their age is advance due to financial concerns.

Mrs Rivero is a devoted Christian as well as her four children She said that she goes to church


7/18

IDENTIFYING FAMILY HEALTH PROBLEMS AND COMPUTING AND JUSTIFYING SCORESOF HEALTH PROBLEMS

1. IMPROPER DRAINAGE SYSTEM AS A HEALTH THREAT

Inability to make decision with respect to taking appropriate health action due to lack of

knowledge alternative solution.

CRITERIA COMPUTATION SCORE JUSTIFICATION

NATURE OF THE

PROBLEM

2/3X1 0.67 The problem is a health threat.

MODIFIABILITY OF THE

PROBLEM

1/2X2 1 The problem is partially modifiable. Thecannot do family has no resources to

PREVENTIVE POTENTIAL 2/3X1 0.67 A close drainage system will prevent vectorslike mosquito to breed and any accidentespecially for children playing nearby.

SALIENCE OF THE

PROBLEM

0/2X1 0 The problem does not need immediate

attention.

TOTAL 2.33

2. UNSANITARY GARBAGE DISPOSAL AS A HEALTH THREAT

Inability to recognize the health threat due to lack of knowledge about the condition


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PROBLEM as long as they have shelter.

TOTAL 2.67

4. HYPERTENSION AS A HEALTH DEFICIT

Inability to make decisions with respect to taking appropriate health actions dueto:

- failure to comprehend the nature/magnitude of the problem.- lack of adequate knowledge as to alternative courses of action open to them

CRITERIA COMPUTATION SCORE JUSTIFICATION

NATURE OF THE

PROBLEM

3/3X1 1 The problem is a health deficit in which willcause complications that requires immediateattention and adequate management of ones

blood pressure.

MODIFIABILITY OF THE

PROBLEM

2/2X2 2 The problem is partially modifiable. Thefamily has difficulty of providing themselvesa bigger place to live due to financialresources

PREVENTIVE POTENTIAL 3/3X1 1 Increasing the living space, will reduce thetransferability of communicable diseases,


9/18

Priority Problem Score

HYPERTENSION AS A HEALTH DEFICIT health deficit 5

CIGARETH SMOKING AS A HEALTH DEFICIT health deficit 4.16

INADEQUATE LIVING SPACE AS A HEALTH THREAT health threat 2.67

UNSANITARY GARBAGE DISPOSAL AS A HEALTH THREAT IMPROPER health deficit 2.67

DRAINAGE SYSTEM AS A HEALTH THREAT

health deficit 2.33

NURSE-PATIENT/CLIENT INTERACTION

STUDENT NURSE CLIENT TECHNIQUE USED ANALYSIS

Hello Maam!Goodmornng po!(Smiles)

Ako pala si Antoniette

Maam. Nursing studentsa WMSU. Anoginagamit niyong salita

Maam?tagalog,chavacano, o bisaya?

Goodmorning!

Bisaya ko Day, pero

kabalo man pud ko magtagalong, ugchavacano.

Greeting

Giving information

and givingrecognition andestablishing rapport.

Client acknowledgesand welcomes studentnurse.

Student nurse introduce

self to establish trust orrapport with client andask permission to

interview and whatlanguage she is

comfortable using


10/18

Dugay na mu diri

nagpuyo maam?

Unya maam inyuha naning balay? Inyuha pudang ilaw?

Ang tubig maam?

Ahh mao ba. Asa manimong pamilya

maam?Imonganak ugbana?

Condolence maam.

Nakasabot ko nga saimong gibati run. Maamkung okay lang nimu.Unsa man ang iyangikinamatay?

Thirteen years na mi

diri. Taga Siocon manjud ko. Pero ako bana

taga diri jud.

Uu amua na ning balay.Ug ang ilaw kami pudnagpataud ani.

Gapalit mig tubigsilingan..water district.

Akong duha nga anaknagtrabaho and duha

nag-eskwela . Akongbana bag-o lang

namatay. Katu langlast month January 13.

Diabetic man tu siya.

