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INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

Family Structure, Characteristics and Dynamics


Name of the family Age Sex Civil Status Position Residence
Members in the
Family
Mary Grace R. Ibasco 40 Female Married Mother Bldg. 22 – 215
P.H. Balut,
Prince Joash Hans R. 19 Male Single Brother Tondo, Manila
Ibasco “

Princess Milcah 18 Female Single Sister


Hannah R. Ibasco ”
15 Male Single Brother
Prince Christianson “
Jace R. Ibasco
13 Female Single Brother
Princess Milzih Kim “
R. Ibasco

Socio-Economic and Cultural Characteristics


Family Member Religion Ethnic Educational Occupation Place of
Backgroun Attaintment Work
d
Mary Grace R. Born - College Teacher Nepa St.
Ibasco Again Graduate Balut,
- Tondo,
Prince Joash Born High School Student Manila
Hans R. Ibasco Again Graduate
- Student
Princess Born High School
Milcah Hannah Again - Graduate
R. Ibasco
Student
Prince Born Elementary
Christianson Again Graduate Student
Jace R. Ibasco Born Elementary
Princess Milzih Again Graduate
Kim R. Ibasco

Income and Expenses


Income Expenses
Mary Grace R. Ibasco – 19,000 Food –
Water – 1500/month
Electricity – 2000/month
Wifi – 1600/month
Others (medicine, monthly check-ups)

Health Status and Risk


Name Age HT WT Wrist BMI REMARK DEGREE REMARK
(m) (kg) Measurement OF
(inches) MALNUTRIT
ION
Mary 40 1.50 46 6 20.4
Grace R.
Ibasco

Prince 19 1.68 58 7 20.5


Joash
Hans R.
Ibasco 18 1.58 50 6 20

Princess
Milcah
Hannah 15 1.68 55 6 19.5
R. Ibasco

Prince 13 1.50 42 5.5 18.7


Christian
son Jace
R. Ibasco

Princess
Milzih
Kim R.
Ibasco

Family Member Age BCG HEPA B DPT OPV MEASLES


Mary Grace R. Ibasco 40 C C C C C

Prince Joash Hans R. 19 C C C C C


Ibasco
Princess Milcah 18 C C C C C
Hannah R. Ibasco
15 C C C C C
Prince Christianson
Jace R. Ibasco
13 C C C C C
Princess Milzih Kim R.
Ibasco
Values, Habits, Practices on Health Promotion, Maintenance and Disease Infection (C =
COMPLETE, I = INCOMPLETE)

Primary source of medical care: ______________ (ex. Chinese Gen. Hosp.)


Hours of sleep (avg. hrs. of sleep per member): 7 hours
Activity and Exercise pattern: (daily walk, household chores etc.): household chores

FLOOR PLAN:
Living space
Length (m2): __________
Width (m2): ___________

Ventilation
Window opening (m2): _______

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