Final FCP ESPARTERO

FAMILY CARE PLAN
A Paper Presented to
The Faculty of College of Nursing
Adventist University of the Philippines
In Partial Fulfillment of
the Requirements for the Course
Maternity and Child Health Nursing
By
Joshua Espartero
July 9, 2021
COLLEGE OF NURSING
COMMUNITY HEALTH NURSING
NARRATIVE INFORMATION ABOUT THE FAMILY
Initial Data Base
A. Family Structure, Characteristics, and Dynamics
The Ompoc Family is a Family of 3 who live in Heritage Spring Homes, Barangay Puting
Kahoy, Silang Cavite. During the first interview only the wife is available to answer the
questions. They have lived in the house for about 1 year. The family consists of Necosalem
Ompoc who the breadwinner and the worker of the family. Mae Ann Ompoc, the wife, who
is a housewife and caretaker of the house. Lived with them is a 9-year-old son named Justin
Ompoc. They live as an nuclear family type structure with only one child. The family is
neutral with what they planned on for themselves. They have a strong bond and have respects
on each other.
The husband, Mr. Ompoc is the main wage earner of the family, he’s the one who supplies
thebulk income for the family. He is also the decision-maker in the family particularly in the
area of lifestyle and leisure time and the family depend on him onproviding solution for the
problems. Mrs. Ompoc, the wife, is the one who supervises the family finances. She is also
the gatekeeper of the family that determines what information will be release from the family
or what new information can be introduced.
B. Socio-economic and Cultural Characteristics
The family is Tagalog, but the wife can also be bisaya in ethnicity and all are Seventh-
day Adventist. Mr. Ompoc graduated in Bachelor of Science in Commerce and Mrs.
Espinosa graduated in Bachelor of Science in Nursing. Mr. Ompoc is the main source of
income for the family, and he work as a sales manager earning a max of 40,000 pesos per
month but not lower than 30,000 pesos per month. The family does not participate in
community activities
Derived from Salvacion G. Ballon-Reyes and Araceli S. Maglaya’s (1978)Initial Data Base for Family Nursing Practice
C. Home and Environment
The family are just renting the house and the construction materials used are concrete. It
has 2 bedrooms used for sleeping and they are powered by electricity. They used alkaline
for their drinking water supply which is 1 kilometer away from their house and jars for their
storage. For cooking they both used gas stove and firewood. They used refrigerator for their
food storage and cabinet. Their drainage facility is closed. They use container for their
garbage and their method for disposal is by waste segregation. For their toilet type it is water-
sealed (septic tank) and it is exclusive only for the family.
They have also 1 dog which is kept in and outside the house and their area prone to
ground shaking and landslide during earthquakes to. They live in a subdivision with
basketball court and park that serves as their recreational facilities. The availability of a
HealthCare Facility is 5 km from the area. They have cellphones and internet that can be
used as communication facilities and jeep and tricycle for transportation.
D. Family Health Status
Mr. Ompoc encountered fever and diarrhea last March 2021. As for their Body Mass
index, Mr. Ompoc has 33 which is classified as obese, for Mrs. Ompoc she has 20.4 which
is in normal weight and for Justin, he has 21.9 which is in normal weight
E. Values and practices of Health Promotion and Maintenance and Disease

Prevention.
Their family is free from vices such as smoking and drugs. They mostly consult in
doctors for their health-related problems and for other problems they consult mostly to
their family mambers
Family Health Problem
2nd Level assessment
I. Malnutrition
1. Inability to make decisions with respect to taking appropriate health action due to failure to
comprehend the magnitude of the condition, low salience of the problem and fear of
consequences of action, specifically: Physical consequences.
“Nag e-exercise naman ako pero bihira lang kasi kulang sa time and hindi ko alam kung tama
ba yung ginagawa ko. Ayaw ko din kasi magkaroon ng medication maintenance. Kaya open
ako matututo at malaman yung mga tamang exercise para sa amin.
2. Inability to recognize the presence of the condition or problem due to attitude in life, which
hinders recognition of a problem
“At first, I am not aware that I am already gaining weight and classified as obese.
Napapabayan ko na pala yung sarili ko at hindi ko alam yun kasi busy ako masyado. So,
normally becauseof that, I'm having a hard time implementing the changes that I wanted to
do because of the time management issue”
Mr. Ompoc states that they do not have the time to do exercise. He does not think it as
a problem because he is working in the office. Mr. Ompoc also stated that he started doing
exercise before, but he stopped due to hectic schedule. They do not know that lacking
exercise or physical activity can lead to various kinds of illnesses. Mrs. Ompoc despite
having normal weight, also states that she was too busy doing household chores and had no
time to do exercise.
I. Unhealthy Lifestyle and Personal Habits/Practices: Lack of/Inadequate Sleep/Rest
1. Inability to recognize the presence of the condition due to lack of or

inadequate knowledge.“Ok lang para sakin kahit 5 hours lang yung tulog
ko basta nakakatulog ako ng maayos.”
2. Inability to recognize the presence of the condition or problem due to denial
about its existence orseverity as a result of fear of consequence of diagnosis.
“Hindi ko inexpect na mataas na pala yung BMI ko.”
3. Inability to make decisions with respect to taking appropriate health action due to
inability to decidewhich action to take from among a list of healthy habits.
“Late na kasi ako lagi umuuwi galing sa work and I need to spent time with my family
also.”
Mr Ompoc states that he always stays up late and wakes up early in the morning. He cannot
practice adequate sleep because of his work and family obligations. He only gets 5 hours of sleep
a day. They also tend to watch movies late at night and eat during midnight.
Family Coping Index
Family Coping Index is measured with the following scores:

1-no competence 3-moderate competence 5-complete competence
Area Description Score Justification

Refers to the family members’
1.Physical mobility and ability to perform The family does not have any
Independence activities of daily living, such as 5 difficulty moving about or do the
feeding themselves and members need assistance to dothe
performing activities necessary Activities of Daily Living
for personal hygiene
Refers to the family’s ability to
2.Therapeutic comply with prescribed or
Independence recommended procedures and
treatments to be done at home, The family lacks ability in
which include medications, complying and practicing dietary
dietary recommendations, 3 recommendations
exercises, application of wound
dressings, and use of prosthetic
devices and other
adaptive appliances such as
wheelchairs and walkers.
Means understanding of the
3. Knowledge of health condition or essentials of
Health care according to the
developmental stages of family
members. Examples are the The family have knowledge aboutthe
degree of knowledge of 5 risk and proper care per condition
responsible family members in and developmental stage.
terms of communicability of a
disease and its modes of
transmission or that a disease is
genetically transmitted, as in
the case of diabetes mellitus.
4. Application of Includes practice of general
principles of health promotion and 5 The family is practice proper
person and recommended preventive hygiene
general hygiene measures.
Refer to the family’s perceptionof
5. Health health care in general. This is Family is willing to have teaching and
Attitude observed in the family’s degree of seek professional help to solve health
responsiveness to promotive, 5 problems
preventive, and
curative efforts of health
workers.
Is concerned with the degree of
6. Emotional emotional maturity of family Family is competent in terms of
Competence members according to their emotional state as the family
developmental stage. This maybe exhibited calmness and control both
observed in behaviors such as 3 through the interview and teaching,
how the family members deal but lack in attentivenessand
with daily challenges, theirability discipline
to sacrifice and think of others,
and acceptance of responsibility.
Refer to interpersonal Family is together in nature, andthe

