I.

FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

Table 1. Demographic Data of the Family

Family Members Name Lola Athena F 47 Married Fish Vendor Sex Age Status Occupation Relationship to the head of the family Head of the Family Catholic High School Graduate Religio n Educational Attainment Positio n in the family Mother Brgy. Aglipay, Batac City Lolo Hades M 47 Married None Spouse Catholic Elementary Graduate Father Brgy. Aglipay, Batac City Dionysius M 29 Single Construction worker Son Catholic High School graduate Eldest son Brgy. Aglipay, Batac City Hypnos M 25 Married none Son Catholic High School level 2nd eldest son Artemis F 18 Married None Daughter-inlaw Catholic High school level Brgy. Aglipay, Batac City Brgy. Aglipay, Batac City Aphrodite F 22 Married none Daughter Catholic High school level Eldest daughte r Poseidon M 20 Single None Son Catholic High School Graduate Younge st son Brgy. Aglipay, Batac City Brgy. Aglipay, Batac City Polyhymnia F 2 Single None Granddaughter Catholic Brgy. Aglipay, Place of Residence

Batac City Terpsichore F 2 Single Granddaughter Catholic Brgy. Aglipay, Batac City

Lola Athena is the head of the family. She is 47 years of age and engaged in selling smoked fish and variety of snacks. He is married for 29 years to Lolo Hades, 47 years old and a native of Nueva Ecija. Lolo Hades worked as a farmer before. They are blessed with six children however, only Dionysius, Hypnos, Aphrodite and Poseidon live with their parents. Dionysius, eldest son who is 29 years old works as a construction worker. Hypnos (25 years old), the second eldest son is married to Artemis (18 years old). Both of them have no

occupation. Aphrodite who is 22 years old is married to Hermes who works as a cashier in Shell Gasoline Station, Laoag City. They were blessed with two children, Erato (4) residing at Laoag andPolyhymnia (2) residing at Batac. At present, Aphrodite is 5 months pregnant. Poseidon, the youngest son who is 20 years old is currently single and has no work. Terpsichore, who is 2 years of age, was the eldest daughter of Hera (18 years old) when she was sexually abused. She is currently residing with her grandparents since Herasettled with her new husband in Paoay. The Greek family has an extended type of family based on internal organization since their family is not only composed of the nuclear family but also other family members such as parents and their siblings own family. There are 9 members of the family living together in Brgy. Aglipay, Batac City. The family includes the parents, siblings, and children. Based on residence, the family is matrilocal since they form a clan consisting of 3 generations in the maternal side living in the same place.

Based on authority, Lola Athena is the one who usually decides for the family whether financial, medical and other aspects since she is one of the breadwinners in the family and his husband is not able to work due to his condition being bedridden, thus it is matriarchal. Mrs. Cecilia claimed that her decision is focused or intended for the good and benefit of all the members of the Greek family. The family uses Iloco and Tagalog as their mode of communication. They also use Tagalog since their father;Hades is a native from Nueva Ecija.They communicate with each other with full respect since they practice using tatang, nanang, manong, manang and adding and anak ko. They have good moral conduct and uses only simple harsh words. There are no conflicts present within their neighbours. According to Aphrodite, misunderstandings are easily solved in their family since it only last for an hour or more. She claimed that they are all mature enough to understand each others feelings and attitudes except the two children. Even if there are no family members who are members of organization within their barangay, they claimed that they are active participants of the community since they participate in community programs such as Oplan Dalus, Barangay Fiesta and Basketball Tournaments. They seldom look for a time to talk and chat with their neighbours.

II.

Socio- Economic and Cultural Characteristics The Greeks total income comes from the combined income of Lola Athena and Lolo

Hermes. However, Dionysius also gives 300 pesos monthly as a share to the family. Lola Athenas source of income comes from selling smoked fish and variety of snacks within Batac and Paoay. She earns P6, 000.00 per month for working 5 days a week except during weekends. Hermes (husband of Aphrodite) works as a gasoline boy at Shell Corporation in Laoag City.

Aphrodite claimed that her husband gives the family P4, 000.00 monthly to sustain the needs of the family especially his wife and his child. Thus, the family can earn up to P10, 300.00 monthly The familys monthly income is divided as follows: food and groceries (P6,000/ month) including rice, meat, fish, vegetables, milk, diapers, condiments, shampoo, toothpaste etc., electricity (P400/month), transportation (P700/month) used by Lola Athena in going to places for her to sell and also with the other family members when they go to the market, RHU and church. Clothing (P500/month) which is usually used to buy new clothing for the 2 children in the family or other family members, health maintenance (P1, 500/month) including the medications for Lolo Hades and Lola Athena. Drinking water (P100/month) included for the 2 children and other expenses (P1, 200) such a load, vices (alcohol beverages and cigarettes), and cosmetics. Total income: Php. 6,000.00/ month (Lola Athena) Php. 4,000.00/month (Hermes) Php. 300/month ( Dionysius) TOTAL: Php. 10, 300/month

THE GREEKS MONTHLY BUDGETARY ALLOCATION

Electricity, 3.88% Water, 0.98% Clothing, 3.88% Transportation, 6.80%

Miscellaneous, 11.65% Food and Groceries, 58.25%

Health Maintenance, 14.56%

According to Lola Athena, their income would just be enough to sustain their family needs. However, when emergency situations occur, they usually stretched their budget to sustain all the needs of the family. She verbalized, Apagisu met lang ti kwarta mi ngem no agkurkurang talagan ket agin-inot kami ta han mi unay kayat ti umut-utang. As to the other family members, Hypnos and Poseidon would sometimes make honey juice from bees house and would sell this. Lola Athena is the one who is responsible in making decisions about money and how they will spend it.

All of the family members are high school graduate, except for Lolo Hades who is an elementary graduate. However, the two children are still young (two years old) to enter school. All of the family members are affiliated to Roman Catholic. The family, especially Lola Athena andAphrodite with the two children go to church twice a month. Lolo Hades cannot go for mass due to his condition being bed ridden. They go to church to pray, ask for help in everyday struggle and to thank God for the blessings they are receiving. ECOMAP
RELATIVES

COMMUNITY

RHU

JAVILLANOR FAMILY

MMMH & MC

MARKET

CHURCH

The ecomap shows the familys interaction with the environment which includes their relatives, community, church, MMMH& MC, RHU and market. They have a good interaction with their relatives. Sometimes their relatives come to their house to visit them. They have a mutual relationship with their relatives since they are open to emotional support.

Aphroditeclaimed that they are actively participating and supporting different projects and activities of their Barangay such as Oplan Dalus, Fiestas and Basketball tournaments. Even though they do not belong to any group within their barangay, they still established good relationship to other members of the community therefore allowing them to develop social skills that will help in their personal and interpersonal development. The family stated that they do not go to church regularly to attend mass usually twice a month. They attend mass sometimes but not as a whole family. The church in return will guide them to live life in peach through sharing the teachings learned inside the church to other members. Their interaction with the market is quite well since they go there four times a week to buy their food and groceries. The family seek health care to RHU whenever they will experience mild illnesses such as cough, cold, and fever. When they will experience serious illnesses, they will then consult MMMH and MC. The family utilizes these facilities via Philhealth wherein they have financial benefits that allow them to visit the facilities as much as possible.

III.

Home and Environment The Greeks residence is located at Brgy.9 Aglipay, Mangapit Street, Batac Ilocos Norte.

