Table of Contents

I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV. XV. XVI. Introduction Objectives Family Developmental Task Initial Data Base Family Coping Index Genogram Family Web Physical Assessment Prenatal Assessment Prioritization Family Nursing Care Plan Health Teachings Nursing Implications Appendix A Appendix b Gallery Bibliography

XVII.

CRITERIA
Content Introduction and objective Developmental Stage Family Coping Index Spot Map Prenatal Assessment Prioritization Family Nursing Care Plan Promptness Reference Format 5% 5% 10% 10% 10% 10% 30% 10% 5% 5% 100%

Introduction

What its children become, that will the community become . A famous quote made by Suzannea LaFollette when she explains a community. A community is unpredictable. No one could tell or foresaw what they will do what they are thinking at the moment and how they will act when youd meet them. A community is a group of interacting organisms sharing an environment. In intent, belief, resources, preferences, needs, risks, and a number of other conditions may be present and common, affecting the identity of the participants and their degree of cohesiveness. In our community which is in Ubalde Health Center, Agdao. Strongly endorses the importance of health among the members giving emphasize in young infants to be immunize.

In the world 2.5 million deaths are averted through vaccination every year and Smallpox was eradicated and poliomyelitis has been eliminated from most countries in the world. In the national statistics 69% Filipino children received all suggested vaccinations while in Davao city the Percent of a fully immunized child from 0 to 12h month grows with 22.22 % from 63% making it to 77%. Immunization is one of the most useful programs that the Department of Health has been implementing and this program was commonly rendered by community health centers.

Families in the community are influenced by a lot of factors and one of these factors is the services that they could get from their own health center. A community health center commits in improving the health of the community. In the Ubalde Health Center they were rendering services to their members with utmost care. They would even do house to house just to ensure that everyone receives the right service that their family should have.

Taking care of a family is a vital role that all members of the community should be aware because everything starts in the family. In the world there were about 34,691 000 and still counting abortion that is being performed all over the world. This number is an eye opening for all of us. To take care of a family was regretted at this part and one of the responsibilities of a member of the health care team is to assure the safety of the family by simply providing health teaching in our little way of guiding them. Among the many clients that we had to choose to, we had chosen the Luciano family. At first you would think that they are just a typical family that is beginning to meet the new life of a family with a preschooler stage but when we get to know them. We realized that you would idolized the way they live with

each other, there was a special trait in them that you could not deny, they are hospitable especially Mrs. Mona the mother in the family together with his Husband Mr. Paulito the head of the family, the one who decides and provides financial support and their daughter Angel Mikaela who is a very energetic child and who loves her mother more than anyone else. We realized that their family was not typical at all evidenced by their gestures for each other and the uniqueness of each character.

This case study would provide students with knowledge and reference regarding the state of the Luciano family this would also provide baseline data for the creation of more enhanced case studies in the future. Lastly, this would present proper understanding of the patients illness and therefore maximize the care provided by all registered nurses locally and internationally.

Objectives

General Objective

That at the end of our exposure in the Ubalde Health Center, Agdao, we will be able to find a client for our nursing case study, and formulate a comprehensive Nursing Case Study that will expand our knowledge and skills as student nurses in our nursing practice, nursing education and nursing research towards our holistic care to our chosen Family by promoting and preserving their health. We should also be able to utilize the information that we have extracted to promote camaraderie among ourselves to learn from the community and lend to them health teaching that could help them at the present and in the future.

Specific Objectives In order for us to have a course of direction for our study, we formulated the following specific objectives to help us achieve and organize flow in the completion of our nursing case study. We aim that we may be able to: establish good interpersonal and therapeutic relationship with the family to gain trust and cooperation, create a specific, measurable, attainable, realistic, and time-bounded objectives, present a thorough family information and assessment on its family characteristics, home and environment, health and health practices , environment and awareness of community organization through a complete and comprehensive Initial Data Base, identify, understand and explain the stages of the family and their corresponding developmental tasks; trace the past and present health history as well as their genogram; trace the illnesses within the family through the use of family web;

provide a basis for estimating the nursing needs of the family through Family Coping Index basing on its nine categories; identify the needs, problems, illnesses of the family, and prioritize these through the categories stated in prioritization of the problems in a family; formulate a family nursing care plan based on the top five priority problems of the family to be able to help and minimize the problems and occurrence of diseases and illnesses in the family; present a Nursing Implication of the study in Nursing Practice, Nursing Research and Nursing Education; provide health teachings based on the familys health condition, its needs and problems, and lastly, present a documentation that will support the information and data we have gathered and stated in this case study.

Family Developmental Task

Every individual undergoes different rates but passes through the same stages. Everyone is unique and has their personalities unlike. A typical preschool child experiences the crisis between initiative versus guilt they had their idea on finding their way out to overcome this stage and complete it. Parents especially those first time mothers and fathers may need a bundle of patience and understanding since in this stage the childs energy is incomprehensible. Children in this stage must be educated in toilet training and must be founded with a big space for learning and growth. A family with a preschooler according to our client is a serious, fun and tiring experience all parents had probably passed and should not be missed. Based from our client there was a lot of changes on the way they treat each other before and after their first baby was born. They become focus to their baby than to their selves. Their attention in a whole day was on their baby. When their daughter had turned 3 yrs. Old the child alone refuses to sleep with her parents and wishes to sleep in the floor covered with clothing and foam. Our client sometimes complains of her childs dynamic energy but understands that this is just normal to a growing child. Their child goes to school as a preschooler child and the parents is happy about it because it was their child not them who decided in going to school. The following are the development tasks of preschool children Settling into healthy daily routines of rest and activity. o Almost every 8 in the morning angel takes a bath guided with his mom. Eats her breakfast and her mother always assure that it is accompanied with bottled milk. After that Angel plays with her cousins in the front yard, her mother or grandparents would tell Angel to wear slippers when playing outside of the house. Around 10:30 Angel goes to school escorted by her cousin Jessica on the way. After school Angel bonds with her mom by watching the television together and by her mom combing her hair. According to her mother, Angel is very active during the day. She is a crowd entertainer whenever she meets new people or their relatives not living near them. Mastering good eating habits. o Angel eats what her mother gives to her regardless of its vegetable or not. Her mother sometimes had to force Angel while eating because according to her

mother Angel should eat first before playing. Angel uses fork and spoon in eating and often messes the table with rice that falls from her plate. Mastering the basics of toilet training o At the present her mother is training her to go to the comfort room and reminds her often to never hold when she feels like urinating especially at night. Angel now goes to the comfort room when she needs, her mom would accompany her in the comfort room for safety.