Naa pud tu sya highblood. Nag inum mantu sila sa gabii diha rasilingan. unya pag-abotdiri sa balay natulog ra

pud siya. Pag-abot

kaadlawun mga alas

Asking information

Asking information

Emphatized with

client. Encouragingor giving broadopenings

Student asked length of

residency of client andother necessary

information aboutclient.

Student emphatized

with client andexpresses deepunderstanding of whatclient feels. And askclient\s

permission/willingness

to talk about her


11/18

Maam mangutanako

tungud sa imong mgaanak? Kinsa man ilang

mga ngalan ug edad?

Maam salamat kaayo sapagdawat sa amua saimong balay. Puhonokay ra gihapun nimu

ang pagbalik namuh diri.

Okay lang maammaghulat lang man midiri kay naa man pud

amuang classmate ngaclient diri

(Client filled in

infomation).

Okay lang pud. Gaadtura ba ku sa lubong saakong asawa kung

buntag.pero muuli ra

man ko.

.


12/18

FAMILY NURSING CARE PLAN

HEALTH PROBLEM FAMILY NURSING

PROBLEM

GOAL OF CARE OBJECTIVES OF CARE NURSING INTERVENTION

METHOD

OF

FAMILY

CONTACT

RESOURCES

REQUIRED

EVALUATION

HYPERTENSION AS

A HEALTH DEFICIT

SUBJECTIVE CUES:

Meron ako High

blood pressure at

tatlong taon na ako

Nagmemaintain ng

Neobloc as

verbalized by the

client.

OBJECTIVE CUES:

Client is seen

smoking

VITALS SIGNS:

BP-140/100

RR- 22

P- 82

Inability to makedecisions with respect totaking appropriate healthactions due to:

1. Failure to comprehendthe nature/magnitudeof the problem.

2. Lack of adequate

knowledge as toalternative courses of

action open to them.

After nursingintervention thefamily will take thenecessary measuresto properly manage,control and lessenthe risk factors ofhypertension.

After nursingintervention the familywill:a. have adequateknowledge aboutproper nutrition thatwill help reducehypertension and

prevent to occurrenceof relative

complications in thefuture.b.be able to determine

the risk factors thatcontribute to

hypertensionc. practice properlifestyle with regards tonutrition and physicalfitness.

Discuss the nature, signs,symptoms and complications thatmight arise due to hypertension.1. Discuss with the family the

risk factors of hypertensionsuch as family history, age,salt and alcohol intake andobesity.

2. Promote a healthy lifestyle

such as:a. encouraging proper food

intake like reduced salt and

fatty foods.b. Prevent obesity through

good nutrition andexercise.

c. Smoking cessation-tobacco or nicotinepromotes atherosclerosisthat may contribute tohypertension both passiveand active smoker.

3. Encourage check-ups andprovide referral with amedical practitioner to lessen

hypertension and modify risk-factors.

HOME

VIS

ITS

Material

Resources:Visual Aids,flyers andcommunitydiscussion.

Time, money

and effort on thepart of the nurse

and family


13/18

DRUG STUDY

NAME OF DRUG MECHANISM OFACTION

INDICATION CONTRAINDICATIONADVERSE REACTION/SIDE

EFFECTS NURSINGRESPONSIBILITIES

Vaccine Hepatitis B

Engerix-BEngerix-B Pediatric

Classification:ImmunizationHepatitis B

The vaccine is made

from inactivatedwhole virus ofhepatitis B. The

inactive virusstimulates your bodyto produce antibodiesto fight hepatitis Bvirus.

The hepatitis B vaccine is given

to children as a series of threeinjections (shots).- The first shot is given to

infants before leaving thehospital. If the baby's mothercarries the hepatitis B virus, thebaby receives the first vaccineshortly after birth.- The second shot is givenbetween 1and 2months of age.- The third shot is given at6months of age.

