CHN: FAMILY CASE STUDY

_____________________________________

A Requirement Presented to

ROBERTO B. AGRAVANTE JR., RN

Clinical Instructor

Tagum Doctor’s College, INC.

Mahogany St. Rabe Subdivision
Visayan Village, Tagum City
______________________________________
In Partial Fulfilment of the Requirements in
NCM– RLE 113

By
Mawali, Sheraina
Manungas, Brigette Dawn G.
Mipaña, Kharizza Shinne M.
Nuenay, Arrah
Neri, Lovely Alyza P.
Neri, Lovely Riza P.
Oguio, Jannele Anne B.
Ortiz, Mavie Shaine C.
BSN-3

September 20, 2021

1
 TABLE OF CONTENTS
Title Page 1
Table of Contents 2
Acknowledgement 3
I. Introduction of the Family 4
II. Objectives of the case 4-5
III. Family Background 5-7
I. Family Structure, Characteristics and Dynamics 5-7
II. Socio-Economic and Cultural Characteristics 8-9
III. Home Environment 9-12
IV. Health Status of Each Family Members 12
V. Values, Habits, Practices on Health Promotion, Maintenance 13-14
and Disease Prevention
IV. Family Coping Index 14-16
V. Nursing Theory 17-18
VI. Problem Identification 19-20
VII. Family Nursing Care Plan 20-21
VIII. Health Teaching 22
IX. Implication (Nursing Education, Nursing Profession, Nursing Research) 22-23
X. Reference 24

2
 ACKNOWLEDGEMENT
We, the student nurses, would like to extend our deepest gratitude towards those
who have aided us in the completion of our academic endeavor in the field of data
gathering and case presentation;
To Prof. Willyn B. Adrias RN, MN, Dean, College of Nursing, for the wisdom,
patience and all-out support as approving the continuously developing activities that are
very helpful to us.
To Mr. Nolie Roy E. Biclar, RN, MN, RLE Coordinator, for his endless support,
and being understanding with all the technicalities during the case presentation.
To Mr. Roberto B. Agravante, Jr. RN, our Community Clinical Instructor, who
patiently guided us in the technicality of the conduct of this case study as well as the
checking of the manuscript and giving suggestions. We express our biggest thanks to
you, Sir as you have helped us comply with all the needed paperwork that was needed
to present what we have found out in our case presentation and study.
To Family O., who agreed to participate and answer all the questions being
asked in our case study, we owe the completion of our study to all of you. Without your
voluntary involvement, no data could be gathered to complete our study’s objective.
To our parents and guardians, who have fully supported us throughout the
conduct of this case study, thank you for your never-ending trust and confidence that we
can complete this family case study successfully.
And to our Father Almighty, we couldn’t have done all of this without You, let us
offer all of this success in Your name.
To God be the Glory.

3
I. INTRODUCTION OF THE FAMILY
Community is defined as a group of people with diverse characteristics linked by
social ties, shares the common perspectives, and engages in joint action in geographical
locations (MacQueen, 2001). These individuals connect and shares interests and
qualities that provides the sense of being together or belongingness. According to
Maglaya (2004), it is a group of people who shares the same geographic boundaries
and/or values and interests. A community's function contains its members' collective
sense of belonging as well as their shared identity, values, conventions, communication,
and mutual interests and concerns.
Family is the smallest unit of the society. It is characterized as two or more
people who depends on one another for emotional, physical, and/or financial support.
Family is considered as the primary recipient of nursing interventions that contributes to
the development of the community. It is composed of individual with biological, legal, or
emotional relationships. There are different family structures which may be categorized
according to membership, authority, residence, and in terms of decision making. some of
which are nuclear family, single-parent family, and extended family.
Community Health Nursing is a field of nursing that progresses and protects
population health by combining nursing and public health skills and knowledge.
Community health nursing is committed to the promotion of health and prevention of
diseases among people in the community. It directs care to individuals, families and,
groups that will result to improvement of health of the community as a whole.
This case presentation revolves around the O Family. The family is extended
according to membership since there are three generations in the family; Mrs. L who is
the grandmother, Mrs. I who is the daughter of Mrs. L, and Ms. M and Ms. A who are the
children of Mrs. I. The decision maker of the family is Mrs. I who is as well the
breadwinner of the family. The family members live in the same house but Mrs. I is an
OFW so she isn’t always at home. Mrs. L, a 63-year old grandmother, is left responsible
for taking care of the children.

II. OBJECTIVES OF THE CASE STUDY

This presents the general and specific objectives of this family case study.
Setting objectives provides direction for planning a family nursing intervention. It
facilitates motivation for the family and student nurse by providing a sense of
achievement. (Kozier, Erb et.al., 2004)

General Objective:
The family will be able to improve their health status and become self-reliant in
maintaining their health through appropriate interventions in a given time frame.

