Concept: Care of Mother, Child, Family, Population Groups and Community

Inclusive Dates: August 30-31, September 1,6-8, 13-15 2012

Group 5 BSN II-AP Joji Castellano, RN, MAN Clinical Instructor

Specific Objectives:

After 2 hours of CHN-Case Presentation, we will be able to: impart the data gathered in the Comprehensive Family Survey. prioritize the 5 Family Nursing Problems gained from assessment. categorize the cues/data and Family Nursing Problems through the Typology of Nursing Problems in Family Nursing Practice which consists of the first and second level assessment. prioritize the 5 Family Nursing Problems through ranking with the criteria : Nature of the problem, Modifiability of the problem, Preventive Potential, Salience. formulate the appropriate Family Nursing Care Plan for each Family Nursing Problem. provide readings or updates about the interventions applicable to the most prioritized Family Nursing Problem.

The Lumambas residence is made of concrete and wood, and they are renting. They are informal settlers. They have electric supply. Their means of cooking , is through charcoal burning. Their source of water is MCWD. Their medical sources are midwife and doctor. Their way of garbage keeping is through the use of garbage can and their garbage disposal is collected by garbage truck. They have excreta disposal pour flush/pail system. The number of couples in the family are two, Aniceta and Severino who is married for 40 years and Rodulfo and Rowena who is married for 12 years. They have minimal knowledge about Family planning and their source of information are the Barangay heath workers, Student Nurses and midwife. The type of family planning method they use mostly is pills and their reason for choosing the method is that it is affordable and satisfactory. The hereditary diseases common to the history of the family are hypertension and asthma. Their usual diet are vegetables, fish and rice . Their type of family is extended. Rica Maes weight at birth is 6 lbs and her brother Randyl is 7 lbs. In their immunization BCG (3 Doses), OPV (3 Doses), DPT (3 Doses), Measles and Hepa B vaccines. The type of feeding administered by the mother to her children during infancy is breastfeeding.

Rank

1st

Family Nursing Problem Foreseeable crisis situations for pregnancy

Score

4.83

2nd
3rd 4th 5th

Malnutrition
Hypertension Poor environmental Sanitation Presence of Breeding sites and insects

4
4 3 2/3 2 2/3

First Level of Assessment (Cues/Data) Family planning is not always practiced by the couples in the family. Mrs. Aniceta Lumambas verbalized Unsa diay birth space....unsa gane to? Ah oh birth spacing diay na?... Contraceptive? Unsa na?... Randyl and Rowena , whenever engaging in sexual intercourse , only uses condoms when they have the money to buy.

Second Level of Assessment (Family Nursing Problem) A. Foreseeable crisis situations for parenthood and pregnancy 1. Failure to utilize community resources for health care due to: a. Lack of knowledge of community resources for healthcare. b. Failure to perceive the benefits of health care/services. 2.Inability to recognize the presence of the condition or problem due to: a. Lack of knowledge b. Philosophy in life which hinders recognition.

First Level of Assessment (Cues/Data) Rica Mae, 11 years old weighs 39 kgs., Looks pale, lethargenic and apathenic, markedly underweight and undernourished.

Grandmother verbalized Naa man gyud panagsa masakpan na sa akong anak nga kining akong mga apo perti kayo mukaon ng mga junkfoods imbis gulay unta ug prutas ang angay ,sus perti jud! Mao sigurong mukaon ni silag pag ayo wala gihapoy pagtambok.
Two preschool members usually are left to the school when parents are working Mother and father are very busy helping earn a living that they could hardly see to the needs of the children. Appetite loss of eating nutritious foods.

Second Level of Assessment (Family Nursing Problem) B. Malnutrition as a health deficit 1. Inability to recognize the presence of malnutrition in a dependent member due to lack of knowledge. 2. Inability to decide about taking appropriate health action due to failure to comprehend the nature, magnitude and scope of the problem 3. Inability to provide adequate nursing care to a members suffering malnutrition due to: a. Lack of knowledge about the health condition b. Lack of knowledge on the nature and the extent of nursing care needed c. Inadequate resources for care, responsible family member and financial constraints.

First Level of Assessment (Cues/Data) Mrs. Anecita has the following vital signs: T- 35.6 C P- 76 bpm R- 16cpm BP- 180/100 mmHg Mrs. Anecita verbalized usahay maliponko basta magdugay ug barog nya ako rang bira-birahon akong buhok nya ako sad pislit-pisliton akong kamot.

C. 1.

2.

a.

b.

