Family Background

Demographic Data of Family Member

Family Member Sex  Age  Civil Relationship Educational Occupation  Religion  Place of
Status to Client Attainment Residence
Willie Boy Melendrez M 54 Married Spouse High School Graduate Farmer Roman Brgy.
Catholic Daquioag,
Marcos Ilocos
Norte
Flora Melendrez F 49 Married Wife High School Graduate Housewife Roman Brgy.
(Patient) Catholic Daquioag,
Marcos Ilocos
Norte
Vien Melendrez F 31 Married Daughter Technical-Vocational Housewife Roman Brgy.
Graduate Catholic Daquioag,
Marcos Ilocos
Norte
ChasMelendrez M 26 Single Son College Undergraduate Delivery Roman Brgy.
Man Catholic Daquioag,
Marcos Ilocos
Norte
Veni Melendrez F 19 Single Daughter College Student N/A Roman Brgy.
Catholic Daquioag,
Marcos Ilocos
Norte

The Melendrez family falls under the nuclear type of family which consists of 5-members – Willie Boy, the patient’s husband,
Flora, the patient, and their three children namely Vien, Chas and Veni. The couple now only live together in a simple bungalow
house located at Brgy. Daquioag, Marcos Ilocos Norte because their daughter Vien is now married and currently residing with her
husband in the same barangay while Veni is temporarily staying in her dormitory in Batac, Ilocos Norte. The youngest daughter goes
home occasionally especially if there is a long weekend or break from their school as stated by Willie Boy.
The primary source of income for the family comes from Willie Boy through farming. According to the patient’s husband,
their estimated gross income monthly is Php 12,000. However, he claimed that the gross income monthly is not fixed due to changes
in inventory values such as sales of produce, harvest issues, crop failures and changing market prices. Aside from that, there are
other source of income in the family such as selling goats and poultry products but he emphasized it is only occasional and seasonal
– not on a monthly basis.
In terms of decision-making, the primary decision-maker in the family is the patient’s husband, Willie Boy. In spite of that, the
couple still consult each other in planning for the whole family. In budget allocation, the primary decision maker was her wife, Flora
however, Willie Boy stated that he took over the role when his wife got sick _______ months ago.
According to the patient’s husband, their family has established a good, strong and smooth sailing relationship with other
despite their social status. He claimed that they rarely have conflicts but whenever a misunderstanding arises between the couple,
or the family members, they would always try to cool down their emotions before talking about it and fix it as soon as possible. The
primary reason of the family conflict is just some of the small misunderstandings that may include money and vices, as verbalized by
the patient. Despite that, the patient said that they still value their family by helping each other out during difficult times. Aside
from that, the patient’s husband also added that whenever conflicts arise between the couple, they choose not to fight in front of
the children and resolve their own issues privately.
As parents, they emphasized that they always cultivate in their children’s mind about the importance of family. According to
Willie Boy, they started disciplining their children at a very young age. They treat their children fairly to make sure that their children
will not feel that there is favoritism among them. Aside from that, even at a young age they trained their older children to look out
and care for their younger siblings, do simple household chores, and to help their father (jakammo English ti mapan mangayo) as
verbalized by the patient’s husband.
As a tradition, the family attends to certain occasions such as birthdays, fiesta and also holy mass which every family member
attends to every Sunday, however, Willie Boy emphasized that they rarely attend Sunday masses when his wife’s condition
worsened few months ago. Moreover, the family also engages themselves in recreational activities such as watching TV as a couple
and singing in karaoke whenever her and oldest and youngest daughter comes home. They rarely go out to malls because they
emphasized that jeep fares are costly and they would rather save the money for groceries and other basic necessities especially now
that his wife’s condition requires a lot of medications such as maintenance and multivitamins. Due to financial constraints, Willie Boy
highlighted that they still make sure to make time for their family by eating and cooking together and having small talks with each
other.

Budget Allocation of Family Melendrez

Savings; 500; 4%
Gasoline; 500; 4%

Non Food; 800; 6%

Cleaning and Laundry; 500; 4%

Food and water; 5000; 40%

Medications; 1200; 10%

Education; 3500; 28%

Electric Bill; 300; 2%

Communication; 200; 2%

Food and water Electric Bill Communication Education Medications Cleaning and Laundry Non Food Gasoline Savings
Food and Water
 Condiments Php 300
 Instant Coffee Php 210
 Bear Brand Php 440
 Pork Php 1000
 Fish Php 650
 Assorted Php 600
Vegetables
 Assorted Php 350
biscuits
 Canned goods Php 500
 Eggs Php 250
 Bread Php 180
 Water Php 350
 Softdrinks Php 170
Non-Food
 LPG Php 800
 Gas Php 500
Cleaning and
Laundry
 Laundry Soap Php 200
 Dishwashing Php 100
 Toiletries Php 200
Electric Bill Php 300
Communication
 Load balance Php 200
Education
 Allowance Php 2000
  Dormitory Php 1500
Medications
 Digoxin and Php 1200
Vitamin B
Complex
Savings Php 500
Total

The family’s estimated average monthly income of Php 12,500 wherein Willie Boy is the only provider for the family. However, he
stated that his daughter would sometime give him Php 500 or Php 1000 whenever he is short in budget. Aside from that, he also sell
his goats and chickens whenever he needed an extra income. This serves the 3 members of the family – the patient, Veni and the
patient’s husband .