Approximately, it is 300 meters away from the town proper. Their house is approximately 3.9x9 m bungalow situated at the hillside. The house is not enough to accommodate all the members since they have only 2 bedrooms and they utilize the living room and kitchen as their sleeping area. Poseidon and Dionysius would sometimes sleep in their uncles house which is just adjacent to their house made of wooden and galvanized room. The wall of their house is concrete and about 10 hollow blocks tall. They have a cemented floor with a floor mantle and their house is made up of two bedrooms, a living room, a

kitchen and a porch. Each has a one bulb lighting utilized at night. Their porch measures 2.06 m x 3.22 m elevated 8 inches above the ground. A swing is hanged diagonally where the 2 children are put into sleep at day time. Their living room is measured 2.15 x 5 m. It has a divider where their television is placed. Figurines and bases are also there. Infront of it are two speakers. A plastic cabinet is also placed in the living room where clothes of Terpsichore and Lola Athenaare placed. Lola Athena and Terpsichore lay a mat in the living room where they sleep. Sometimes, Dionysius and Poseidon would also lay a mat and sleep on that area. They have 2 bedrooms; each measures 1.75 x 2.5 m. the bedrooms are divided with fixed plywood. The left bedroom is the room of Lolo Hasdes. It has two windows (0.82x1.22 m.) each. It has a single bed where Lolo Hades spends most of his time because of his inability to move out from his bed. On his bed are seen some sticks of Mighty Green cigarettes. A wooden cabinet is also seen where Lolo Hadess clothes are placed. There is also 1 stand fan there. The right bedroom is the room of Aphrodite and her child Polyhymnia. It has a window (0.82x1.22 m.). A mattress bed is laid on the floor which they utilize in sleeping. Two Orocan cabinets are also there where they put their clothes. There is also a stand fan that they used whenever the weather is hot. Their kitchen measures 3.09X5.08 m. A hanging cabinet where kitchen wares are put is located on the right wall of the right room. A gas stove is also there but it is not what they utilized for cooking. Instead, an earthen stove is used to cook their foods placed beside the gas stove. There is no chimney in the house for the escape of smoke from cooking. Piles of woods reachable by children are also noted. They also utilized the kitchen as their dining area wherein a rectangular table is placed and with 3 monobloc chairs. Also, a single bed is located on the kitchen area where Hypnos and Artemis sleep. An orocan cabinet is also placed there where they put their clothes. There is also an open extension of their house, 2.21x3.8m wherein it is has a galvanized

roof where piles of woods are scattered and are reachable to the children. They have a water sealed toilet on the right corner back of their house. It is made of a concrete wall and rusty galvanized door. An open earthen jar for water storage is also seen. Jetmatic pump is the source of their water supply. They used the water for bathing and washing clothes and dishes. They usually get their drinking water from the house of Lola Athenas mother because it is cleaner than the water from their pump. However, they boiled the water for drinking usedof the adults and purified water for the two children.Their septic tank is approximately 5 m away from their water source which is jetmatic. A bathroom (1.65 m x 2.33m) is located right corner in front of the porch. A pail without water, dipper, soaps and detergents were also seen. On the left side of the house is an open extension wherein sometimes they cooked their food in an earthen stove and sometimes where they eat. Presence of pile woods and long and untrimmed tall plants where mosquitoes can breed are also seen. A canal approximately 2 m deep is also located on the right side of their house where they throw some of their garbage. It is also where the water they used for bathing and washing goes. A 1x2 m bridge in the canal that connects the barangay road to their house has no rails. The family has no refrigerator for food storage instead they use plastic containers as their storage for their left over foods. They used clean water from their grandmothers house for drinking. They used water pump for cooking, bathing and washing their clothes and dishes. They usually practice burning of their wastes or throwing on the canal. They do not segregate their garbage. They have a slum type of neighbourhood since their houses is approximately 10-15 m from their neighbours. Their neighbours were all their relatives on the maternal side. There were no conflicts present with their neighbours instead they have a close bonding with each other.

There are no health facilities available within their barangay, however RHU have reach out programs in their barangay like the Anti- Tigdas vaccination, Vitamin A supplementation and height and weight monitoring for children. They also go to RHU for medical consultations when their children have any health problems such as coughs, colds and fever and when Lola Athena feels nape pain or headache she goesthere for blood pressure monitoring.Also,Aphrodite utilized the RHU for her weekly prenatal check-up. Poseidon and Dionysius sometimes utilize the social facilities of their barangay such as the basketball court which serves as their playing area for basketball. Day-care centers are also available but it is not being utilized by the family yet since the kids are still too young. They dont have land line connection in their house instead they are using four cellular phones for communication. They have a radio and television that serves as their form of entertainment and news information. They have a motor cycle but usually utilized by Hermes in his work in Laoag. However, they also ride in a tricycle. IV. Health Status of each Family Member The Greek family experienced common illnesses such as cough and colds, headache and fever. According to Aprodite, they do not immediately go to the RHU whenever they experience such conditions. Instead, they manage their condition by taking in plenty of water, pineapple and calamansi juice, have enough rest and take some medications, specifically Biogesic 500 mg TID for fever and Neozep 500 mg tablet BID for colds (1.5 ml of Neozep for Terpsichore and Polyhymnia). The family sometimes practice use of herbal medications such as kalachuchifor wound healing and believes in quack doctors. One of the family members, Hades is currently suffering from diabetes mellitus and gout which were diagnosed by Dra. Paoay, last May 10. According to Lola Athena, his husband fainted last because he was drunk and does not eat at that time. His condition was accompanied

with underlying problems such as blurring of vision, swelling of both upper and lower extremities and body weakness. He was confined in MMMH & MC for one month and

undergone several laboratory exams and procedures such as CBC, RBS and X-ray. He was then prescribed by his physician several medications such as Ampalaya plus 250 mg capsule TID, Mefanamic acid 500 mg capsule PRN for pain, Tramadol 25 mg capsule TID and Allupurinol 500 mg TID for gout. His last check-up was one year ago. At present, he is unable to move out from his bed and is unable to walk and he verbalized that Agtagerger toy kannigid a tumeng ko nu ipadas ko ti tumakder ken kasla haan na mabagkat ti bagik. He is being carried from his room to the bathroom for bathing usually twice a week. He is not able to open and close his palms and fingers. Fresh wounds are present on his both arms and they apply Betadine, Hydrogen Peroxide or Kalachuchi. According to Aphrodite, his father doesnt go for follow-up check-up because he doesnt want to be carried from their home to the hospital and is ashamed of his condition. On the other hand, Lola Athena suffered from a high blood pressure in last December 2011 when she was in the hospital selling smoked fish. She was rushed to the Emergency Room because of headache, dizziness and a blood pressure of 150/120 mmHg taken by a nurse. She was given Amlodipine 10 mg. She usually goes to his brother for blood pressure monitoring whenever she feels dizzy accompanied by headache and was given a sublingual medication. She also goes to the RHU sometimes and was given Amlopidine 10 mg by medical representatives. Dionysius was diagnosed with Asthma 3 years ago by Dr. Agbayani. He was prescribed Salbutamol nebulization and takes in whenever his asthma attacks. He added that his condition is triggered by dust, smoke and whenever he eats plenty of fatty foods.

Hypnos suffered from vehicular accident last 2008. He was confined at Governor Roque B. Ablan Sr. Memorial Hospital for three weeks. He was operated by Dr. Tapia

perforrmedORIF(Open Reduction Internal Fixation) on his left leg. He was prescribed with Antibiotics but forgot the other medications he took. He also used cane when walking. At present, he now walks without the aid of a cane. At present,Aphrodite is 5 months pregnant. It is her 3rd pregnancy and claimed that it is unplanned. Her last menstrual period was August 6,2011 and her expected date of confinement will be on May 13, 2012. She has a weekly prenatal check-up that started last December 2011 at RHU Batac. She was prescribed to take Ferrous sulphate 1 tab OD as iron supplement. At present, she undergone urinalysis and was diagnosed to have UTI by Dr. Agbayani. She was prescribed to take Cefalexin 500 mg TID. She has also cough and colds and was prescribed Voxan mg TID. She has already received TT1-TT4 and scheduled to have her TT5 this

February. She has a present weight gain of 4 kg. (55kg before pregnancy and 59 kg at present). As to her past obstetrical data, her first baby boy was delivered through NSD on December 10,2007 at MMMH&MC when she was 18 years old. She suffered from UTI when she was 4 months pregnant and was prescribed Amoxicillin 500 mg OD by Dr. Agbayani. She claimed that her pregnancy was unplanned. As to her second pregnancy, she delivered a baby girl through NSD on their house by a RHU midwife. She suffered UTI when she was 2 months pregnant and was prescribed Amoxicillin 500 mg OD by Dr. Agbayani. Poseidon was diagnosed to have asthma 3 years ago at MMMH & MC. He was

prescribed to take Salbutamol nebulization. His asthma triggers due to weather change and eating chicken. At present, he would take Salbutamol nebulization when his asthma attacks.

