Sample Family Care Study (n107) z3e6s

N107- Family Case Study 2012 INTRODUCTION

I.

A. OVERVIEW Community refers to a group of people who interact with each other; it is a social group determined by geographic boundaries, common values and interest. It functions within a social structure, exhibits and creates norms, values, and social institution. (Microsoft ® Encarta, 2009) In Community health nursing, one of the two major fields of nursing in the Philippines, nursing practice in the community means different things to different nurses. Its primary goal is the promotion and preservation of health of its client that could be in the individual, family, population, group and community. In community health nursing practice includes nursing directed to individuals, families, groups; the dominant responsibility is the population as a whole. With these, the health of the people is a reflection of the communities of which they live, play, work and learn. Communities shape the lifestyle that people adopt and their livelihood of living safe, fulfilling and productive lives. Family, basic social group united through bonds of kinship or marriage, present in all communities. Ideally, the family provides its with protection, companionship, security, and socialization. The structure of the family, and the needs that the family fulfills vary from society to society. The nuclear family—two adults and their children—is the main unit in some societies. In others, it is a subordinate part of an extended family, which also consists of grandparents and other relatives. In a community, the family is considered to be its basic unit. (Microsoft ® Encarta, 2009) Our community experience has been founded on the above principle. This exposure did not only provide an avenue to apply what we have acquired in the classroom but also provided an opportunity to serve our fellowmen. Because being in the community is more than meeting the requirements in the Related Learning Experience (RLE), it is being experience the real world, making real memories and rendering service with competence, conscience, commitment and care. This paper presents a case of a nuclear family of five (5) at The Tent City, Calaanan, Cagayan de Oro City. As a community health student nurse assigned in the area, I was given a chance to care for a certain family. After initial survey of the place, I came across to the XX family. The objective of the study is to smooth the progress of putting into practice the concept of family-oriented nursing care and make certain an organized approach in the delivery of the nursing services to the families in the community, purposely in the application of the nursing process. It aims to identify the health problem of a family within the community. As student nurse, I could give and apply some nursing interventions that are applicable and attainable within the community health services.

Sample by: Torregosa, Cyrus Dan A.

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N107- Family Case Study 2012 At the end of two (4) weeks of Community Health Exposure, I will be able to provide to the XX family nursing interventions to the identified health problems affecting the family. The health programs of the Department of Health (DOH) for the promotion of health and prevention of illnesses and the improvement of the conditions in the social and physical environment will also be imparted to the family, and also to participate with the family in the over-all health plan affecting the family, in its implementation and evaluation.

B. SCOPE AND LIMITATION OF THE STUDY This Family Health Care Study provides information and additional knowledge about health to the family concerned. The student is focusing only on the XX family, on their health promotion, prevention of illness and possible ways of alleviating health problems. The student also rendered health teachings according to our knowledge of health care concepts as well as through the culminating and microteaching last March 01, 2012. The student also emphasized DOH programs offered by the Department of Health and the services they offered at Barangay Health Centers. Family care study covers only four (4) weeks of Community Health Nursing. This is also limited to the family's capabilities and willingness to participate and cooperate with the nursing interventions.


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N107- Family Case Study 2012 II.

SPOT MAP A. NARRATIVE DESCRIPTION Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City, Misamis Oriental is

located Southwest and 7.5 kilometers away from Cagayan de Oro City proper. Our reference point is from Liceo de Cagayan University-main campus to Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City. From here the students have to charter a jeepney to transport the group to and from with the fare of 43 pesos. From the school, the jeepney should turn right on the intersection going to Patag, ing through the SSS building, GSIS building, Highschool Department, National Grid of the Philippines. The jeepney will then turn left with the House of Bulalo as the landmark then going to the Villarin street ing through the establishments of Department of Telecommunication and National Irrigational istration, straight ing the St. Mary’s Academy and Mt. Carmel Church. Then turn left from the intersection between Macanhan and Upper Carmen ing Immanuel Mission School and Landfill Zayas, Upper Carmen going downward ing the Silver Creek Subdivision and St. Therese Chapel. Upon arriving on the Canitoan Road, the jeepney must turn left to P.N Roa area, going straight ing to the P.N Roa Elementary school then finally to the Tent City. The Tent were numbered and arranged by five, the tent of our family is # 273.

B. ALTERNATIVE ROUTE One may ride a jeepney going to Cogon Market where you will stop near Petron Gasoline Station facing south you will go then to the street leading to National Bookstore. At the back of the National Bookstore is where you will the find the jeepney going to the P.N Roa including Calaanan. Upon riding on that jeepney, you can by the Rotonda circle and Upper Carmen ing Immanuel Mission School and Landfill Zayas, Upper Carmen going downward ing the Silver Creek Subdivision and St. Therese Chapel. Upon arriving on the Canitoan Road, turn left to P.N Roa area, going straight ing to the P.N Roa Elementary school then finally the Tent City.The Tent were numbered and arranged by five, the tent of our family is # 273.


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‘ C. ILLUSTRATION/DIAGRAM OF THE MAP Spot Map of The Tent City, Calaanan Relocation Site, Canitoan, Cagayan de Oro City, Misamis Oriental


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‘ III.

FAMILY PROFILE

Client’s Name:

Mr. XX

Position in the Family:

Head

Gender:

Male

Age:

27 years old

Civil Status:

Married

Birth date:

April 08, 1984

Birth place:

Punong, Gingoog City

Citizenship:

Filipino

Religion:

Roman Catholic

Occupation:

Motor- rela driver

Monthly income:

P 1,500.00

Client’s Name:

Mrs. XX


Wife

Gender:

Female

Age:

22 years old

Civil Status:

Married

Birth date:

May 14, 1989

Birth place:

Punong, Gingoog City

Citizenship:

Filipino

Religion:

Roman Catholic

Occupation:

Housewife

Monthly income:

None

NO PICTURE TAKEN


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‘

Client’s Name:

XX1


1st Child

Gender:

Female

Age:

4 years old

Civil Status:

Child

Birth date:

January 23, 2008

Birth place:

Northern Mindanao Medical Center, CDOC

Citizenship:

Filipino

Religion:

Roman Catholic

Client’s Name:

XX2


2nd Child

Gender:

Female

Age:

2 years old

Civil Status:

Child

Birth date:

May 07, 2009

Birth place:


Citizenship:

Filipino

Religion:

Roman Catholic


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‘

Client’s Name:

XX3


3rd Child

Gender:

Male

Age:

1 year old

Civil Status:

Child

Birth date:

October 26, 2010

Birth place:


Citizenship:

Filipino

Religion:

Roman Catholic

IV.