Developing the physical skills appropriate to his stage of motor development. o Angel does a lot of things already according to her mom. Angel often mimics what her mother acts like massaging his father but she acts it like pushing her hands towards his father back. Angel knows how to go down in the stairs alone and can walk and run without any assistance. Her mother is still the one who dresses her and buttons her blouse.

Becoming a participating member of his family o Angel loves to entertain and is not a shy child as observed by the people. In our span staying with the family, her mother would always kiss and hug angel would do the same in return. Together with her cousins they would play inside their house and does not show any signs of jealousy

Beginning to master his impulses and to conform to others expectations o Angel enjoys the company of her cousins and sometimes prefers to bond with his mother. When we were interviewing her mother Angel would also listen and would also act what her mother would perform. According to her mother she would listen to his father whenever his father is talking and talks a lot when she thinks her mom and dad would quarrel and say you them ayaw mo away.

Developing healthy emotional expressions for a wide variety of experiences o Based from her mother Angel is expressive on what she feels and shows it into action like entertaining visitors or her mom and shows participation when attention is called.

Learning to communicate effectively with an increasing number of others

o Angel expresses her thoughts through her actions like acting it out and doing what others tell her to do right. She is able to stay close and comfortable to her immediate family and also to us. Developing the ability to handle potentially dangerous situations o When Angel goes down the stairs she would hold tight in the sides of the wood. Angel tells her mom whenever she wants to go to the bathroom since the door of their bathroom is hard to open and it has a hole after the door that could be dangerous for a child. Her mother also told us that they would tell Angel not to touch objects that could harm her. Learning to be an autonomous person with initiative and a conscience of his own. o According to Angels mom it was Angel that decides that she wants to go to school and both of the parents were happy about it. Her mother also said that t Laying foundations for understanding the meaning of life o According to her mom, Angel is very close to her but does not show any jealousy when she is with his husband or vice versa. Angels explore things and situations around her and tends to understand it by listening. The following is the developmental tasks of Parents at the preschool stage Parenting without a partner o Both parents were aware of their responsibility as parents and they planned of it as having designated assignments that one should do. Mrs. Mona stays at home and takes care of the house and the child as well as the necessary things needed in the house like going to the market to buy foods and doing the house chores. According to Mrs. Mona his husband is often stays in his work than at home and she understands this because Mr. Lito works for his family for financial support. Relying on television- mixed bag o Mrs. Mona watches television with her daughter since she was always at home. Both mother and child love to watch the shows in ABS-CBN and Myx wherein some of the short scenes in the program are not suitable for Angel but it was unnoticed. Accepting each other in the family

o Mr. and Mrs. Luciano was very happy when they found out that Mrs. Mona is pregnant in their first baby and now that Mrs. Mona is pregnant again they cant wait for it to be born especially Angel who oftentimes touch his mother abdomen. Continuing to develop as married adults o The couple still has time to talk and renegotiate their marital relationship and having a child at home does not hinder them to keep their marriage alive and growing.

These are the familys developmental task with a preschool child. Supplying adequate space, facilities and equipment for the expanding family. o The family was planning on extending their house and having their own kitchen and sink for their own convenience in the near December to January. They are aware that it is important for their growing family to have complete facilities and dreams to have a bigger house whenever theyll have financial stability Meeting predictable and unexpected costs of family life with small children. o The family pays 800 pesos for their childs studies. According to the mother as for now they were able to provide their childs need and wants since their child sometimes understands and listens to them whenever the childs wishes for a thing is not granted. They were able to balance their expenses and save some of it for any emergency that may come. Assuming more mature roles within the expanding family. o According to our client before when they were only the two of them they always quarrel and sometimes fight but when they had their first baby their quarrels and fights were reduced and practices in a give and take relationship. In deciding both parents talk and the final decision is from the father in the family. The decision is always in concern with the family especially for their child. Maintaining mutually satisfying intimate communication in the family. o Seldom was the family able to bond with each other whenever they are all present in the house when the father is playing the playstation while the mother is watching him play and the child is cheering for his father due to the fathers

works that is always in his field of work. The child is more close to her mother than to his father. According to the mother the child is somehow afraid of his father because the father scolds her child whenever she does any wrong and a single strike of voice from the father the child immediately listens and stops on what she is doing. Rearing and planning for children. o Both of the parents were planning to have three children at any gender. The mother does not want to have a twin child because she thought it would be so hard but when this happens she will accept it and raise the child together with his a husband bond with good values and conduct. After the mother will give birth, both of them wishes to have an interval of 2-3 yrs gap of age to their third child. At the present the family is still in the process of completing this stage of the family development since they are still tasks that are to be noted and modified.

Initial Data Base

I.

Demographic Data: The Luciano family is our subject in our case study. They have been a resident

of house number 14 at the Del Pilar Street Jerome Extension Barangay Number 0132 for 5 years as a family. II. Family Data:

The whole family is composed of three members and can be considered as nuclear family where it is composed of the father, child and our pregnant client, the mother. Mr. Pailito comes from Samal and their tribe is Waray. He is a Highschool Graduate because of lack of financial support coming from his parents. Mrs. Monalisa is truly a Bisaya and currently living since birth here in Davao City. Mrs. Monalisa is also a Highschool graduate because at the age of 18 years old, she decided to stop totally in school and get married after all. She wants to stay home and take good care of her family especially her children. They are both Roman Catholic and receive their sacrament of matrimony in Holycross church Davao City. Mr. Pailito Luciano, 24 years old works as a business man delivering meat in some places here in Davao City. On the other hand, Mrs. Monalisa Luciano, 23 years old works plainly as a housewife. Mr. Pailito is the head of the family but together with his wife, Mrs. Monalisa shares and works hand-in-hand in deciding and supporting all the needs of the family. They have a daughter namely Angela Mikaela Luciano, she is 3 years old studying as a Nursery student at the Immacon Learning Center in Ubalde, Agdao. She is fully immunized child.

Familys Members Chart

FAMILY MEMBERS

AG E

SEX CIVIL

POSITION

INRELATIONSHIP

EDUCATIONAL OCCUPATION

STATUS THE FAMILY TO FAMILY HEAD ATTAINMENT

Monalisa Luciano

23

Married

Mother

Wife

HG

Housewife

Angel Mikaela 3 Luciano

Single

Child

Daughter

Preschooler

Pailito Luciano

24

Married

Father

Head

HG

Business man

III.

Family Characteristics: A.)Family Structure The type of the family structure that they have is a nuclear family which is

composed of the mother, child and father. They belong to a Patriarchal type of family where Mr. Pailito Luciano acts as the head of the family. His wife also helps in decision-making and works is in the budget concerns but the final say of a certain decision comes from Mr. Pailito.