7. Family Living relationships among family 5 relationships are neither strained or
members pressured in any way
noticeable to the nurse
Includes home, school, work, and The physical environment of the
8. Physical community environment 5 family, the home and community
Environment- that may influence the health of practice proper sanitation
family members.
Is the ability of the family to The family actively seeks
9. Use of seek and utilize, as needed, both healthcare from government and
Community government-run and private 5 private facilities to monitor and
Facilities health, education, andother help in the management of each
community services. members health.
Adventist University of the Philippixdddnes
College of Nursing
Family Health Problem

1 & 2nd Level Assessment
st
Name of Espartero, Joshua B. Section: B

Student:
Family Health Problem Date Date

Problem Cues 1st
Level
2nd Level Assessment
Assessment Identified Resolved
Subjective:
“I'm worried
and glad that I
know where I
am now with
my BMI. I
know also
there are some
related health 1. Inability to make decisions
risks to this, with respect to
that that is taking appropriate health
quite action due to: June 20, July 3, 2021
concerning so 2021
i am very • Failure to comprehend
concerned and the nature/magnitude
worried about of the
it.” problem/condition
Objective: Malnutrition • Low salience of the
• One as a Health problem
Malnutrition
member of Deficit • Fear of consequences of
the family action, specifically:
is - Physical
measured consequences
to be 2. Inability to recognize the
obese. presence of the condition
• Sir Neco’s or problem due to:
BMI is • Attitude/Philosophy in
33.7, it life, which hinders
means he is recognition/acceptance
obese. The of a problem
normal
BMI is
around
18.5—
24.9.
• Lack of
Physical
Activity
Derived from Salvacion G. Ballon-Reyes and Araceli S. Maglaya’s (1978) Initial Data Base for Family Nursing Practice
1. Inability to recognize
Subjective: the presence of the
“Lagi akong
condition due to
puyat dahil sa
work tapos • lack or inadequate
kailangan ko knowledge about the
pa tulungan importance of sleep June 20, July 3, 2021
yung wife ko 2. Inability to recognize 2021
sa bahay.” the presence of the
“Minsan 12
condition or problem
Unhealthy AM na ako
Lifestyle and natutulog due to
Unhealthy • denial about its
Personal tapos maaga
Lifestyle as
Habits/Practices: pa ako existence or severity as
Health
Lack nagigising” a result of fear of
Threat
of/inadequate consequence of
Sleep Obective: diagnosis.
• Mr.
3. Inability to make
Ompoc’s
sleeping time decisions with respect
is around to taking
11:30 PM. appropriate health
• He only gets action due to
five hours of • inability to decide
sleep every
which action to take
night.
from among the list of
techniques.
College of Nursing
Ranking of Family Health Problems

Summary
Name of Student: Joshua B. Espartero

Name of the Head of the Family: Necosalem Ompoc
Address: Marigold St., Puting Kahoy, Silang Cavite.
List of Health Problems Nature of Problem (1st Level Assessment)

1. Malnutrition Health Deficit
2. Unhealthy Lifestyle Health Threat
Ranking of Health Problems of the Family
PRIORITY FAMILY PROBLEM SCORE

1ST Priority Malnutrition 4 1/6
2nd Priority Unhealthy Lifestyle 2 5/6
College of Nursing
Prioritization of Family Health

Problems
Name of Student: Joshua B. Espartero

Name of the Head of the Family: Necosalem Ompoc
Problem 1:
Malnutrition
Criteria Standard Score Weight Actual Justification

Score
Wellness State 3
1. Nature of the Problem Health Deficit 3 The health deficit necessitates immediate
Health Threat 2 3 1 1 action to prevent untoward health complications.
Foreseeable 1
Crisis/Stress points
Knowledge is already acquired, and resources
are accessible, the problem can be alleviating
2. Modifiability of the Easily 2 through intervention. The family has a treadmill
2
problem Partially 1 and good environment for exercise. The nurse
Non-modifiable 0 can help the father by introducing the
2 2 importance of physical activity and active.
Teaching healthy lifestyle and personal
3. Preventive Potential High 3 practices might totallyprevented if
Moderate 2 1
intervention is done on the problem under
Low 1 2 2/3 consideration.
A condition or problem,
needing immediate attention
4. Salience 2 This is quite recognized by the family as a
A condition or problem not health problem. The family consider it as a
1
needing immediate attention minorproblem.
1 1 1/2
Not perceived as a problem
0
Total Score: 4 1/6
Problem 2 : Unhealthy Lifestyle
Criteria Standard Score Weight Actual Justification
Score
1. Nature of the Problem Wellness State 3 Unhealthy lifestyle is a health threat because it
Health Deficit 3 can contribute to the risk of developing some
Health Threat 2 2 1 2/3 illnesses and other health problems.
Foreseeable 1
Crisis/Stress points
Easily 2 The current knowledge, interventions and
2. Modifiability of the Partially 1 resources aren’t acquired and available to
problem Non-modifiable 0 1 2 1 solve the problem about unhealthy lifestyle
High 3 Solving problems in unhealthy lifestyle can

3. Preventive Potential Moderate 2 2 1 2/3 prevent the family to acquire disease and
Low 1 conditions.
A condition or problem,
4. Salience needing immediate attention The family perceived it as aminor problem.
2
A condition or problem not
needing immediate attention 1
1 1 1/2
Not perceived as a problem

0
Total Score: 2 5/6
College of Nursing
Family Care Plan
Intervention Plan
Health
Cues Family Nursing Problems Goal of Care Objectives
Problem Method of Nurse- Resources
Nursing Intervention
Family Contact Required
Problem Subjective:
No. 1 Sir Neco stated that, “I'm Video Conference
After nursing Material
Malnutrition worried and glad that I A. Inability to make • Define Physical
After nursing intervention, Sir Resources:
know where I am now decisions with respect to Activity
intervention, Neco will be able PowerPoint
with my BMI.”Wala akong taking appropriate health • Discuss the
Neco Ompoc to: presentation,
time para mag exercise at action due to: Importance of
will learn and visual aids such
mag prepare ng food ko.” Physical Activity
practice a. Define physical as flashcards,
“Sa sobrang busy ko hindi • Lack of discipline regarding in daily life.
healthy activity video
na rin ako nakakatulog ng food intake, exercise, and • Demonstrate
lifestyle. presentations
maaga” “Lagi din kami sleep. sample exercises
Sir Neco will and
nag mimidnight snacks ng • Low salience of the for Obese
prioritize his b. Recall the infographics.
family ko” problem Condition
health and importance of
• Enumerate the
practice health physical activity Time and effort
Obective: B. Inability to recognize the benefits of
discipline in 1 of the nurse
• Family’s 24hr food presence of the malnutrition regular physical
week time. c Practice regular and the head of
recall consisted of animal- due to: activity.
physical activity the family.
based products. •Lack of knowledge and time • Recall the
• 1 member of the family on the nature and extent of Complications of
d. Enumerate the
is obese. nursing care needed. Obesity
benefits of regular
• Sir Neco’s BMI is 33.7, •Failure to see the
physical activity.
it means he is obese. The consequences of continuing of
normal BMI is around lack of sleep and physical
d. Recall the
18.5—24.9. exercise
complications of
obesity
Intervention Plan
Family Nursing
Health Problem Cues Goal of Care Objectives
Problems Method of Nurse- Resources
Nursing Intervention
Family Contact Required
Problem No. 2
1. Inability to
Subjective: 1. Define sleep Video Conference Material
recognize the presence of
Unhealthy lifestyle Sir Neco stated that, Resources:
the condition due to After nursing After nursing
and personal “Lagi ako natutulog ng 2. Discuss the PowerPoint
• lack of or intervention, intervention, Sir
habits/practices 11 pm at gumigising importance of sleep presentation,
inadequate knowledge Neco Ompoc Neco will be able
ng 4 am para mag that may help him to visual aids such
about the importance of will learn and to:
work” “Sobrang achieve optimum as flashcards,
sleep practice healthy
nakaka pagod but I get health. video
2. Inability to lifestyle. a. Define sleep
used to it na” “Nag presentations
recognize the presence of Sir Neco will
eexercise din ako pero 3. Enumerate the and
the condition or problem prioritize his b. Recall the
sobrang bihira lang benefits of having infographics.
due to health and importance of sleep
dahil sa lack of time.” adequate sleep
• denial about its practice health
“Usually, our meals Time and effort
existence or severity as a discipline in 1 c. Discuss different
are not well balance, 4. Discuss different of the nurse
result of fear of week time. healthy sleeping
more on meat products healthy sleeping habits and the head of
consequence of diagnosis. habits
na din yung kinakain the family.
3. Inability to make
namin” 5. Discuss the dangers
decisions with respect to d. Enumerate the
of lack of sleep
taking benefits of having
Obective:
appropriate health adequate sleep
• Family’s 24hr food
action due to
recall mainly
• inability to decide e. Recall the dangers
• He only sleeps
which action to take from of lack of sleep
atleast 5 hours a day
among a list of techniques
(shown in Gordon’s
Assessment)
Health Family Nursing Diagnosis
Cues Goals & Objective Nursing Intervention Evaluation
Problem
Problem No. 1 Subjective: A. Inability to make Goal: Goals met