FAMILY HEALTH HISTORY 1. Client Mr. XX Mr. XX is 27 years of age, and is presently residing with his whole family now at the

Tent City, Calaanan Relocation Site, CDO; Tent No. 273. He had common colds and cough last month and doesn’t have any chronic illness as claimed. He was fully immunized during his childhood days since his mother was a BHW in their place. Last 2005, he suffered from Urinary Tract Infection thus consulted and itted at NMMC which lasted for 5 days. He had heredofamilial diseases of asthma, diabetes mellitus II and hypertension. No known food and drug allergy.

2. Client Mrs. XX Mrs. XX is 22 years of age, a housewife. She had her first menstruation at the age of 12 years old and had a regular monthly period. She was immunized completely during childhood. She claimed that she was positive for Hepatitis B when she was carrying her 2nd child on her womb (4 years ago) after a blood test was performed. She was in denial at that time, she did request another test but the result was still the same. She had no idea where she got the dreadful disease. She knows how the disease was transmitted. Now she’s in a stage of acceptance as she claimed.


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‘ She has no known food and drug allergy and don’t have any history of diseases in their family line. She delivered her children through normal spontaneous vaginal delivery at Northern Mindanao Medical Center. She had her prenatal check-up at same institution. So far she had no complications experienced for her past pregnancy.

Gynecology History  Menarche at 12 y.o. regular subsequent menses, 5 days (-) dysmenorrhea Obstetric History  G1- (January 23, 2008)

XX1- NSVD, NMMC

 G2- (May 07, 2009)

XX2- NSVD, NMMC

 G3- (October 26, 2010)

XX3- NSVD, NMMC

Hospital Confinement  UTI itted at NMMC for 4 days (2008)

3. Client XX1 Client XX1, a 4 year old female child, was delivered through normal spontaneous vaginal delivery at Northern Mindanao Medical Center. She was fully immunized. The child was hospitalized when she was about 6 months old at NMMC for a week due to Acute Gastroenteritis with Moderate Dehydration.

4. Client XX2 Client XX2, a 2 year old female child, was delivered through normal spontaneous vaginal delivery at Northern Mindanao Medical Center. She was fully immunized. Like her older sister, she was hospitalized when she was about 6 months old at NMMC for 4 days due to Acute Gastroenteritis with Moderate Dehydration.

5. Client XX3 Client XX3, a 1 year old male child, was delivered through normal spontaneous vaginal delivery at Northern Mindanao Medical Center. He was fully immunized now. Like his older sisters, again he was hospitalized when he was about 6 months old at NMMC for just 4 hours for hydration purposes due to severe dehydration. Their mother did say that her children experienced the same disease when they were about 6 months old. Coincidence?


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‘

PRESENT HEALTH STATUS

V. A. 1.

Client Mr. XX Mr. XX claimed that he doesn’t have any illnesses at the moment. His cough and colds

subsided a month ago. He works as a motor-rela driver. No history of drinking alcoholic beverages and non-smoker. Vital signs was taken last February 02, 2012 with a Pulse: 88 bpm RR: 21m

2.

BP: 130/80 mmHg

Temp: 36.2 oC.

Client Mrs. XX Mrs. XX claimed that he doesn’t have any illnesses but do have troubled sleeping at

night when they transferred at their tent. She’s a housewife and always taking care of their young ones, making sure that they’re safe and sound. No history of drinking alcoholic beverages and non-smoker as claimed. Vital signs was taken last January 20, 2012 with a Pulse: 78 bpm RR: 23m

3.

BP: 110/80 mmHg

Temp: 36.5

Client XX1 During assessment, cough and colds with whitish sputum was noted with client XX1. Her

mother said that her cough and colds was intermittent for the past 4 weeks. The child does take Vitamin C and Multivitamins given by the clinic for free after consultation. Vital signs: Pulse: 97 bpm RR: 25m BP: no pedia cuff avail,

4.

Temp: 36.30C

Client XX2 No illness was noted with client XX2. She’s playful, energetic and cheerful during the

course of assessment. The child also takes Vitamin C and Multivitamins. Vital signs: Pulse: 89 bpm

5.

RR: 23m

BP: no pedia cuff avail.

Temp: 36.3oC

Client XX3 Cough and colds with whitish sputum was noted with client XX3 with no respiratory

distress, just like her eldest sister. The mother said that his cough and colds was intermittent for the past 2 weeks and was given Vitamin C and Multivitamins after consulting the clinic. Vital signs: Pulse: 94 bpm

RR: 24m

BP: no pedia cuff avail.

