Family Diagnosis *CHN

INTRODUCTION
A work like this present realistic situation, allowing us to balance theory
with practice. Family Nursing Diagnosis represents the clinical judgment about
actual or potential health problems and life process occurring with the family. It is
validated when it is clearly identify and link to the defining characteristics, related
factors and risk factors found within the assessment. The planning process is
characterized by logical thinking whereby relationships are put together to arrive
at rational decisions. This study involves the family health needs and problems,
in establishing priorities, selecting appropriate course of action, implementing
them and evaluating outcomes.
The use of the family nursing process will result in a care plan describing
the needs and care for each client. It is a set of action a nurse decides an
implementation that are chosen from among alternatives after careful analysis
and weighing options to be able to resolve identified family health and nursing
problems.
This study focuses on Crisostomo family, a residence of Sitio Asana 2,
Barangay Santisima Cruz, Sta. Cruz, Laguna. We chose this family as we
identified their problems that would affect their health and give solutions for them
to cope up by rendering health teachings and interventions, the family will be
able to understand and learn about existing/potential health problems and will
take appropriate actions to solve their problem on their own. Through our
participatory planning, it gives the family feeling that its dignity and integrity are
preserved because of the realization that it is not totally helpless and can still do
something about the problem situation.
Indeed, for us to fully understand the specific problems of the family and
identify how nurses should work with a patient or family to improve their health;
we provided information as we set their priorities for care. In this Family
Diagnosis we attained additional knowledge and skills about the problems that is
presented here, where we gathered health information regarding to the family.
1

CHAPTER I
INITIAL DATA BASE
A. Family Structure and Characteristics
Family Name: Crisostomo Family
Type of Family: Extended
Filipino families enjoy close kin bonds, and extended families living
together are the norm. Blood bonds are so important, traditionally, that a person
can be judged on the basis of who her or his relatives are. It follows that parents
and children share an exceptionally strong and intimate bond. They give each
other much mutual affection and respect.
According to Castillo, G., and Pua, J. (1963) - Research Notes on the
Contemporary Filipino Findings in a Tagalog Area, an extended family is a
family that extends beyond the immediate family, consisting of grandparents,
aunts, uncles, and cousins all living nearby or in the same household. An
example is a married couple that lives with either the husband or the wife's
parents. The family changes from immediate household to extended household.
An example would be an elderly parent who moves in with his or her children due
to an old age. This places large demands on the caregivers, particularly on the
female relatives who choose to perform these duties for their extended family.
Family Member Age Sex Civil Status Relationship
George Crisostomo 65 y/o M married husband
Irma Policarpio Crisostomo 60 y/o F married wife
Angelita Magpili Policarpio 84 y/o F widowed mother of the
wife
This type of family is extended which the married couple Mrs. Irma
Crisostomo (60 years old) and Mr. George Crisostomo (65 years old) lives with
the wife's parents Mrs. Angelita Policarpio, 84 year old widowed woman, where
2

they lived at Sitio Asana II, Barangay Santisima Cruz, Sta. Cruz Laguna. Based
on our interview, the couple decided to live with Mrs. Angelita since their two
children had their own family and separated with them that’s why they had no
companion anymore in their house.
Based on The Importance of Extended Family to Building Strong, Healthy
Families; this research shown that there are advantages living in extended
families. One good benefit is that extended families help to prevent elderly
people live alone. Also, it has disadvantages that sometimes there is no privacy
when there are so many problems that can cause conflict and meddling in other
members of the family.
According to Gelia Castillo and Juanito Pua (1963, p. 116) classify the
Filipino family as "residentially nuclear but functionally extended." This means
that the household tends to be nuclear in form, but the family is extended in so
far as relationships among members of the wider kin group are concerned.
Members of the same kin group assist one another in times of need, and they
participate in joint family activities even if they do not live together in the same
household.
3

B. Socio-Economic and Cultural Factors
Socioeconomic and cultural factors have long been thought to influence
an individual's health. It determinants the conditions of people’s live; where they
are born, grow up, live, work, and age. These determinants or things that make
people healthy or not include the following factors:
• Income and social status - higher income and social status are linked to
better health. The greater the gap between the richest and poorest people,
the greater the differences in health.
• Education – low education levels are linked with poor health, more stress
and lower self-confidence.
• Physical environment – safe water and clean air, healthy workplaces,
safe houses, communities and roads all contribute to good health.
• Employment and working conditions – people in employment are
healthier, particularly those who have more control over their working
conditions.
• Social support networks – greater support from families, friends and
communities is linked to better health.
• Culture - customs and traditions, and the beliefs of the family and
community all affect health.
• Genetics - inheritance plays a part in determining lifespan, healthiness
and the likelihood of developing certain illnesses.
• Personal behavior and coping skills – balanced eating, keeping active,
smoking, drinking, and how we deal with life’s stresses and challenges all
affect health.
• Health services - access and use of services that prevent and treat
disease influences health
• Gender - Men and women suffer from different types of diseases at
different ages.
4