Terpsichore also suffered from food allergy when she was one year old. Rashes were present all over her hands when she ate fried chicken. They consulted a quack doctor on the condition but as claimed her grandmother, it was not resolved. Hence, after five days they consulted at MMMH & MC and was prescribed Loratadine 5mg/5ml syrupand Bethamethasoe vallerate ointment by Dr. Laoag. Polyhymnia also suffered from food allergy to egg. She was prescribed Allerkid syrup 1 tsp. OD for 1 week by Dr. Agno. Table 2. Nutritional Status of Children Name Erica Celina Weight 10 kg 14 kg Height 79 cm 81 cm Mid-upper circumference 13.3 cm 15.5 cm

Table 3. Nutritional Status of the Adult Members Name Cecilia Eduardo Edisel Sonny Boy Ronna Mae April Joy Mark Anthony Height 1.62 1.68 1.69 1.60 1.55 1.65 1.58 Weight 65 73 59 55 52 59 kg 53 BMI 24.7 25.86 20.66 21.48 21.64 21.67 21.23

The nutritional status of each adult family member is normal a manifested by their Body Mass Index (BMI) which ranges within the ideal BMI of 19.1-25.8 and 20.7-26.4 for females and males respectively. Table 4. 3- Day Diet Recall January 09, 2012 Meal Monday Breakfast 11 pcs. of Tuyo Tuesday 3 packs of Lucky Me Wednesday 4 orders of fresh January 10, 2012 January 11, 2012

5 pcs. of scrambled 6 pcs. Of sunny side- pancit egg 5 cups of rice 3 cups of milo 3 cups of coffee 1 L of water Lunch up egg 5 cups of rice 2 cups of milo 2 cups of coffee 1 L of water *Only 4 members ate their breakfast 3 cups of coffee 1 glass of water

kg Sinigang na 2 bundles of ginisang 6 pieces smoke fish baboy 5 cups of rice 1 L of coke 2 L of water petchay 11 pcs. Of 3 servings of

fried pukpuklo 5 cups of rice 2 L water

galunggong 5 cups of rice 2 L of water

Dinner

kg of Pinakbet 5 cups of rice 13 pcs of smoke fish 2 L of water

13 slices of sinigang Medium sized repolyo na bangus 5 cups of rice 1 L of coke ginisa 5 cups of rice 1 L of water

2 L of water Snacks Once a day (usually Baby Alfred and Baby Erika) 2 Refresh juice and 2 cupcake (Baby Alfred and Baby Erika) 2 L of Coke and biscuits (Other members of the family)

According to Aphrodite, all of the family members eat their meal at the same time. 6:30am 7:30 am for breakfast wherein they prefer fried foods such as smoke fish, processed food and noodles. 11:30am-12:30pm for lunch where sinigang, fried and sauted foods are prepared. While for dinner the same methods for preparation are used, left overs are also served and they eat at 7:30pm- 8:30pm. She relayed that eating together could be their best time to bond and relay each others problem. As to food preferences, the family prefer to eat fish and vegetables. They seldom eat meat. While the time of eating their snacks varies at the time they are starving. The family members have vices such as smoking. Lolo Hades, Hypnos, Poseidon and Dionysius and drinks alcohol either 1 bottle of Gin Bilog or 1 bottle each person of Red Horse every day.

METRO MANILA DEVELOPMENT TEST (MMDST) Terpsichore Age: 2 years and 29 days old Date of Assessment: January 11, 2012 PERSONAL-SOCIAL SECTOR Along the Age line: Plays interactive games - Passed

-the child was able to play hide and seek with the examiners Uses spoon spilling little - Passed

-the child was able to use spoon while eating Puts clothing - Failed

-the child wasnt able to put on any other clothing thus she is dressed by her grandmother Removes garment - Failed

-she wasnt able to remove her clothing as observed when she has to take a bath Left of the Age line: Imitates housework - Passed

-the child was able to imitate sweeping the floor Helps in house simple tasks - Passed -the child followed orders like keeping her toys Drinks from cup - Passed

-the child was able hold the cup and drink from it without spilling Right of the Age line: Washes and dries hands - Passed

-the child was able to wash and dry her own hands Separates from mother - Passed

-the child separates easily because she is away from her mother Buttons up - Passed

-the child was able to button her clothes Analysis:

On the personal-social sector along the age line, Terpsichore passed on playing with interactive games and using a spoon spilling little. She failed on putting on clothing however, this is not a delay because 90% of a normal child can perform this by approximately 4 years old and the child is just two years old. Moreover, she also failed in the removing of garments however it is not a delay because 90% of a normal child can pass the task at approximately 2 years and 10 months old and the child is 2 years old. On the tasks on the left and right of age line, she passed all the tasks except for buttons-up however it is not a delay because 25% of a normal child can perform the task at 3 years old. Thus, Celina is considered normal for this sector because she has no delays on the tasks she performed.

FINE MOTOR ADAPTIVE Along the Age line: Tower of four cubes - Passed

-the child was able to tower blocks Imitates vertical line - Passed

-she was able to draw vertical line Dumps Cheese Curls from bottle spontaneously Passed

-she was able to place cheese curls in the bottle and get it out without being shown. Dumps Cheese Curls from bottle demonstrated Passed

-the child was able to place cheese curls from the bottle with demonsration

Left of the Age line:

Neat pincer grasp

- Passed

-the child was able to pick the cheese curls using the end of thumb and index finger with an overhead approach Scribbles spontaneously - Failed

-the child wasnt able to make two or more purposeful markings on the paper Tower of two cubes - Passed

-the child was able to put on block on top of another and balanced it. Right of the Age line: Tower of 8 cubes - Passed

-the child was able balance 8 blocks Imitates bridge - Failed

-the child was not able to imitate bridge the examiner made Copies O - Failed -the child wasnt able to draw O Analysis: On the fine motor adaptive sector, she passed all the tasked along the age line. On the left of the age line, she passed on doing neat pincer grasp and tower of four cubes, however, failed to scribble spontaneously. This is considered a delay because 90% of a normal child can pass this by the age of 18 months and the child is already 2 years old. On the right of the age line, she passed on towering of 8 cubes but failed on imitating a bridge and copies O. This is not considered a delay because 25% of a normal child can perform these tasks at the age 2 years old and 3 1/8 years old respectively and the child is still 2 years old.

LANGUAGE Along the age line: 3 words other than papa, mama -Passed

-the child was able to utter bola, saan and wen Combines two words - Passed

-the child was able to say jak kayat Points to one named body part - Passed

-the child was able to point her nose, eyes and mouth Names 1 picture - Failed

-the child wasnt able to name any of the pictures given Follows directions - Passed

-the child was able to follow directions correctly Left of the age line; Dada or mama nonspecific - Passed

-the child was able to say mama Imitates speech 1 sounds - Passed

-the child was able imitate sound made by the examiner Dada or Mama specific - Passed

-the child was able to say mama

Right of the Age line: Uses plurals - Failed

-the child wasnt able to use plurals Gives 1st and last name - Failed

-the child wasnt able to say her full name Comprehends 3 prepositions -Failed

-the child wasnt able to follow all of the 4 orders correctly Analysis: On the language sector, Terpsichore passed all the tasks along the age line except for naming 1 picture as she cant name the pictures shown. However, this is not a delay because 90% of a normal child can pass the task at the age 3 years and 1.5 months and she is only 2 years old. On the left of the age line, all the tasks like the use of plurals, giving 1st and last names and comprehend 3 prepositions, the client was failed. However, it is not a delay because 25% of a normal child can perform these tasks at 2 years and two months old, 2 years old and 2 years and 11 months old respectively. Thus, she is considered normal for the sector because she has no delays on the tasks she performed.

GROSS MOTOR SECTOR Along the Age line: Kicks ball forward - Passed

-the child was able to kick a ball without holding on to any support Throws ball over hand - Passed

-she throws the ball within arms length of tester Balance on 1-foot 1 sec. - Passed

-she balanced one foot without holding on

Jumps in place

- Passed -she races both feet off of the floor at the same time

Left of the Age line: Walks well - Passed -she was able to walk without difficulty walking and does not tip from side to side Walks backwards - Passed

-she was able to walk three steps backward Walks up steps - Passed

-she can walk up steps as she enters the porch Right of the Age line: Pedals bicycle - Passed -she was able to pedal her own bicycle forward on ground level Broad jump - Failed -she wasnt able to jump once with both feet over the medium bond paper Balance on 1 foot 5 sec. - Failed

-she failed to stand on either foot within 5 seconds or more within 3 trials Analysis: On the gross motor sector, Terpsichore passed all the tasks along the age line. Also, on the left of the age line, she passed all the tasks performed. On the right of the age line, Celina passed on pedals bicycle as she has a bicycle in their house and she usually play with it. However, she failed on doing broad jump and balance on 1 foot within 5 seconds but this is not a delay because 25% of a normal child can perform these tasks 2 years and 5 months old and 3

years old respectively and the child is only 2 years old. Thus, she is normal for that sector because no delays were noted. General Analysis: Based from the result of the Metro Manila Developmental Screening Test (MMDST), the child is considered a normal child because she was able to perform and pass all the items in each sector along her age line except for putting clothes and removing garments under the personalsocial sector. Also, she has delayed on the fine motor adaptive sector (scribbles spontaneously) however no 2 or more sectors with one or more delays are noted or a sector with 2 or more delays plus 1 more sectors with 1 delay, thus making her normal. As observed and tested, there are advancements on the childs growth and development because she was able to perform tasks right of her age line that she will be able to perform in her later life. With regards to the result, the childs growth and development should still be properly monitored and guided to determine if child is undergoing a normal process as she grows and develops.