Malnutrition Sir Neco stated decisions with respect to After nursing intervention, • Define Physical Activity
(Obesity) that, “I'm worried taking appropriate health The family will be able to After 1 week of nursing
• Discuss the Importance of Physical
and glad that I action due to: prioritize and practice healthy intervention, the client
know where I am lifestyle. Activity in daily life. states, “I’ve done 1 week of
now with my • Lack of discipline getting the 21 days of
• Demonstrate sample exercises for
BMI.”Wala akong regarding food intake, Objectives: exercise but my goal is not
time para mag exercise, and sleep. After nursing intervention, Obese Condition only to finish 21 days but to
exercise at mag • Low salience of the Sir Neco will: carry on this as a lifestyle”
• Enumerate the benefits of regular
prepare ng food problem
ko.” “Sa sobrang a. Define physical activity physical activity. The family started to
busy ko hindi na B. Inability to recognize practice brisk walking
• Recall the Complications of Obesity
rin ako the presence of the b. Recall the importance of atleast 3-5 times a week for
nakakatulog ng malnutrition due to: physical activity 30 minutes. The client also
maaga” “Lagi din •Lack of knowledge and recognized the importance
kami nag time on the nature and c. Encourage to practice and good benefits of
mimidnight snacks extent of nursing care regular physical activity physical activities and his
ng family ko” needed. blood sugar level lowered a
•Failure to see the d. Enumerate the benefits of little.
Obective: consequences of continuing regular physical activity.
• Family’s 24hr of lack of sleep and physical Mr. Ompoc’s blood sugar
food recall exercise d. Recall the complications of level before is around 250-
consisted of obesity 260 mg/dl. Now he has
animal-based 190-200 mg/dl.
products.
• 1 member of Overall, the client sets goals
the family is for his better health
obese. practices.
• Sir Neco’s
BMI is 33.7, it
means he is obese.
The normal BMI
is around 18.5—
24.9.
Family Nursing Diagnosis
Health Problem Cues Goals & Objective Nursing Intervention Evaluation
Problem No. 2 Subjective: A. Inability to make Goal: 1. Define sleep Goals met
Unhealthy Sir Neco stated decisions with respect to After nursing intervention,
lifestyle and that, “Lagi ako taking appropriate health Neco Ompoc will learn and 2. Discuss the importance of sleep that After 1 week of nursing
personal natutulog ng 11 action due to: practice healthy lifestyle. may help him to achieve optimum intervention, the client
habits/practices pm at gumigising Sir Neco will prioritize his health. recognized the importance and
ng 4 am para mag • Lack of discipline health and practice health
benefits of adequate sleep. The
work” “Sobrang regarding food intake, discipline in 1 week time 3. Enumerate the benefits of having
nakaka pagod but exercise, and sleep. adequate sleep family started to sleep atleast 7-9
I get used to it • Low salience of the Objectives: hours. Also, the family practice
na” “Nag problem After nursing intervention, 4. Discuss the different healthy sleeping at around 9:30-10 PM.
eexercise din ako Sir Neco will: sleeping habits
pero sobrang B. Inability to recognize the The client states, “We started
bihira lang dahil presence of the a. Define sleep 5. Discuss the dangers of lack of sleep sleeping early and practice
sa lack of time.” malnutrition due to:
healthy sleeping habits. At first,
“Usually, our •Lack of knowledge and time b. Recall the importance of
meals are not well on the nature and extent of sleep it’s kind of hard but I know that
balance, more on nursing care needed. we will get to that soon”
meat products na •Failure to see the c. Discuss different healthy
din yung kinakain consequences of continuing sleeping habits
namin” lack of sleep and physical
exercise d. Enumerate the benefits of
Obective: having adequate sleep
• Family’s 24hr e. Recall the dangers of lack of

food recall mainly sleep.
animal based-
products.
• He only sleep
atleast 5 hours a
day (shown in
Gordon’s
Assessment)
Recommendation:
Doing the intervention is quite hard because the client is busy. Reminding their family to maintain their
physical activity is also challenging because of lack of time.
There is no major problem because they willingly participated in the intervention plan, he also
emphasizes that he fully understands the problem and the health teaching.
As for their first problem it is recommended that:
• The family to have a continuous exercises routine and if possible, not only home workout but
also outside the house exercises such as brisk walking or biking.
• Exercise should be paired with eating a healthy diet and adequate sleep.
• Be consistent is everything to have satisfactory results from the food they eat and doing exercises.
• The family should start slowly and gradually add the exercise and the difficulty of it.
As for their 2nd problem it is recommended that:
• The family must practice sleeping atleast 7 to 8 hours per night.
• The family should eat lighter meals at night and at least two hours before bed.
• Sleeping early (10 pm) must become a habit for the family.
• Screen time should be avoided during bedtime.
As for the future nurse, always remember to establish priorities for the future problems so that you can
balance what actions to take first and what to prioritize.
References
• Big Health Fitness. (2019). 7 Effective and Easy Workouts for Overweight Beginners:
http://wwwbighealthandfitness.co.uk/easy-workouts-for-overweight-beginners/
• Better Health Channel. (2020). Physical activity - it's important:
https://www.betterhealth.vic.gov.au/health/HealthyLiving/physical- activity-its-important
• Centers for Disease Control and Prevention (2018) Adult Obesity Causes & Consequences:
https://www.cdc.gov/obesity/ adult/causes.html
• Clinic Barcelona. (2020). Obesity:
https://www.clinicbarcelona.org/en/assistance/diseases/obesity/symptoms
• Foley, L. (2020). Why Do We Need Sleep?: https://www.sleepfoundation.org/how-sleep-works/why-do-
we-need-sleep
• Healthline. (2016). Cardiovascular Exercises: healthline.com/health/fitness-exercise/cardio-exercises-list#
• Healthline. (2020). Reasons Why Good Sleep Is Important: https://www.healthline.com/nutrition/10-
reasons-why-good-sleep-is-important
• Medical News.(2019). Why sleep is essential for health:
https://www.medicalnewstoday.com/articles/325353#better-calorie-regulation
• My Health Finder.(2021). Get Enough Sleep: https://health.gov/myhealthfinder/topics/everyday-healthy-
living/mental-health-and-relationships/get-enough-sleep
• Takeaway Jenn Sinrich.(2019).10 Best Cardio Workouts for Weight Loss:
https://www.mensjournal.com/health-fitness/best-types-cardio- workouts-weight-loss/
• World Health Organization (26 November 2020). Physical activity: https://www.who.int/news-room/fact-
sheets/detail/physical- activity
Appendices
Consent
COLLEGE OF NURSING
FAMILY ASSESSMENT GUIDE
FIRST LEVEL ASSESSMENT