Specific Objective:
After 3 days of data collection, health teaching, and student nurse-family
interaction, the student nurse should be able to:

4
  Establish rapport and trust from the family
 Identify actual and potential problems which may be a hindrance in attaining
optimum health.
 Prioritize the identified family health nursing problems.
 Established a family nursing care plan which would be beneficial to the family
and let the family participate for the plan or nursing actions to the prioritized
health problems.
 Appropriately carry out the apply nursing interventions necessary for the patient’s
case considering the student nurses’ capabilities, community and the family’s
resources.
 Evaluate changes in condition after giving nursing interventions.

III. FAMILY BACKGROUND

I. FAMILY STRUCTURE, CHARACTERISTICS and DYNAMICS

a. Member of the Household and Relationship to the head of the Family

Member of the Household Relationship to the Head of the Family
I Head of the Family
L Mother
M Daughter
A Daughter

b. Demographic Data
Member of
Civil
the Birthday Age Sex Position in the Family
Status
Household
August
L 63 Female Married Grandmother/Mother
27, 1958
July 19,
I 39 Female Married Mother/Daughter
1982
October
M 20 Female Single Daughter/Granddaughter/Sister
28, 2000
May 6,
A 6 Female Single Daughter/Granddaughter/Sister
2015

c. Place of residence of each member

Member of the Household Place of Residence
L Living with the family
OFW-Seafarer, currently in Europe/ Lives
I with the family when she return to the
Philippines
M Living with the family
A Living with the family

5
 d. Type of Family Structure
i. Extended (According to membership)
The family is extended according to membership since the
family consists of three generations. Mrs. L is the mother of
Mrs. I. Mrs. I is the mother of Ms. M and Ms. A. M and A
have different biological father, both separated from Mrs. I.

ii. Matrilocal (According to residence)

The family is matrilocal according to residence. The family
is living in the wife’s community.

iii. Matricentric (According to authority)

The family is matricentric according to authority since Mrs.
I is the head of the family, she is the breadwinner, and she
makes the decision for the family.

GENOGRAM

Legend:
L
Male

Female

Deceased

Anxiety Disorder M A
Hypertension

Diabetes

e. Dominant family members in terms of decision making

Ms. I, the daughter of Mrs. L and the mother of Ms. M and Ms. A,
is the one who makes the decision for the family.
f. General Family Relationships/dynamics

6
 Like any other family, they also experience conflicts at some point.
The most common problem that they always encounter is financial-
related.

Activities of Daily Living

i. Sleeping patterns and daily activities
Mrs. I usually wakes up around 10:30 am to prepare for work. She
spends the day at work and have an hour of break at 3:00pm. Her
work is usually finished at 1:30am, so she can sleep at around
2:30AM.
As Mrs. I is currently working in Europe, she is 6 hours behind the
Philippine time.
Mrs. L wakes up at 5:00AM to open their sari-sari store. She then
prepares breakfast for the grandchildren. She looks after the sari-
sari store if M is having her online class. She usually sleeps at
around 10:00PM.
Ms. M wakes up at around 5:00-6:00AM, depending on her class
schedule. She then performs household chores. During
weekdays, she will prepare for her younger sister’s online class
and for her own class. She usually sleeps at around 11:00 pm to
2:00 am, depending on the activities given to them.
A is usually woken up by her older sister M at 9:00am and help
her to take a bath and then prepare for her online class. She will
spend the day watching TV and playing with her toys if she has no
class. She usually sleeps at 10:30PM.

ii. Eating patterns

The family can eat three meals a day and can have their snack at
the afternoon if they want to. However, A is a picky eater and have
inadequate quality and quantity of food. She refrains from eating
breakfast and only drink her milk. She is also a picky eater. They
seldom eat at restaurants because they spend their money on
more important things.

Lunch Dinner Who

Breakfast
12:00NN- 6:30PM- prepares the
8:00-9:00AM
1:00PM 7:00PM meal
Rice, Eggs,
Beefloaf, Rice, Fish, Rice,
Chicken, Fish, Soup, Pork, Vegetables, Mrs. L
and some Vegetables Fish, Pork
fruits

iii. Leisure time

7
 Due to the pandemic, the family just stays at home. Mrs. L and
Ms. M take turns every Sunday to who will go to church first than
the other so that one can look after A.. Mrs. I is busy at work and
spends her break resting than going out.

II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

a. Income and Expenses

Nam
Position in the family Occupation Income Place of work
e
Grandmother/Mother Sari-sari Php
L store owner/ 9000 –sarisari Tagum City
Pension 2700-pension
Mother/Daughter OFW-
I Php 54,000 Europe
Seafarer
M Daughter/Granddaughter/Sister None/Student N/A N/A
A Daughter/Granddaughter/Sister None/Student N/A N/A
Php 65,700

Monthly Expenditure Amount

Electricity Bill Php 3,000
Water Bill Php 400
Internet fee –PH and on board Php 5,800
Groceries (foods and household
Php 15,000
items)
Drinking water Php 800
Others (Subdivision fee,
medications, vitamins, TV Cable, Php 6, 400
transportation, pet foods and care)
M’s school expenses (tuition and
Php 13,000
allowance)
A’s school tuition Php 2, 000
A’s tutor Php 3, 000
Entertainment Php 1,400
Total Php 50,800

The family has enough income that can cover all their monthly expenses.