The family allocates 44% of their monthly budget to food which equates to Php 5000. The patient claimed that they do not eat in
fast food chains since they are saving up a lot for her medications and for Veni’s education. Aside from that, they do not include rice
in their budget since they utilize and their own harvest

For the non-food expenses, they spend 7% or approximately Php 800 for liquefied petroleum gas (LPG). The husband stated that it
could take them 2 months before they change their LPG tank since they are also using an earthen stove (dalikan) to cook their food.
Aside from that, the husband stated that there is no member from the family that have vices such as smoking and drinking liquors.
On the other hand, they also allocate 4% or Php 500 cleaning and laundry materials. This includes the dishwashing soap, toiletries
such as shampoos, body soap and toothpaste and laundry soap.
The family do not own any vehicles however they own a 2-wheeled drive tractor and water pump which Willie boy use when
working. Therefore, they allocate at least Php 500 or 4% of the monthly budget for the engine oil. In terms of transportation, the
husband claimed that he does not ride tricycle or public vehicles and stated, “Buludek nukua latta tay lugan ni kabsat kon wenno
makiangkas nak nu adda mapan jay ili.” He explained that he opts not to ride public vehicles because the back and forth fare in their
hometown is expensive.
Meanwhile, the family can only consume 2% for the electricity and communication which equates to approximately Php 300 and
Php 200. For the educational finances, Willie Boy and Jenny Purr allocates Php 3500 or 29% for Veni’s dormitory fees and allowance.
As for her miscellaneous fees and school supplies, he stated that her daughter utilizes her scholarship stipend and his son Chas
would also give her additional allowance.
The family allocates 10% or approximately Php 1200 of their monthly income for Jenny Purr’s medication which includes Digoxin and
Vitamin B Complex. Jenny Purr was diagnosed with cardiomegaly and has been taking Digoxin half tab OD and Vit B. Complex half
tab Od since 2017. As for Willie Boy, he claimed that he does not take any food supplements or medications however, he would
purchase paracetamol and other OTC drugs as his emergency medications for fever and body pain. Lastly, they set aside the
remaining 4% of their monthly budget which equates to approximately Php 500 for check-up and for emergency purposes.
Analysis:
Based from the Philippine Statistics Authority (2019), a family of five needed no less than Php 7,337, on average to
meet the family’s basic food needs for a month. On the other hand, no less than Php 10, 481, on average, was needed to meet both
basic food and non-food needs of a family of five in a month. This amount is the poverty threshold. This indicates that the budget of
Purr family is adequate in meeting the needs of their family. However, given the current inflation rate in the Philippines as of
November 2022 which equates to 8.0%, it would be impossible to provide the needs of the members of the family. According to
National Economic and Development Authority (2022), the skyrocketing consumer prices will not only drag down the country's
economic growth, but also keep many Filipino families trapped in poverty even if they earn more. Being financially stable has
tremendous benefits for overall health and well-being, extending far beyond the ability to pay bills on time and readily meet the
needs of the family. It has positive implications on educational achievement, contributes to better health outcomes, and builds or
can help create a healthier and happier relationship, which will overflow into the rest of the home. (Children’s Bureau, 2019).