Date Assessed: June 15, 2021
I. Family Structure, Characteristics, and Dynamics
Family Name: Ompoc
Address: Marigold St., Heritage Spring Homes, Puting Kahoy, Silang Cavite.
A. Demographic Data
Household Number: Block 114, Lot 16 Barangay House No.: NA
Family Data
Length of residency 1 year
Place of origin: Panay, Capiz
Family size: 3
Religion: Husband Seventh-Day Adventist
Wife Seventh-Day Adventist
Family Member’s Chart

Civil Position in Relationship to
Family Members Age Sex Status the Family
Family Head
1. Neco Ompoc 43 Male Married Father Head of the family
2. Mae Ann Julian Ompoc 43 Female Married Mother Wife
3. Justin Owen Ompoc 9 Male Single Only child Son
B. Family Characteristics
Type of Family Structures
Family Description Please check applicable

Nuclear Dyad, Cohabitation, Single-parent, Blended, Communal,
Foster, Adoptive, ✓
Single living alone, elder living alone
Extended Single with relatives, Elder with relatives, nuclear with non-
immediate family
dependents
Others Gay/Lesbian
C. General Family Relationship/Dynamic
“Family dynamics are the patterns and interactions we have with different members of our family”(Miles,
2015).
SMILKSTEIN'S FAMILY SYSTEM APGAR ITEMS (Smilkstein, 1976)
Component Items Score Justification

Both parents help each
Can you turn to your family for help 2 other during the financial
Adaptation something is troubling you? survival period of their
family
Are you satisfied with the way your The family often likes to
Partnership family talk things over with you and 2 talk through their feelings
shares problems with you? as they’re getting into bed.
Are you satisfied that your family Both parents are free
accepts and supports your wishes to 2 from vices. They can eat
Growth take on new activities three times a day
or directions? together with midnight
snack.
Are you satisfied with the way your The family always has
family expresses affection and time to bond with each
Affection responds to your emotions, such as 2 other by doing
anger, sorrow, and love? recreational activities
such walking and
watching movies.
Are you satisfied with the way your The family has enough
Resolve family and you share time together? 2 time to talk and bond
especially in
problems with their son.
The family Apgar result
is 10 which means that
their family is highly
functional. It shows that
TOTAL 10 their family is able to
communicate well and
use the appropriate
resource available in
the community.
Scoring: 0 point = “Hardly ever” Interpretation: 0-3 = severely dysfunctional family

1 point = “Some of the time” 4-6 = Moderately dysfunctional Family
2 points = “Almost always” 7-10 = Highly functional Family
Family Function and Roles
Fat Mother
Roles Description her
(please check to whom
applicable)
The one who supplies the bulk of the income for the
Wage Earner family ✓
Supervises the family finances (pays the bills, ✓
Financial Manager provides for future savings)
The family depend on to provide the solution for ✓
Problem-solver problems
Makes decisions, particularly in the area of lifestyle ✓
Decision-maker and leisure time
Determines what information will be release from ✓
Gate Keeper the family or what new information can be
introduced.
Patriarchal/Matriarchal? (Please refer to Family functions & roles) Patriarchal
Significant other/s aside from parents, who makes decision for the family? NA
II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
Position in Educational
Family Members Ethnicity Religion Occupation
the Family Attainment
Sales
Necosalem Ompoc Father Filipino SDA BSC Manager
Mae Ann Ompoc Mother Filipino SDA BSN Nurse
Justin Owen Ompoc Son Filipino SDA Grade Student
Who makes decisions about money and how it is spent? Mae Ann Ompoc (Mother)
Monthly Family Income Source

Husband 30,000 pesos
Wife No income
Others NA
Monthly Family Income

TOTAL (checked bracket)
Php 5,000 Php 20,000 - 30,000
Php 5,000 – 10,000 Php 30,000 – 40,000 ✓
Php 10,000 – 15,000 Php 40,000 – 50,000
Php 15,000 – 20,000 Php 50,000 & above
Significant Others Roles they play to the family life

NA NA
Relationship of the family to larger community (describe the nature and extent of participation of the family
in the community activities) : NA
III. HOME AND ENVIRONMENT
1. Home
a. Ownership: Owned ✓ Rented Rent-Free
Mortgag Others(Specify
ed )
b. Construction materials used: Wood ✓ Concrete Mixed

Makeshift Others, specify
c. Number of rooms used for sleeping 2
d. Lighting facilities ✓ Electricity Kerosene Others, specify
e. What are the appliances owned by the family? Televesion, electric fan, induction cooker, electric kettle, air
conditioner, refrigerator, blender, rice cooker, blower, vacuum, sound system, iron
f. General sanitary condition: The house is well sanitized
2. Water Supply
a. Drinking water
Source: Deep well Shallow Springs Others, specify Purified water

well
Distance from house: 80 meters
Storage: Jars ✓ Bottles Plastic pitcher Others, specify
3. Kitchen
a. Cooking facility Electric stove Gas stove ✓ Firewood/Charcoal
b. Food storage Refrigerator ✓ Cabinet ✓ Pots/pans, etc.
c. Sanitary condition: The kitchen is well sanitized
d. Drainage facility None Open Closed ✓
4. Waste Disposal
a. Refuse and Garbage
1. Container: ___✓___ plastic bag ______ sacks ______ Others, specify ___________________
2. Method of Disposal: ______ none ______ dumping ______ burning ______ burying
___✓___ waste segregation ______ feeding to animals
______ throw in river/sewer ______ Others, specify __________________
b. Toilet
1. Type
______ Pit privy __✓____ Water-sealed(Septic Tank) ______ Water sealed (Sewer) ____ Others
2. Distance from house: The toilet is inside the house
3. Identify if there is sharing of toilets The toilet is only used by the Pangilinan family
c. Type of drainage system
Open____________ With Cover_✓___
1. Domestic Animals
Kind Number Where Kept Vaccination Status
Dog 1 Outside the house Not yet
2. Identify presence of breeding sites for vector diseases. Stagnant water, Dog, cats, and tall grass.
3. Identify potential accident hazards: The area is prone to ground shaking and landslide during earthquakes.
4. Describe the neighborhood (i.e. slums, congested & etc.): Subdivision
5. Recreational Facilities: Sport facility and park
6. Availability of Health Care Facilities and Health Manpower Resources: There are 2 Private hospitals and 1
clinic available.
7. Distance of House from nearest Health Care Facility: 5 km
8. a. Communication facilities
_✓_ Cellphone
Landline
Letter
_✓_ Internet
Others (specify)
b. Transportation facilities
Private car
Motorcycle
_✓_ Tricycle
_✓_ Jeep
Bike
Others (specify)
I. FAMILY HEALTH Derived