GRAPH

8
 b. Educational attainment, Religious Affiliation, and Cultural Factors of the
Family
Nam Position in the Educational Ethnic
School Religion
e family Attainment background
Grandmother High school Maryknoll
L /Mother graduate Highschool Cebuano Catholic
of Kapalong
Mother College Joji Ilagan
/Daughter Undergraduate International
I Cebuano Catholic
School
Davao
Daughter College
Tagum
/Granddaughter Student –
M Doctors Cebuano Catholic
/Sister currently 3rd
College, Inc.
year
Daughter Elementary Arriesgado
/Granddaughter Student – College
A Cebuano Catholic
/Sister currently grade Foundation,
1 Inc.

c. Significant others
Ms. G is the sister of Mrs. I and the eldest daughter of Mrs. L. She lives in
the same subdivision as the family. She, together with her daughters -- K
and E, are considered significant people by the family. They celebrate
special occasions together and they support and help each other in times
of challenges.

d. Relationship of the family to larger community

The family lived in the community for about 25 years now. Since then,
they have lived comfortably without any problems related to their
community. They are active participants and attend community activities
like health programs. They also had A’s newborn immunizations at the
health center near them. The family also attends mass at the chapel
within their subdivision and at the church near them

III. HOME ENVIRONMENT

a. Housing

9
 i. Adequacy of living space
The house that the family lives in has enough space for them to
move around the house comfortably. The house is approximately
150 sqm. with a living room, kitchen and dining area, 2 rooms, 1
toilet, and a terrace with a small sari-sari store. The living space is
enough for Mrs. L and her two grandchildren since Mrs. I is
usually away from home.

ii. Sleeping arrangement

The family sleeps together at a single room with 2 sofa bed. M
sleep alone at one bed while Mrs. L and A sleep together at the
other bed. Mrs. I will join them at the same bed if she returns at
the Philippines.

iii. Presence of breeding or resting sites of vector of diseases

The family kept their house clean at all times. They ensure that
there is no standing water left in pots and open containers to avoid
possible breeding sites of mosquitoes. They noticed a few
cockroaches in their house but managed to address it with the use
of insecticide spray.

10
 iv. Presence of accident hazard
Their house is made up of mixed materials. Most of the walls are
made up of concrete materials with some areas of the house
made up of light materials like plywood. The family ensure that
gas stoves are closed and electric outlets are unplugged when not
in use. The family obtain light from electricity. They use candles
when there is a brownout.

v. Food storage and cooking facilities

Mrs. L buys their food from the mall and sometimes from the mini-
market behind their subdivision. They store their food at the
refrigerator and some on their kitchen cabinet. Their cooking
facilities are kept clean every after using it and after meals.

vi. Water supply

The family has a water supply from the Tagum Water District.
They have four faucets within their house; one at the terrace, one
at the kitchen, one at their toilet, and one at the back. Their water
supply is good but sometimes they notice problems like slow
water stream at busy hours.

vii. Toilet facilities

The family has their own toilet facility inside their house. Their
toilet is flush type with septic tank disposal. where they take a
bath, urinate, and defecate. Their toilet is clean and M cleans it for
at least once to twice a week, depending on her schedules.

viii. Garbage/refuse disposal

The family places one sack outside their house where they throw
their garbage and places one trash bin inside their house and one
at the back. They separate cardboard materials as it is collected at
their Purok every Saturday. The garbage is also collected by DPS
truck every Saturday. In addition, their food leftovers are collected
by a man every night.

ix. Drainage System

The family has a blind drainage system in their house in which
waste water flows in closed pipes underground. No any bad odor
from the drainage system is noticed. The family notice slight poor
drainage during heavy rains.

b. Kind of neighborhood
The family lives in a residential area. They live in Villa Subdivision,
Tagum City for approximately 25 years now. During their first few
years in the subdivision, it was still sparsely populated. But now,
most of the houses within the said subdivision is occupied. The
houses are separated with concrete walls. It is fronting the
National Highway. The subdivision is near the downtown area of
the City. The area is very accessible to public transit and is near to

11
 several establishments like shopping malls, schools, and
restaurants.

c. Social and health facilities available

The Subdivision that the family lives in is just a few minutes away
from social and health facilities. There is even a Pregnancy Clinic
called Mercy Moms, a basketball court, and a chapel within their
subdivision. The Health Center, Tagum Doctors Hospital, and
Mission Hospital is approximately 5-10 minute-drive from their
subdivision. Other hospitals are about 10-15 minutes away.
Arriesgado College Foundation, Inc. where A is studying is right
across their subdivision. Also, Tagum Doctors College Inc. is only
around 5-minute drive. Other social facilities like churches,
cemetery, and malls are also near them.

d. Communication and Transportation facilities available

There are tricycles and motorcycles that roams around as the
means of transportation. The family uses their own mobile
phones, tablet, laptop and telephone as means of communicating
to others. They have an installed internet connection within their
home and also subscribe to Cignal which is a television network.

