Republic of the Philippines University of the Philippines College of Nursing Tamag, Vigan City

FAMILY CASE STUDY

In Partial Fulfillment of the Requirements For Community Health Nursing

Presented to: Ms. Zielene Myrus Alzo, RN Instructor

Presented by: REGINETTE CHAN BSN II- ANGELICA

February 5, 2012

A. Family Structure, Characteristics and Dynamics/Relational Pattern Name Rachel Obinario Rashly Faye Obinario Relation Wife Age 25 Civil Status Female Married Female Single Sex Educational Attainment High School Graduate Not yet schooling Occupation Housewife Toddler Religion Roman Catholic Roman Catholic

Daughter 2

Head of the Family Ferdinand Obinario Age: 26 years old Civil Status: Married Educational Attainment: High School Undergraduate Occupation: Carpenter Religion: Roman Catholic Mr. Ferdinand Obinario is the head of the family, 26 years old, male, high school undergraduate, carpenter and a Roman Catholic. He was married to Mrs. Rachel Obinario, 25 years old, high school graduate, housewife and a Roman Catholic. Rashly Faye Obinario is their daughter, 2 years old. Shes a Roman Catholic and shes not yet schooling. Family Obinario is a nuclear family because it is composed of a husband, wife and a child. It is also a patriarchal family because it was headed by Mr. Ferdinand Obinario. In terms of decision making, both Mr. Obinario and Mrs. Obinario decide. Mr. Obinario makes decision regarding financial aspects of the family life while Mrs. Obinario manages the home and care for Rashly. Rashly hugs her father and mother if she has something to say and something she want. If Mr. Obinario and his wife encounter problem, theyre trying to solve it together. As claimed by Mrs. Obinario, her husband is very open to her particularly when they have financial problem

like when their monthly income is not enough for the whole month. When they solved their problem, they bond together in a simple way like playing with their child. When I asked Mrs. Obinario if they still want to have another child, she answered that they wanted to, but not yet this time because of their situation such as their income is not enough for the three of them. If they will have another child, it will be very difficult for them to provide the needs of the baby. B. Socio-economic and Cultural Characteristics Only Mr. Obinario is the one who works for the family. He works as a carpenter. He is a permanent worker. He has a salary of P400.00 weekly. He works 2 times a week. He can have an income up to P1,600.00 monthly; 75% of their monthly income is spent for their daily meals; 25% of their income is for their basic necessities. Mrs. Obinarios mother is paying for their electric bill because they are just connecting electricity to them. Whenever Mrs. Obinario is giving their contribution for the electric bill, her mother is not accepting it. If Mr. Obinario has no work, he goes together with his wife to make charcoal for them to have an additional income which they can earn up to P250.00 a month. A sack of charcoal costs P100.00-P120.00. They can sell 2 sacks of charcoal a month. Their total monthly income is P1,850.00. Mr. Obinario was a high school undergraduate at Balaoan National High School, Balaoan, La Union. He decided to stop from studying because he always cut-the-class and he was influenced by his friends. Mrs. Rachel Obinario was a high school graduate at Ilocos Sur National High School, Vigan City, Ilocos Sur. She wanted to continue her study but because of financial problem she decided to stop. Her father was a fisherman and his income was not enough for her and for her brother to continue his studies in college. Mr. Ferdinand Obinario is from Balaoan, La Union and Mrs. Rachel Obinario is from Caoayan, Ilocos Sur. After their marriage, they decided to reside at Caoayan, Ilocos Sur. They speak Ilocano as their medium of communication. They attend mass 2 times a month. They are always praying every night and every morning. They are still appreciating traditional health practices like patako. When Rashly had a fever, they had this traditional health practice. The one who did that traditional health practice told them that there was a spirit bothering Rashly and asked Mrs. Obinario to throw some grains before the sun sets because they believe that their sickness was caused by spirits.