STATUS from Salvacion G. Ballon-Reyes and Araceli S. Maglaya’s (1978) Initial Data Base for Family Nursing Practice
A. Common Illnesses encountered for the last 6 months and the treatment applied/given.
Illness Treatment
Necosalem - Fever & Diarrhea (Last March IV fluids, Paracetamol & Loperamide
2021)
B. Nutritional
Assessment Family
Dietary Habits
What did you eat yesterday? (24-hour Dietary recall)
Breakfast: White rice, egg, hotdog, and water.
Lunch: White rice, beans, fish, and water.
Supper: Spaghetti with beef, chicken siopao, and water.
Body mass
Family Member Index Classification
Necosalem Pilapil Ompoc 33.7 Obesity
Normal
Mae Ann Julian Ompoc 20.4 weight
Justin Owen Ompoc 21.8 Normal

weight
C. Identification of risk factors for specific lifestyle disease through the use of Gordon’s health
assessment tool.
Lifestyle Risk Factors
Inadequate rest/sleep Stress and sleeping disorder
Excessive food intake both in quality and Obesity and Hypertension

quantity
D. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical

practitioner): NA
E. Results of laboratory/diagnostic and other screening procedures. NA
IV. FAMILY VALUES, AND HEALTH PRACTICES
A. Immunization status of family members (For Children ages 0-5 years old)
Family member Immunization Status
NA NA NA
B. Identify healthy lifestyle practices Free from vices such as smoking, alcohol and drugs. Practicing daily
exercise like, brisk walking and sometimes treadmil.
C. Adequacy of rest and sleep, exercise, use of protective measure (bet nets, footwear), relaxation and other
stress management activities ( you can also use the Gordon’s assessment tool here)
Sir Necosalem Ompoc has only 5 hours of sleep daily while Justin and Mae ann Ompoc has adequate sleep
and rest on a daily basis. Their stress management activities are walking, gardening, and watching movies
D. Use of promotive-preventive health services: They are not using promotive-preventive health services
E. Identification of risk factors for specific lifestyle disease through the use of Gordon’s health
assessment tool.
Lifestyle Risk Factors
Inadequate rest/sleep Stress and sleeping disorder
Excessive food intake both in quality and Obesity and Hypertension

quantity
F. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical

practitioner).
NA
G. Results of laboratory/diagnostic and other screening procedures. NA
H. Whom do you consult for health related problems?
Manghihilot Albularyo
Midwife Nurse
✓ Doctor Health Center

BHW Others, specify
I. For problems other than health, whom do you consult?

✓ Family members Relatives
Friends Barangay Officials
Priest/pastor Others, specify
Identified Problems from the Initial Data Base (1st Level Assessment)
Problem Cues
Objective:
• Sir Neco’s sleeping time is around 11:30 PM
Unhealthy Lifestyle • He only gets five hours of sleep every night.
• Family’s 24hr food recall mainly consisted of
animal based products.
• The family does not practice regular exercises.
Objective:
Malnutrition • 1 member of the family is obese.
• Sir Neco’s BMI is 33
HEALTH ASSESSMENT BASED ON
GORDON’S FUNCTIONAL
HEALTH
I. Health Maintenance-Perception Pattern PATTERN
Before Hospitalization During Hospitalization
Cigarette Smoking No  Yes  Cigarette Consumption : Cigarette Smoking No  Yes  Cigarette Consumption :
<pack/day <pack/day
1-2 pack/day  >2 packs/day 1-2 pack/day  >2 packs/day
 
QUIT :  Date/year QUIT: QUIT :  Date/year QUIT:
Alcohol No  Yes  Type: Beer  Hard Liquor  Alcohol No  Yes  Type: Beer  Hard Liquor 
Other  Specify: Other  Specify:
Therapeutic Drugs No  Yes  Type of Therapeutic Drugs No  Yes  Type of

Drug: Purpose: Drug: Purpose:
Allergies Drugs  Food  Dyes  Others  Specify: Shrimp Allergies Drugs  Food  Dyes  Others  Specify: Shrimp
II. Nutritional- Metabolic Pattern
Special No  Yes  Specify: Special No  Yes  Specify:

Diet Diet
Dietary Supplements/Vitamins No  Yes  Dietary Supplements/Vitamins No  Yes 
Appetite Normal  Increased  Decreased  Appetite Normal  Increased  Decreased 
Decreased taste sensation  Decreased taste sensation 
Nausea  Vomiting  Stomatitis  Weight loss/gain lbs Nausea  Vomiting  Stomatitis  Weight loss/gain lbs
Swallowing Normal  With Difficulty  With NGT  Swallowing Normal  With Difficulty  With NGT 
Dentures Upper(Partial: Full:  ) Lower (Partial: Full:  Dentures Upper(Partial: Full:  ) Lower (Partial: Full: 
) )
III. Elimination Pattern
Bowel Diarrhea  Bowel Constipation  Diarrhea 

Habits Habits
No. of Bowel Movement ( BM)/day: 1 Date of last BM: June 16, 2021 No. of Bowel Movement ( BM)/day: : 1 Date of last BM: June 16,
2021
With Ostomy  Appliance  Self Care  With Ostomy  Appliance  Self Care 
Frequency  Dysuria  Burning  Urgency  Frequency  Dysuria  Burning  Urgency 
Bladder Hematuria  Dribbling  Nocturia  Bladder Hematuria  Dribbling  Nocturia 

Habits Habits
Incontinency yes  No  Daytime  Night time Occasional Incontinency yes  No  Daytime  Night time Occasional
 
Difficulty delaying voiding  Difficulty delaying voiding 
Catheterization Retention/Indwelling/Foley  Straight  Catheterization Retention/Indwelling/Foley  Straight 
Condom/weebag  Cystoclysis  Condom/weebag  Cystoclysis 

Urine Color: Light Urine Color: Light
yellow yellow
IV. Activity and Exercises

Before Hospitalization
0 1 2 3 4
Self-Care Ability Derived from Salvacion G. Ballon-Reyes and Araceli S. Maglaya’s (1978) Initial Data Base for Family Nursing Practice
Remarks
Independent Assistive Assistance from Assistance from person Dependent/Unable
Device
Eating/Drinking

Bathing

Dressing/Grooming

Toileting

Bed Mobility

Transferring 
Ambulating

Stair Climbing

Shopping

Cooking

Home Maintenance

Cane 
During Hospitalization
0 1 2 3 4
Self-Care Ability Assistance from Assistance from person Remarks
Independent Assistive others and equipment Dependent/Unable
Device
Eating/Drinking 
Bathing 
Dressing/Grooming

Toileting 
Bed Mobility

Transferring 
Ambulating 
Stair Climbing

Shopping 
Cooking

Home Maintenance 
Assistive Devices: None  Crutches  Walker  Bedside Commode 
Cane  Splint/Brace  Wheelchair  Other  Specify:
V. Sleep/Rest Pattern
Sleeping Habits: Regular  Irregular  With AM Nap  With PM Sleeping Habits: Regular  Irregular  With AM Nap  With PM
Nap Nap
Time of Sleep:11:30 PM Time of Arising:5AMTotal hours of sleep at night: Time of Sleep:11:30 PM Time of Arising:5AMTotal hours of sleep at night:
5.5 5.5
Problems None  Early Walking  Insomia  Nightmares  Problems None  Early Walking  Insomia  Nightmares 
VI. Cognitive—Perceptual Pattern
Mental Alert  Oriented  Confused  Combative  Mental Alert  Oriented  Confused  Combative 
Unresponsive  Receptive Aphasia  Unresponsive  Receptive Aphasia 
Speech Speech
Spoken Language: Interpreter: NA Spoken Language: Interpreter: NA