Polyhymnia Age: 2 years and 24 days old Date of assessment: January 11, 2012

PERSONAL-SOCIAL SECTOR Along the age line: Plays interactive games - Passed

-she was able to play hide and seek with the examiner Uses spoon spilling little - Passed

-the child was able to use spoon when eating Puts on clothing - Failed

The child wasnt able to put clothing by herself Washes and dries hands - Passed

-the child was able to dry and wash her own hands by herself Removes garment - Failed

-the child wasnt able to removes her garment on her own Left of the age line: Imitates housework - Passed

-the child was able to imitate the examiner in sweeping the floor Plays ball with examiners - Passed

-the child was able to play ball with examiner Drinks from cup - Passed

-the child was able to hold the cup and drink from it without spilling Right of the age line: Buttons up - Failed

-the child wasnt able to button up her own cloth Separates from mother easily - Failed

-the child wasnt able to separate from her mother Dresses with supervision - Failed

-the child wasnt able to dress even with supervision Analysis:

On the personal-social sector, Polyhymnia has passed most of the tasks in her age line except for putting on her clothes and removing of garment. Although she failed to perform these tasks, it is not considered a delay because 90% of a normal child can perform these tasks at age 4 and 2 years old respectively. The child has also passed all the tasks on the left of the age line. On the right of the age line, she failed to perform buttons up and separates from mother easily. However, these are not considered as delays because 25% of a normal child can perform these at the age of 2 years old and 2 years old respectively. Thus, the child is considered normal for her age because no delayed on the tasks were noted.

FINE MOTOR ADAPTIVE Along the age line: Tower of 8 cubes - Passed The child was able to tower 8 cubes and balance it - Passed

Imitates vertical line The child was able to draw vertical line

Dumps Cheese Curls from bottle spontaneously -

Passed

The child was able to place cheese curl on the bottle and get it out without being shown

Left of the age line: Tower of 2 cubes Towers of 4 cubes The child was able to tower 4 cubes - Passed The child was able to put a block on top of another block - Passed

Dumps Cheese Curls from bottle demonstrated

Passed

-the child was able to place cheese curls in the bottle and remove it from the bottle as demonstrated Right of the age line: Copies + - Failed -the child wasnt able to copy + Copies O - Failed -the child wasnt able to copy O Picks longer lines - Failed

-the child wasnt able to pick longer line Analysis: The child was able to pass all the tasks along her age line and at the left side of her age line. Therefore, the child is developing normally in relation to her fine motor adaptive skills. Although the child failed to perform the tasks on the right of the age line, it is not considered as a delay since 25% of a normal child can perform these tasks (copy + and copy O) at the age of 3 and 3 respectively.

LANGUAGE Along the age line: Combines 2 words - Passed

-the child was able to say kwak deta Names 1 picture - Failed

-the child wasnt able to name picture

Follows direction

- Passed

-the child was able to follow directions asked by the examiner Points to one body part - Passed

-the child was able to point her nose, mouth and ears Uses plurals - Passed

-the child was able to use plural Left of the age line: 3 words other than Mama and papa - Passed

-the child was able to say saan, wen and lola Dada or mama specific - Passed

-the child was able to say mama and papa to her parents Initiate speech sounds - Passed

The child was able to initiate speech sounds such as pintas Right of the age line: Comprehends cold, tired, hungry - Failed

-the child wasnt able to comprehend cold, tired and hungry Uses 1st and last name -Failed

-the child wasnt able to say her first and last name Comprehends 3 prepositions - Failed

-the child wasnt able to do perform all the orders given by the exminer Analysis:

The child passed all the tasks along the age line except for naming 1 picture. However, this is not a delay because 90% of a normal child can pass this task at the age of 3 years and 2 months of age and the child is only 2 years and 2 months old.

GROSS MOTOR Along the age line: Kicks ball forward - Passed

-the child was able kick ball forward while playing with the examiner without holding on any support Throws ball overhand - Passed

-the child was able to throw ball overhead Balance 1 foot 1 sec. - Passed

-the child was able to balance 1 foot in 1 second Jumps in place - Passed

-the child was able to jump in her own place Pedals bicycle - Passed

-the child was able to pedal a bicycle forward Left of the age line: Walks well - Passed

-the child was able to walks well without help Walks backward - Passed

-the child was able to walk 3 steps backward Walks up steps - Passed

-the child was able to walk up steps as she enter their porch Right of the age line: Broad jump - Failed

-the child wasnt able to jump once with both feet over the medium bond paper Hops on 1 foot - Failed

-the child wasnt able to hop with her one foot Balance on 1 foot 5 sec. - Failed

-the child wasnt able to balance on 1 foot within 5 seconds or within 3 trials Analysis: The child has passed all the tasks along the age line and in the left side of their age line. On the other hand, she has failed to perform the tasks on the right of the age line such as doing broad jump, hops on 1 foot and balance on 1 foot 5 sec. because 25% of a normal child can perform these tasks at the age of 3 years old, 3 years old and 3 years old.

General analysis: Based from the result of Metro Manila Developmental Screening Test (MMDST), the child is considered a normal child because she was able to perform and pass most of the items in each sector along her age line except for putting clothes and removing garments under the personal-social sector and naming one picture under the language sector. As observed and tested, there are advancements on the childs growth and development because she was able to perform tasks right of her age line that she will be able to perform in her later life. With regards to the result, the childs growth and development should still be properly monitored and guided to determine if child is undergoing a normal process as she grows and develops.

Physical Assessment Date: January 13, 2011

Lolo Hades is a 47 year old Filipino. His stated age is not congruent with his apparent age. He is seen lying in bed and is mesomorphic. He wears white sando and brown slacks

during the assessment. Foul odor is observed from the client. He is cooperative by answering questions appropriately. The clients speech is clear and in normal volume. The patient is currently conscious and with intact memory. He has a sound judgment and reasoning. He is welloriented with time, place and person. Vital signs taken as follows: Body Temperature: 36.6oC taken on the right axilla Blood Pressure: 130/100 mmHg taken at the right arm, sitting Respiratory Rate: 19 breaths per min Pulse Rate:73 bpm

HEAD Symmetrically round Skull is smooth in contour with no depression noted Normocephalic No involuntary movements observed Erect and in midline Superficial temporal artery is soft when palpated; not tender The scalp has no lesions

The scalp is lighter and shiny hair is black with gray hair Hair is wavy and thin with no split ends Hair is dry in texture The eyebrows, eyes and ears are symmetrical No swelling; no pain felt by the client No clicking sound when he opens his mouth With intact cranial nerve V and VII-able to do the test without pain and discomfort; there is symmetry of movement of facial muscles.

EYES black with equal palpebral fissure eyebrows are black and evenly distributed Eyelids appear symmetrical with no drooping. Eyelashes and eyebrows are evenly and symmetrically distributed bulbar conjunctivae are pale with no ulcers Palpebral conjunctiva are whitish , moist and free from lesions Sclera is white, no foreign bodies noted cornea is clear and smooth Iris is black Lens are transparent Pupils are equally round and reactive to light and accommodation (PERRLA) with poor visual acuity

EARS

unable to read a size 16 font, 2 feet distance

Ears are equal in size bilaterally. with no lesions, masses or abnormalities noted Upper connection of earlobe is at 10 degrees lower with outer canthus of the eye The color is the same with his facial color With unattached earlobes With good hearing acuity -able to hear and repeat whisper at a distance of 2 feet

NOSE Nasal septum is in midline with no lesions noted No nasal flaring noted no tenderness noted nasal septum located midline with no perforation and lesions noted With intact CN I - able to distinguish different aromatic odors With pinkish nasal mucosa; no discharges noted

MOUTH & THROATH with unusual foul odor noted Lip is brownish, symmetrical, dry without swelling and lesions noted gums are pink, moist and firm with tight margins to the teeth, no lesions noted has upper and lower yellowish teeth

Pinkish, moist buccal mucosa, no lesions noted Tongue is in midline position slightly rough at its dorsal portion ventral surface is smooth, shiny, pink with visible veins. no tenderness, lesions and masses noted

Hard Palate is whitish and bony soft palate is intact and smooth Uvula is positioned midline, pink with no swelling Throat is pinkish and vascular with no swelling exudates and lesions noted Smooth palate has no lesions and malformation noted tonsils appear to be pink

NECK stooped with difficulty in moving his neck upward, downward and sideward with complaints of discomfort No masses and tenderness noted No enlargement noted upon palpation on the thyroid gland Lymph nodes not palpable Trachea is centrally located in midline of the neck