Temp: 36.2 oC


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‘ B. NURSING ASSESSMENT (SYSTEM REWIEW CHART) Name: XX, Mr. XX Vital Signs: Pulse: 88 bpm BP: 130/80 mmHg

Date: February 02, 2012 Temp: 36.2 oC Height: 5’5’’ Weight: 77 kg

EENT: � Impaired vision � blind � pain � reddened � drainage � gums � hard of hearing � deaf � burning � edema � lesion � teeth Asses eyes, ears, nose Throat for abnormality √ no problem RESP. �asymmetric � tachypnea � apnea � rales � cough � barrel chest � bradypnea � shallow � rhonchi � sputum � diminished � dyspnea � orthopnea � labored � wheezing � pain � cyanotic Asses resp. rate, rhythm, depth, pattern breath sounds, comfort √ no problem CARDIO VASCULAR � arrhythmia � tachycardia � numbness � diminished pulses � edema � fatigue � irregular � bradycardia � murmur � tingling � absent pulses � pain Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort √ no problem GASTRO INTESTINAL TRACT � obese � distention � mass � dysphagia � rigidity � pain Asses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problem GENITO-URINARY and GYNE � pain � urine color � vaginal bleeding � hematuria � discharge � nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge √ no problem NEURO � paralysis � stuporous � unsteady � seizures � lethargic � comatose � vertigo � tremors � confused � vision � grip Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ 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 Asses mobility, motion, galt, alignment, t function /skin color, texture, turgor, integrity √ no problem

LEGEND: 1ST WEEK

3RD WEEK

2ND WEEK

4TH WEEK

-slightly elevated blood pressure of 130/80 mmHg -dirty fingernails

-dirty toenails

Place an (√) in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure if appropriate, using (√)


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‘

Name: XX, Mrs. XX Vital Signs: Pulse: 78 bpm BP: 110/80 mmHg

Date: January 20, 2012 Temp: 36.5 oC Height: 5’2’’ Weight: 58 kg

EENT: � Impaired vision � blind � pain � reddened � drainage � gums � hard of hearing � deaf � burning � edema � lesion � teeth Asses eyes, ears, nose Throat for abnormality √ no problem RESP. �asymmetric � tachypnea � apnea � rales � cough � barrel chest � bradypnea � shallow � rhonchi

-pale in appearance

� sputum � diminished � dyspnea � orthopnea � labored � wheezing � pain � cyanotic Asses resp. rate, rhythm, depth, pattern breath sounds, comfort √ no problem CARDIO VASCULAR � arrhythmia � tachycardia � numbness � diminished pulses � edema � fatigue � irregular � bradycardia � murmur � tingling � absent pulses � pain Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort √ no problem GASTRO INTESTINAL TRACT � obese � distention � mass

-difficulty sleeping -(+) Hep. B

� dysphagia � rigidity � pain Asses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problem GENITO-URINARY and GYNE � pain � urine color � vaginal bleeding � hematuria � discharge � nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge √ no problem NEURO � paralysis � stuporous � unsteady � seizures � lethargic � comatose � vertigo � tremors � confused � vision � grip Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ 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 Asses mobility, motion, galt, alignment, t function /skin color, texture, turgor, integrity √ no problem

LEGEND: 1ST WEEK

3RD WEEK

2ND WEEK

4TH WEEK



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‘

Name: XX, XX1 Vital Signs: Pulse: 97 bpm

Date: January 26, 2012 BP: no pedia cuff avail,

Temp: 36.3 oC Height: 103 cm Weight: 13.2 kg

EENT: � Impaired vision � blind � pain � reddened � drainage � gums � hard of hearing � deaf � burning � edema � lesion � teeth Asses eyes, ears, nose Throat for abnormality √ no problem RESP. �asymmetric � tachypnea � apnea � rales � cough � barrel chest

- tooth decay all throughout the assessment -cough and colds with whitish sputum in minimal amount

� bradypnea � shallow � rhonchi � sputum � diminished � dyspnea � orthopnea � labored � wheezing � pain � cyanotic Asses resp. rate, rhythm, depth, pattern breath sounds, comfort √ no problem CARDIO VASCULAR � arrhythmia � tachycardia � numbness � diminished pulses � edema � fatigue � irregular � bradycardia � murmur � tingling � absent pulses � pain Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort √ no problem GASTRO INTESTINAL TRACT � obese � distention � mass

- Moderate personal hygiene - Dirty nails


LEGEND: 1ST WEEK

3RD WEEK

2ND WEEK

4TH WEEK



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‘


Date: January 26, 2012 BP: no pedia cuff avail.

Temp: 36.3oC Height: 97cm Weight: 14 kg

EENT: � Impaired vision � blind � pain � reddened � drainage � gums � hard of hearing � deaf � burning � edema � lesion � teeth Asses eyes, ears, nose Throat for abnormality √ no problem RESP. �asymmetric � tachypnea

-tooth decay all throughout the assessment

� apnea � rales � cough � barrel chest � bradypnea � shallow � rhonchi � sputum � diminished � dyspnea � orthopnea � labored � wheezing � pain � cyanotic Asses resp. rate, rhythm, depth, pattern breath sounds, comfort √ no problem CARDIO VASCULAR � arrhythmia � tachycardia � numbness � diminished pulses � edema � fatigue � irregular � bradycardia � murmur � tingling � absent pulses � pain Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort √ no problem GASTRO INTESTINAL TRACT � obese � distention � mass

-moderate personal hygiene -dirty fingernails


LEGEND: 1ST WEEK

3RD WEEK

2ND WEEK

4TH WEEK



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‘


Date: January 26, 2012 BP: no pedia cuff avail.

Temp: 36.2 oC Height: 79cm Weight: 49 kg

EENT: � Impaired vision � blind � pain � reddened � drainage � gums � hard of hearing � deaf � burning � edema � lesion � teeth Asses eyes, ears, nose Throat for abnormality √ no problem RESP. �asymmetric � tachypnea

-cough and colds with whitish sputum in minimal amount

� apnea � rales � cough � barrel chest � bradypnea � shallow � rhonchi � sputum � diminished � dyspnea � orthopnea � labored � wheezing � pain � cyanotic Asses resp. rate, rhythm, depth, pattern breath sounds, comfort √ no problem CARDIO VASCULAR � arrhythmia � tachycardia � numbness � diminished pulses � edema � fatigue � irregular � bradycardia � murmur � tingling � absent pulses � pain Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort √ no problem GASTRO INTESTINAL TRACT � obese � distention � mass

-moderate personal hygiene -dirty fingernails


LEGEND: 1ST WEEK

3RD WEEK

2ND WEEK

4TH WEEK



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INTERGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

VI.