Filipino Filipino
Level of Anxiety Mild  Moderate  Severe Panic  Level of Anxiety Mild  Moderate  Severe Panic 
Hearin Normal  Hearin Normal 

g g
Hearing Aid  Tinnitus 
Vision Normal  Eye glasses  Contact Lenses  Vertigo 
Vision Normal  Eye glasses  Contact Lenses  Vertigo 
Discomfort/Pain Discomfort/Pain
Pain Management: NA Pain Management: NA
VII. Role - Relationship Pattern
VII. Role-Relationship Pattern VII. Role-Relationship Pattern
Marital Status Single  Married  Separated  Widow/Widower  Marital Status Single  Married  Separated  Widow/Widower 
Employment Employed  Unemployed  Employment Employed  Unemployed 

Short-term/long-term disability  Short-term/long-term disability 
Occupation: Sales Manager Support Occupation: Sales Manager Support
System Spouse  Neighbors/Friends System Spouse  Neighbors/Friends
 None Other  Specify:  None Other  Specify:
Family concerns regarding hospitalization: NA Family concerns regarding hospitalization: NA
VIII. Sexuality - Reproductive Pattern
VIII. Sexuality—Reproductive Pattern VIII. Sexuality—Reproductive Pattern

SUBJECTIVE (REPORTS) SUBJECTIVE (REPORTS)
Sexually active: Yes Use of condoms: No Sexually active: Yes Use of condoms: No
Birth control method: NA Birth control method: NA
Sexual concerns/difficulties: None Sexual concerns/difficulties: None
Recent change in frequency/interest: None Recent change in frequency/interest: None
Female: Subjective (Reports) Female: Subjective (Reports)
Age at menarche:NA Length of cycle: NA Age at menarche:NA Length of cycle: NA
Duration: NA No. of pads used/day: NA Duration: NA No. of pads used/day: NA
Last menstrual period: NA Last menstrual period: NA
Pregnant now: NA Pregnant now: NA
Bleeding between periods: NA Bleeding between periods: NA
Menopause: NA Menopause: NA
Vaginal lubrication: NA Vaginal lubrication: NA
Surgeries: NA Surgeries: NA
Hormonal therapy/calcium use: NA Hormonal therapy/calcium use: NA
Practices breast self-examination: NA Practices breast self-examination: NA

Last mammogram: NA Last mammogram: NA
Pap smear: NA Pap smear: NA
Objective (Exhibits) Objective (Exhibits)
Breast examination: NA Breast examination: NA
Genital warts/lesions:
IX. Coping NAVaginal
- Stress Tolerance/ Discharge: NA Genital warts/lesions: NAVaginal Discharge: NA
Self-Perception/Self-Concept
Male: Subjective (Reports) During Hospitalization
Male: Subjective (Reports)
Penile discharge: None Prostate disorder:
IX. Coping- Stress Tolerance/ Self-Perception /Self-Concept
IX. Coping- Stress Tolerance/ Self-Perception /Self-Concept
None Circumcised: Yes None Circumcised: Yes
Major concerns regarding hospitalization or illness Major concerns regarding hospitalization or illness
Vasectomy: None Vasectomy: None
(Financial, self-care): (Financial, self-care):
Practice self-examination: Breast:NA Testicles: No Practice self-examination: Breast:NA Testicles: No
Breast:NA Penis: None
Major loss/crisis/change in past year/s: NoneYes 
Testicles: Breast:NA Penis: Nonein past
Major loss/crisis/change year/s:NoneYes 
Testicles:
No 
Genital warts/lesions: None Discharge:None No 
Genital warts/lesions: None Discharge:None
Specify: Specify:
Fear of Violence Yes  No  Who/Specify: Fear of Violence Yes  No  Who/Specify:
Outlook on Future: 8 (rate 1-poor to 10- very optimistic) Outlook on Future: 8 (rate 1-poor to 10- very optimistic)
Describe: Describe:
Sir Neco has a positive outlook for his future Sir Neco has a positive outlook for his future
X. Value —
situations in Belief
life. HePattern
stated that, situations in life. _
“I already made my future plans in life.” _ _“I already made my future plans in life.”
No 
OTHER INFORMATION
The client’s name is Necosalem Pilapil Ompoc, he is the head of the Ompoc family.
HEALTH ASSESSMENT BASED ON GORDON’S FUNCTIONAL
HEALTH PATTERN
I. Health Maintenance-Perception Pattern

Cigarette Smoking No  Yes  Cigarette Consumption : Cigarette Smoking No  Yes  Cigarette Consumption :
<pack/day <pack/day
1-2 pack/day  >2 packs/day 1-2 pack/day  >2 packs/day
 

Allergies Drugs  Food  Dyes  Others  Specify: None Allergies Drugs  Food  Dyes  Others  Specify: None
No  Yes  Specify: No  Yes  Specify:
) )
Constipation  Diarrhea  Constipation  Diarrhea 

No. of Bowel Movement ( BM)/day: 1 Date of last BM: June 15, 2021 No. of Bowel Movement ( BM)/day: 1 Date of last BM: June 15, 2021
With Ostomy  Appliance  Self Care  With Ostomy  Appliance  Self Care 
Frequency  Dysuria  Burning  Urgency  Frequency  Dysuria  Burning  Urgency 
Bladder Hematuria  Dribbling  Bladder Hematuria  Dribbling 

Habits Habits
Incontinency yes  No  Daytime  Night time Occasional Incontinency yes  No  Daytime  Night time Occasional
 
Difficulty delaying voiding  Difficulty reaching toilet  Difficulty delaying voiding  Difficulty reaching toilet 
Catheterizati
on
Catheterization
Condom/weebag  Cystoclysis 
cc/ml cc/ml

Before Hospitalization Derived from Salvacion G. Ballon-Reyes and Araceli S. Maglaya’s (1978) Initial Data Base for Family Nursing Practice
0 1 2 3 4
Self-Care Ability Remarks
Device
Eating/Drinking 
Bathing 
Dressing/Grooming

Toileting

Bed Mobility

Transferring 
Ambulating

Stair Climbing

Shopping

Cooking

Home Maintenance

Assistive None 
Devices:
Cane 
0 1 2 3 4
Device
Eating/Drinking 
Bathing 
Dressing/Grooming

Toileting 
Bed Mobility

Transferring 
Ambulating 
Stair Climbing

Shopping 
Cooking

Nap Nap
7.5 5.5
VI. Cognitive-Perceptual Pattern VI. Cognitive-Perceptual Pattern
Speech Speech
Interpreter: NA Interpreter: NA

g g
Hearing Aid  Tinnitus  Hearing Aid  Tinnitus 
Vision Normal  Eye glasses  Contact Lenses  Vertigo  Vision Normal  Eye glasses  Contact Lenses  Vertigo 
Impaired  Right( Impaired  Right(

)Left() )Left()
Pain Management: Pain Management:
VII. Role - Relationship Pattern
Marital Status Single  Married  Separated  Widow/Widower  Marital Status Single  Married  Separated  Widow/Widower 
Employment Employed  Unemployed  Employment Employed  Unemployed 

Short-term/long-term disability  Short-term/long-term disability 
Occupation: House Wife Support System Occupation: House wife Support System
Spouse  Neighbors/Friends Spouse  Neighbors/Friends
 None Other  Specify:  None Other  Specify:
Family concerns regarding hospitalization: none Family concerns regarding hospitalization: none
VIII. Sexuality - Reproductive Pattern
VIII. Sexuality—Reproductive Pattern VIII. Sexuality—Reproductive Pattern