B.)General Family Relationships/Dynamics The Luciano family works together in order to sustain the family needs. Parents are very supportive in the activities of the child in school and provide good nutrition to all the members and eat three times a day. Mr. Pailito works hard in order to gain

money. His monthly income is 8,000 a month and pays all the bills in their house such as electric bills, water bills and etc. Although problems arise within their family, they have the ability to adapt and seek far any solutions and plan for a better future. They respect each other and they practice give and take or consult each other in order to solve problems easily and come up into a right decision. They maintain an open communication that make their bond strong and have a harmony and a productive living. Their family sleeps by 10pm and wakes up by 6am. The monthly income of the family is 8,000 pesos which comes from the head of the family. Upon asked about their family health history, our client told us that her husband has a history of Diabetes Mellitus and cancer. Her husband has a health history of hypertension and Diabetes Mellitus and their child had a diarrhea last 6 months and given antibiotics such as Nifuroxazide, ercefuryl and other anti bacterial drugs. Their child has already completed her immunization since she already received 1 dose of BCG, 3 doses of DPT, 3 doses of OPV, 3 doses of Hepatitis-B and 1 dose of Measles Vaccine. Immunization of Children

Childs Name

BCG

DPT

OPV

HEPA B

MEASLES

Angel Luciano

Mikaela 3 doses 1 dose 1dose 1dose 3 doses

The child is fully immunized child (FIC) because she receives 3 doses of BCG, 1 dose of OPV, 1 dose of DPT, 1 dose of Hepa B and 3 doses of Measles before the child reaches 1 year old. Immunization of Mother Mothers name TT1 TT2 TT3 TT4 TT5

Monalisa Luciano

1 dose

1 dose

1 dose

The mother is not yet a fully immunized mother but the giving of the Tetanus toxoid for her is currently on going and she is willing to complete this activity to prevent diseases and promote wellness within her. a.) Home and Environment Mr. and Mrs. Luciano own the house but they shares on the expenses regarding the electric as well as water bills with their relatives in the other area. The type of housing material that they have is mixed and they have 3 ventilations/windows. The total area is 13.84 m2 and their total ventilation is in over satisfactory with a result of 22%. They only have one room for the sleeping with one sofa bed. Inside the house the appliances are organized but the eating utensils are not well kept and are exposed to external environment. Outside the house it was so messy in which you can see waste wrappers and also nails on the floor. The pond was also dirty with the presence of mosquito larvae in the bigger pool. Their water system comes from DCWD and they dont store any foods or water inside their house because they have no refrigerator at all. For their lighting facilities, they use a bulb as their source and they pay it to Davao light monthly. They have a common toilet which is a water-sealed and they dispose their garbage in a sack .It is collected by the Brgy truck. Their drainage system is a closed system and they use to raise chickens in the yard.

b.) Health and Health Practices Illness or Condition 1. High Cholesterol 2. Tonsilitis OTC (Specify) Vitamin B12 Antibiotics Herbal (Specify)

3. Diarrhea

Nifuroxazide, ercefuryl (anti-bacterial drugs)

4.) Cough 5.) Fever 6.)

Carbociestiene, cephalaxin Paracetamol

Lagundi

The family uses OTC drugs to provide some medications to ill members in the family and use community resources such as the barangay health center when the condition turns to be out of control. They do immunization for the prevention of the occurrence of the disease but they are not aware and dont recognize any problem or even the existing problem at all. Sometimes, they are not willing to go to the health center anymore because of the attitudes of the health workers that makes them unaware and not updated. During our assessment, their eating utensils are not properly kept in a container and which it serves as a mode of transmission for some diseases. However, they still provide nutritious foods and eat three times a day.

c.) Weekly Dietary Recall The family manages to prepare different viand and most nutritious food for their members. In the morning the family always serves a heavy breakfast which is good for the development of their daughter. As we could see, they ate more on protein and less in veggies. Monday Milo Pan Luncheon Meat Juice Tuesday Milo Pan Sabaw Rice Kinilaw Wednesday Gatas Pan Rice Bola-bola Fried egg

Beef loaf Rice

Fried rice Fried egg

Rice Egg and hotdog Paksiw Sabaw

Rice Piniritong Isda Saging

Pinakbet Hinalang Na baka durian

Rice Adobong baboy Sabaw Isda Durian

Family Members

Weight

Height

Body Mass Index (BMI) 22.0741 kg/ m2

Monalisa Luciano

51 kgs

1.52 m

Angel Luciano

Mikaela 12 kgs

.87 m

15.854142 kg/ m2

Pailito Luciano

70 kgs

1.60 m

27.34375 kg/ m2

Interpretation for adults: 15 18.4 kg/ m2 = underweight 18.5 22.9 kg/ m2 = normal 23 27.5 kg/ m2 = overweight 27.6 40 kg/ m2 = obese

d.) Activities of Daily Living The pattern of the familys retiring and getting up hours vary from one member to the other. It is dependent on the time of each individual. They have the freedom on when to sleep and wake up except if they have responsibilities to attend to especially work and school. Most of the time, the familys source of income is the fathers occupation as a business man. He works 6 days per week. The mother sleeps late but still can manage the house properly and take good care of the child carefully. They have a friendly neighborhood and they communicate each other via cell phones. They use trisikad as a source of their transportation.

e.) Awareness of Community Organization The family is not actively participative in the activities in the community. She is not aware of the existing organizations in the community such as Womens association and GKK and is still not a registered voter. On the other hand, she is aware and participates in the fiestas in their Barangay and the use to celebrate it with a simple gathering within their family. f.) Socio economic The familys economic staus is a low class family since their income is below 20,000 according to the National Statistics Office: Low class Income lower than 20,000 a month Middle Class- Income is 20,000 160,000 a month High Class- Income is higher than 160,000 a month.

Family Coping Index

FAMILY COPING INDEX The Family Coping Index provides a basis for estimating the nursing needs of a particular family. The table below presents the rating of the Luciano family during our home visit last September 28, 2009 until September 30, 2009 respectively.

ADMISSION Nine Areas of Family Nursing Description (September 28, 2009) Rate Physical Independence This is 5 Justification

DISCHARGE (September 30, 2009) Rate Justification The members maintains independence performing activities of family still their by their daily

All members in the 5 family can perform their activities of

concerned with ability to move about, to get out of bed, to take care of daily

daily living such as bathing, grooming, walking, eating and etc. Parents are

grooming, walking, etc.

living and providing physical needs and appropriate among members. care the

able to provide the needs and care of all the members.