IV. HEALTH STATUS OF EACH FAMILY MEMBERS

a. Medical Nursing history indicating current or past significant illnesses or

beliefs and practices conducive to health and illness
Mrs. L is diagnosed with Hypertension, Diabetes, and anxiety disorder.
She currently has maintenance medication for the said diseases.
Mrs. I experienced gestational hypertension during her pregnancy with A
but her blood pressure levels went back to normal level after birth.
Ms. M was last admitted when she was still in elementary school due to
diarrhea.
A was last admitted to the hospital when she was around 8 months old
due to amoeba.

b. Nutritional Assessment
i. Anthropometric data
Name Age Weight (kg) Height (cm) BMI
L 63 63 kg 150 cm 28
I 39 56 kg 163 cm 21.1
M 20 45 kg 160 cm 17.6
A 6 27 kg 126 cm 17

ii. Dietary history specifying quality and quantity of food or nutrient

per day
Mrs. L stated that she prepares varied types of food in their meals.
She usually cooks vegetables, pork, chicken, and fish in various

12
 recipes. In addition, they consume fruits like mangos, oranges,
apples, and bananas.

iii. Eating/feeding habits/practices

The family ate three meals per day which consists of breakfast,
lunch, and dinner. Sometimes, they also have their snacks at the
afternoon. A have inadequate quality and quantity of food. She
refrains from eating breakfast and only drink her milk. She is also
a picky eater

V. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION,

MAINTENANCE AND DISEASE PREVENTION

a. Immunization status of family members

Name BCG DPT MMR HEPA OPV
L ̷ ̷ ̷ ̷ ̷
I ̷ ̷ ̷ ̷ ̷
M ̷ ̷ ̷ ̷ ̷
A ̷ ̷ ̷ ̷ ̷

b. Healthy lifestyle practices

Mrs. L eats a healthy diet which consists of various fruits, vegetables,
meat and dairy products. She complies with her maintenance medications
and have her regular laboratory tests. Mrs. L loves to do walking in the
morning and afternoon as a way of exercise.
M also eats fruits and vegetables that her grandmother prepares and she
takes vitamin C daily. M tries to lend some time to perform some
exercises for at least twice a week.
A take their daily vitamins and milk. One problem that they face is that A
doesn’t like to eat fruits and vegetables. The only thing that she like is
banana and squash.
Mrs. I eats varied types of food also. There are variety of foods prepared
that they can choose from.

c. Adequacy of:
i. Rest and sleep
Mrs. L and A have adequate rest and sleep. Mrs. L sleep for at least
7-8 hours per day, while A sleep for at least 9 hours per day.
Mrs. I sleeps for at least 6-7 hours per day. M’s time of sleep is
depending on their class schedules and activities. She stated that if
there are plenty of requirements in school, she will only be able to
sleep for at least 3-5 hours per day. Otherwise, she sleeps for at
least 8 hours per day.

13
 ii. Exercise
Mrs. L loves to do walking in the morning and afternoon as a way
of exercise. Mrs. I’s work is a way of exercise for her. M tries to
perform some cardio and strength workout for at least twice a
week for 20 minutes.

iii. Use of protective measures

The family wears slipper at all times everywhere. They use
different slipper inside their house, another one for use inside their
bathroom, and another slipper for use outside their house.

iv. Relaxation and other stress management activities

Mrs. L loves to go to the market or malls when she’s stressed. It is
her way of relaxation and to shift her attention away from the
stress.
M loves to eat and watch Youtube or Facebook videos when she’s
stressed.
Mrs. I likes to sleep when she’s stressed. She also loves to
message her family members which will help her to relax as one
thing that stresses her out is that she misses them.

d. Use of promotive-preventive health services

The family makes use of promotive-preventive measures as they
take health as a very important aspect of their life. Recently, Mrs. I
and M had their COVID-19 vaccine to protect themselves and
their loved ones from COVID. However, Mrs. L didn’t have her
COVID-19 vaccine because she stated she’s scared of its
possible effects to her especially when she hears gossips about
people dying after having their vaccine. Mrs. L have her regular
check-ups with her doctors. Mrs. I also have her annual medical
check-up.

e. Perception of the role of health professionals and their services

The family think highly of health professionals and they respect
their services. They believe that health professionals play vital
roles in improving their health and in treating and managing
diseases.

f. Past experiences with health professionals

Mrs. L regularly visit her doctors for check-ups. Mrs. I was
confined in a birthing clinic when she gave birth to A.