SHOULDERS Shoulders are symmetric without swelling or deformity

fully developed with no redness noted with difficulty in performing full ROM of the shoulders

BREAST CHEST Chest are symmetric Spine vertically aligned Spinal column is straight, right and left shoulders and hips are symmetric Cardiac rate of 80 bpm symmetrical areola is round and dark brown nipples are round no lumps, tenderness and discharges noted upon palpation

ABDOMEN abdominal skin paler than the general skin umbilical skin tones are similar to the surrounding abdominal skin tone umbilicus is in midline at lateral line Abdomen is protuberant Abdominal respiratory movement seen No bruit sound heard over the aorta No friction rub heard over spleen and liver No tenderness or pain reported by the client. Abdomen non-tender and soft

No palpable masses are present

THORAX AND LUNGS: Normal breathing, normal outward expansion of the abdomen and lower ribs Skin and subcutaneous tissue are free of lesions and masses Normal breath sounds Palpation does not elicit tenderness Respirations per minute, relaxed and even

UPPER EXTREMITIES left and right arm are symmetrically aligned nails are dirty and long hard and basically immobile with a capillary refill of 3 seconds

black and dry areas noted on the extremities swelling of both hands noted fresh wounds noted on both hands Skin color darker than the complexion Warm in temperature unable to flex the fingers with difficult ROM of the wrist

LOWER EXTREMITIES Legs are symmetrically aligned

black and dry areas noted on the extremities nails are dirty and long hard and immobile

swelling noted no varicose veins observed fresh wounds noted on both extremities equal hair distribution Warm temperature Skin color darker than the complexion unable to perform ROM of the ankles unable to move finger toes

Physical Assessment Date: January 13, 2011

Aphrodite is a 22 year old Filipino. Her stated age is congruent with her apparent age. She is appropriately dressed with the weather. She is mesomorphic and no foul odor was observed from the client. The client projects a good mood and is very conversant. The patients speech is in normal volume. Vital signs are taken as follows: BP: 110/70 mmHg taken at right axillary area

RR: 18 bpm PR: 83 bpm Temperature: 36.6oC taken at the right arm in sitting position Hair and Scalp Hair dry and brittle upon inspection Hair evenly distributed No masses, depressions and tenderness noted Scalp intact, moist and with no scars noted Scalp slightly lighter than the faces color Head and Face Head has no involuntary movement Head is hard and smooth without lesions Face is symmetric Face is brown in complexion CN IV intact EEN Eyes Able to pop out cheeks Able to raise and lower eyebrows Able to bare teeth Able to smile broadly

 Eyes black with equal palpebral fissure Eyebrows black and evenly distributed Eyelids are symmetrical Eyelashes black, curved outward and evenly distributed Eyeballs are symmetrically aligned Both conjunctivae clear, moist and smooth Sclera white Cornea clear and smooth Iris black Clear lens PERRLA

Ears Ears bean shaped, parallel and symmetrical Ears are equal bilaterally Skin is smooth with no lesions, lumps or nodules. Auricle slightly higher 10 degrees with the outer canthus of the eye with no lesions, masses or abnormalities noted. Small amount of cerumen is present. (Odorless, yellowish in color) Nose Color is the same with the clients face (brown) With patent nostrils

 No lesions, mass and lumps noted

Mouth and Throat Lips are pink, moist with no lesions Thirty two slightly yellowish in color Gums is moist and pinkish in color Buccal mucosa is smooth and moist Tongue is moist and pinkish with no lesions No unusual odor Throat is pink with no lesions and secretions noted Uvula hangs freely in the midline

Neck Symmetric with head centered and no bulging masses noted. Thyroid cartilage move upward as the client swallows Able to flex and extend Trachea is midline Chest RR of 18 bpm CR of 83 bpm Abdomen Rounded in shape

 Abdomen is symmetric Abdominal respiratory movement is seen Abdomen is slightly lighter than the general skin color Linea nigra and stria gravida is present on the sides of the umbilicus. Umbilicus skin tone are similar to abdominal skin tone Umbilicus is midline at lateral line Upper extremities Brown in color Symmetric Nails are hard and basically immobile Good capillary refill of 2 seconds No involuntary movements Temperature is warm and even With normal association With normal motor function With full ROM Lower extremities Brown in color Symmetric Nails are hard and basically immobile Good capillary refill of 1.8 seconds No involuntary movements

 Temperature is warm and even With normal association With normal motor function With full ROM

V. Values, Habits, Practices on Health Promotion, Maintenance and Disease prevention With regards to the family members immunizations, Lola Athena claimed that the family members were immunized. As to Lolo Hades and Lola Athena, they received BCG, DPT and OPV during their time as claimed by Lola Athena. On the other hand, Aphrodite and her siblings were also immunized. She mentioned that they received BCG, DPT, OPV, Hepa B, and antimeasles. Aphrodite also received 4 doses of Tetanus Toxoid vaccines. She is still scheduled to receive the last dose of Tetanus Toxoid this February. As to the two children in the family, Terpsichore received BCG, 3 doses of DPT, 3 doses of OPV, 3 doses of Hepa B and antimeasles. Polyhymnia also received BCG, 3 doses of DPT, 3 doses of Hepa B, OPV and antimeasles. Lola Athena claimed that they are trying their best to maintain a healthy lifestyle. They eat a lot of green vegetables. Jogging is also the form of exercise of Poseidon, 30 minutes to 1 hour early in the morning around their neighbourhood (barangay road). They also visit RHU and MMMH & MC for check-up as much as possible. It is also their habit to use disinfecting alcohol for proper hygiene. They do hand washing before and after meals. They also use mosquito nets and spray Baygon as protection against mosquitoes. However, most of the members dont use slippers inside their house and whenever they are inside the bathroom. Even the children do no wear slippers when they are inside the house or outside the house playing. All the family

members take a bath one to two times a day usually in the morning except for Lola Hades that takes a bath twice a week because of his inability to move out from bed. Other family members would carry him in going to the bathroom and Lola Athena would assist him in taking a bath and grooming. Also he asked assistance when he eats, voids and defecate. With regards to their spiritual well-being, they dont usually go to church. They claim that they just go to church twice a month. However, Lola Athena said that they still acknowledge the almighty God as the highest Supreme Being. They also teach Terpsichore and Polyhemia to pray every night to enhance the childrens faith in God. The family usually sleeps at 8:30-9:00 pm except for Poseidon who sleeps around 11:00pm because he spends his time strolling outside the house. They wake up at around 5:307:00 am. Aphrodite claimed that the 2 children sleep/nap every afternoon and sometimes other members of family also take a nap in the afternoon whenever they feel tired. Almost all of the family members were busy with their works and doing different chores. They do not have enough time to have their exercise every morning but Aphrodite claimed that Poseidon is the only member in the family who exercise every morning. He jogs within the community for the maximum duration of 1 hour The Greek family practices measures to prevent the existence of diseases since their family includes children who are very vulnerable to different agents of diseases. One practice is wearing of slippers outside their house however they do not practice wearing of slippers inside the house. The presence of canals around the house, rodents and mosquitos may thrive there so the family use mosquito nets especially during night time to prevent the occurrence of Malaria and Dengue. Aphtodite also claimed that they sweep the floor every day since children are fond of sitting and lying on the floor.

The Greek family practices relaxation and other stress management such as watching television every after work to let themselves loosen up their long hours of tiring work. They also visit their neighbour to have some talk and to relax themselves.

FIRST LEVEL ASSESSMENT 1. Presence of Wellness Condition A. Healthy Lifestyle Supporting cues: The Greek Family eats their meal three times a day. They also have their snacks in the morning and in the afternoon. They eat variety and balance of foods in moderation such as fish, meat and vegetables which are rich in protein, iron, vitamins and minerals. The children drinks purified water whereas adults drink boiled water. One member of the family, Poseidon, engage in physical activity by jogging around their neighbourhood for about 30 minutes to 1 hour every early in the morning. They practice proper sanitation through the use of alcohol and hand washing techniques before meals. All of the family members practice Most of them also practice proper hygiene by bathing 1-2 times a day, tooth brushing 2-3 times a day and proper grooming with the exception of Lolo Hades. They also use mosquito nets and Baygon spray.