Therapeutic Competence

This

is 3

The family is able 5 to provide some

The maintains

family its

concerned with all of the or

interventions to ill members in the

competence in the treatment proper management of its members. and

procedures treatments prescribed the care

family but fails to for of use modeate Over the counter drugs.

illness, such as giving medications, using appliances,

dressings, exercise relaxation, special etc. Knowledge Health Condition of This is 3 The family has 5 The family has its diets, and

concerned with the particular

general knowledge towards condition the or

increased

awareness towards problems that can affect the condition of its members and also health the through our

health condition that is the for

disease but is not aware of the

occasion care.

problems that can affect the health of their family recognize problem at all. family. The doesnt any

teachings family has

acquired knowledge the problem about that

can be prevented or lessened. Application Principles General Hygiene of This is 3 The family serves 5 different nutritious The family used the dish organizer that weve While donated. our health

of concerned with family action in relation maintaining family nutrition, securing adequate and for members, carrying accepted preventive measures such out rest to

food and they eat three times a day but the problem is that the eating

teachings for the mother success was a

utensils they are using are not kept in a container and which it serves as a mode of for The

because

she was able to sleep early the

relaxation family

night before.

transmission diseases.

family sleeps for about 8 hours a

as immunization and medical safe

day except for the mother.

appraisal,

homemaking habits in relation to storing and preparing foods. Health Attitudes Care This is 5 The family utilizes 5 the community resources for existing The family is able to understand the condition of its

concerned with the family about way the feels health

member and gives early interventions.

prevention such as immunization. The family understands the medical illness. need care of in

care in general including preventive services, care of illness public and health

measures. Emotional Competence This is concern 5 with the maturity and integrity The family is in 5 equilibrium and has the sense on In of both the The family is able to maintain maturity and times integrity of in

with which the members of the family are able to meet the

maturity parents. phase of

crisis.

Parents are able to understand each

conflict

their daughter acts as a referee of her

other and deal with problem harmonious way. in

usual

stresses

and problems of life, and to plan for happy and fruitful living.

because

they are able to solve the problem in the state of

calmness.

Family Patterns

Living This concerned

is 5

The members

family 5 respect

The maintains interpersonal connection

family its

largely with the interpersonal or group of how aspects life, the

each other even in decision making

with

they tend to listen with each other.

each other by doing things together if possible.

family well

Every evening they would wait for each other until

members of the family get along with another, one the

everyone is in the table and start their supper together.

degree of their respect affection show for and they one

another. Physical Environment This is 3 In the house the 3 appliances are Some problems solved of the were because

concerned with the home, the community and the work

organized but the eating utensils are not well kept and exposed external environment. Outside the house it was so messy in which you can see waste wrappers to

weve donated dish organizer and

environment as it affects family health.

cleaned the area by picking up the nails and throwing the wrappers trash in the The

can.

pond remained as it is because the family doesnt own that pond.

and also nails on the floor. The pond was also dirty with the presence of

mosquito larvae.

Use Community Facilities

of This is concern 3 with the degree to which the

The

family

is 3

The attitude of the family is still the same as before

oriented about the facilities that available in are the

family about wisdom

knows the with

and the mother is already fixed in her decision that she would deliver her baby Family. in Well-

health center. The problem is about the attitude of the health worker that is why they dont

which they use available community resources health, education welfare. and for

usually avail those free services. The family also attends mass Sunday in every the

community.

Genogram

Family Web

CHURCH G-MALL

PEOPLE S PARK

WORKING PLACE

BEACH

HEALTH CENTER MARKET

LEGEND:

SELDOM = ALWAYS =

It is important for a family to have widened their intimacy though they are already married and already had a child. This is indispensable to build a more strong foundation in every family.

Most of the time Mr. Lito is always at work leaving her wife and daughter in the house. They seldom go to church and at least for a year they could all visit the house of God twice.Six days and a half during Sundays in a week Mr. Lito goes to his work selling pigs while Mrs. Mona stays at home with his child. When Mrs. Mona is not busy doing the house chores she carries Angel to Peoples Park for at least ones a month. With Mr. Lito the head of the house they sometimes go to the beach to swim and have fun bonding with each other. Everyday Mrs. Mona goes to the Market or the store near them to buy food for breakfast, lunch and dinner since they dont have storage for easily spoiled food like f ish and the like. When they have money they sometimes go to the Mall. They seldom go to the health center except when her daughter was receiving immunizations. Angel also goes to school every weekdays.

Physical Assessment

PHYSICAL ASSESSMENT

Name: Monaliza T. Luciano Sex: Female Age: 23 years and 5 months Date of Assessment: September 29, 2009 Time of Assessment: 9:35 10:55 am

Citizenship: Filipino Birth date: April 19, 1986

I.

GENERAL SURVEY On our encounter, she was coherent, responsive and not in any kind of respiratory disturbance. Upon observation, she is mesomorphic with a proportional weight and height and her movements were coordinated while walking. Body and breath odor is absent during our interaction with no signs of distress as well as the present of any illnesses. She was in the mood and willingly cooperated to what we are saying. Her responses were understandable and the thought also makes sense.

ANTHROPOMETRIC MEASUREMENTS Weight: 51 Kilogram Height: 155 cm VITAL SIGNS Vital Signs Temperature Pulse Rate Heart Rate Respiratory Rate Blood Pressure Patients Vital Signs 36.6C 83 bpm 86 bpm 21 cpm 120/90 mmHg Normal Values 35.6-36.7 C 80-90 bpm 80-90 bpm 16-20 cpm 110/70-130/90 mmHg Head Circumference: 52 cm Abd. Circumference: 93.5cm

II.

APPEARANCE AND MENTAL STATUS She was wearing a loose, black sleeveless and a pink shiny short with black single stripe on each side extending two inches from the knee. A towel was also with her for the sweat and it was usually placed on her right shoulder. Her hair was pulled backed into a pony tail. She is oriented with the time, place and persons who is with her and her responses about the things that happened that day were in a chronological order.

III.

THE SKIN The general skin color complexion of our client is brown, the complexion of a typical Filipino. Hyperpigmentations on the skin were not been identified exept for the linea nigra at the abdomen and moles . Striae gravidarum were also evident. An irregular shaped scar was identified at the left acromial area extending to the deltoid site with a length of 20cm. No edema, vesicles, and other abnormalities were known. The skin was also moist and warm to touch with a good skin turgor.

IV.

THE HAIR The hair is thick and hair growth on the scalp is evenly distributed upon inspection. Her hair is silky and salient without any evidence of infection and infestation. Any lacerations, lesions and any break ups are absent and her body hair is evenly distributed.

V.

THE NAILS Her nail plates are colorless and the shape of it is a convex curve. It seemed that the nails are not well trimmed and pinkish in color. Both of her nails of the toe and the fingers are smooth in texture. The tissues around the nail have no lesions and are intact, with the result of the blanch test of 2 seconds.