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Date: January 26, 2012 Child’s name: XX3 Age: 1 year old

Sex: Male

Weight: 9.5 kg

Temp: 36.2˚C

ASK: What are the child’s problem? Cough and colds all throughout the assessment (WEEK 2-WEEK4) Initial visit and Follow-up Visit ASSESS

CLASSIFY

CHECK FOR GENERAL DANGER SIGNS NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING

YES___

CONVULSIONS

NO_√_

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes_√_ No___ For how long?  Count the breaths for one minute. _26_breaths per minute. Fast breathing?  Look for chest indrawing?  Look and listen for stridor. DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_ For how long? ___days Is there blood in the stools? 

Look at the child’s general condition. Abnormally sleepy or difficult to awaken?

No Pneumonia : Cough and Cold

No Dehydratio n

Restless or irritable?  

Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink 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 37.5C or above) Yes__ No_√__ Decide Malaria Risk  

Does the child live in malaria area? No Has the child visited a malaria area in the past 4 weeks? No


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‘ If malaria risk, obtain a blood smear.  

Look or feel for stiff neck. Look for runny nose. + Pf Pv -

Not done

 For how long has the child had fever? __days  If more than 7 days, has fever been present every day?  Has the child had measles within the last 3 months? Look for signs of MEASLES  Generalized rash and  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. …………………………………………………………………………………………………………………………. Decide Dengue Risk: Yes__ N o__√_ If dengue risk, then ask:          

Has the child had any bleeding form the nose or gums or in the vomitus or stools? No Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other signs and has fever for more than 3 days.


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‘ DOES THE CHILD HAVE AN EAR PROBLEM? Yes___ No__√_  

Is there ear pain? No Is there ear discharge? No If yes, for how long? ___days

 

Look for pus draining from the ear. None Feel for tender swelling behind the ear. None

No Ear Infection

THEN CHECK FOR MALNUTRITION AND ANEMIA   

Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? None



Determine weight for age Very Low? Low.

CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today _√__ BCG

_√__ DPT1 __√__ DPT2 _√___ DPT3

__√_

__√__

No Anemia and low weight

Return for next immunizat ion on:

OPV1 HEPB1 _√__ OPV2

__√_

____√___

HEPB2 MEASLES

(date)

__√__ __√___ OPV3 HEPB3

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___

Vitamin A needed today Yes___ No_√__

ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old. 

Do you breastfeed your child? Yes__ No__√__ If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a__



Does the child take any other food or fluids? Yes_√__ No___ If Yes, what food or fluids? _Bear brand milk, fruits, noodles, canned goods, rice


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How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_ If very low weight for age: How large are servings?___child is within normal weight___ Does the child receive his/her own serving? yes__ Who feeds the child and how?_mother, spoonfeeding; child feeds on his own most of the time 

During the illness, has the child’s feeding changed? Yes _√__ No___ If yes, how? Fair appetite

ASSESS OTHER PROBLEMS: Moderate personal hygiene


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‘ MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Date: January 26, 2012 Child’s name: XX2 Age: 2yrs

Sex: Female

Weight: 14 kg

Temp: 36.3˚C

ASK: What are the child’s problem? None all though out the assessment (WEEK 2WEEK 4) Initial visit and Follow-up visit ASSESS

CLASSIFY


YES___

CONVULSIONS

NO_√_

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? No_√__

Yes__

For how long?

No Pneumonia

 Count the breaths for one minute. _24_breaths per minute. Fast breathing?  Look for chest indrawing?  Look and listen for stridor. DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_ For how long? ___days Is there blood in the stools? 


No Dehydratio n









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Not done





DOES THE CHILD HAVE AN EAR PROBLEM? Yes___ No__√_  

Is there ear pain? No Is there ear discharge? No


No Ear

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‘ If yes, for how long? ___days  

Infection








_√__ DPT1 __√__ DPT2 _√___ DPT3

__√_

__√__




__√_

____√___

HEPB2 MEASLES

(date)

__√__ __√___ OPV3 HEPB3



ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old. 

Do you breastfeed your child? Yes_ _ No__√__ If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a



Does the child take any other food or fluids? Yes_√__ No___ If Yes, what food or fluids? _noodles, milk, fruits, rice and canned goods How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_ If very low weight for age: How large are servings?_n/a_____ Does the child receive his/her own serving? yes__ Who feeds the child and


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‘ how?_child herself, spoonfeeding 


ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene


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‘ MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Date: January 26, 2012 Child’s name: XX1

Age: 4yrs

Sex: Female

Weight: 13.2 kg

Temp: 36.7˚C

ASK: What are the child’s problem? Cough and colds all throughout the assessment (WEEK 2-WEEK4) Initial visit and Follow-up visit ASSESS

CLASSIFY


YES___

CONVULSIONS

NO_√_

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? No_√__

Yes__

For how long?  Count the breaths for one minute. _25_breaths per minute. Fast breathing?  Look for chest indrawing?  Look and listen for stridor. DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_ For how long? ___days Is there blood in the stools? 


No Pneumonia : Cough and Cold

No Dehydratio n









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Not done





DOES THE CHILD HAVE AN EAR PROBLEM? Yes___ No__√_  

Is there ear pain? No Is there ear discharge? No


No Ear

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‘ If yes, for how long? ___days  

Infection








_√__ DPT1 __√__ DPT2 _√___ DPT3

__√_

__√__




__√_

____√___

HEPB2 MEASLES

(date)

__√__ __√___ OPV3 HEPB3



ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old. 

Do you breastfeed your child? Yes_ _ No__√__ If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a



Does the child take any other food or fluids? Yes_√__ No___ If Yes, what food or fluids? _noodles, fruits, rice and canned goods_ How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_ If very low weight for age: How large are servings?_n/a Does the child receive his/her own serving? yes__ Who feeds the child and


Page 28

‘ how?_the child herself, spoonfeeding 


ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene


Page 29

‘ VII.

HOME AND ENVIRONMENT

1. Housing 

All families who were victims of the typhoon Sendong, including family XX were sent at Calaan Relocation Site, Canitoan, Cagayan de Oro City (known as the Tent City) and were also given a tent (known as the Shelter box) by the government where

they

will

temporarily reside. The family was on Tent No. 273. 

