FAMILY SERVICE AND PROGRESS RECORD

HEAD OF THE FAMILY __ JAWOD, MICHEAL SCOFIELD_____________________ FAMILY NUMBER: __8_____________

ADDRESS: ________________ OCEAN PARK BRGY. SAUYO _______________________________

I. Assessment of the Family, Home and Environmental Conditions:

A. Members of the Household

RELATION S HIGHEST REMARS/

MARITAL
FAMILY MEMBER TO THE E BIRTHDATE EDUC OCCUPATION DATE
STATUS
HEAD X COMPLETED ENTERED
No Name Month Year Type of Place
work
1 JAWOD, M. FATHER M
2 JAWOD, D. IN LAW F
3 JAWOD, M R. CHILD M
4 CABANAY, H. IN LAW F
5 JAWOD, M A. CHILD M
6 JAWOD, M. CHILD M
7 JAWOD, M C. CHILD M
8 JAWOD, M JR. CHILD M
9
10

B. Home and Environment

Date Assessed: __FEB 18, 2023 __________________________________________________
1. Home
a. Ownership ( ) Owned ( ) Rented ( X ) Rent-Free
b. Construction Materials used: ( ) Light ( X ) Mixed ( ) Strong
c. Number of rooms for sleeping: ___3_______________________
d. Lighting facilities ( X ) Electricity ( ) Kerosene ( ) Others Specify
e. General sanitary condition: ___THEIR SURROUNDINGS ARE CLEAN ALSO ______
___________________________________________________
2. Drinking water supply
Source: ( X ) Private ( ) Public Potability: ________________________________________
Distance from house: __________________________________________________________
Storage: ( X ) None (Direct from faucet or pipe)
( ) Large covered container with faucet
( ) Large uncovered container without faucet
( ) Others, Specify ____________________________________________________
3. Kitchen
Cooking facility: ( ) Electric stove ( X ) Gas Stove ( ) Firewood/charcoal
Sanitary condition: ___ITS CLEAN ________________________
Drainage Facility: ( X ) Open drainage ( ) Blind drainage ( ) None
4. Waste Disposal
a. Refuse and Garbage
Container: ( X ) Covered ( ) Open
Method of disposal:
( ) Hog feeding ( ) Composting
( ) Open dumping ( ) Open burning
( ) Burial in pit ( ) Others, specify: _PICK UP BY GARBAGE
COLLECTOR ________________________
b. Toilet
Type: ( ) None ( ) Pail system
( ) Overhung latrine ( ) Antipolo
( ) Open pit privy ( X ) Water sealed latrine
( ) Closed pit privy ( ) Flush type
( ) Bored-hole latrine
( ) Others, specify: ______________________
Distance from house: ______________________________
Sanitary condition: ________________________________
5. Domestic Animals:
KIND NUMBER WHERE KEPT

6. The Community in General

a. General sanitary condition: ____________________________________________________
b. Housing congestion: ( ) Yes ( X ) No
c. Recreational Facilities:
_________NONE_______________________________________________
d. Availability of health care services (describe briefly): ____THEY COOPERATE
____________________________
___________________________________________________________________________
e. Distance of house from nearest health care facility: _” ISANG SAKAY LANG NG TRYCYCLE
“________________________________
___________________________________________________________________________
II. Problem Sheet

HEALTH CONDITIONS SUPPORTING DATA DATE

NURSING PROBLEMS
AND PROBLEMS CUES IDENTIFIED RESOLVED
Cavities and tooth decay Toothache, bad breath Feb 18,2023 Feb 19, 2023
TOOTHACHE , an unpleasant taste in
your mouth

III. Nursing Care Plan

HEALTH CONDITIONS EVALUATION

AND PROBLEMS AND OBJECTIVE OF NURSING PLAN OF OUTCOME
METHOD /
FAMILY NURSING CARE INTERVENTION CRITERIA/
TOOLS
PROBLEMS INDICATORS
to get rid of your Nursing Interventions to clean their I conduct an
Tooth cavities toothache, for children to Rationale teeth interview with a
learn how to brush their Provide a mouth care 4 years old child
teeth properly routine including with cavities
toothbrushing at and tooth decay
regular intervals with a
soft-bristle toothbrush
and fluoride
toothpaste.
IV. Service and Progress Notes

NURSING INTERVENTIONS, ACTIONS AND

DATE NURSING PROBLEMS SIGNATURE
PROGRESS

02-18-
20223 to
Teach gentle flossing teeth with unwaxed dental
02-19-
Cavities and tooth decay floss., Assist the patient in performing oral hygiene
2023
every after meal and as often as needed.
 INITIAL DATA BASE
I. CHARACTERS:
A. What is the type of family structures?
______ Nuclear ___X____ Patriarchal
___X___ Extended _______ Matriarchal
B. Who makes decision regarding health care? ___mother__________________
C. What is the present family relationship?
_________________ with conflicts between members
________x_________ without conflicts between family members
D. Activities of daily living:
1. Sleeping pattern:
Retiring/getting up hours ___6:00am__________
Nap during the day _____1pm_____________
Do members sleep together ____yes_______
2. Eating pattern
How many meals each day? _3-4meals__________
Who appears overweight? ___none_________
Who appears underweight? __none_________
3. Leisure time activities
How does each member spend leisure hours? __” nag lalaro ng mobile games tsaka kumain ng kumain”
__________________________
Is it appropriate for the sex and age group? __yes____________________________
What is the effect to the family? ____” pang patanggal stress “ ______________________
Any joint activity for leisure? ________none __________________________________