VI.

THE SKULL AND FACE The head is round and normociphalic, without any observable and palpable deformities. The skull contour is uniform and smooth, with depressions and nodules or any other masses absent. She was observed to have symmetric facial features and movements. Lesions, bruises and edema were not noted on the face.

VII.

THE EYE STRUTURE AND VISUAL ACUITY Her eyebrows are aligned equal movement, hair equally distributed and intact skin, without any observable lesion, scars and flakes. The eyelashes are slightly curled outward and hair is evenly distributed. Upon observation of the upper and lower eyelids, the skin is intact without any discolorations and discharges. When the lids are open, the upper and lower borders of the cornea are slightly covered and the rim of the sclera is not visible between the lid and the iris. There was no tenderness noted upon palpation on the site where the lacrimal gland, lacrimal sac and nasolacrimal duct. The palpebral conjunctiva was observed to be pinkish, with no signs of inflammation and any observable masses. The bulbar conjunctiva is clear and transparent. She has 15 involuntary blinks per minute, with bilateral blinking. The blinking reflex is evident when the cornea is lightly touched, indicating the intactness of the trigeminal nerve. Pupils are dark brown, with brisk reaction upon stimulation and with isocoric size of 3mm. She does not use any corrective lenses and has a normal vision, being able to read fine print from paper placed 12 inches away from her eyes.

VIII.

EARS AND HEARING Her ears have the same color as facial skin. The size and the position are symmetrical. After folding the pinna, it immediately recoils back to its original position, with no tenderness noted as well as lesions, flaking or any signs of inflammation. A little amount of wet cerumen can be observed in the external auditory canal and there were no lesions and any discharges noted. She was able to hear the sound of the

watch place on the back of the ear and the examiners whisper as well as the normal voice. The tympanic membrane was not examined due to the unavailability of the otoscope.

IX.

NOSE AND SINUSES As we have observed, the external nose has a uniform color with her facial skin, without localized areas of redness or lesions. It is straight and symmetric without any discharges. Tenderness was not noted upon palpation and other masses and displacements as well. Patency of both nasal cavities was good, air freely moving through the nares upon breathing. The mucosa of the nasal cavities appeared to be normally pink, studded with hair follicles and redness, swelling, growth and discharges were absent. The nasal septum is intact and in midline. The frontal and maxillary sinuses were non tender during palpation.

X.

MOUTH AND OROPHARYNX The outer lips was observed to be symmetrical in contour and are soft, moist and smooth in texture with a uniform dark pink color. Her buccal mucosa is uniformly pink, with a moist, soft, and elastic texture. Mucosal cysts, ulcerations, and nodules are not found on both the inner part of the lips. The second molars of the lower jaw are missing as well as the first pair of incisors of the upper jaw. Only those missing teeth of the upper jaw were replaced by dentures and the rest of her teeth appeared to have caries. Her gums were moist, firm, and pink in color, without any bleeding, lesions and inflammation noted. The tongue is positioned at the center and observed to be moist and pink in color, with a thin whitish coating. It has some raised papillae and has no visible lesions. It moves freely in all directions. No palpable lesions, nodules, lumps, and masses were observed and the tongue base is smooth with some prominent veins. Soft and hard palate was is pinkish and both palates were free from discolorations and abnormal growths. The uvula is intact and positioned in midline of the soft palate. The oropharynx is pink and free from edema, lesions, and discharges.

The tonsils are pink with no signs of inflammation or discharges. Upon pressing the back portion of the tongue, the gag reflex has been observed.

XI.

THE NECK Muscle size is equal and head centered, upon inspection with no swelling or masses noted. The client is able to move her head freely; flexes 45 hyperextends 60,laterally flex 40 and laterally rotates 70. The strength of the clients neck muscles is equal with the examiners resistance. Upon palpation, no masses where felt and tenderness was also not noted. The trachea is located at the midline of the neck with equal spaces on both sides. There was no visible local enlargement noted while the client was asked to swallow. The jugular veins are observed to be non-distended and the pulsations of the carotid arteries are full, symmetrical, and consistent, without the presence of a bruit.

XII.

THORAX AND LUNGS Chest expansion is symmetric during respiration. APL ratio is 7.5 inches: 15 inches (1:2). The costal angle is approximately less than 90. The right and left shoulders and hips at the same height. The spinal column is straight and vertically aligned. Bulges, lumps, depressions, and areas of tenderness were absent on the skin and chest wall with intact and uniform normal temperature. Respiratory excursion is 2 cm. On the posterior chest of our client, the vocal fremitus is bilaterally palpable and is best felt at the apex of the lungs. The client breathes without any difficulty, has rhythmic and has an effortless respiration. Upon auscultation on all lung fields, clear breath sounds can be heard.

XIII.

HEART AND CENTRAL VESSELS The precordium is observed to have no abnormal pulsations, lifts or heaves. Abdominal aortic pulsations were palpable at the epigastric area. The aortic and pulmonic pulsations can easily be listened to upon auscultation. However, the tricuspid and apical pulses can only be minimally heard due to the size of the clients breasts.

XIV.

THE BREAST AND AXILLAE The breasts of our client are round, generally symmetric, but slightly unequal. Skin color is the same with the abdomen and without any localized discolorations, retraction, and edema. The areolae having a dark brown color are generally the same and a minimal of hair follicle is present on the Montgomerys glands. The nipples are round, everted, equal, and pointing at the same direction. Crusts and cracks are absent. When using the concentric-circle pattern no masses, nodules, or lesions were also palpable on the breast. The axillary lymph nodes were non-tender and nonpalpable.

XV.

THE ABDOMEN Stretch marks and fading linea nigra was evident on the abdominal skin without the presence of visible lesions and discharges. Our clients abdomen is generally round, symmetrical, and without any evidence of enlargement of the liver or spleen when the client was doing deep breath. Symmetric movements caused by respiration are visible as well as the aortic pulsations at the epigastric area. Bowel sounds were active upon auscultation and there were no arterial bruits or friction rubs noted. Superficial masses, areas of tenderness, and abdominal guarding were absent, during palpation.

XVI.

EXTREMITIES Upper Limbs Our patients fingers are complete. Her shoulders, arms and hands are symmetrical, and edema is absent. Contractures, fasciculations, and tremors were not noted. On each body side, the client exhibited smooth coordinated movements with equal strength. The bones and joints of the arms were free from any types of deformities, and can move freely within its specified range of motion.

Lower Limbs Both feet are symmetrical and have a complete set of toes. No areas of tenderness noted. Muscle strength and movement is equal with bones properly aligned. The joints are free from crepitations and swelling, allowing the patient to move her legs and stand with ease.

XVII.