B. Health Maintenance Supporting cues: The family makes use of the available health facilities in their community such as the RHU and MMMH & MC for their health maintenance and medical check-ups. Terpsichore and Polyhymnia received their

immunizations such as BCG, 3 doses of DPT, 3 doses of Hepa B, 3 doses of OPV and anti-measles. Aphrodite also received the TT1-TT4 vaccines and scheduled to receive TT5 on February. She also takes Ferrous Sulfate 1 tab once a day as supplement. Lolo Hades takes Ampalaya plus 250 mg capsule thrice a day, Mefanamic Acid 500 mg capsule, Tramadol 25 mg capsule TID and Allupurinol 500 mg thrice a day for gout. Lola Athena also takes Amlodipine 10 mg

C. Spiritual Well-Being Supporting cues: They teach children to offers prayers every night to enhance their faith in God even though they are not attending religiously. D. Social Well-Being Supporting cues: They participate in community programs and activities such as Oplan Dalus, Barangay Fiestas and basketball tournament. 2.) Presence of Health Threats A. Accidents Hazards Supporting cues: There are piles of woods in their kitchen at the side of their house which are reachable by children. There is also a rusting galvanized iron with no frame used as a door in the toilet. a.) Fire hazards There is one earthen stove which is placed in a wooden beam and it is close to the wooden beam by 1.5 meters. They also have an open electrical outlet which is reachable by children and their electric wires are uncovered with PVC pipe. b.) Fall hazards There is an open canal at the right side of their house mat which is 2 m deep with 1x2 m bridge that doesnt have rails. They have a porch where the children usually play which is elevated about 8 inches from the ground and the baluster where children could reach.

C. Poor home/ environment condition/ sanitation a.) Inadequate living space Supporting cues: The Greek familys house has only 2 small bedrooms with one single bed on the first room and use only foam bed on the other room. Lola Athena and Terpsichore lay a mat on the living room where they sleep sometimes. Dionysius and Poseidon would also lay a mat in the living room or sleep in their uncles house adjacent to their house. A single bed is located on the kitchen area where Hypnos and Artemis sleep. b.)Improper drainage system Supporting cues: They have an open drainage system from their bathroom to the open canal where water is kept stagnant for a long period of time. c.) Improper garbage disposal Supporting Cues: The family throws their garbage in the canal that impedes the flow of the water and not practicing proper garbage segregation

d.) Presence of breeding or resting sites of vector diseases Supporting Cues: There is an uncovered earthen jar used to store water in their toilet and untrimmed tall plants. There are also pile of woods placed in their kitchen and presence of rodents, roaches and mosquitoes are seen. There are also mosquitoes and flies in the stagnant water and the trashes in the canal.

D. Unhealthy lifestyle and personal habits and practices a.) Alcohol drinking Supporting Cues: Lolo Hades, Hypnos, Dionysius and Poseidon drinks 1 bottle of GSM bilog or 1 bottle each of Red Horse every day. b.) Cigarette Smoking Supporting Cues: Lolo Hades, Hypnos, Dionysius and Poseidonengage themselves in cigarette smoking . Lolo Hades consumes 5 sticks a day of mighty(green) whereas, Poseidon, Dionysius and Hypnos can consume at least 5 sticks of Marlboro(red) a day. c.) Walking barefooted Supporting Cues: Terpsichore and Polyhymia were observed walking barefooted outside their surroundings while playing. 3. Presence of Health Deficits a. Asthma Supporting cues: Dionysius, Hypnos and Poseidon are the family members who has Asthma. b. Hypertension Supporting Cues: Lola Athena has a hypertension.

c. Diabetes and Gout Supporting Cues: Lolo Hades has a Diabetes Mellitus and Gout in their family d. UTI Supporting Cues: Aphrodite who is 5 months pregnant was diagnosed to have a UTI 4. Presence of Stress points a. Additional member Supporting Cues: Aphrodite is on her second trimester of pregnancy (5 months). Her pregnancy is unplanned and which needs adjustments among the family members and demands additional financial support to facilitate the needs and care of the newborn. b. Illegitimacy Supporting Cues: Terpsichore, the daughter of Hera was left to her grandparents after Hera decided to reside with his new husband, Eros in Paoay.

FAMILY COPING INDEX

NINE AREAS 1. Physical Independence

RATE 3

JUSTIFICATION All of the members of the family are able to take care of themselves and perform physical independence except for Lolo Hades and the two children, Terpsichore and Polyhymnia. Lolo Hades was not able to get out of bed, walk and take care of his daily grooming since he is suffering from diabetes mellitus and gout which causes limited movements and discomforts. He usually seeks assistance from the other family members when he eats, void, defecate, and take a bath and when he wants to move out of bed. The other family members carry him in going to the bathroom and Lola Athena would assist him in taking a bath and in grooming. As to the two children, they are not able to perform individual task such as bathing, grooming, eating, bladder and bowel elimination alone because they are still in the stage of developing these developmental milestone.

2. Therapeutic competence

The Greek family seeks medical attention by going to RHU and MMMH &MC when there are presence of diseases. Aphrodite utilized the RHU for her weekly prenatal check-up and adhering to the medications prescribed

for her UTI. Lola Athena also go to RHU/sibling(nurse) for BP moitoring and taking the prescribed medicine for her Hypertension. Dionysius, Hypnos and

Poseidon were prescribed nebulizations when their Asthma attacks, which they carry out safety and efficient. However they are not competent enough in modifying their

lifestyle due to evident continuous smoking. Also with Lolo Hades, he was prescribed to take medications for his Diabetes and Gout however he is still engaging himself to smoking and alcohol drinking. 3. Knowledge of Health Condition 3 Some members of the family are aware and knowledgeable about some illnesses that would affect their family but they are inadequately informed of its underlying principle such as prevention and intervention measures. Lolo Hades was diagnosed to have Diabetes mellitus and gout and prescribed with medications about 2 years ago. His last check-up was one year ago and were prescribed with Ampalaya plus as a

supplemental medication for his DM and Allupurinol and Mefenamic acid for his gout. At present, he still manifests these diseases and still he manage to drink alcohol 1 bottle of GSM bilog a day and smoke 5 sticks of cigarettes a day. Other family members like Hypnos, Dionysius and Poseidon smoke at least 5 sticks of cigarette a day and drinks

alcohol even though they have asthma. 4. 4. Application of Principle of General Hygiene 3 The family did not fail to apply general principles of hygiene. As to their family

nutrition, meals are served well three times a day. They eat balanced and variety of foods in moderation such as protein and iron rich food. The children drink purified water and boiled water for adults. They practice

protective measures to prevent the existence of diseases such as using mosquito nets on the two bedrooms and use Baygon spray. The family members also wear slippers outside the house, but sometimes they dont wear when they go to the bathroom. The two children also are not wearing slippers inside and even outside their house while playing. The family also practices proper hand washing before and after meals and the use of disinfecting alcohol for sanitation. Most members of the family take a bath one to two times a day usually in the morning, however, Lolo Hades who is bedridden only take a bath every week. Most of the family

members brush their teeth 2-3 times a day and enough sleep. 5. Health Attitudes 3 The family accepts health care with some degrees but with reservation. The family is aware of the health facilities such as RHU and MMMH & MC. In the case of Lolo Hades who has a DM and Gout, the family accept the health condition and they are

willing to help him however one year ago was their last consultation and they never continue to seek health care facilities even if evident manifestations of the diseases are still seen. Some members use OTC drugs for their common cold and coughs. When illnesses arise, they accept it calmly and finds way for recovery and rehabilitation 6. Emotional Competence 3 The family is able to face lifes stresses and problems with maturity and with reasonable degree of emotional calm.

Misunderstandings are easily solved in their family since it only last for an hour or more. Since two members are 2 years of age, these members dont have much capacity to face reality with maturity and emotional control. 7. Family Living 5 The family gets along with each other and seldom have rivalries or conflicts among them. The family solve their problem as soon as possible as evidenced by discussing issues and talking to each other with respect. The family also practices division of labor among the family. They also respect each others feelings and attitudes therefore they can adjust with each other easily. 8. Physical Environment 3 The familys house needs some repair and improvement such as their toilet room since they have a rusty galvanized door without frame and the earthen jar with water is not covered. The water which they use in bathing, washing of clothes and dishes goes

directly to the open canal and the canal has stagnant water and lots of garbage, this will serve as breeding sites of rodents and mosquitoes. Piles of woods are also scattered in the side of their house. The canal has a 1mx2m bridge without rails that could cause risk for fall especially to the children. They use an eathen stove inside their house which is placed in a wooden board. The earthen stove is also 1.5 m away from the wooden beam. 9. Use of community facilities The family is aware of the community facilities such as the RHU and MMMH & MC for health maintenance and check-ups. Aphrodite being 5 months pregnant does her prenatal check- up every week. They are aware who and where to call help and attention when illness arises. They are not members of the organization or clubs in their barangays however they are participating in barangay activities such as Oplan Dalus, Brgy Fiesta and Basketball tournament

SECOND LEVEL ASSESSMENT A. Accident Hazards Inability to provide home environment conducive to health maintenance and personal development due to negative attitude in life which is not conducive to health maintenance and personal development as evidenced by scattered piles of woods in the kitchen and at the side of their house which are reachable by children, an earthen stove in the kitchen placed in a wooden board open electric outlet with uncovered electric wires, uncovered canal of 2 m deep and narrow bridge (1x2 m) without rails and elevated porch about 8 inches from the ground with a baluster reachable by children. C. Poor home/environment condition/sanitation Inability to provide a home environment conducive for health maintenance and personal development due to inadequate family resources specifically financial constraints and limited financial resources as manifested by utilization of kitchen and living room as sleeping area and sleeping of the other family members in their uncles house which is adjacent to their house to accommodate the 9 family members Inability to provide a home environment conducive to health maintenance and personal development due to inadequate knowledge of preventive measures as evidenced by improper drainage system since the water used for bathing, washing their clothes and dishes directly flows to the canal.