The

whole

(doors,

covering

flooring,

and

small windows) of the Tent is made up of polyester cloth which is a specialized kind of cloth

that

can

stand

heat and rain, and can’t be easily tear or damage. They were given a special mat additional for their flooring inside the tent. Two doors, the back and front have a pair of zippers used to lock their houses when they’re not around. Windows are widely open at night time. The family said that when its day to noontime (around 9am-3pm) it’s totally hot inside the tent, and very cold at nighttime to dawn (around 10pm-5am). 

Inside the tent, at the center of it is where their little sala is seen, and the left and right compartments serve as the rooms where they usually sleep, change clothes and for the privacy of the couple.



Clothes hanging inside are noticeable also (resting sites of vectors of diseases such as mosquitoes).



Uses no electricity for their lighting facilities and other electrical devices ( cell phone charger, electric flashlight, electric fan, radio)



Has proper ventilation when the doors and windows are widely open


Page 30

‘

2. Water supply 

Water comes from the common source where they usually have to walk and fetch from the water station

(25 meters away from

their tent- washing clothes and dishes, taking baths)



They

use

pail

and

plastic

containers as storage of water for washing the dishes.



Uses plastic gallons as storage for purified drinking water where it’s usually free and delivered by DUAL NARRA. If their supply is already consume, they then usually buy purified drinking water at the nearest drinking water system.

3. Toilet facility 

The LGU’s, NGO’s and other private sectors donated these portalette, a portable toilet where the people urinates and expel their wastes. Every day it is cleaned by a ―poso negro‖ personnels.



The walls are made up of special concrete plastic thing.



Antipolo type



After three weeks of visit, the toilet facility was changed from a portalet into a water sealed type for a better and more sanitized toilet for all.


Page 31

‘

4. Kitchen 

Doesn’t have sink, they usually wash dishes at the water station 25 meters away from their tent



Uses firewood/charcoal for cooking



Washes their dishes using pail as storage of water



Foods are placed on the table outside the tent; leftovers are covered with plates only and a special covering device was noted

5. Garbage/waste disposal 

The family does not segregate their

wastes.



Uses plastic cellophane container then

throws it when its already full at the big barrel for garbage collection

6. Domestic Animals 

They don’t have any domesticated animals and pets in their tent.

7. Neighborhood 

Their neighbors are composed mostly of low-income families and all of them were victims of the typhoon Sendong. Most of these families are friendly and show concern for one another especially when there is a problem among them.



The health center is near and no need to spend money for fare



No fresh air and trees that give shade to the surrounding


Page 32

‘ VIII.

FAMILY COPING INDEX The objective of this indicator is to present a benchmark for approximating the nursing

needs of the particular family, thus Family Coping Index. It is the coping capacity and not the underlying problem that is being rated, and it is designed to record family rather than individual coping capacity. The family cannot be seen only as a factor that affects health; rather, the family is the patient.

Legend: 1 – No competence 3 – Moderate competence 5 – Complete competence CATEGORY

1. Physical Independence

SCALE 5

JUSTIFICATION All family are physically fit and physically capable

of

performing

independently.

The

family

provides needs to its . The father works as a motor-rela driver to provide the needs of his family. The mother takes care of the children and is responsible for bathing, grooming and making their children clean and safe.

2. Therapeutic Competence

3

The family’s initial treatment was the use of herbal medication to treat existing diseases. They

consult to

the physician only if referred from the barangay health center and if immediate medical attention is required due to financial problems.

3. Knowledge of Health Condition

3

Has some general knowledge of the disease or condition, but has not grasped the underlying principles, or is only partially informed and does not know how to lessen & prevent the disease.

4. Application of Principles of General Hygiene

5

In of hygiene, the family was consciously practicing and applying hygiene principle as part of their lifestyle. Based on the objective observation, as well as assessment gathered. They usually attends seminars about health and hygiene as stated by the mother when there is time.

5. Health Attitudes

3

Accepts

health

care

in

some

degree

but

with

reservations. Most of the time, the family does not seek the help of medical professionals only if symptoms persists and intensifies.

6. Emotional Competence

3

The family was able to maintain a fair degree of emotional calm, face up to illness realistically and


Page 33

‘ hopefully; their problem was only lack of financial that was not able to sustain what are those family needs.

7. Family Living

3

Family’s does things together and act for the good of the family as a whole and they have good interpersonal relationship. The children do respect their parents as what I’ve observed.

8. Physical Environment

3

The house is generally in good condition and safe. But they don’t have a proper drainage. The environment possibly has vectors that can cause diseases such as dengue or filariasis.

9. Use of Community Facilities

3

Family is aware of and uses of the health services offered in their place. Their children had received already full immunization.


Page 34

‘ IX.

SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM

SOCIO-CULTURAL FACTORS

Political

Economic

NONE

FATHER

High school undergraduate

Motor- rela driver

Cultural

NONE

MOTHER

High School undergraduate

Housewife

Financially unstable with a monthly income of Php 1, 500

No other additional expense for the Family

HEALTH THREAT: -

Family size beyond what family resources can adequately provide (financially unstable)


Page 35

‘

BIOLOGICAL FACTORS

Physical

Psychosocial

- Typhoon Sendong took away so many things from them, but they were able to adjust in the new environment they have. They’re in the stage of acceptance -Express anxiety over budget compensation for additional budgets

Genetic

Father

-

-

Children Hypertension. DM II and asthma on paternal side

- Long dirty fingernails and toenails - Slightly elevated BP of 130/80mmhg

HEALTH THREAT -

Mother

Moderate personal hygiene Heredito-familial diseases: hypertension, asthma and DM II

- Difficulty sleeping - Lack of sleep - (+) Hep. B

HEALTH DEFICIT -

Lack of sleep Hepatitis B disease Elevated blood pressure cough and colds

- Moderate personal hygiene - Dirty nails - Tooth decay - Cough and colds

FORESEEABLE CRISIS -

infection hospitalization death

Dirty nails Tooth decay


Page 36

‘

ENVIRONMENTAL

Home and Sanitation Condition

TENTS: -No proper division. - No privacy. -Fire Hazard (made up polyester cloth)

Inadequate living space, no proper sleeping grounds, room for contamination is of high risk

Water Supply

Water Source is 25 meters away from the tent. Community faucets used for bathing and washing dishes and clothes.