NEUROLOGIC STATUS The patient is well oriented and well organized. Sharp and dull pain can be

differentiated. Her stereognosis, extinction phenomenon and 1-2 point discrimination was good. She has an upright posture but has a little difficulty in walking. Heel-toe walking was able to maintain by our client along a straight line and finger-nose test was repeatedly and rhythmically executed. The examiners finger can simultaneously touch by her with coordination. Her eye opening was spontaneous and obeys all commands. As a result, she has an RLS of 1 and GCS of 15. Cranial Nerves Cranial Nerve Olfactory Type Sensory Function Smell Assessment The patient was

able to determine various objects

through their scent or smell. Optic Sensory Vision and visual fields Patient can read

fine print from a paper without any corrective lenses Oculomotor Motor Extraocular movement, Pupils has a brisk movement of the reaction to light and

sphincter of the pupil; stimulation movement muscles of of ciliary accommodation.

lens. Pupil size (3mm),

Supplies fibers to four Her eyes was able of the six mucles of the to move in different eye(superior, inferior directions.

and medial rectus and inferior oblique.)

Trochlear

Motor

EOM moves

specifically Patients eyes were eyeball able to move

downward and laterally. downward and turn laterally simultaneously. Trigeminal Sensory Sensation of cornea, Sensation on both skin of the face, and part of the face was nasal mucuso. felt. Blink reflex is present. Abducens Motor EOM; turns elevates elevates it and Without difficulty,

laterally, able to move her the eye, eyes up and turn it and

moves the eye medially laterally and depress the eye. Facial downward

Sensory and Motor Facial expression and She closed her eyes taste (anterior two tightly, puffed her cheeks, frowned,

thirds of tongue)

raised her eyebrows and smile. Vestibulocochlear Sensory Transmit impulses for She was able to the sense of balance hear and cochlear both the and

branch whispered

transmits impulses for normal voice. sense of hearing. Glossopharyngeal Sensory and Motor Swallowing ability, gag reflex, production, (posterior tongue) Vagus Sensory and Motor Sensory of pharynx and Roughness of the larynx, swallowing; voice was not noted and was able to swallow. Her gag reflex was and was

salivary present

taste able to swallow.

vocal cord movement

Accessory

Motor

Shrugging of shoulders She was able to Head movement. move her head with symmetrical strength shoulders shrugged. and were

Hypoglossal

Motor

Protrusion

of

the Her

tongue

was

tongue, moves tongue able to protrude and up and down and side can be moved in to side. different directions.

Prenatal Assessment

A Prenatal Assessment was by group conducted last September 29, 2009 at around 10:00am, with the consent of Ms. Monaliza T.Luciano, the client. Our client is 23 years old and at present pregnant to her second baby. She is also now on the 7th month of Gestation.

I. General Survey On our encounter with Mrs. Monaliza T. Luciano, our client, she was coherent, responsive and not in any kind of respiratory disturbance. LMP: February 24,2009 EDC: December 1, 2009 AOG: 31 weeks Fundic height: 28 cm FHR: 121 bpm Height: 155 cm Weight: 51 kg. Immunization status: 3rd dose of TT given Last prenatal visit: September 22, 2009 Procedure done: Prenatal Check up

II. Vital Signs

Vital Signs Temperature Pulse Rate Heart Rate Respiratory Rate Blood Pressure

Patients Vital Signs 36.6C 83 bpm 86 bpm 21 cpm 120/90 mmHg

Normal Values 35.6-36.7 C 80-90 bpm 80-90 bpm 16-20 cpm 110/70-130/90 mmHg

Diagnosis NORMAL NORMAL NORMAL NORMAL NORMAL

III.

Neurological System

Upon interviewing our client, she has said that there are times that she had headache and 5-10 minutes after the onset, it will just disappear. Any sudden unconscious involuntary twitch of movement was not identified to be present.

IV.

Cardiovascular System

After checking the blood pressure of our client, the result was 120/90 mmHg. It is in the normal range which means theres a low chance that our client will be experiencing eclampsia but even though we need to instruct our client what she needs to know. Our client is not experiencing any chest pain that may be a sign of any cardiovascular related complication. Varicosities are evident and only few of blood vessels are noticeable.

V.

Respiratory System

Upon auscultation, both lung fields have clear breath sounds. The client stated that shes not experiencing any difficulty in breathing of any kind. Her respiration rate slightly higher than the normal but it those not mean that any problem at all.

V.

Gastrointestinal System

Our client those not complained of nausea and vomiting. As we have observed, our client likes to eat. Her gums were not swollen but she told us that she had a tooth that was growing on the back part of the mouth. Our client also told us that she had no dental problems even though our client has a pair of missing teeth.

VI.

Renal System Clients average urination per day is 6-8 which does not mean that she is dehydrated. There

were traces of glucose in the urine and protein is absent, proven by the test for Albumin, as we conducted our crude urinalysis in the community.

VII.

Endocrine System

Our client has no history of diabetes mellitus and we have proven that with the use of our urine testing.

VIII.

Reproductive System

During our assessment, the clients breast is not swollen and there were no masses and tenderness noted. The breast was observed to be slightly unsymmetrical cause our clients left breast is a bit bigger than the right. The areola is dark-brown in color. X. Integumentary System Her skin is moist and with good skin turgor. Skin was is normal color and warm to touch upon palpaton. Signs of pregnancy were present such as linea nigra, striae gravidarum, chloasma as well as vascular spider with increase hair growth on scalp.

XI. Skeletal System

Our client has slight complain at her lumbar area but she doesnt mind that as a problem at all because she finds it normal to every pregnant women.

XII. Nutritional Status For only about 3 days we found out that the family of our client eats food rich in protein. XIII. Lifestyle Habits Our client is in a simple living. She is already happy with her life having her loving and caring husband and her lovely Angel. Every night they tend to wait for each other and eat together for bonding purposes. Our client has no vices at all.

Prioritization

PRESENCE OF BREEDING OR RESTING SITES OF VECTORS OF DISEASES CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 The problem is a health threat that needs JUSTIFICATION

immediate action. MODIFIABILITY THE PROBLEM OF 2/2 x 2 2 The problem is easily modifiable since all the needed resources are available and

accessible to the family. PREVENTIVE POTENTIAL 3/3 x 1 1 Changing and cleaning the breeding sites of mosquitoes can prevent diseases like: a.) Dengue Dengue hemorrhagic fever b.) Malaria c.) Filarasis SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family perceived fever/

this as a problem but does not need

immediate action due to the small number of mosquitoes at the area. TOTAL SCORE 4 1/6

POINTED/SHARP OBJECTS IMPROPERLY KEPT CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 It is a health threat that needs action. MODIFIABILITY THE PROBLEM OF 2/2 x 2 2 The problem is easily modifiable since immediate JUSTIFICATION

resources needed are available and

accessible to the family. PREVENTIVE POTENTIAL 3/3 x 1 1 Infections like Tetanus can be prevented if the problem is eliminated. SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family perceived

this as a problem but does not need

immediate action since no one was available to do it. TOTAL SCORE 4 1/6

UNHEALTHFUL LIFESTYLE AND PERSONAL HABITS / PRACTICES DUE TO SMOKING CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 It is a health threat that needs immediate action since it is dangerous to the whole family JUSTIFICATION

especially the unborn child.