Inability to provide home environment conducive to health maintenance and personal development due to negative attitude in life which is not conducive to health maintenance and personal development as evidence by improper garbage disposal such as throwing garbage in the canal, burning and not practicing proper segregation. Inability to provide home environment conducive to health maintenance and personal development due to negative attitude in life which is not conducive to health maintenance and personal development as manifested by uncovered earthen jar with water in their toilet, stagnant water in the canal, pile of woods and untrimmed bushes which are evidence of breeding sites of mosquitoes, flies, rodents and roaches. D. Unhealthyl lifestyle and personal habits and practices Inability to recognize the presence of the condition due to negative attitude in life which hinders recognition of a problem as manifested by continuous alcohol drinking and smoking at least 5 sticks of cigarettes every day by Lolo Hades. Inability to recognize the presence of condition due to inadequate knowledge about the possible effects of walking barefooted as evidenced by not wearing of slippers inside and outside the house when playing. E. Illness states Inadequate knowledge about the disease/health condition as manifested by continuous cigarette smoking of Lolo Hades, that would worsen his current condition and of Dionysius, Hypnos and Poseidon that would trigger the occurrence of their Asthma.

Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to prolonged disease or disability progression which exhaust supportive capacity of the family member as evidenced by lack of concern for regular check-ups of Lolo Hades, lack of necessary care such as daily bathing, cleaning of wounds and enhances ROM and tolerating him to continue drinking alcohol and smoking cigarette despite his current condition. F. Foreseeable Crisis Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member due to lack of knowledge about development and care of the child.

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES A. ACCIDENT HAZARD Criteria 1. Nature Problem of Computation the 2/3 x 1 Actual Score 0.67 Justification This is a health threat since the pile of woods, earthen stove placed in a wooden board inside their kitchen, open reachable electric by outlet children,

uncovered electric wires, open canal of 2 meter deep with and narrow bridge (1m x 2m) without rails and elevated porch with baluster reachable by

children can cause injuries and accidents to the

members of the family especially the children.

Moreover, the unfixed and unframed rusting

galvanized door in their toilet can harm and injure any individual thin the family.

2. Modifiability of 2/2 x 2 the Problem

The

problem

is

easily

modifiable since the pile of woods can be kept and properly arranged in a safer place which cannot be

reachable by the children. The family can also use alternative materials such as bamboos in making temporary fences along the canal and temporary rails for the bridge. Accidents from fall are easily adult

modifiable if the

member of the family will supervise and watch over the children during

playtime. The family can put their earthen stoves at the back of their house or remove the wooden board to prevent fire. It is also the responsibility of the family member to look over the food they are cooking to lessen the risk of fire. 3. Preventive Potential 3/3 x 1 1 Accidents can be prevented if they recognize the

dangers of the problem and if they have in adequate providing

knowledge

protective

measures

to

prevent accidents and if they will cultivate positive attitude towards

improvement and safety of their environment. 4. Salience 0/2 x 1 0 The family does not

recognize the existence of the problem since they are already used to that kind of environment. The family

does not also allot money and intend to improve their facilities and does not mind the dangers of hazards due to their negative attitudes in life. Total Score 3.67

B. INADEQUATE LIVING SPACE Criteria 1. Nature Problem of Computation the 2/3 x 1 Actual Score 0.67 Justification This is a health threat to the family since they stay in an inadequate may lead space to which

improper easy of diseases.

ventilation transmission communicable

and

Their sleeping arrangement will also bring stress points to the family members and

it may interfere with their sleeping pattern which may lead to inadequate rest and sleep necessary for

maintaining wellness. 2. Modifiability of 1/2 x 2 the Problem 0.5 This is partially modifiable because it needs time,

effort and most especially financial resources and

adequate space are needed to completely modify the problem. However, through health teachings and

complete work force of the family members they could somehow organize the

things in their house to accommodate more space to promote wellness and comfort to the family. 3. Preventive Potential 1/3 x 1 0.33 The family cannot prevent the problem easily due to financial constraints and inadequate construct space to

additional

facilities (bedrooms) for the improvement of their and living

comfort condition 4. Salience 0/2 x 1 0 The

family

does

not

recognize the existence of

the problem since they are already used to that kind of environment and there are no concerns coming from the family members about their sleeping arrangement. Despite of their adequate family income, they do not tend to save money to improve and construct

additional house facilities. Total Score 1.5

C. IMPROPER DRAINAGE SYSTEM

Criteria 1. Nature Problem of

Computation the 2/3 x 1

Actual Score 0.67

Justification This is a health threat since this could be a breeding site for mosquitoes and harmful microorganisms which can cause diseases among the family members.

2. Modifiability of 1/2 x 2 the Problem

0.5

The

problem

is

easily

modifiable since they can have a general cleaning and clearing of the canal to allow proper drainage of water. They could also spray insecticide to

terminate the breeding site of mosquitoes and vectors.

It

is

easily

modifiable

because we can impart health teachings regarding the importance of proper drainage system therefore increasing the awareness of the family members that cleanliness is necessary to uphold safe and healthy environment. 3. Preventive Potential 3/3 x 1 1 The problem is highly

preventable if they will understand the possible

threat of improper drainage system. Moreover, it is also preventable if the family will carry out all the

possible

preventive

measures such as cleaning and clearing out of the canal to maintain the flow of water and spraying

insecticides to terminate the breeding site which will decrease the risks of

acquitting diseases brought about by improper drainage system. 4. Salience 0/2 x 1 0 The family does not

recognize the existence of the problem because they

still let the water to flow to the canal and continue

throwing plastics and other garbage that causes

stagnation of water. The family doesnt intend to clean and clear out waste that impedes the flow of their drainage system. Total Score 2.17

D. Improper Garbage Disposal

Criteria 1. Nature Problem of

Computation the 2/3 x 1

Actual Score 0.67

Justification This is a health threat since improper disposal of

garbage especially on the canal will impedes the flow of water that will result to stagnation which is a good breeding mosquitoes sites and of other

vectors that could cause diseases such as dengue and malaria. 2. Modifiability of 2/2 x 2 the Problem 2 The problem is easily

modifiable because health teachings on the possible effects of improper garbage disposal could be imparted which will enhance the

awareness of the family on the importance of proper garbage disposal and

segregation. It is also easily modifiable if the family will carry out and apply health teachings imparted to them. 3. Preventive Potential 3/3 x 1 1 The problem is highly

preventable by informing and encouraging the family to practice recycling and proper segregation instead of throwing the garbage in the canal. They could also use some of their natural resources to make some containers for their wastes.