The family is given a galloon of purified drinking water

Uncovered water containers and storage

Toilet

Communal toilet

Antipolo Portalet and Water sealed type of toilet

Garbage Disposal Waste segregation not practiced. The family hangs a plastic bag adjacent to the tent for their garbage and throws it when full at a big barrel of garbage

Kitchen

Dirty kitchen adjacent to their tent

Prone to fire accdients

- presence of vectors for diseases such as mosquitoes and flies

HEALTH THREAT FORESEEABLE CRISIS - presence of breeding or resting sites of vectors of diseases - infection - improper garbage disposal - hospitalization - making fire at children’s reach may cause burns and - death injuries - inadequate living space Sample by: Torregosa, Cyrus Dan A. Page 37

‘

FAMILY HEALTH PLAN

X.

CUES

Subjective: ―Kani lagi sila akong mga anak kay gipang ubo ug sip on,‖ as verbalized by the wife Objective: -productive cough with whitish sputum in minimal amount - colds

HEALTH PROBLEM

Cough and colds as health deficit

FAMILY NURSING PROBLEM

1. Inability to make decisions about taking appropriate action due to: a. failure to comprehend the nature and magnitude of the problem. b. Fear of consequences of action, specifically economic consequences. 2. Inability to provide

GOAL OF CARE

OBJECTIVES OF CARE

At the end of nursing intervention,

At the end of nursing interventions, the family will:

The children in the family with cough and colds will be relieved.

a. gain knowledge on the management of cough and colds; b. bring the child to the health center for consultation; c. be able to carry out appropriate interventions to relieve the child’s cough and colds;

INTERVENTION PLAN Nursing Method Resources Interventions of NurseRequired Family

1. Taught the mother the ways to soothe the throat and relieve cough with a safe remedy such as tamarind, calamansi and ginger.

Home Visit Material resources:

2. Instructed the mother not to use cough syrups and other decongestants if not prescribed by the doctor.

-tamarind, calamansi or ginger

Time and effort of the nurse and the family

Goal partially met At the end of nursing interventions, the family: a. gained knowledge on the management of cough and colds; ;

Expenses for transportation of the student nurses

3. Instructed the mother to increase the


EVALUATION

Page 38

b. was able to carry out appropriate interventions to relieve the child’s cough and colds.

‘ - not in respiratory distress

adequate nursing care to a member suffering from cough and colds due to:

child’s fluid intake. 4. Instructed the mother to keep the child’s back dry.

a. inadequate knowledge regarding the health condition; b. lack of knowledge on the nature and extent of nursing care needed;


Page 39

‘ CUES

Subjective: ―Gaibutang ra namo among mga pagkaon sa lamesa dayon takluban ug palto‖ as verbalized by the wife Objective: -no other storage facilities to secure their uncooked and left over foods

HEALTH PROBLEM

FAMILY NURSING CARE

GOAL OF CARE

OBJECTIVES OF CARE

Presence of health threat due to poor condition as evidenced by lack of food storage facilities

-Inability to provide a home environment conducive to health maintenance and personal development due to: a. inadequate family resources specially financial constraints or limited financial resources

At the end 30 minutes of nursing interventions, the family will be able to: a. Verbalize understanding about the importance of having better food storage.

After the nursing intervention carried out, the family will at least have better containers or cover to secure their foods and from contamination.

b. Place their food in a safe place away from pests.

INTERVENTION MEASURES

MODE OF NURSEFAMILY 1.Assess knowledge Home visit of the family towards the pending problem. 2.Discuss possible threats to the family’s health due to these containers. 3.Discuss the advantages which will bring about the partial solution to their problem. 4.Plan appropriate action to the problem.


RESOURCES NEEDED Food storage

EVALUATIONS

After 30 minutes of nursing Time and effort interventions, the of the nurse and family was able actual to: participation a.Verbalized and understanding empowerment about the of the family importance of having better Financial food storage. Resources b. Placed their food in a safe place away from pests.

Page 40

‘

CUES

Subjective:

HEALTH PROBLEM

Unsanitary food ―Wala lage me handling as saktong a health butanganan sa threat mga plato ug uban pang materyles sa pagpreparar sa pagkaon‖ as verbalized by the wife Objective: Unwashed utensils Unorganized placements of utensils Exposed stencils to pest and rodents Improper food storage and

FAMILY NURSING PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE

Inability to decide about taking appropriate actions due to failure to comprehend the identified problem as a health threat

After 4 weeks of rendering nursing interventions, the family will be able to practice the proper ways on handling food and recognize the importance of proper food handling

After 4 weeks of rendering nursing interventions, the family will be able to:


METHODS OF FAMILYNURSE

1. Assess the family Home visit concerning their practices on handling and preparing the food 2. Discuss with the family the health problems that will occur if improper food handling will persist and lead to undesirable illnesses such as diarrhea

1. Recogni ze the risk factors that will contribute to the identified 3. Teach the family to problems; do proper hand 2. identify washing and the different encourage them to measures to perform it before and prevent the after handling foods arousal of the risk arise factors of the 4. Discuss to the family problem on how to handle the 3. determi food properly: ne the importance of 5. Encourage the


RESOURCES REQUIRED

EVALUATION

Participation and At the end of 4 empowerment of weeks, the the family family was able to practice proper ways about handling Time and effort food and of the nurse and recognized the family member importance of proper food preparation and food handling

Page 41

‘ handling, foods exposed to flies

preparing and family to keep the handling the house clean specially food properly; the kitchen area 4. practice and apply the techniques of food handling and preparation; 5. keep their kitchen clean and free from insects an rodents


Page 42

‘

CUES

Subjective:

HEALTH PROBLEM

Poor home environment ―Hugaw jud al condition ang amu as a health palibot, cge threat man ko panlimpyo pero mahugaw ra jpon‖ as verbalized by the wife Objective: -unclean environment -clothes hanging inside the tent


GOAL OF CARE

OBJECTIVES OF CARE

Inability to provide a home environment conducive to health maintenance and personal development due to failure to comprehend the identified problem as a health threat

After 4 weeks of rendering nursing interventions, the family will be able to recognize the problem as a threat and will be able to recognize the importance keeping the home clean

After 4 weeks of rendering nursing interventions, the family will be able to take action in cleaning their tent area and maintaining its cleanliness.