Sexually active: Yes Use of condoms: No Sexually active: Yes Use of condoms: No
Birth control method: NA Birth control method: NA
Sexual concerns/difficulties: None Sexual concerns/difficulties: None
Recent change in frequency/interest: None Recent change in frequency/interest: None
Female: Subjective (Reports) Female: Subjective (Reports)
Age at menarche: 15 Length of cycle: 28 Age at menarche: 15 Length of cycle: 28
Duration: half day No. of pads used/day: 2 Duration: half day No. of pads used/day: 2
Last menstrual period: June 3 Last menstrual period: June 3
Pregnant now: No Pregnant now: No
Bleeding between periods: No Bleeding between periods: No
Menopause: No Menopause: No
Vaginal lubrication: Vaginal lubrication:
None Surgeries: None None Surgeries: None
Hormonal therapy/calcium use: None Hormonal therapy/calcium use: None
Practices breast self-examination: yes Practices breast self-examination: yes

Last mammogram: None Last mammogram: None
Pap smear: None Pap smear: None
Breast examination:
IX. Coping - Stress None Breast examination: None
Tolerance/ Self-Perception/Self-Concept
Genital warts/lesions: None Genital warts/lesions: None
Vaginal Discharge: None Vaginal Discharge: None
IX. Coping- Stress Tolerance/ Self-Perception /Self-Concept IX. Coping- Stress Tolerance/ Self-Perception /Self-Concept
Male: Subjective (Reports) Male: Subjective (Reports)
Major concerns
Penile discharge:regarding
NA hospitalization or illness
Prostate disorder: NA Majordischarge:
Penile concerns NAregarding hospitalization or illness
Prostate disorder: NA
Circumcised:
None NA Vasectomy: NA Circumcised: NA Vasectomy: NA
Practice self-examination: Breast: Yes Testicles: NE Practice self-examination: Breast: Yes Testicles: NE
Major loss/crisis/change
Objective (Exhibits) in past year/s: Yes  Major loss/crisis/change
Objective (Exhibits) in past year/s: Yes 
Breast:NA Penis: NA No 
Testicles: NA No 
Breast:NA Penis: NA Testicles: NA
Genital
Specify: warts/lesions: Noone Discharge:NA Genital
Specify: warts/lesions: Noone Discharge:NA
Describe: Describe:
She has a very positive outlook in the future and NA _
X.
sheValue — Belief
is hoping to livePattern
in the U.S _ _
Religious Restrictions:No pork and seafoods
No 
OTHER INFORMATION
The client’s name is Mae Ann Julian Ompoc, she is the wife of Sir Ompoc.
HEALTH ASSESSMENT BASED ON GORDON’S
FUNCTIONAL HEALTH PATTERN
I. Health Maintenance-Perception Pattern
Cigarette Smoking No  Yes  Cigarette Consumption :
<pack/day
1-2 pack/day  >2 packs/day
  

Allergies Drugs  Food  Dyes  Others  Specify: None Allergies Drugs  Food  Dyes  Others  Specify: None
No  Yes  Specify: No  Yes  Specify:
) )
Constipation  Diarrhea  Constipation  Diarrhea 

No. of Bowel Movement ( BM)/day: 1 Date of last BM: June 16, 2021
No. of Bowel Movement ( BM)/day: 1 Date of last BM: June 16, 2021
With Ostomy  Appliance  Self Care 
With Ostomy  Appliance  Self Care 
Frequency  Dysuria  Burning  Urgency 
Frequency  Dysuria  Burning  Urgency 
Bladder Hematuria  Dribbling 
Habits Bladder Hematuria  Dribbling 
Incontinency yes  No   Habits
Daytime Night time Occasional
 Incontinency yes  No  Daytime  Night time Occasional

Difficulty delaying voiding  Difficulty reaching toilet 
Difficulty delaying voiding  Difficulty reaching toilet 
Catheterizati
on
Catheterization

0 1 2 3 4
Self-Care Ability Remarks
Device
Eating/Drinking

Bathing

Dressing/Grooming

Toileting

Bed Mobility

Transferring 
Ambulating

Stair Climbing

Shopping

Cooking

Home Maintenance

Assistive None 
Devices:
Cane 
0 1 2 3 4
Device
Eating/Drinking 
Bathing 
Dressing/Grooming

Toileting 
Bed Mobility

Transferring 
Ambulating 
Stair Climbing

Shopping 
Cooking

Nap Nap
8.5 8.5
Role - Relationship Pattern
VI. Cognitive-Perceptual Pattern VI. Cognitive-Perceptual Pattern
Speech Speech
Interpreter: NA Interpreter: NA

g g
Normal  Eye glasses  Contact Lenses  Vertigo 

Normal  Eye glasses  Contact Lenses  Vertigo 
Vision
Vision
Impaired  Right(
)Left()
Pain Management: Pain Management:

VII.
Marital Status Single  Married  Separated  Widow/Widower  Marital Status Single  Married  Separated  Widow/Widower
Employment Employed  Unemployed  Employed  Unemployed 

Short-term/long-term disability  Occupation: Short-term/long-term disability  Occupation: Student Support
Student
Syste Spouse  Neighbors/Friends 
m None
Support System Spouse  Neighbors/Friends  None  Other  Specify:
Other  Specify:
Family concerns regarding hospitalization: None
I. Sexuality - Reproductive Pattern

VIII. Sexuality—Reproductive Pattern

Sexually active: No Use of condoms: No
Birth control method: NA Sexual concerns/difficulties: None
Sexual concerns/difficulties: None
Recent change in frequency/interest: None
NA Length of cycle: NA
Female: Subjective (Reports) Duration: NA No. of pads used/day: NA
Age at menarche: NA Length of cycle: NA Pregnant now: NA
Duration: NA No. of pads used/day: NA Menopause: NA Vaginal lubrication: NA

Last menstrual period: NA Surgeries: NA
Pregnant now: NA NA
Bleeding between periods: NA Pap smear: NA
Menopause: NA Objective (Exhibits)

Vaginal lubrication: NA
Genital warts/lesions: NA
Surgeries: NA
Hormonal therapy/calcium use: NA Penile discharge: None Prostate disorder: None

Circumcised: No Vasectomy: None
Testicles: No
Practices breast self-examination: NA
Objective (Exhibits)
Last mammogram: NA Breast:NA Penis: None Testicles: None
Pap smear: NA Genital warts/lesions: None Discharge:None
Breast examination: NA
Genital warts/lesions: NAVaginal Discharge: NA
Male: Subjective (Reports)
None Circumcised:
Derived from SalvacionNo
G. Ballon-Reyes and Araceli S. Maglaya’s (1978) Initial Data Base for Family Nursing Practice
Vasectomy: None
Practice self-examination: Breast:NA Testicles: No
Breast:NA Penis: None Testicles: None
Genital warts/lesions: None Discharge:None
I. Coping - Stress Tolerance/ Self-Perception/Self-Concept
IX. Coping- Stress Tolerance/ Self-Perception /Self-Concept IX. Coping- Stress Tolerance/ Self-Perception /Self-Concept
Major concerns regarding hospitalization or illness Major concerns regarding hospitalization or illness
Major loss/crisis/change in past year/s: Yes  Major loss/crisis/change in past year/s: Yes 
No  No 
Specify: Specify:
Describe: Describe:
As an elementary student, he has a positive As an elementary student, he has a positive
I.outlook — Belief
Value for Pattern
his future. He is looking forward for a outlook for his future. He is looking forward for a
harmonious and simple life. harmonious and simple life.
Religious Restrictions: No pork and seafoods
_
No 
OTHER INFORMATION
The client’s name is Justin Owen Ompoc, he is the son of Mr & Mrs Ompoc.
Instructional Design
Title: Importance of Physical Activity
Goals: The family will be able to enumerate the benefits of Physical Activity and be able to demonstrate the sample physical
activities.
Objectives Content Method of Time Evaluation