Family
Member
Educational
Attainment
Occupation Place
of work
Religion Income
George
Crisostomo
College
Graduate
Retired Chief
Police
--------- Aglipay 35,000 up
to 45,000
Irma
Policarpio
Crisostomo
High School
Graduate
None ---------- Aglipay None
Angelita
Magpili
Policarpio
Grade 2 None --------- Aglipay None
SOCIOECONOMIC STATUS
Family Crisostomo depends on the monthly pension of Mr. George, he
has a Bachelor’s degree in Criminal Justice and becomes Chief Police, and now
at the age of 65 he is a pension. They have no problem when it comes to
financial; where he received a monthly income of 35,000 to 45,000 that is exact
for their foods and expenses a month.
It is known that education leads to a better jobs and higher incomes.
According to the researchers, better-educated individuals live longer, has a
healthier lives than those with less education, and their children are more likely to
thrive. But however, with that good thing people able to live in everything they
want; some of them can affect their health and result to an illness in terms of their
lifestyle such as their food eating habit (high-fat and high-salt intake), etc.
5

C. Environmental Factors
World Health Organization indicates that environmental health
addresses all the physical, chemical and biological factors external to a
person. It encompasses the assessment and control of those environmental
factors that can potentially affect health. It is targeted towards preventing
disease and creating health-supportive environments.
Environmental factors affect human health in important ways, both positive
and negative. Positive environmental factors sustain health, and promoting
them is preventive medicine. Negative environmental factors are threats to
health, and controlling them is public environmental health.
These are the following environmental factors that found to Crisostomo
Family.
Positive Environmental Factors Negative Environmental Factors
Home Structure - concrete (owned) Garbage disposal – open and burning
Adequate living space Food intake – improper balanced diet
Excreta disposal – flush type with
septic tank
Animals- dog
Drinking water – mineral Pest/ Insect - mosquito
6

D. Health Assessment of Each Family
Family member: Angelita Magpili Policarpio
Date of birth: February 6, 1930
Age: 84 years old
Gender: Female
HISTORY
Mrs. Angelita M. Policarpio is an 84 year old widowed woman with no
known history of childhood illness, accidents or injuries. Her husband died 20
years ago because of stroke. There is a positive family history of Hypertension,
where her father died on heart attack. She had her first menstruation (menarche)
at the age of 14 and she was menopause at the age of 55 year old. She has a
total of 8 pregnancies with a 4 children living.
When she was 45 year old, she was diagnosed having kidney stone and
she was hospitalized for almost 1 month at the Hospital of Manila area since she
experienced nausea and vomiting with an intense pain on her back, abdomen,
groin and genital. On that time of her hospitalization she undergone on operation
to remove all her kidney stone.
At the age of 60 year old she was diagnosed of Arthritis and Hypertension
since she experienced dizziness, headache, back and knees pain with swelling
and tenderness in joints. She had medication which is prescribed by her
physician.
• Voltaren (emulgel) 75 ml – it is used for the local treatment of traumatic
inflammation of tendons, ligaments, muscles & joints. Localized forms of
soft tissue rheumatism & rheumatic disease.
• Diclofenal NA (voren) 50 mg BID – it is used to relieve pain, swelling
(inflammation), and joint stiffness caused by arthritis/ osteoarthritis.
• Amlodipine besylate (calcium channel blocker) – used in the treatment
of high blood pressure.
7

Age: 84 years old
Gender: Female
GORDON’S 11 FUNCTIONAL HEALTH PATTERNS
Health Perception and Health
Management
when sick she used to go in private
hospital for the General Check-up.
Nutrition and Metabolism eats her meal three times a day, often
times to eat fruits and vegetables only
once in a week, she loves to eat meats
and frozen food. Take 4 to 6 glass of
water a day.
Elimination Pattern Mrs. Policarpio had 6 to 8 times of
urination. She had at least 1 bowel
movement every second or third of the
day. Yellowish color of urine.
Activity and Exercise Pattern she has no regular exercise, she just
staying at home most of the day.
Cognition and Perception speech well and clear, doesn’t have
any sensory deficit, facial expression
appropriate to situation.
Sleep and Rest Pattern she sleep 10:30 in the evening after
watching television and awaken 5:00 in
the morning. Sleeps with one pillow.
Self- Perception and Self- Concept ----------------------------------------------------
8

