COMMUNITY HEALTH NURSING RLE

PART A. INITIAL DATA BASE

I. CHARACTERS:
A. What is the type of family structure?
Nuclear Single - Parent
Extended Others (specify)
B. What is the type of family based on authority?
Patriarchal
Matriarchal
C. Who makes decisions regarding health care? father
D. What is the present family relationship?
with conflicts between members
without conflicts between family members
E. Activities of daily living:
1. Sleeping pattern:
Retiring/getting up hours 5 am
Nap during the day 3 to 4 pm
Do members sleep together No
2. Eating pattern
How many meals each day? 3 meals
Who appears overweight? father
Who appears underweight? daughter
3. Leisure time activities
How does each member spend leisure hours? cooking
Is it appropriate for the sex and age group? Yes
What is the effect on the family? bonding
Any joint activity for leisure? None

II. FAMILY INFORMATION

Head of the family: Father
Address: cavite
Members of the household: 2

NAME RELATIONSHIP AGE EDUCATIONAL ATTAINMENT

Lemuel John Mayer Father 51 N/A
Vanessa Mayer Daughter 25 college graduate

/avg 1
 III. SOCIO-ECONOMIC AND CULTURAL FACTORS
A. Income

NAME OCCUPATION PLACE INCOME /

MONTH
Lemuel John Mayer Multiple job cavite N/A
Vanessa Mayer Sales lady N/A N/A

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

Yes No
2. Who makes decisions regarding money matters? Father
3. Religious affiliation: INC
4. What roles does the family play in the community? Good neighbor

IV. ENVIRONMENTAL FACTORS

A. Housing
1. Ownership
Owned Rented Rent-Free Others (specify)
2. Construction materials used
Light Mixed Strong
3. Living space
Adequate Inadequate
4. Sleeping arrangement:
5. Adequacy in furniture
Adequate Inadequate
6. Water source
Private Public
7. Food storage
Refrigerator Jars/container Others (specify)
8. Cooking facility
Electric stove Firewood Others (specify)
Gas Stove Kerosene
9. Drainage facility
Open drainage Blind drainage None
10. Toilet facilities/type
Flushed Overhung latrine
Water-sealed latrine Bored-hole latrine
Pail system Others (specify)
11. Sanitary condition
Fair Good Poor
Provide brief description: private homes

12. Neighborhood
Congested Slum Other
13. Availability of Health Care Facility
/avg 2
 Describe briefly: couple of miles to the nearest one
14. Garbage disposal
Dumped at street corner Picked up by garbage collector
Buried Burned then buried Others(specify)

V. HEALTH MEDICAL HISTORY

NAME PAST ILLNESS DIAGNOSED / ILLNESS STATE HEALTH ACTION
UNDIAGNOSED TAKEN
Vanessa Mayer Flu Diagnosed Cured Rest

VI. VALUE PLACED ON PREVENTION OF DISEASE

Vaccinations

NAME AGE COMPLETE INCOMPLETE

Vanessa Mayer 25 COMPLETE

Other preventive practices employed by the family: Good hygiene

Sources of Health Care:
Health Center Government Hospital
Private Hospital Others (specify)

/avg 3
 PART B.

DETERMINE AT LEAST 3 FAMILY HEALTH PROBLEMS. IF NONE, DETERMINE THE FAMILY’S PROMOTIVE OR PREVENTIVE
PRACTICES.

FAMILY HEALTH PROBLEMS. TYPOLOGY OF HEALTH PROBLEM

(WELLNESS STATE , HEALTH DEFICIT,HEALTH THREAT,
(IF NONE, FAMILY’S PROMOTIVE OR FORESEEABLE CRISIS)
PREVENTIVEPRACTICES.)

1 Good hygiene

PART C.

DO THE SCALING OF THE 3 IDENTIFIED HEALTH PROBLEMS OR PROMOTIVE PRACTICES OF THE FAMILY.

HEALTH PROBLEM 1: PREGNANT 34 WEEKS

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

NATURE OF THE PROBLEM 2 0.66

MODIFIABILITY OF THE 1
PROBLEM 2

PREVENTIVE POTENTIAL 1 0.33

SALIENCE 0 1

TOTAL 2.99

HEALTH PROBLEM 2:

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

NATURE OF THE PROBLEM

MODIFIABILITY OF THE
PROBLEM

PREVENTIVE POTENTIAL

SALIENCE

TOTAL
/avg 4
 HEALTH PROBLEM 3:

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

NATURE OF THE PROBLEM

MODIFIABILITY OF THE
PROBLEM

PREVENTIVE POTENTIAL

SALIENCE

TOTAL

Villareal, Kian Anthony N.

Surveyed by _________________________
Date ______________________________
March 16, 2024

/avg 5