1. Encourage the every Home visit family member to participate in cleaning 2. Discuss the importance of keeping the home/tent clean 3. Discuss the possible health condition that may arise

RESOURCES REQUIRED

Participation and At the end of 4 empowerment of weeks, the the family family was able to: a. Recognize Time and effort the importance of the nurse and of home family member environmental sanitation B. Family participated in maintain the cleanliness of their place

4. Encourage the family to maintain the cleanliness in their home/tent

-Presence of flies and mosquitoes flying the house


EVALUATION

Page 43

‘

CUES

Subjective cue: ‖Sa cellopane nalang namu ginatambak tanan, then amu gnalabay sa barrel nga basurahan, kwaon raman daun sa mangulekta ug basura ‖ as verbalized by the wife. Objective cues: Presence of flies and

HEALTH PROBLEM


Improper garbage disposal as a health threat

Inability to provide home environment conducive to health maintenance and personal development due lack of knowledge of proper garbage disposal

GOAL OF CARE

At the end of nursing interventions, the family will be able to realize the harmful effects of improper garbage disposal and benefits of clean and healthy environment

OBJECTIVES OF CARE

Short term objectives:


Health teachings with emphasis on the importance of waste At the end of 15 management. minutes, the family will Human waste and receive health diseases. It is very teachings about important to keep importance of human waste out of proper waste water supplies. disposal Human waste (faeces, poo, kuma, urine, Long term wee) contains objectives: diseases that make At the end of 4 people sick. Human waste can get into the weeks , the local water supplies family will be from leaking septic able to adopt tanks, releasing proper waste contaminated water


Home visitations of the student for six visits within 6 weeks Family Interaction


Page 44

RESOURCES REQUIRED

EVALUATION

Time and effort of the student and the family

At the end of 4 weeks ,the goal partially met. The family was not able to apply the proper waste disposal. But the family intermittently followed the waste management.

Fare for the students

‘ mosquitoes Unsegregated way of garbage disposal and dumping in a cellophane bag

mangement

from sewerage treatment plants, dirty nappies, leaking sewerage pipes and people using local creeks as a toilet. Injury and disease. People can get diseases like tetanus and leptospirosis if they cut or scratch themselves on pieces of metal, nails or glass. Children can be seriously hurt by playing with old car batteries or household cleaners that they find lying around. Litter can be a problem. Broken bottles and tins, for example, can cause injury. Mosquitoes and other vectors can breed in water trapped in old tyres and bottles.


Page 45

‘

CUES

Subjective cue: “ Dili jud maigo ang sweldo sa akong bana, gamay kaayo. ” as verbalized by the wife. ”Wala pod ko trabaho ” as verbalized by the wife

HEALTH PROBLEM


GOAL OF CARE

Low family income as a health threat

Inability to provide home environment conducive to health maintenance and personal development due to inadequate family resources specifically financial constraints/fina ncial resources

At the end of nursing interventions, the family will be able to recognize or realize ways that will help in maximizing their money.

OBJECTIVES OF CARE


Short term objectives:

Establish a family budget.

At the end of 20 minutes, the family will be able to recognize ways in saving money through giving adequate information.

Spend Less.Try to never waste money and make every purchase a considered purchase.

Long term objectives: At the end of 4 weeks , the family will be able to apply measures in saving money.

Use less. If could all use and consume less there would be less waste, less power consumption, and the benefits for you are SAVING MONEY.


Home visitations of the student for six visits within six weeks

RESOURCES REQUIRED

Time and effort of the student and the family Fare for the student

Family Interaction

Save Money.Each week or each month get into the habit of putting an amount,


Page 46

EVALUATION

At the end of 4 weeks , the goal was partially met. The family recognized ways in saving their money but needs to be applied in longer duration for sufficient results.

‘

Objective cues: Father – P1,500/mon th income Poor family living

however small into your savings. Start by saving a very small fixed amount each time and then move to putting in larger amounts once you begin to save money from your other money saving strategies. Shop Wisely. Consider markets, superstores, farmer's markets, local shops, marts and stores. Buy used. There are huge money savings to be made in buying used


Page 47

‘ XI.

ACTUAL IMPLEMENTATION

WEEK 1: January 19-21, 2012 (Orientation Phase) The first encounter with my family was last January 20, 2012 when we started our family profiling and somehow after gathering data, this family fitted the criteria for the family case study. As always, I greeted Mrs. XX and introduced myself. I stated the purpose of the visit and eventually asked permission using a consent letter if it is okay for them to be a part for the family case study. Then, I explained to her the whole course of the study, its purposes, benefits and all: family profile, assessment for 4 weeks, implementation of care and health teachings and documentations. I also assessed the family about their coping as for what had happen during the typhoon Sendong. We talked a lot. She did express her feelings and verbalized her thoughts.

WEEK 2: January 26-28, 2012 (Working Phase) During this week I continued my assessment and put my attention to their 3 children. I assessed them individually using my nursing skills and with the used of the IMCI booklet. Problems were identified and made me plan for the succeeding days to come. Same with Mrs. XX, problems were raised and explanations of such diseases

were

implementations

discussed. done

and

The health

whole

week,

teachings

were

imparted to the family. The importance of hygiene to achieve a healthy well being was emphasized; bathing, grooming and cutting long and dirty fingernails were performed with the family .