Most infants who receive the

hepatitis B vaccine have noside effects. Others may haveminor problems, such as

soreness and redness at theinjection site or a mild fever.Serious problems are rare andare mainly due to allergicreactions to a component ofthe vaccine

Diptheria/TetanusToxoids: Pertusis

Vaccine, DTPinjection

Generic Name:Diptheria ToxoidAdsorbed, PertusisVaccine, Acellular(Adsorbed)

Brand names:Adacel (containingDiphtheria, TetanusToxoids, Acellular

Pertussis Vaccine)

Boostrix (containing

Diphtheria, Tetanus

Is used to preventdiphtheria, tetanus,

and pertussisinfections.

- See your health careprovider for all shots of this

vaccine as directed.

- To have protection frominfection, you must have 3shots of this vaccine plusboosters as needed.

- Tell your doctor right awayif you have any serious orunusual side effects aftergetting this vaccine.

Not advisable if you have-blood disorders like

hemophilia-fever or infection-immune system problems-neurologic disease-seizures-an unusual or allergicreaction to vaccines,thimerosal, latex, othermedicines, foods, dyes, orpreservatives-pregnant or trying to getpregnant-breast-feeding

-immune globulin

-medicines that suppress yourimmune function like

Side effects that you should report toyour doctor or health care

professional as soon as possible:-allergic reactions like skin rash,itching or hives, swelling of the face,lips, or tongue-breathing problems-fever of 103 degrees F or more-flu-like symptoms-inconsolable crying-infection-pain, tingling, numbness in thehands or feet-seizures-swelling of arm or leg that was

injected-unusually weak or tired

Side effects that usually do notrequire immediate medical attention


14/18

Toxoids, Acellular

Pertussis Vaccine)

Certiva (containing

Diphtheria, Tetanus

Toxoids, Acellular

Pertussis Vaccine)

Drug Class:Combinations withA Tetanuscomponents.

adalimumab, anakinra,infliximab-medicines to treat cancer-medicines that treat or

prevent blood clots likewarfarin, enoxaparin, and

dalteparin-steroid medicines likeprednisone or cortisone

(report these side effects to yourdoctor or health care professional ifthey continue or are bothersome):-fussy, irritable

-loss of appetite-fever of 102 degrees F or less

-pain, tenderness, redness, swelling,or a 'knot' at site where injected-vomiting

Bacillus Calmette-Gurin (BCG LiveSystemic)VACLASSIFICATIONPrimary: IM100

Commonly usedbrandname(s): TICE

BCG.

Category:Immunizing agent(active/live

vaccine)

A live culture ofattenuated organismsof bacillus Calmette-Gurin (BCG) strainof Mycobacteriumbovis

BCG live vaccine

induces cell-mediatedimmunity againsttuberculosis.

- Bacillus Calmette-Gurin(BCG) live vaccine, intendedfor immunization of uninfected(tuberculin negative) persons toinduce tuberculin sensitivity asa protection against tuberculosisinfection.

- Conditions affecting use,especially: Sensitivity toBCG live

- Other medications,especially anti tubercularagents, corticosteroids,immunosuppressant agents,

or killed or live virusvaccines

- BCG live vaccine should beused with caution inindividuals withasymptomatic HIVinfection and in individuals

known to be at high risk forHIV infection

The initial skin lesions, which aresmall red papules, appear in 10 to 14days and reach a maximum diameterof 3 mm each after 4 to 6 weeks,which may scale and slowly subside.If not an abscess forms, whichusually softens and tends to openspontaneously. The abscess heals

within a few weeks, and, in suchinstances, a scar may form. Theintensity and duration of the local

reaction depend on the depth ofpenetration achieved inadministration and the individualvariation in tissue reaction.

Those indicating need for medicalattention

INCIDENCE MORE FREQUENT

- Abscesses (accumulation of pus)

- dermatologic reactions (peeling orscaling of the skin)- granulomas (aggregation ofinflammatory cells)- lymphadenitis (inflammation of 1


15/18

or more lymph nodes)- ulceration at site of injection (soresat place of injection)

RARE INCIDENCE

- Allergic reaction or erythemanodosum (skin rash)

- BCG infection,disseminated (fever; cough)

- osteomyelitis (increase in bonepain)


16/18

HEALTH TEACHING PLAN

SUBJECT MATTER: HYPERTENSIONTIME ALLOTMENT: 20 MINUTES

ASSESSMENT LEARNINGNEEDS

TEACHINGOBJECTIVES

CONTENT STRATEGIES RESOURCES EVALUATION

SUBJECTIVECUES: Meron akoHigh blood pressure attatlong taon na akoNagmemaintain ngNeobloc asverbalized by theclient.