MODIFIABILITY THE PROBLEM

OF 1/2 x 2 1

The problem is partially modifiable the considering and

cooperation

willingness of the father to reduce or if possible quit smoking. PREVENTIVE POTENTIAL 3/3 x 1 1 Minimizing eliminating or cigarette

smoking will prevent the risk of cancers, skin disorders, complications unborn child. SALIENCE PROBLEM OF THE 2/2 x 1 1 The family perceived to and the

this as a problem that needs immediate action to prevent complications for the whole family.

TOTAL SCORE

3 2/3

UNSANITARY FOOD HANDLING AND PREPARATION CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 The problem is a health threat that needs JUSTIFICATION

immediate action. MODIFIABILITY THE PROBLEM OF 2/2 x 2 2 The problem is easily modifiable since

resources are available and accessible. PREVENTIVE 3/3 x 1 1 Diseases such as Acute

POTENTIAL

Gastroenteritis can be prevented if this

problem is eliminated. SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family perceived

this as a problem but does need immediate action considering the financial status.

TOTAL SCORE

4 1/6

ACCIDENT HAZARD: FIRE HAZARD CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 It is a health threat that needs action. MODIFIABILITY THE PROBLEM OF 1/2 x 2 1 It is partially modifiable since the house is made in wood. PREVENTIVE POTENTIAL 3/3 x 1 1 Burns, death, and loss of shelter can be immediate JUSTIFICATION

prevented if the problem is eliminated. SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family perceived

this as a problem but does not need

immediate action due to the scarcity of the

resources. TOTAL SCORE 3 1/6

LACK OF FOOD STORAGE FACILITIES CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 It is a health threat since foods are JUSTIFICATION

exposed to dusts and pests. MODIFIABILITY THE PROBLEM OF 1/2 x 2 1 The partially since resources inadequate. PREVENTIVE POTENTIAL 3/3 x 1 1 Having adequate food storage facilities will problem was

modifiable financial are

prevent food poisoning from perishable foods. SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family perceived

this as a problem but does immediate considering that not need action the

family have adequate knowledge problem. TOTAL SCORE 3 1/6 about the

ACCIDENT HAZARD: FALL HAZARD CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 The problem is a health threat considering that JUSTIFICATION

there is no presence of handles for supporting each member in going up and down the stairs that may lead to

injuries. MODIFIABILITY THE PROBLEM OF 1/2 x 2 1 The problem is partially modifiable and since of time an

effort

individual is unavailable presently. PREVENTIVE POTENTIAL 3/3 x 1 1 Falling prevented can be

considering

that the materials are available accessible. SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family perceived and

this as a problem but does not need

immediate action since they can manage on moving up and down the stairs. TOTAL SCORE 3 1/6

GARBAGE DISPOSAL CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM MODIFIABILITY OF It can be easily modified OF THE 2/3 x 1 2/3 It is a health threat. JUSTIFICATION

THE PROBLEM

2/2 x 2

since

materials

are

available. PREVENTIVE POTENTIAL 3/3 x 1 1 Foul smell and insects which can cause

discomfort for the family will be eliminated. SALIENCE PROBLEM OF THE 0/2 x 1 0 The family is unaware of the problem and does not find the improper garbage disposal as in need for change. TOTAL SCORE 2 2/3

INADEQUATE LIVING SPACE CRITERIA COMPUTATION ACTUAL SCORE NATURE PROBLEM OF THE 2/3 x 1 2/3 It is a health threat considering transmission possible of JUSTIFICATION

communicable diseases to each member of the family. MODIFIABILITY THE PROBLEM OF 0/2 x 2 0 The problem is not the

modifiable familys

since

finance

resources presently are not enough considering the daily expenses of the family. PREVENTIVE POTENTIAL 3/3 x 1 1 Increasing the living

space will reduce the

possible transmission of communicable diseases, provides

privacy to each member of the family, and to allow movements performing activities. SALIENCE PROBLEM OF THE 1/2 x 1 1/2 The family is aware of the problem but does not need immediate adequate when daily

action since the family had planned to have an extension on the month of January next year. TOTAL SCORE 2 1/6

Family Nursing Care Plan

Health Teaching
MEDICATIONS:

1. Instruct the family to take only those medicines which are prescribed by their doctor/physician. Instruct to take the medicines at the right time, number/amount, route and dosage. Elaborate the importance of taking medications, their side effects and benefits. 2. Encouraging all the family members to have their monthly check- up in the health center to maintain good health. 3. Instruct mother, father and other reliable family members to have a consultation with their doctor or physician or went to the nearby health center if signs and symptoms of diseases occur. 4. Inform the patient that not all drugs are safe to use while breastfeeding.

EXERCISES:

1.) Perform exercise and other relaxing activities at least 3 times in a week to help in promoting good blood circulation; to avoid health problems and make their bodies physically fit - such as jogging and walking. 2.) Encourage the family to participate in the organizations of the community and join such organizations that help them grow as a more mature and responsible persons. 3.) Encourage the family to do walking and do socialization among their neighbors.

TREATMENT:

1.) Encourage the husband as well as the family members about the dangerous of smoking and instruct not to smoke or gradually stop smoking for it endangers our health. Frequent smoking affects the functioning of the respiratory system and might cause lung cancer. 2.) Teach and emphasize the family the signs, symptoms and complications brought by smoking. This will make the family members to be aware of the effects of smoking in the body. 3.) Encourage family members not to drink alcohol/beer for it damages the liver and could lead to severe complications. 4.) Provide the mother and father some teaching programs especially for family planning such as birth control and natural methods and give emphasis on the importance of contraceptive methods. 5.) Discuss the mother with the importance of breastfeeding that promotes health not only on babies but also for the mommies.