Second Level of Assessment (Family Nursing Problem) Hypertension as a health deficit Inability to recognize the presence of the condition or problem due to inadequate knowledge. Inability to make decisions with respect to taking appropriate health action due to: Failure to comprehend the nature or magnitude of the problem or condition Fear of consequences of actions specifically: Economic consequences.

Exposed to the heat of the sun from 7am-3pm everyday while vending vegetables.

First Level of Assessment (Cues/Data) -

Second Level of Assessment (Family Nursing Problem)

Garbage collection initiated through D. Poor Environmental Sanitation barangay garbage truck is not 1. Failure to utilize community followed and complied by the family. resources for health care due to: a. Failure to perceive the benefits of Mrs. Anecita verbalized Among health care/services. mga ginagmay na basura diha ra sa 1. Inability to provided home kilid-kilid ilabay labi na kanang mga environment conducive to health chichirya nga basuranah! Akong maintenance and personal mga apo ana gyud. development due to: a. Inadequate knowledge of preventive They clean their house only every measures. Sunday.

First Level of Assessment (Cues/Data) Water containers are uncovered and stored water is stagnant. Mrs Anecita verbalized Mag stock mi ug tubig gamit among drum ug balde Mosquitoes are abundant in their residence because of the presence of breeding sites.

Second Level of Assessment (Family Nursing Problem) E. Presence of Breeding sites and insects 1. Inability to make decisions with respect to taking appropriate health action on the health threats due to: a. Failure to comprehend the nature of the problem b. Inability to provide a home environment conducive to health maintenance and personal development due to: Ignorance of preventive measures Inadequate family resources specifically: ^ Financial resources

CRITERIA 1. Nature of the problem

COMPUTATION 1/3x1

ACTUAL SCORE 0.33

JUSTIFICATION It is a foreseeable crisis.

1. Modifiability of the problem

2/2x2

Resources are available and interventions are feasible.

Their ability to prevent the problem is high. The problem does not need change.

1. Preventive Potential 1. Salience of the Problem

3/3x1

1/2x1

1/2

TOTAL SCORE

4.83

CRITERIA 1. Nature of the problem

COMPUTATION 2/3x1

ACTUAL SCORE 1

1. Modifiability of the problem 1. Preventive Potential

2/2x2

3/3x1

JUSTIFICATION It is a health deficit that requires immediate management to eliminate untoward consequences. The problem is easily modifiable. Susceptibility to other diseases and infections can be prevented if malnutrition is eliminated. It is not a felt problem.

1. Salience of the Problem TOTAL SCORE

0/2x1

CRITERIA 1. Nature of the problem

COMPUTATION 3/3x1

ACTUAL SCORE 1

1. Modifiability of the problem

2/2

JUSTIFICATION The problem is a health deficit and requires more immediate intervention. The resources and interventions needed to solve the problem are available to the family. The possibility of complications can be prevented if HPN situations are reduced. The family does not recognize the existence of the problem

1. Preventive Potential

3/3

1. Salience of the Problem

0/2

TOTAL SCORE

CRITERIA

COMPUTATION

ACTUAL SCORE JUSTIFICATION

1. Nature of the problem 1. Modifiability of the problem

2/3x1 2/2

2/3 2

It is a health threat. Resources are available and interventions are feasible.

Occurrence of parasitism and other communicable diseases can be reduced

1. Preventive Potential

3/3

1. Salience of the Problem TOTAL SCORE

No data available

No data available 2 2/3

CRITERIA 1. Nature of the problem 1. Modifiability of the problem

COMPUTATION 2/3 x 1

ACTUAL SCORE 2/3

JUSTIFICATION Presence of Breeding sites and insects is a health threat. The resources are partially available and interventions are feasible. The communicable diseases that insects can transfer has low rate of prevention. The family perceives it as a problem needing no attention.

1/2 x2

1. Preventive Potential

2/3x 1

1. Salience of the Problem TOTAL SCORE

0/2 x 1

2 2/3

Health Problem

Family Nursing Problem

Goal of Care (SMART)

Nursing Intervention

Inability to Foreseeable crisis recognize the Situations for presence of the Pregnancy condition or problem due to attitude and philosophy in life towards accepting the magnitude of the problem

After nursing intervention the family will be able to realize the post threat of foreseeable crisis situations for pregnancy as well as to be able to choose the most applicable measure to them.

Short Term: After 2-3 hours of Home visit and health teaching the family will be able to identify the presence of the problem and ways on how to alleviate the problem as evidenced by the discussion of the family. Long Term: After 4 days of home visit, the family will be able to comply and demonstrate the health teaching of the student nurses such as to find ways on how to prevent cases of pregnancy.