Neurological. Patients typically present with altered mental status manifested by lethargy, confusion or delirium. Occasionally, the
mental status of the patient is so severely depressed that it is necessary to secure their airway (that is, perform endotracheal
intubation). Despite this, the neurological examination at this time is typically without focal neurological findings. In the assessment,
other causes of neurological disturbance (for example, hypoxaemia, hypoglycaemia, drug toxicity or central nervous system
infection) should be ruled out or if present, addressed.
Pulmonary. One of the most common manifestations of sepsis is increased respiratory rate. Tachypnoea (a hallmark of sepsis-
induced adult respiratory distress syndrome) can be associated with abnormal arterial blood gases, typically, a primary respiratory
alkalosis. Accompanying hypoxaemia and/or hypercarbia can also occur; respiratory muscle fatigue, hypoxaemia or hypercarbia
might necessitate endotracheal intubation for therapy. The aetiology of the respiratory failure in sepsis is due to inflammatory
mediator- induced damage to alveolar capillary membranes. This cytokine-mediated lung injury results in noncardiogenic pulmonary
oedema that can be profound and that causes decreased lung compliance and impaired oxygen uptake and carbon dioxide
elimination. Decreased lung compliance and activation of juxtacapillary receptors lead to increased ventilation and are partly
responsible for the tachypnoea. Chest X-ray imaging usually shows increased lung water with bilateral pulmonary infiltrates. Left
ventricular heart failure must be ruled out as the cause of the pulmonary changes. Although patients with sepsis may have
profound, life-threatening hypoxaemia, most patients do not die of hypoxaemia but rather of multiple organ failure.
Cardiovascular. Myocardial depression, which is characterized by hypotension or shock, is a hallmark of severe sepsis. Several
cytokines have direct cardiomyocyte toxic effects. Mild increases in circulating cardiac troponins are frequently present in sepsis and
are indicative of sepsis severity. Myocardial depression affects both the right and the left ventricles and this finding distinguishes
sepsis-induced myocardial depression from coronary atherosclerotic-induced myocardial ischaemic dysfunction. Sepsis-induced
myocardial depression can be profound with decreases in the left and right ventricular ejection fractions, necessitating therapy with
inotropic agents.
Oxidative and nitrosative stress (the build-up of reactive oxygen and nitrogen species, respectively) also contribute to cardiovascular
and other organ failure, which is one of the root causes of tissue hypoxia88. Nitrosative stress is a major component of the
pathophysiology of sepsis, and upregulation of inducible nitric oxide synthase (iNOS) might provide the link between inflammatory
activation and cardio vascular compromise. In this context, the role of hypoxia-induced factor-α (HIFα) in sepsis also plays a major
part in defining its pathophysiology.
Renal. Renal dysfunction that progresses to frank renal failure is a major cause of sepsis-induced morbidity. Although the exact
mechanisms responsible for sepsis- induced renal failure are unknown, clinicians can reduce the incidence of severe renal failure in
sepsis by aggressive and appropriate volume resuscitation in the disorder. Because of loss of intravascular volume in sepsis due to
leaky capillary membranes and vasodilation, patients typically require volume resuscitation to replace these losses. Accordingly,
clinicians must avoid the use of nephrotoxic agents in patients with sepsis if at all possible. For example, administration of
intravenous contrast agents for radiological imaging studies can precipitate new-onset renal failure if given to a patient with sepsis
who is intravascularly volume depleted. The absence of full renal recovery in sepsis is associated with poor long-term outcomes, so
management of renal function during sepsis is of crucial importance. Even minor increases in the concentrations of serum creatinine
are associated with increased mortality.
Haematological. DIC is one of the most striking manifestations of severe sepsis. DIC can present in one of two contrasting clinical
fashions: with overt bleeding from multiple sites or, conversely, with thrombosis of small and medium blood vessels. The reason for
the striking differences in presentation of DIC is attributable to the fact that the coagulation system represents a balance between
the clotting and fibrinolytic systems. In individual cases of sepsis, either system can predominate. If the fibrinolytic system is
dominant, the patient will present with bleeding from multiple sites. Conversely, if the coagulation system is dominant, the patient
will present with cyanotic (discoloured) fingers and toes that may progress to frank gangrene of the digits or upper and lower
extremities. It is imperative to rule out heparin-induced DIC, which may masquerade as sepsis-induced DIC.
Hepatic. Liver dysfunction is common in sepsis, whereas sepsis-induced acute liver failure is rare, occurring in <2% of patients.
Sepsis-induced liver injury is indicated by increased concentrations of serum alanine transaminase and increased levels of bilirubin.
The exact aetiology of liver dysfunction in sepsis is unknown. Undoubtedly, a large part of liver dysfunction in patients with septic
shock is due to centrilobular necrosis of the liver secondary to poor hepatic perfusion. Autopsy studies of patients who died of sepsis
have shown necrotic hepatocytes in the regions surrounding the central veins. In addition to necrotic cell death in the livers of
patients with sepsis, hepatocytes have also been observed to be undergo apoptotic cell death. Interestingly, electron microscopy has
shown that there are increased autophagic vacuoles present within hepatocytes from patients with sepsis. In rare cases, autophagic
vacuoles were so extensive as to be consistent with autophagy-induced cell death. Thus, it seems that hepatocytes undergo multiple
different types of cell death in sepsis.
Patients progressing to septic shock will experience signs and symptoms of severe sepsis with hypotension. Of note, at an early "compensated"
stage of shock, blood pressure may be maintained, and other signs of distributive shock might be present, for example, warm extremities, flash
capillary refill (less than one second), and bounding pulses, also known as warm shock. This stage of shock, if managed aggressively with fluid
resuscitation and vasoactive support, can be reversed. With the progression of septic shock into the uncompensated stage, hypotension ensues,
and patients may present with cool extremities, delayed capillary refill (more than three seconds), and thready pulses, also known as  cold shock.
After that, with continued tissue hypoperfusion, shock may be irreversible, progressive rapidly into multiorgan dysfunction syndrome and death.