IV. FAMILY COPING INDEX

COPING AREAS SCALE JUSTIFICATION HEALTH TEACHINGS
5 The family have a complete Encourage the family
1. Physical physical independence. They members to continue

14
 have the ability to perform
activities of daily living
independently. Since A is still 6 to assist A on learning
years old, M assists her and to do things on her
Independence
starts to teach her on how to take own, ensuring that she
a bath and do other activities on does it properly and
her own. Mrs. I is also able to safely.
move about independently by
herself.
The family follows what their
Advise Mrs. L to
physician says with regards to the
continue taking her
management of their health
prescribed
condition. Mrs. L takes her daily
maintenance
maintenance of medications for
medications as these
2. Therapeutic her hypertension, diabetes, and
5 will help to manage
Competence anxiety disorder. They also
her health. Continue
modify their diet like avoiding salt
avoiding salty foods in
intake for Mrs. L. Mrs. I also seek
their diet, along with
for medical help in their crew
eating fruits and
doctors and nurses whenever she
vegetables.
feels unwell.
Encourage family
The family have knowledge about members to include
their health conditions. They are healthy practices in
all aware about Mrs. L’s their routine such as
conditions and what diseases that regular exercise as it
3. Knowledge of Mrs. L is at risk for. They also can help them improve
5
Health Condition believe that Mrs. I and other their health and avoid
members of the family are at risk certain diseases.
for developing conditions like Additionally,
hypertension as it can run encourage to continue
through the genes. seeking medical help
to monitor their health.
3 The family have a moderate As Mrs. L and M are
4. Application of competence in terms of the ones who is
Principle of application of the principles of always with A,
General Hygiene general hygiene. Although Mrs. L, encourage them to
Mrs. I and M eats a nutritious diet, prepare creative
A doesn’t really like to eat fruits nutritious meals for A
and vegetables. A has an like transforming
inadequate quality and quantity of meals to look like
food intake. Mrs. I and M seldom animals or faces. They
have inadequate sleep due to can also replace
Mrs. I’s work and M’s school sweetened juice with
activities. The family complies fresh fruit shakes.
with immunizations however, with With regards to the
the recent COVID-19 vaccine, COVID-19 vaccine,
Mrs. L doesn’t want to be encourage Mrs. L
vaccinated because she’s scared about getting the
of the possible side effects it vaccine against
would cause her. COVID-19. Tell her

15
 that such vaccine is
very important
especially that the
pandemic is still
ongoing. Tell Mrs. L
that those things that
she heard are all just
gossips and aren’t
really confirmed.
Instead, she must
believe on the
professionals and
experts working
behind the vaccine.

Encourage the family

members to seek
Although the family think that medical help as soon
health is an important aspect of as possible when they
their life, they often try to treat experience some
symptoms like runny nose, fever, symptoms before it
5. Health Attitudes 3 vomiting, and diarrhea at home gets worse. Also,
before they consult a physician. If instruct them to
the symptoms don’t go away after perform safety
a few days, that is the time that measures when they
they seek medical help. have such symptoms
to protect the people
around them.

Instruct family
The family has complete
members to continue
competence in accepting and
talking to each other
facing life stresses and problems.
6. Emotional when they are stress
5 They talk to each other and try to
Competence about something.
figure out plans that will help
Encourage them to be
them go through and survive such
a good listener to other
problems.
member’s problems.
Most often, the family members
get along well with each other. Encourage Mrs. L and
7. Family Living However, sometimes Mrs. L and Mrs. I to be more open
3
Pattern Mrs. I have conflict with each to hear each other’s
other that causes them not to talk concerns
with each other for days.
5 The family have complete Encourage the family
8. Physical competence in keeping their members to continue
Environment environment clean and organized. at keeping their house
The garbage truck collector clean. Ensure that
collects their garbage every there will be no

16
 stagnant water that will
Saturday, while cardboard
be possible sites of
materials are collected in their
breeding for
purok.
mosquitoes.
The family know about the Advise the family
available community facilities members to continue
9. Use of
around them. They make use of participating in the
Community 5
these community facilities, hence activities that their
Facilities
they had A’s immunizations at community facilities
their barangay health center. are conducting.
Total Score:
39