Intervention Plan Nursing Method of Resource Interventions Nurse s Family Required Contact Home Visit -Time and Assess the Plan effort general/living of the condition of the student family and as nurses& well as their the perceive familyhindrances in Participati formulating on and solution to the cooperatio problem.n of the Present to them familythe consequences Skills and of the present knowledge conditionof the Identify student alternatives ways nurse on how to increase knowledge on family planning to meet the needs of all the members

Health Problem

Family Nursing Problem

Goal of Care (SMART)

Intervention Plan Nursing Nursing Method of Resource Intervention Interventions Nurse s Family Required Contact using contraceptives and practicing birth spacing - Present to the mother and father the available contraceptive methods available provided by the community.-Educate the advantages and disadvantages of the various contraceptives presented.-Present the various risks brought about by proper birth spacing.-Emphasize the risks presented by the inability to provide for the needs of the family members.

Intervention Plan Health Problem Family Nursing Problem Nursing Method of Interventions Nurse Family Contact Inability of the >After effective After effective Re-iterate other Establishin patient to continue nursing nursing people who are g rapport taking her interventions, interventions, the smokers and as (Good eyemedication as the patient will patient will able well as alcohol to-eye prescribed due to: be able to to drinkers to at contact).H a.) Always keeping remind herself :a.) Educate her least limit ome visit. self busy. in taking of her family measures consumption Health b.) Unable to medication and about the of liquors or to teachings remind herself for also the importance of stop it together regarding taking due importance of regular check-up. with smoking. hypertensi medication. having regular b.) Explain Encourage them on c.) Inadequate check-up.>The importance of to consider knowledge on patient will able proper diet or lifestyle preventive to impart her food intake. modification for measures. knowledge to c.) Enumerate the their benefits. d.) Inability of her family diseases that Teach them on patient to visit members the might develop if how to take RHU/clinic for things that will hypertension is blood pressure regular check-up. be discussed not prevented on their own regarding earlier. .Educate them preventive d.) Educate the proper way measures by patient on the of taking good healthcare Dos and Donts care of their provider. of hypertension health and food intake Goal of Care (SMART) Nursing Intervention Resource s Required BP apparatus .Medicati on .Visual aid for discussio n

Hypertension as health deficit

Health Problem

Family Nursing Problem

Goal of Care (SMART)

Nursing Intervention

A. POOR 1. Inability to decide ENVIRONMEN about taking TAL appropriate actions SANITATION: due to failure to Improper comprehend the Garbage nature and scope of Disposal the problem

Within proper nursi ng intervention s, the family will be able to determine the importance of practicing proper meth ods on waste disposal

Short Term: After one Home visit and health teaching the family will be able to demonstrate compliance with the health teachings given as evidenced by the cooperation of the family. Long Term: After 4-5 days of home visit, the family will practice and maintain a good environmental sanitation

Intervention Plan Nursing Method Interventions of Nurse Family Contact Home Assess the familys Visit Plan environmental sanitation- Assess the level of understanding of the family regarding to the problemEducate the family the effects of improper garbage disposal such occurrence of diseases- Discuss how garbage could cause illnesses. >Explore with the family the advantages and disadvantages of the different methods of waste disposal

Resources Required

Time and effort of the student nurses& the familyParticipati on and cooperatio n of the familySkills and knowledg e of the student nurse

Emergency Contraception (EC): A Safe and Effective Way to Prevent Unplanned Pregnancy 04.01.06 - It is estimated that over three million American women have unplanned pregnancies each year, and over half of these end in abortion. Emergency contraception (EC), sometimes called the "morning-after pill," is an effective method of preventing unwanted pregnancy.1 EC is Safe and Effective to Use EC prevents pregnancy via a course of hormonal contraceptive pills taken in one- or two-dose regimens. EC is most effective if the first dose is taken within 24 hours after unprotected sex; however, it can be effective up to 5 days after intercourse. If the regimen is started within 24 hours, EC can be 95% effective. EC is well tolerated by most women, including those who have had trouble using oral contraceptives regularly. Reported side effects are generally mild, including headache, nausea and stomach discomfort, and vary with the brand used. Because EC can be used at all stages of a woman's menstrual cycle, its mode of action varies. After intercourse, EC may prevent pregnancy by preventing ovulation, blocking fertilization or possibly preventing implantation of a fertilized egg. Link: http://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-andeffective-way-to-prevent-unplanned-pregnancy

Maglaya, Araceli. (2004) Nursing Practice in the Community : fourth edition. Philippines : Argonauta Corporation. Pages 66-73 & 89.