Teaching Alloted
After 22 minutes • DEFINITION OF PHYSICAL ACTIVITY:

of teaching-
learning activity, a. It is defined as any bodily movement produced by Lecture using 2 The client
the family will be skeletal muscles that requires energy expenditure. recorded minutes was able to
able to: b. Physical activity refers to all movement including PowerPoint define
during leisure time, for transport to get to and from Presentation physical
places, or as part of a person’s work. activity.
A. Define c. Both moderate- and vigorous-intensity physical
physical activity improve health.
activity. d. Physical activity in daily life can be categorized
into occupational, sports, conditioning, household,
or other activities.
2.Discuss the Importance of Physical Activity:

importance of 5
physical activity in • Physical activity is important to Lecture using Recorded minutes The client was able
daily life. prevent and reduce risks of PowerPoint Presentation to discuss at least 2
importance of
many diseases and improve physical activity.
.
physical and mental health.
• Physical activity is an important
step you can take to improve
your overall health.
• Physical activity is very
important for obesity. It
decreases fat around the waist
and total body fat, slowing the
development of abdominal
obesity.
• It is an important determinant of
health. Regular physical activity
may help prevent or delay many
health problems.
• Most importantly, regular

activity can improve your
quality of life. It can even help
you live longer and widely
recognized as the best way to
keep the body healthy and
active
Sample exercises for obese condition:
3.Demonstrate Lecture using recorded 5 minutes The client was able
Sample exercises Obese adults should be encouraged PowerPoint to do return
for obese to perform at least 30 mins presentation demonstration of
condition of at least moderate-intensity sample exercise for
physical activity on 5 or more days Video watching about sample obese condition.
a week. The activity can exercise from YouTube:
be undertaken in one session or https://youtu.be/J8E8T3QwMh8
several lasting 10 mins or more. If
you're ready to start on your path to
improvement, don't put too much
pressure on yourself!
a. Walking
Not only is it free, but it’s also
a low- impact exercise that you
can donearly anywhere, inside
or out. For morbidly obese
people, walking may be
difficult. But it’s doable with
assistance.
b. Riding a Stationary Bike

In addition to walking, riding a
stationary bike is a great
exercise you can use to improve
your body and get your heart
rate up. Stationary bikes can
come with backrests, providing
additional support and a more
comfortable experience.
c. Jumping Jacks
It might seem like a basic
exercise, but they offer some
serious benefits, including
boosting your cardiovascular
system and toning your
muscles great as other cardio
machines, like treadmills and
stair masters.
d. Aerobic exercise.
Aerobic exercise, which speeds
up your heart rate and
breathing, is important for many
body functions. It gives your
heart and lungs a workout and
increases endurance.
e. Stairs.
Climbing stairs is a fantastic
way to get your heart pumping
and your body sweating. Find a
park with a big set of stairs, or
just a stairwell at a nearby
building. Any climb will do.
And if you need to stay indoors,
the Stairmaster is your friend.
4. Enumerate the Benefits of regular physical activity
benefits of regular Flashcards 5 minutes The client was able
physical activity. If you are regularly physically to enumerate atleast
active, you may: 3 benefits of regular
physical activity.
• Reduce your risk of a heart
attack
• Manage your weight better
• Have a lower blood cholesterol
level
• Lower the risk of type 2
diabetes and some cancers
• Have lower blood pressure
• Have stronger bones, muscles
and joints and lower risk of
developing osteoporosis
• Lower your risk of falls
• Recover better from periods of
hospitalization or bed rest
• Feel better – with more energy,
a better mood, feel more
relaxed and sleep better.
5. Recall: The • Adult Obesity Possible Lecture using Recorded The client was able
Complications of Complications. PowerPoint Presentation 5 minutes to recall at least 2
Obesity complications of
a. All-causes of death (mortality) Obesity.
b. High blood pressure Infographics
(hypertension)
c. High LDL cholesterol, low HDL
cholesterol, or high levels of
triglycerides (Dyslipidemia)
d. Type 2 diabetes
e. Coronary heart disease
f. Stroke
Photos
Family Picture 1st Level Assessment
2nd Level Assessment Goal Setting with the Family
Client Teaching Evaluation

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FAMILY CARE PLAN

NARRATIVE INFORMATION ABOUT THE FAMILY

Initial Data Base

A. Family Structure, Characteristics, and Dynamics

B. Socio-economic and Cultural Characteristics

D. Family Health Status

E. Values and practices of Health Promotion and Maintenance and Disease

I. Unhealthy Lifestyle and Personal Habits/Practices: Lack of/Inadequate Sleep/Rest

1. Inability to recognize the presence of the condition due to lack of or

Family Coping Index is measured with the following scores:

Area Description Score Justification

Refer to interpersonal Family is together in nature, andthe

Family Health Problem

Name of Espartero, Joshua B. Section: B

Family Health Problem Date Date

Ranking of Family Health Problems

Name of Student: Joshua B. Espartero

List of Health Problems Nature of Problem (1st Level Assessment)

Ranking of Health Problems of the Family

PRIORITY FAMILY PROBLEM SCORE

Prioritization of Family Health

Name of Student: Joshua B. Espartero

Criteria Standard Score Weight Actual Justification

High 3 Solving problems in unhealthy lifestyle can

Not perceived as a problem

Problem No. 1 Subjective: A. Inability to make Goal: Goals met

• Family’s 24hr e. Recall the dangers of lack of

physical activity is also challenging because of lack of time.

As for their first problem it is recommended that:

also outside the house exercises such as brisk walking or biking.

As for their 2nd problem it is recommended that:

• The family must practice sleeping atleast 7 to 8 hours per night.

• Screen time should be avoided during bedtime.

balance what actions to take first and what to prioritize.

• Better Health Channel. (2020). Physical activity - it's important:

• Clinic Barcelona. (2020). Obesity:

• Foley, L. (2020). Why Do We Need Sleep?: https://www.sleepfoundation.org/how-sleep-works/why-do-

• Healthline. (2016). Cardiovascular Exercises: healthline.com/health/fitness-exercise/cardio-exercises-list#

• Healthline. (2020). Reasons Why Good Sleep Is Important: https://www.healthline.com/nutrition/10-

• Medical News.(2019). Why sleep is essential for health:

• My Health Finder.(2021). Get Enough Sleep: https://health.gov/myhealthfinder/topics/everyday-healthy-

• Takeaway Jenn Sinrich.(2019).10 Best Cardio Workouts for Weight Loss:

• World Health Organization (26 November 2020). Physical activity: https://www.who.int/news-room/fact-

FAMILY ASSESSMENT GUIDE

FIRST LEVEL ASSESSMENT

Family Member’s Chart

Family Description Please check applicable

SMILKSTEIN'S FAMILY SYSTEM APGAR ITEMS (Smilkstein, 1976)

Component Items Score Justification

Scoring: 0 point = “Hardly ever” Interpretation: 0-3 = severely dysfunctional family

Patriarchal/Matriarchal? (Please refer to Family functions & roles) Patriarchal

II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

Monthly Family Income Source

Monthly Family Income

Significant Others Roles they play to the family life

III. HOME AND ENVIRONMENT

b. Construction materials used: Wood ✓ Concrete Mixed