V. NURSING THEORY
Jean Piaget's Theory of Cognitive Development
In our case, we utilize Jean Piaget's Theory of Cognitive Development for a
reason that Piaget's theory was used to focus on nutrition education for preoperational
children. One of the health problems mentioned in our case presentation is the
Unhealthful nutritional habit of the child: Inadequate food intake both in quality and
quantity as a health threat. Ms. A is six years-old that could be best described as picky
eater. She doesn’t want to eat vegetables nor fruits. According to Piaget's theory, it
offers a precise definition of children's cognitive development, emphasizes a child-
centered approach, underlines play and self-discovery and provides guidance in the
preparation of age-specific education contents. It was stated in the theory that it can be
difficult to educate children about nutrition during the preoperative stage ages 2-7 years
old. As we all know that Nutrition and the relationship between nutrients and food may
be difficult for children to understand. Also, they may not be aware of the effects that
food has on to our body. The preoperative stage is a difficult time for children to
understand and explain abstract concepts such as health and nutrition.
Mrs. L, the grandmother of Ms. A, a six-year-old child, mentioned that whatever
she cooked, Ms. A did not want to eat; instead, she drank her milk every morning. If
children don't like a food, they won't eat it. So, in connection to Piaget based his ideas
on biological maturation and stages, which means there is concept of ‘readiness’
involved with development. He believed children to require a certain level of maturity
before they can be taught a specific concept. Until the child is mature enough to think of
other people’s feelings, it can be difficult to make them understand how other children
might not find teddy bears cuddly. These findings bolstered his belief that children's
minds are not simply miniature adult brains, but that development and intelligence occur
in stages. At the age of six, Ms. A was still in the period of learning more about their
environment.
In this idea of his theory, cognition, learning, and behavior should be connected
in a way that makes sense. As a result of Piaget's hypothesis, we can better
comprehend children's cognitive development and how they learn. Nurses may therefore
improve the quality of care they provide by assessing family’s requirements and devising
a realistic plan of action. To provide guidance for all the family to give nutritional

17
education to Ms. A. As a result, the family and other learners especially the child must
take an active role in training or education.
The food pyramid is used to explain what needs to be eaten from which food
groups for healthy nutrition.

18
VI. PROBLEM IDENTIFICATION
Undernutrition is a type of malnutrition that pertains to a deficiency of calories or
of one or more essential nutrients necessary for health (Morley, 2021). Undernutrition
can lead to stunting (low height-for-age), wasting (low weight-for-height), underweight
(low weight-for-age), and micronutrient deficiencies (About Malnutrition, n.d). Nutritional
deficiency may be caused by following a restricted diet, consuming unhealthy food
choices, or intestinal problems that interferes with the absorption of vitamins. However,
an inadequate food intake is one of the most basic reasons why a person became
nutritional deficit (Pathania, 2017).
Many parents are concerned with their children’s picky eating behavior during
early childhood (Taylor and Emmett, 2020). Children who are picky eaters are at risk for
nutritional deficiency since they tend to refuse fruits and vegetables and likes to indulge
in sweets and processed foods (Goh and Jacob, 2012).
Nutritional deficiency is a health risk because a lack of nutrients is linked to the
development of diseases and chronic health conditions. Underweight, in particular, has
been associated with an increased risk for ill health, poor physical performance,
lethargy, and even death (About Malnutrition, n.d.). Undernutrition can compromise
barrier function, thus allowing pathogens for an easier access. It compromises the
immune system and decreases the person’s ability to eliminate pathogens that have
entered the body (Calder and Jackson, 2000). According to Murray and Nowicki (2020,
as cited in Nutritional Deficiency, n.d.), the most common cause of depressed immune
system is nutrient deficiency. Hence, even a deficiency in a single nutrient can impair the
immune system. Moreover, infections are the most common causes of death among
undernourished children (Bourke et. al., 2019). This shows that an immune system’s
ability to fight off infections is impaired in undernourished children.
In addition, underweight has been also linked to low performances of children in
school. According to Asmare, et. al. (2018), low educational performances were
significantly higher among underweight children when compared to normal children.
Malnutrition is a global problem that can affect both adults and children.
According to Bourke et al. (2019), millions of children both in low- and middle-income
countries are affected by undernutrition. Hence, undernutrition has caused almost half of
all deaths among children below 5 years of age. In fact, 149 million of children below 5
years of age were estimated to be stunted on 2020 and 45 million children were
estimated to be wasted. Moreover, approximately 45% of children deaths under 5 years
of age are linked to undernutrition (Malnutrition, 2021).

19
20
VII. FAMILY NURSING CARE PLAN
FAMILY NURSING CARE PLAN
INTERVENTION PLAN
FAMILY
METHOD OF
DATE/ HEALTH NURSING GOAL OF OBJECTIVES NURSING RESOURC
NURSING
CUES PROBLEM PROBLEM CARE OF CARE INTERVENTIO ES EVALUATION
INTERVENTI
S NS REQUIRED
ON
Septembe Unhealthful 1. Inability After 3 days After 3 days of 1. Establish H Visual aids Goal met.
r 13, 2021 nutritional to make of health health teaching, rapport with O to discuss
habit of the decision teaching, Mrs. L and M the client to M importance After 3 days of
Objective child: s with Mrs. L and will be able to: gain client’s E of adequate health
Data: Inadequate respect M will make a. Verbalize trust quality and teaching, Mrs.
food intake to taking necessary the 2. Provide V quantity of L and Ms. M:
A: both in appropri measures importance health I food intake. a. Verbalized
6 years quality and ate to improve of adequate teaching S the
old female quantity as a health A’s quality food intake related to I Video importance
health action and for a child’s the T presentation of
BMI: 17 threat. due to: quantity of overall importance and images adequate
a. Low food intake. health. of adequate to show quality and
Refrains salie quality and some ideas quantity of
from nce b. Demonstrat quantity of of creative food intake
eating of e skills in food intake. meal for a
fruits and the preparing 3. Import preparation child’s
vegetable probl creative knowledge s overall
s. em nutritious about health.
2. Inability meals such creative Blender – b. Demonstra
to as making meals and family ted skills in
Subjective provide an animal drinks resources preparing
Data: adequat shape out of preparations creative
“Dili man e fruits and by showing and
jud siya nursing vegetables. video nutritious
(A) care to c. Demonstrat presentation meals that
mukaon the at- e skills in s and is