4. Salience

0/2 x 1

The

family

does

not

recognize the existence of the problem. Total Score 3.67

E. PRESENCE OF BREEDING OR RESTING SITES OF VECTORS OF DISEASE Criteria 1. Nature Problem of Computation the 2/3 x 1 Actual Score 0.67 Justification This is a health threat because the uncovered

earthen jar in their toilet; untrimmed bushes and

stagnant water in the canal are good breeding sites of

mosquitoes

that

could

result to dengue, malaria, and other diseases. Pile of woods in the kitchen is also good breeding place for rodents and cockroaches. 2. Modifiability of 2/2 x 2 the Problem 2 The problem is easily since could be

modifiable interventions

easily done such as proper cleaning of the canal for the continuous flow of water, covering of the

earthen jar in the toilet room and trimming the bushes. Proper pilling of woods in the kitchen would also eradicate the presence of rodents and cockroaches. 3. Preventive Potential 3/3 x 1 1 The problem is highly

preventable through proper health teachings such as in preventing the possible

effects involved to this problem accompanied by the compliance of the

family members to trim long bushes, cover the earthen jar and arrange properly the pile of woods that will prevent and

eradicate the presence of breeding sites of vectors of diseases. 4. Salience 0/2 x 1 0 The family does not

recognize the existence of the problem. Total Score 3.67

F. ALCOHOL DRINKING

Criteria 1. Nature Problem of

Computation the 2/3 x 1

Actual Score 0.67

Justification This is a health threat since too much consumption of alcohol may increase their risk of developing serious liver problems. could the Alcohol also current

drinking aggravate

condition of Lolo Hades. 2. Modifiability of 1/2 x 2 the Problem 1 It is partially modifiable because drinking alcohol is highly addictive and it is already a part of their lifestyle. giving However, health by

teachings

about the effects of alcohol drinking, it can motivate them to quit alcohol

drinking and improve their lifestyle. 3. Preventive 2/3 x 1 0.67 The problem is moderately

Potential

preventive cannot

since ask

you the

totally

members to quit drinking alcohol. Nevertheless, by giving they health will education, lessen amount the of

frequency

alcohol consumption. 4. Salience 0/2 x 1 0 The family does not

perceive the problem. Total Score 2.34

G. CIGARETTE SMOKING

Criteria 1. Nature Problem of

Computation the 2/3 x 1

Actual Score 0.67

Justification This is a health threat since cigarette increase developing smoking their risk may of

respiratory

problems especially some of them have cases of asthma. With regards to Lolo Hades, cigarette

smoking could trigger and worsen his current illness. 2. Modifiability of 1/2 x 2 the Problem 1 It is partially modifiable because cigarette smoking of Lolo Hades is tolerated by the members of the family. However, health

teachings on the effects of the cigarette smoking can motivate them to quit and improve their lifestyle. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventable cannot since ask you the

totally

members to quit smoking. 4. Salience 0/2 x 1 0 The family does not

perceive the problem. Total Score 2.34

H. WALKING BAREFOOTED

Criteria 1. Nature Problem of

Computation the 2/3 x 1

Actual Score 0.67

Justification This is a health threat since walking barefooted could cause injuries and accidents to family members

especially on children. 2. Modifiability of 2/2 x 2 the Problem 2 It is easily modifiable

because encouraging the children to walk with

slippers could be done to minimize eradicate the the or cause to of

accidents and the transfer of microorganism to them. 3. Preventive Potential 3/3 x 1 1 The problem is highly

preventable by enforcing the children the rule of

wearing slippers at home to prevent risk of injuries and accidents. 4. Salience 0/2 x 1 0 The family does not

recognize the existence of the problem. Total Score 3.67

I. ILLNESS STATES

J. ILLNESS STATES Hypertension Criteria 1. Nature Problem of Computation the 3/3 x 1 Actual Score 1 Justification This is a health deficit because the Hypertension of Lola Athena conditions may greatly affect their daily routine and activities for daily living. Eating pattern for example is

altered due to different food restrictions. Presence of this condition could lead to development of other problems thus, affecting overall health being of the sick family. 2. Modifiability of 1/2 x 2 the Problem 1 It is partially modifiable because even though they have medications or access members of the

to health care facilities to improve their condition Lola Athena doesnt limit her time in walking to sell smoked fish walking. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventive because Lola Athena could so some could to to

relaxation removed lessen

that her her

stress risk

hypertension. 4. Salience 2/2 x 1 1 The family perceives the problem needing

immediate attention. Total Score 3.67

Asthma Criteria 1. Nature Problem of Computation the 3/3 x 1 Actual Score 1 Justification This is a health deficit because the Asthma of Dionysius and Poseidon is within the family. These conditions may greatly

affect their daily routine and activities for daily living. Presence of these conditions could lead to development of other

problems thus, affecting

overall health being of the sick family. 2. Modifiability of 1/2 x 2 the Problem 1 It is partially modifiable because even though they have medications or access to health care facilities to improve they their condition in members of the

still

engage

unhealthful lifestyle such as drinking alcohol and smoking cigarette. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventive because

presence of these different conditions cannot be totally eradicated however, it can be controlled by imparting health education to provide proper management and

care therefore, improving the wellness condition and physical competence of the sick members. 4. Salience 2/2 x 1 1 The family perceives the problem needing

immediate attention. Total Score 3.67

Diabetes Mellitus Criteria 1. Nature Problem of Computation the 3/3 x 1 Actual Score 1 Justification This is a health deficit because the Diabetes

Mellitus of Lolo Hades is present within the family. These condition may

greatly affect their daily routine and activities for daily living. Eating pattern for example is altered due to different Presence food of

restrictions.

this condition could lead to development of other

problems thus, affecting overall health being of the sick family. 2. Modifiability of 1/2 x 2 the Problem 1 It is partially modifiable because even though Lolo Hades have medications or access to health care members of the

facilities to improve his condition he still engage in un healthful lifestyle such as drinking alcohol and smoking cigarette. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventive because

presence of these different conditions cannot be totally eradicated however, it can be controlled by imparting health education to provide proper management and

care therefore, improving the wellness condition and physical competence of the sick members. 4. Salience 2/2 x 1 1 The family perceives the problem needing

immediate attention. Total Score 3.67

Gout Criteria 1. Nature Problem of Computation the 3/3 x 1 Actual Score 1 Justification This is a health deficit because the Gout of Lolo Hades is present within the family. This condition may greatly affect their daily routine and activities for daily living. Presence of this condition could lead to development of other

problems thus, affecting overall health being of the sick family. members of the

2. Modifiability of 1/2 x 2 the Problem

It is partially modifiable because even though Lolo Hades have medications or access to health care

facilities to improve his condition he still engage in un healthful lifestyle such as drinking alcohol and smoking cigarette. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventive because

presence of Gout cannot be totally eradicated however, it can be controlled by imparting health education to provide and proper care

management

therefore, improving the wellness condition and

physical competence of the sick members. 4. Salience 2/2 x 1 1 The family perceives the problem needing

immediate attention. Total Score 3.67

K. Presence of Stress Points/ Foreseeable crisis a. Additional member

Criteria 1. Nature Problem of

Computation the 1/3 x 1

Actual Score 0.33

Justification This is a foreseeable crisis for the family since the pregnancy of Mrs.

Aphrodite is unplanned and this demands additional

financial support for the needs and care for the incoming member of the family; it needs preparation from prenatal to

postpartum care. Also the incoming member of additional the family

needs space since their house is just enough for them summing it up this will result to occurrence of stress points. 2. Modifiability of 1/2 x 2 the Problem 0.5 The problem is partially modifiable since Aphrodite is still on her 5th month of pregnancy which means she will have enough time to save or work for money that will support her child financially. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventive because health education can be imparted

to the family members especially Aphrodite ways to regarding Mrs. the

on adjusting and

preparing on her pregnancy and the coming of the newborn. Teachings on

earning and saving money could also be imparted. 4. Salience 2/2 x 1 1 The family does not

perceive the problem. Total Score 2.5

b. Illegitimacy Criteria 1. Nature Problem of Computation the 1/3 x 1 Actual Score 0.33 Justification This is a foreseeable crisis since the absence of the parents (Hera and Eros) on the daily life of their daughter, Terpsichore, has a great impact on the growth and development of the child. Their daughter is already in toddlerhood

wherein parents are the most significant person in her life. Their absence will affect her overall wellbeing especially on her

emotional

development

which will be observed as Terpsichore progresses on her development. 2. Modifiability of 1/2 x 2 the Problem 0.5 It is partially modifiable since the presence of her grandmother, Athena, will compensate the absence of her parents. Lola Athena is capable of providing

necessary needs and care that could help in the development of

Terpsichore. The family could somehow convince the male family members to be a father figure to Terpsichore. They should also look for a way for Terpsichore to cope with this situation by

maintaining communication and

bonding to her biological parents. 3. Preventive Potential 2/3 x 1 0.67 The problem is moderately preventive Terpsichore because cannot

immediately adopt herself with her biological mother since she already

established

tight

relationship to the family members especially to her grandmother. However, it is still necessary for her to acknowledge the presence of her biological parents by means bonding continuous of providing time and open

communication especially during her years of

development. 4. Salience 1/2 x 1 0.5 The family perceives the problem not needing

immediate attention. Total Score 2

OVER-ALL RANKING OF THE HEALTH PROBLEMS

Rank 2.5

Total Score 3.67

Problem Accident hazard Improper garbage disposal Presence of breeding or resting sites of vectors of disease Walking Barefooted Illness states

5 6.5

2.5 2.34

Additional family member Alcohol drinking Cigarette smoking

8 9 10

2.17 2.0 1.5

Improper drainage Illegitimacy Inadequate living space