Mr. Obinarios brothers, Albert Obinario and Allan Obinario, help them in cases of emergency. Like when Rashly was rushed into the hospital because she was drowned in the river last July 2011, they gave P3,000.00 to Mr. Ferdinand for the bill in the hospital. They paid P2,000.00 for the bill and the P1,000.00 excess was kept by Mr. Ferdinand for them to have an extra money in case of emergency. Family Obinario is active and aware about Rural Health Units services like dental services, family planning services and immunization services. The last time they went to Rural Health Unit was when Rashly had scabies on her head last June 2011. They gave antibiotic with a generic name of Cloxacillin. They also go there if there are free medicines to be given and free consultation. C. Home and Environment 2m 1.5 m Kitchen Living Room Elevated 1 foot Dining Area 2m Family Obinario lives in Don Alejandro Quirolgico for almost 3 years. Their house is 7mx5m in size. Their kitchen and dining area were located outside the house. Their living room was about 5m long and 3m wide. Their kitchen was 2m long and 1.5m wide. Their dining area was 2m long and 2m wide. They dont have a comfort room. They share comfort room with Mrs. Obinarios mother beside their house. Their house doesnt have a bedroom but their living room serves as an area for them to sleep. Their house is made up of light materials like bamboo, nipa, wood and a cardboard. Their house is ventilated because they have 2 windows with a measurement of 1mx1m. 2m 3m 5m

The family usually stays inside the house and usually make some rest in front. But when they are inside the house, theres an obvious evidence of inadequate living space. They have limited space for living but seeing that they do not have any furniture and they dont have too much appliances, only electric fan, youll slightly see that they can still move around the house. When they are sleeping, Rashly sleeps between Mr. Obinario and Mrs. Obinario but sometimes Rashly sleeps at the house of her grandmother beside their house. There is a dirty canal owned by their neighbor near to their house that could be a breeding or resting site of mosquitoes. That canal is really dirty and they dont clean it. As per observation, their house was made up of light materials like bamboo, wood and nipa which are easy to burn-down. Their kitchen area is located outside their house. They are using dalikan when they are cooking. They cook their food for about 30 minutes to 1 hour. Another thing that may cause accident is their stairs which is made up of wood and theres no handle on sides. Theres a possibility that Rashly would fall from it. Some of their foods are being stored in a big tupperware and Mrs. Obinario placed it in the house of her mother. Her mother doesnt have a refrigerator. They just placed it there because theres no safe area in their house for their food. Some are being placed in a plastic bag and they hang it in their roof so that it would not be eaten by rats. Their water supply is coming from Nawasa and uses this water for drinking. They placed their drinking water in a water jug. They dont boil the water because they are satisfied with the potability of it. The water use for cooking and washing dishes was placed in a jar coming from the water pump placed in front of their house. For bathing and washing clothes, they used water from a public water pump which is 6m from their house. Sometimes, their garbage is placed in a plastic and burns it in an open air. But mostly, their garbage is collected by the garbage collector that rounds around the barangay every week. They have an open drainage system and the waste flows through an open canal. They clean it every day to avoid microorganisms that may cause diseases.

Their neighborhood is congested because there were too many houses and they are connected to each other. Almost of their neighbors are their relatives. They have a good relationship to one another sharing the public water pump. They fall-in-line to fetch water and as claimed, no one has a superior attitude when line is long. Each of them waits for their turn. Family Obinario is not using herbal medicines and doesnt believe in albularyo. If someone gets sick, they consult a physician and buy the medications prescribed. They only have one cellular phone. Both Mr. Obinario and Mrs. Obinario know how to use it. They dont have any transportation. They ride on a tricycle that roams around the barangay whenever they have somewhere to go. D. Health Status of each Family Member Rashly had a fever last August 8, 2011. It lasted for about 2 days. They consulted in the center and gave them Paracetamol and Rashly is taking that medication twice a day. Mrs. Obinario has an allergy that was diagnosed last November 2010. She cannot eat chicken because her whole body would be itchy. She consulted in the center when there was a program for skin diseases and they gave an ointment but they forgot already its brand name. Rashly eats 3 times a day. She eats 3 cups of rice every day. She is not already drinking milk since her mother stopped to breastfeed her when she was 1 year old because Mrs. Obinarios right breast had a boil last August 2010 and she didnt want Rashly to drink milk from her breast. So from then on, Rashly is drinking Milo placed in a bottle. Mr. Obinario is the only one who smokes in the family. He started to smoke when he was still in high school. He was influenced by his friends. He can consume 10 sticks a day. Mr. Obinario was not experiencing any signs and symptoms while he is smoking. E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention Name Rashly Faye BCG Hepatitis B DPT-OPV Measles