21
 risk making photos. appealing
member fresh fruit 4. Assist them for A.
sa akong
due to: shakes in planning c. Demonstra
ginaluto
a. Inadequ using a their daily ted making
maam oy,
ate blender. routine and fruit
samot na
family ensure that shakes
gulay. Pati
resource nutritious using a
prutas dili
s of care food blender.
jud siya.
specifica preparation
Pilian
lly: is included
kaayo
Absence in their
siya ug
of priorities.
pagkaon.
responsi 5. Provide
Sa
ble emotional
buntag,
member support.
gatas
b. Member’
rapud na
s
iyang
preoccu
inomon”,
pation
as
with own
verbalized
concern
by Mrs. L.
s/interes
ts

22
23
VIII. HEALTH TEACHING
PRIMARY PREVENTION
1. Encourage Mrs. L to get the COVID-19 vaccine to get herself and the people around
her protected.
2. Education about healthy and safe habits (e.g. eating well, exercising regularly, not
eating unhealthy foods)
3. Explain the importance of adequate quality and quantity of food intake for growth
and development and for a strong immune system.
4. Educate the family members about creative meal preparation for A such as making
an animal-looking figure out of healthy food meals
5. Discuss about recipes for a fresh fruit shake that is a good alternative for sweetened
juices for A
6. Educate them about the importance of engaging in a healthy lifestyle, such as
having a regular exercise and a good diet, as means of promoting health and
preventing diseases
7. Advise the family members to continue keeping their environment clean and ensure
that there is no stagnant water that could possibly become breeding sites for
mosquitoes. Also, continue take actions to get rid of cockroaches and other insects
as they are known as vectors of diseases that may affect people’s health

SECONDARY PREVENTION
1. Advise seeking medical help for symptoms experienced and avoid self-medication
2. Advice Mrs. L to continue taking her prescribed maintenance medications as well as
their vitamins in the right dosage.
3. Educate them about their BMI, particularly Mrs. L who is considered overweight.
Explain the normal range of weight for her. Discuss about risk factors that contributes to
an over increase in weight as well as possible health conditions that may develop as a
result of being overweight.

TERTIARY PREVENTION
1. Advise members to ensure that they turn off the candles after using it to avoid fire
accidents.
2. Chronic disease management programs especially with Mrs. L is diagnosed with
Hypertension, Diabetes, anxiety disorder, and amoeba
3. Acute disease management programs with Ms. M was last admitted when she was
still in elementary school due to diarrhea
4. Educate every members of the family to monitor each other health status helping one
another as well

22
IX. IMPLICATION OF THE STUDY
Nursing Education
A nursing family case study helps us student nurses to gain knowledge and
understanding about actual scenarios in every family in a community. It helps us to gain
skills in identifying actual and potential health problems, making a plan of care,
implementing interventions to minimize or completely eliminate health and nursing
problems, and evaluate the health care services given in a family and in the community.
In this family case study, we chose a family with a unique family structure and dynamics
which contributes to the appearance of health problems that we have identified within
their family. Nutrition is one of the important aspects of health in which nurses ensure
that their patients have an adequate intake of essential nutrients through promoting
healthy eating habits. Through this case study, we will be able to expand our
foundational knowledge about nutrition. We will be able to learn what factors may
contribute to problems like nutritional deficiencies and identify solutions to address these
problems. In addition, we will also provide health education to the family members to
establish understanding of the importance of adequate nutrition in overall health.
Through this new learning method system, we were given the opportunity to perform
community health nursing activities even though we weren’t able to have an actual
community exposure. We were able to realize the significance of learning these
community health nursing activities as part of our Nursing Education in which we are
able to develop and enhance our skills in utilizing the Nursing Process in the promotion
of health and prevention of diseases in the community setting.
This case study contributes nursing education as it provides a supportive
relationship with the family with trust, respect and acceptance. We, student nurses have
the expertise and responsibility to ensure the family nutritional needs are met by
providing nutrition screening and appropriate nutritional advices that are essential to
improve health outcomes of the family and to provide with a knowledge about the
importance of nutrition and coping strategies that will help them to make a lifestyle
changes and healthier choices. Overall, student nurses grasp important information from
the family specifically the health issues that they are experiencing and will be able to
impart knowledge to improve health status and determine preventive measures to help
avoid future health problems, specifically to encourage Mrs. I and M to extend A’s diet to
include more nutrient-rich items, especially fruits and vegetables, and less nutrient-poor
sugary foods.