OBJECTIVE CUES:

Clients is seensmoking

Vital signs:

BP- 140/100RR-22

P-82

At end of 20minutes the client

will be able to:

Verbalizeunderstanding ofthe diseasecondition.

States the riskfactors ofdeveloping orhaving a high

blood pressure.

Enumerate waysto choose foods

forproper

nutrition andphysical

activities thatwill help reducehypertension

and prevent tooccurrence of

relativecomplications inthe future.

At the end of 20 minutesof community discussionand with client present,the client /communitywill be able tounderstand about thedisease condition, statesthe risk factors ofdeveloping or having ahigh blood pressure, andenumerate ways to

choose foods forpropernutrition and physical

activities that will helpreduce hypertension

and prevent tooccurrence of relative

complications in thefuture.

HIGH BLOOD PRESSURE

- is known as the silent killer because you canhave high blood pressure and not know it.

- High blood pressure is one of several risk factorsthat can increase your chance of developing heart

disease, a stroke, kidney failure and other serious

conditions.

Blood pressure is the force of blood that pushes against

the wall of the blood vessels as the heart pumps. High

blood pressure is also called hypertension.

There are two measurements that are used to assess

blood pressure:

systolic pressure

- is the blood pressure when the heart pumps bloodaround your body.

diastolic pressure

- is the measure of blood pressure when the heart isresting in between beats. The blood pressure

numbers are written with the systolic number

above or before the diastolic number

WHAT BLOOD PRESSURE NUMBERS MEAN:

Less than 120 systolic/Less than 80 diastolic

-Healthy Range(recheck in 2 years)Maintain healthy

lifestyle

130-139 systolic/85-89 diastolic

-Approaching high risk(recheck in 1 year)Begin lifestyle

Communitydiscussion

InternetBooks/flyersMoneyTime andeffort


17/18

changes to prevent full blown hypertension

More than 140 systolic/More than 90 diastolic

-Your blood pressure is high(follow-up with doctor )Work

with your doctor to control your BP

YOU ARE AT INCREASED RISK FOR

DEVELOPINGHIGH BLOOD PRESSURE IF YOU:

1. Are overweight

2. Dont exerciseon a regular basis

3. Eat foods high in salt or sodium4. Dont eat many fruit andvegetables

5. Drink an excess of alcoholic beverages(more than 1 to 2

drinks per day)

6. Have a family history of high blood pressure

7. Are of African descent

8. Are aged over 65

HIGH BLOOD PRESSURE CANT BE CURED,BUT

IT CAN BE LOWERED AND CONTROLLED IF

YOU:

1. Keep to a healthy weight

2. Exercise regularly (30 minutes per day)

3. Eat more fruit and vegetables(five or more servings a

day)4. Cut out added salt and choose sodium free, and low

sodium foods instead

5. Dontsmoke

6. Limit alcohol intake to 2 drinks a day for men and1 for

women

7. Take your blood pressure medication as directed(do not

stop medication without your doctors approval)

8. Get your blood pressure checked at least every twomonths

TIPS TO REDUCE SODIUM INTAKE:

Follow the DASH diet.

This diet includes fruits, vegetables, whole grains,

legumes and nuts, lean meats, and low-fat dairy

products.

Avoid processed, canned and fast foods.

Avoid adding salt during cooking and at the table.

Read food labels to determine sodium content of


18/18

foods and avoid those high in sodium.

The Percentage Daily Value (%DV) tells you whether a

food has a little or a lot of a given nutrient. Foods with:

- 5% sodium DV or less are considered low in sodium

- 15% sodium DV or more are high in sodium.

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