II. FAMILY INFORMATION

Head of the family: ___JAWOD, M. ______________________
Address: __OCEAN PARK BRGY. SAUYO ________________
Members of the household: __________________

NAME RELATIONSHIP AGE EDUCATIONAL ATTAINMENT

JAWOD, M. 49 HIGHSCHOOL GRADUATE
JAWOD, D. IN LAW 47 HIGHSCHOOL GRADUATE
JAWOD, M R. CHILD 25 HIGHSCHOOL GRADUATE
CABANAY, H. IN LAW 21 SENIOR HIGHSCHOOL LEVEL
JAWOD, M A. CHILD 22 SENIOR HIGHSCHOOL LEVEL
JAWOD, M. CHILD 19 SENIOR HIGHSCHOOL LEVEL
JAWOD, M C. CHILD 8 ELEMENTARY LEVEL
JAWOD, M JR. CHILD 4 ELEMENTARY LEVEL
III. SOCIO-ECONOMIC AND CULTURAL FACTORS
A. Income

NAME OCCUPATION PLACE INCOME

JAWOD, M. CONTRACTOR QUEZON CITY 40,000
JAWOD, D. SHOPEE HELPER QUEZON CITY 9,000
JAWOD, M R. DRIVER QUEZON CITY 15,000

1. Does the working family member meet the basic necessities?

____x____ Yes _____ No
2. Who makes decisions regarding money matters? ____JAWOD, D._________________
3. Religious affiliation: _____all catholic ______________________
4. What roles does the family play in the community? __community members _________________

IV. ENVIRONMENTAL FACTORS

A. Housing
1. Ownership
_________ Owned ________ Rented ______x_____ Rent-Free
2. Construction materials used
_________ Light __x______ Mixed ___________ Strong
3. Living space
____x_____ Adequate ________ Inadequate
4. Sleeping arrangement: “nag lalagay kami ng divider ang bahay para amgkaroon ng kwarto kaya sagto
lang samin yung bahay “_____________________________
5. Adequacy in furniture
___x______ Adequate ________ Inadequate
6. Water source
___x______ Private ________ Public
7. Food storage
___x______ Refrigerator ________ Jars/container
8. Cooking facility
_________ Electric stove ________ Firewood
_____x____ Gas Stove ________ Kerosene
9. Drainage facility
____x_____ Open drainage ________ Blind drainage ________ None
10. Toilet facilities/type
_________ Flushed ___________ Over hung latrine
_________ Bored-hole latrine _____x______ Water-sealed latrine
_________ Pail system ___________ None
11. Sanitary condition
_____x____ Fair ___________ Good ________ Poor
12. Neighborhood
_________ Congested ___________ Slum _rural_______ Other
13. Availability of Health Care Facility
 Describe briefly: __”nag kakasundo naman kami sa gawaing bahay kaya na mmaintain yung bahayn g
maayos “__________________________________________________
14. Garbage disposal
__________ Dumped at street corner ____x________Picked up by garbage collector
__________ Buried ____________ Burned then buried

V. HEALTH MEDICAL HISTORY

A. Presence of illness
__X_____ Diagnosed _________ Undiagnosed ________ None
NAME PAST ILLNESS ILLNESS STATE HEALTH ACTION TAKEN
JAWOD, D. FEVER CONTROLLED Quanrantined and
monitored by health
workers

VI. VALUE PLACED ON PREVENTION OF DISEASE

NAME AGE COMPLETE INCOMPLETE
JAWOD, M. 49 x
JAWOD, D. 47 x
JAWOD, M R. 25 X
CABANAY, H. 21 x
JAWOD, M A. 22 x
JAWOD, M. 19 x
JAWOD, M C. 8 x
JAWOD, M JR. 4 x

Preventive practices employed by the family: _________________________

Sources of Health Care:
_________ Health Center ____________ Government Hospital
_________ Private Hospital ____________ Others

DETERMINE FAMILY HEALTH PROBLEMS. IF NONE, DETERMINE THE FAMILY’S PROMOTIVE OR PREVENTIVE

PRACTICES.

FAMILY HEALTH PROBLEMS. / TYPOLOGY OF HEALTH PROBLEM

(IF NONE, FAMILY’S PROMOTIVE OR (WELLNESS STATE , HEALTH DEFICIT,HEALTH THREAT,
PREVENTIVE PRACTICES.) FORESEEABLE CRISIS)
1. Tooth Cavity Health threat
DO THE SCALING OF HEALTH PROBLEMS OR PROMOTIVE PRACTICES OF THE FAMILY.

HEALTH PROBLEM 1: TOOTH CAVITY AS HEALTH THREAT

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

NATURE OF THE PROBLEM 2/ 3 X 1
• Health threat
MODIFIABILITY OF THE
PROBLEM
• Easily modifiable
PREVENTIVE POTENTIAL
• Moderated
SALIENCE
• A serious problem,
immediate action
needed
0.67 If cavities aren't treated,
they get larger and affect
deeper layers of your
teeth. They can lead to a
severe toothache, infection
and tooth loss.
1/ 2 X 2 1 What we eat can
frequently lead to tooth
decay. You can harm your
teeth if you don't typically
brush them right after each
meal. Sugar can linger on
your teeth, in the spaces
between them, and even
along your gum line.
2/ 3 X 1 0.67 Moderated because its
easy to tell children about
brushing their teeth
1/2X1 0.5 it needs to be done in
action so that other teeth
are not affected
TOTAL: 2.84