According to Mrs. Obinario, vaccines for Rashly were already completed. She couldnt find the yellow card already. Rashly was delivered in their house normally by a partera. There were no complications when she was delivered. Family Obinario is always visiting the hospital if one member of the family gets sick. Mrs. Obinario said that it is better to go to the hospital to prevent more risks. In the afternoon, they rest for about 3 hours a day by lying in their floor. They sleep at 89pm and wake up at 6am in the morning. The duration of their sleep is 9-10 hours. Rashly is drinking Milo every night before she goes to sleep because her parents believe that hot Milo stimulates her body to enhance her sleeping period. Family Obinario is not using any protective measures like mosquito net because it is hot and they are not comfortable with it. As claimed, there are times that they dont use footwear outside. Rashly is not also using footwear when she is playing outside. Mrs. Obinarios form of relaxation are chatting with their neighbors, reading pocket books, and sometimes playing games in her cellular phone. Mr. Obinario is just sitting in front of their house and going to their neighborhood to watch television. Rashly is playing outside their house with the supervision of her mother and sometimes her grandmother.

Scoring
1. Fall Hazards 1a. Stairs without handles on sides Criteria 1. Nature of the Problem 2. Modifiability of the Problem Computation 2/3 x 1 2/2 x 2 Actual Score 2/3 2 Justification The problem is said to be a health threat. Interventions and resources needed in solving the problem are available to the family, proper utilization is just needed. Risk and threats for accidents will be prevented if proper management to the problem will be done earlier. The family recognizes it as a problem needing attention but its just they lack resources

3. Preventive Potential

3/3 x 1

4. Salience of the Problem

2/2 x 1

4 2/3 2. Poor Environmental Sanitation 2a. Presence of breeding and resting site of vector of diseases Criteria 5. Nature of the Problem Computation 2/3 x 1 Actual Score 2/3 Justification The problem is said to be a health threat not only to the family but to their neighboring families. It should be given appropriate attention and management. Interventions and resources needed in solving the problem are available to the

6. Modifiability of the Problem

2/2 x 2

7. Preventive Potential

3/3 x 1

8. Salience of the Problem

0/2 x 1

family, proper utilization is just needed. Acquiring/ prevalence of certain diseases cause by vectors such as mosquitoes, flies, and rodents will be reduced or eliminated if the problem will be managed as soon as possible. The family is not aware of the occurrence of the problem.

3 2/3

2b. Improper Drainage System Criteria 1. Nature of the Problem 2. Modifiability of the Problem Computation 2/3 x 1 2/2 x 2 Actual Score 2/32 2 Justification The problem is a health threat. Resources are available to the family and interventions are feasible. Occurrence of waterborne diseases and parasitism and other communicable diseases can be reduced/minimized if the problem is solved earlier. The family doesnt perceive it as a problem.

3. Preventive Potential

3/3 x 1

4. Salience of the Problem

0/2 x 1

3 2/3

3. Unhealthy Lifestyle Cigarette Smoking Criteria 1. Nature of the Problem Computation 2/3 x 1 Actual Score 2/3 Justification The problem is a health threat to the patient who has arthritis and hypertension as well as to other family members. The problem is partially modifiable since although resources are available, motivation and initiative in smoking cessation is lacking. Occurrence of air borne diseases and hazards to other family members, occurrence of other diseases as well as complications to preexisting diseases will be reduced if smoking will be stopped although it will be gradual. The patient recognizes the condition as a problem since he tried to stop it years ago but it wasnt 'yet he dont see it needing immediate action.

2. Modifiability of the Problem

3/3x 2

3. Preventive Potential

2/3 x 1

2/3

4. Salience of the Problem

x1

1/2

3 5/6
** scoring, not yet prioritized**

Prioritized Problems
Problem 1. Stairs with no handle on sides 2. Cigarette Smoking 4 2/3 3 5/6 Score

3. Poor Environmental Sanitation 3a. Presence of breeding & resting sites of vector of diseases 3 2/3

3b.Improper Drainage System

3 2/3

FAMILY NURSING CARE PLAN