HYGIENE:

1. Take a bath everyday at least twice a day to clean the body from any dirt and foul smell. Practicing good and proper hygiene will greatly affect our health. 2. Use soap while taking a bath to remove properly the dirt in the body. Lather it thoroughly and gently to remove all microorganisms that is present in the body. Using soap in taking a bath will easily remove the dirt and oil present in our skin. 3. Promote tooth brushing using toothpaste and toothbrush, doing it after meals at least three times a day. Cleaning the teeth helps to prevent the accumulation of tartar and plaque in between the teeth. 4. Teach the family how to do the proper hand washing especially before and after eating meals to prevent the transmission of microorganism into our body. 5. Emphasize to the family the use of slippers in walking, playing and going inside or outside the house in order to protect and avoid any accidental bruises and scars in the feet. Using slippers will also help in preventing the invasion of microorganism that might enter in any open part of our skin.

6. Instruct the client to clean her nipples before and after breast feeding plainly with water.

OUT PATIENT VISIT:

1.) Maintain an open communication among the family members. 2.) Continuing a warm relationship between the mother, father, child and others relatives within the compound. 3.) Provide the mother and father some teaching programs especially for family planning such as birth control methods and natural methods and give emphasis on the importance of contraceptive methods. 4.) Encourage the family to properly dispose their garbage to maintain cleanliness of their surrounding and to prevent acquiring diseases. 5.) Keep water containers empty to prevent mosquitoes from breeding. 6.) Clean properly all utensils such as spoon and forks, glass, plate, etc. before using. 7.) Motivate the family to utilize the available resources at home for proper food storage and handling such as containers with cover for keeping their eating utensils as well as their foods. 8.) Inform the family about safety precautions on; avoiding children not to put objects in their mouth keep sharp and fire objects away from their reach, keep insecticides, solutions, and medicines from the reach of children. 9.) Encourage the family to communicate and coordinate with the health care officials or team in the barangay health center. 10.) Encouraging the infants efforts to develop new skills, to cope up with problems

and to amuse, comfort, feed and progressively care for her. 11.) Educate the mother about the benefits of breastfeeding to the mother as well as

the newborn.

DIET:

1. Encourage the family to eat nutritious foods such as fruits and vegetables that will help to maintain our immune system since fruits and vegetables are highly rich in vitamins and minerals. 2. Instruct the family to drink clean supplies of water and if doubt, boil the water for 3x. 3. Encourage the family especially the mother to take foods rich in calcium, protein, vitamins, carbohydrates and fats that will help in the normal functioning of our body system. Foods rich in fiber are necessary in our diet since dietary fibers increase our sense of fullness. 4. Always have a balance diet by having meals 3 times a day by eating natural foods and different variety of foods which are prepared in a simple and tasty way.

Nursing Implication

Nursing implications are necessary in the making of this family case study in different nursing areas in such a way. Not only to help the family but for us to learn.

Nursing Education Nursing education is the primary responsibility of ours that should be rendered to our client. In such a way we are learning in the different situations and dynamics that we have faced throughout the span of duty. This case study can also be a way to help our client evaluate themselves. Nursing education does not focus on the gain of our selves alone to learn and study their living in the family that could affect the community instead we are promoting a nursing education that could lend them to stand strong in the society by knowing the necessary education and achieving the important skills in battling the problems in the community.

Nursing Research This nursing study is a great help for us in the near future. We could apply our learning in the different areas since this could study also sum-up our gained knowledge through our previous years in studying and can be a great need for our future studies. This research can be a great help for those student nurses like us who would undergo community health nursing rotation.

Nursing Practice A place for return demonstrations are different from those in the outside would. Initiative is used and no procedure could say how you would do the practice in the real world. We have pondered that though we meet a lot of people with different personalities it is important for us to respect them and be courteous. These practices are essential for our growing and will mold us to a competent student nurse someday.

Appendix
Ventilation (TWO/TFA x 100)
Total Floor Area TFA = L x W = 4.32308m x 3.2004m = 13.84m2 *CR = 1.8034m x 1.5240m = 2.75m2
x

13.84m2

2.75m2

TFA = 16.59m2

Total Window Opening

TWO = L x W = 1.18872m x 0.7112m x 4 = 3.38m2 3.38m2

x 0.209m2 TWO = 3.59m2

*CR = 0.209m2

TWO/TFA x 100 = 3.59m2/16.59m2 x 100 = 22% - satisfactory

Overcrowding The family managed to live in the house but they were already planning to have an extension for some important purposes. Their family is growing and considering the furnitures they have, it lessens the space for the family the space is not enough especially for a child who is in the growing stage of development.

LMP: February 24, 2009 EDC:

Sept-29 217/7 = 31wks. Fundic Height: 28cm 28/4 = 7months Fetal Heart Rate: 121bpm Last Prenatal Visit: September 22,2009 BMI (Weight in kg/Height in meters square) Monalisa Luciano 51kg/(1.52m)2 = 22.50 kg/m2 Pailito Luciano 70kg/(1.60m)2 = 27.34kg/m2 Angel Mikaela Luciano 12kg/(0.87m)2= 15.85 kg/

02 24 09 -3 +7 +1

12 01 09 Feb-4 Mar-31 Apr-30 May-31 June-30 July-31 Aug-31 AOG:

Appendix

From San Pedro College, we ride a jeep going to Barangay Ubalde, Agdao City. The health center was cemented and is abundance of flowers in the front yard. Our

client's house is located at Barangay Ubalde, Agdao City Del Pilar street Jerome Extension. From the baranggay health center just walk across the street and at the basketball area turn into the right road entering the Del Pilar Street Jerome extension. While entering the street, there are many houses at different types and a lot of people are being encounter in which some of them greet us as Goodmorning maam/sir. You need to walk and encounter 22 houses to get on the red gate and pass many stores until you can arrive on our clients house. At the 23 hause is our clients house. Their house and lot is not so big but the members of the compound are approachable and willing to accept visitors. Their compound is composed of two houses, our clients house built in the right side area while on the other side is the house of the husbands parents. They raise chickens in their surroundings and they also have a small sari-sari store owned by the parents of the husband.

Gallery

Bibliography
Book source:

Duvall, Evelyn Millis. Marriage and Family Developent, 5th Editon. JB Lippincott Company, Philidelphia 1977.pp 249-272 Pilitteri, Adele,PhD, RN, PMP. Maternal and Child health Nursing. Care of the Childbearing and Childrearing family 5th Edition. Lippincott Williams and Wilkins. 2007,p 230-237 Kozier,Barbara, MN, RN , et al. Fundamentals of Nursing: Concepts, Process and Practice, 7th Edition. Pearson Education South Asia. 2004.pp 535-614

Internet source:
http://www.unicef.org/infobycountry/philippines_statistics.html http://www.ncbi.nlm.nih.gov/pubmed/18789997?ordinalpos=8&itool=EntrezSystem2.P Entrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSu m http://www.nscb.gov.ph/RU11/davao_city/social_health.htm http://www.worldometers.info/abortions/