Nursing Profession
In this case study, we set out to identify the family's health problems based on
their family structure and dynamics, and we discovered that the family has a nutritional
health problem. As a result, the student nurses will be able to provide solutions and
interventions to the family that is interconnected with nutritional issues. Additionally,
student nurses have the expertise and responsibility to ensure the family's nutritional
needs are met in which proper nutrition plays a big role in disease prevention, recovery
from illness and ongoing good health. Since nurses are the main point of contact with
patients, they must understand the importance of nutrition basics and be able to explain
the facts about healthy food choices to the family. In community, student nurse focuses
on the prevention aspect which helps in giving the basic education regarding the
prevention of certain nutritional deficiency disease rectifies the different patterns of the

23
nutrition opted by the people that is why it is important that nurses understand proper
nutrition as it relates to recovery as well.
Moreover, it will be able to scale up our basic fundamental nutritional knowledge
and be able to ascertain out what factors may contribute to such nutritional health
issues, as well as providing nursing interventions. With that, we will provide family
members with health education to help them understand the importance of proper
nutrition in overall health. In nursing profession, we recognized the importance of having
to learn these community health nursing activities, as it allows us to develop and
improve our skills in implementing the nursing process in the promotion of health and
disease prevention in the community setting.

Nursing Research
Nutritional deficiency is one of most common health problems affecting many
people at any ages worldwide. It is considered as a health threat as studies have shown
that it is linked to the development of nutrition-related diseases and other chronic health
conditions. There are different factors that leads to nutritional deficiency in which it
includes the picky eating habit that is seen in children that leads to inadequate intake of
nutrients such as vitamins and minerals needed by the body. As a result, lower intakes
of energy and nutrients will compromise the health of children.
In this case study, the student nurses found out through the assessment with the
family that inadequate food intake of children is somehow not realized by some family
members as a health threat. In addition, the absence of responsible parent/s which is
seen on children of OFW workers can also contribute to the inability to provide them with
an adequate nursing care particularly with regards to their nutritional intake. Combined
with the fact that family members are preoccupied with their own concerns, ensuring of
adequate food intake both in quality and quantity in children may be altered.
This case study will therefore recommend that future researches about nutritional
deficiency that may focus on identifying interventions which could make family members
realize inadequate food intake as a health threat. Moreover, they should come up with
more interventions that will make family members prioritize nutrition and strategies that
will reform children to engage with their food, and to see it as an important aspect of
health.

24
X. REFERENCE
About Malnutrition. (n.d.). Retrieved from
https://globalnutritionreport.org/resources/about-malnutrition/
Asmare, B. et. al. (2018). Nutritional status and correlation with academic performance
among primary school children, northwest Ethiopia. Retrieved from
https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-018-3909-1
Bourke, et. al. (2019). Current Understanding of Innate Immune Cell Dysfunction in
Childhood Undernutrition. Retrieved from
https://www.frontiersin.org/articles/10.3389/fimmu.2019.01728/full
Calder, P. and Jackson, A. (2000). Retrieved from
https://pubmed.ncbi.nlm.nih.gov/19087431/
Goh, D. and Jacob, A. (2012). Perception of picky eating among children in Singapore
and its impact on caregivers: a questionnaire survey. Retrieved from
https://doi.org/10.1186/1447-056X-11-5
Jonesboro, Arkansas (September 20, 2016), “The Role of Nurses and Nutrition in
Healthy Patient” Retrieved from https://degree.astate.edu/articles/nursing/the-role-
of-nurses-and-nutrition-in-healthy-patients.aspx
Jonesbro, Arkanas (March 2018), ‘’ The Nurse’s Role in Patient Education’’
https://degree.astate.edu/articles/nursing/nurses-role-patient-education.aspx
Nutritional Deficiency. (n.d.). Retrieved from
https://www.sciencedirect.com/topics/medicine-and-dentistry/nutritional-deficiency
Malnutrition. (2021). Retrieved from
https://www.who.int/news-room/fact-sheets/detail/malnutrition
Morley, J. (2021). Undernutrition. Retrieved from
https://www.msdmanuals.com/home/disorders-of-nutrition/undernutrition/
undernutrition
Pathania, N. (2017). What Causes Nutritional Deficiencies? Retrieved from
https://www.parashospitals.com/blogs/what-causes-nutritional-deficiencies/
Piaget J. The origins of intelligence in children. New York: International Universities
Press; 1952. p.1-7, 35, 42, 157, 345, 381.
Taylor, C. and Emmett, P. (2020). Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398579/
Xiaoyue xu, Deborah Parker, Caleb Ferguson, louise Hickman, (September 2017),’’
Where is the nurse in nutritional care?
’’https://www.tandfonline.com/doi/full/10.1080/10376178.2017.1370782?
scroll=top&needAccess=true

25