Page 48

‘ WEEK 3: February 02-04, 2012 (Working Phase) The third week of the exposure here at the Tent City, I finally assessed the head of the family Mr. XX. He’s not always at their tent since he’s the only one working as a motor- rela driver for the needs and provision of his family. After the assessment and interview, health teachings were again imparted to him since he has an elevated blood pressure. He also claimed that they do have a family history of hypertension, asthma and DM II which makes him more at risk. Cleanliness not only to their bodies but also to their environment was stressed out. The disease conditions that one can get from improper handling of food, improper garbage disposal, and uncleanliness made the family more conscious about their health and hygiene. The family did raise many questions and I did answer them based on the books I read. WEEK 4: February 17-18, 2012 (Termination Phase) The fourth week and termination phase has already come. Together with the family, we evaluated the course of home visits and asked the family what they’ve learned for the past weeks. Same with them, I thanked the family for the hospitality and time they had given to me. Finally, I invited them to come and the income generating activity and microteaching this coming March 01, 2012.


Page 49

‘ XII.

EVALUATION AND RECOMMENDATION Community Health Nursing has been a part of every student nurse’s life. It is a nurse’s

duty to bring to the people the health programs of the government. To provide immediate health care to the community people’s health problems before going to the higher health care facilities. Prevention is our primary task so it is our duty to do every means in order to educate the people. After four weeks of visitation, I had identified several family health problems and environmental problems as well. As included in the whole process of assessing, imparting health teachings and rendering care to the family , I recommend that the family should give first priority to their health and avail the services offered by the local government at the Tent City for proper referrals and further intervention of their disease conditions in which they are not familiar with. I am hoping and looking forward that the XX family will apply the things that the student nurse imparted to promote health and well being. Overall, the intervention that was implemented to family made a difference on their perception towards promoting health, and preventing illness. As a practicing health care giver, the experience that I have gain during the rotation had improved my understanding about community health nursing, not only that I have implemented interventions but the feeling of being accepted as a health care provider and helped in the improvement of others’ lives is very heartwarming and gave me a sense of accomplishment. For me, the concept of Community Health Nursing is not all about fulfilling the requirements to or just intervening the problems identified, it’s how the health care giver touches others lives and be one of them in attaining the solution of the problem, it’s about empathy and motivation towards one self and the community to perform such task pertaining to promoting health and preventing disease. This exposure inculcates to us lots of learning and values which would eventually help us to become competent health care providers as future nurses.


Page 50

‘

BIBLIOGRAPHY

XIII.



Maglaya, A., & Earnshaw, R., Nursing Practice in the Community.



Community Health Nursing by DOH



Kozier, et al. Fundamentals of Nursing. Singapore: Pearson Education Asia Ltd., 2004



Smeltzer, S. Medical-Surgical Nursing. Manila, 1996.



Reyala, A. et al. Community Health Services in the Philippines. Manila: National



League of the Philippine Government Nurses, Inc., 2000



Maglaya, A. Nursing Practice in the Community. Philippines: Argonauta



Microsoft® Encarta® 2009. © 1993-2008 Microsoft Corporation.

Corp.


Page 51

‘ XIV.

APPENDICES A. LETTER OF CONSENT FOR CARE STUDY AND TAKING OF PICTURES


Page 52

‘ B. PRIORITIZING HEALTH CONDITION AND PROBLEMS (ACTUAL COMPUTATION)

RANK 1 Problem: Cold and Cough as health deficit Criteria Nature of the condition or problem presented Modifiability of the condition or problem Preventive potential Salience

Computation 3/ 3 x 1 = 1

Actual Score 1

Justification Health deficit problem

2/ 2 x 2 = 2

2

Easily modifiable

3/ 3 x 1 = 1 2/ 2 x 1 = 1

1 1

Highly preventable Needing immediate attention Highest weight

Total Score and Rank

5

RANK 2 Problem: Presence of health threats due to poor food sanitation as evidenced by lack of food storage facilities Criteria Nature of the condition or problem presented Modifiability of the condition or problem Preventive potential Salience

Computation 2/ 3 x 1 = 0.66

Actual Score 0.66

Justification Health threat problem

2/ 2 x 2 = 2

2

Easily modifiable

3/ 3 x 1 = 1 2/ 2 x 1 = 1

1 1 4.66


Computation 2/ 3 x 1 = .66

Actual Score 0.66


2/ 2 x 2 = 2

2

Easily modifiable

3/ 3 x 1 = 1 2/ 2 x 1 = 1

1 1



RANK 3 Problem: Unsanitary food handling as health threat Criteria Nature of the condition or problem presented Modifiability of the condition or problem Preventive potential Salience Total Score and Rank

4.66


Page 53

‘ RANK 4 Problem: Poor home and environmental condition as health threat Criteria Nature of the condition or problem presented Modifiability of the condition or problem Preventive potential Salience


Actual Score 0.66


2/ 2 x 2 = 2

2

Easily modifiable

3/ 3 x 1 = 1 1/ 2 x 1 = 0.5

1 0.5

Highly preventable Problem not really perceived needing change


4.16

RANK 5 Problem: Improper garbage disposal as a health threat Criteria Nature of the condition or problem presented Modifiability of the condition or problem Preventive potential Salience


Actual Score 0.66


2/ 2 x 2 = 2

2

Easily modifiable

3/ 3 x 1 = 1 1/ 2 x 1 = 0.5

1 .5 4.16

Highly preventable Not needing immediate attention Highest weight


Actual Score 0.66


1/ 2 x 2 = 2

1

Partially modifiable

1/ 3 x 1 = 0.33 2/ 2 x 1 = 1

0.33 1

Low preventable Needing immediate attention Highest weight


RANK 6 Problem: Low family income as a health threat Criteria Nature of the condition or problem presented Modifiability of the condition or problem Preventive potential Salience Total Score and Rank

2.99


Page 54

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