Roles and Relationship she had good relationship with her
daughter Irma, well-supported by her
daughter and son-in-law.
Sexuality and reproduction she has a total of 8 pregnancy with a 4
children living.
Coping and Stress Tolerance cope up with stress by just staying at
home and taking a nap or sleep and
watching television.
Values and Belief Religion; Aglipay, believes in God but
doesn’t go in the church.
9

DATA BASE: PHYSICAL EXAMINATION
(Head-to-Toe Assessment)
Age: 84 years old
Gender: Female
VITAL SIGNS
 Temperature: 35.8 ℃
 Pulse Rate: 72 beats per minute
 Respiratory Rate: 16 breaths per minute
 Blood Pressure: 140/90 mmHg
AREA METHOD FINDINGS INTERPRETATION
INTEGUMENTARY
Skin Inspection
and
palpation
Skin color is tan.
Has an equally
warm temperature
on both arms and
legs. Poor Skin
turgor. Absence of
lesions and masses
on the surface of
the skin.
Normal
Presence of poor
skin turgor is normal
during of old age
According to the
Family Resource
Center, Elderly
individuals are at a
heightened risk for
dehydration because
their bodies have a
lower water content
than younger people.
Because of visual,
cognitive, or motor
impairments, elderly
persons may have
difficulty getting fluids
for themselves. They
also may have only a
muted perception of
thirst.
10

Reference: Nursing
and Rehabilitation
Centers. Retrieved
from: (October 28,
2014)
http://nursinghome.org
/fam/fam_018.html
Hair Inspection Hair color is gray
with smooth and
fine hair strands.
Absence of
alopecia and
hirsutism.
Normal
Gray hair is accepted
as a normal part of
elderly people. (a sign
of aging)
Nails Inspection Nail bed texture is
soft and pinkish.
Capillary refill time
< 3 sec. There is no
presence of nail
clubbing.
Normal
HEAD
Skull and Face
Inspection
and
palpation
Head is of a regular
shape with no
apparent lesions,
masses or foreign
bodies. Scalp no
evidence of skin
condition or
infestation, and
exhibited no
tenderness on
palpation. Cheeks
are sunken, facial
movements are all
equal.
Normal
Eyes and Vision Inspection Eyes are aligned, Normal
11

eyebrow is free of
scaling, pinkish
conjunctiva and
white sclera that is
normal. Extra
ocular movement
(EOM) are intact.
There is no
presence of edema
and hollowness. No
evidence of
increased tearing.
Pupils equally
rounded, reactive to
light and
accommodation.
Ears and Hearing Inspection Symmetrical ears
and equal in size
aligned on the outer
canthus of the eye.
No presence of
tenderness,
masses and
drainage clogged/
cerumen. Pinna
recoils immediately.
Normal
Nose and Sinuses Inspection
and
palpation
Nose is midline on
the face without
swelling, bleeding
or lesions. Patient
can breathe
normally in both
nostril. No
presence of
discharge, bumps
and tenderness; no
pain reported.
Normal
Mouth and
Oropharynx
Inspection Lips is smooth,
symmetrical,
pinkish and free of
cracks. No
suspected lesions
Normal
12

or masses on
tongue, gums, hard
and soft palate and
tonsils. Uvula is in
the middle, tonsils
is pink without
hypertrophy.
Tongue easily
move in all
directions, pinkish
with presence of
whitish spots, moist
and with gag reflex.
Presence of
denture on the
upper and lower
part of the gums.
NECK
Neck Muscles Inspection
and
palpation
Symmetrical with
head in central
position.
Symmetrical
movement of neck
muscles.
Movement through
full range of motion
without complaint of
discomfort. Active
ROM; flexion,
extension, lateral
rotation and tilting.
Normal
Lymph nodes Palpation Lymph nodes are
non-palpable.
Normal
Trachea and
thyroid gland
Palpation In midline position,
non- palpable
lobes, not enlarged
Normal
13

and rises as patient
swallows.
Breast Inspection
and
palpation
Symmetrical breast
and nipple. No
presence of
masses, lesions or
discharge in nipple.
Normal
Chest Inspection Symmetrical
respiratory effort
without use of
accessory muscles.
Normal
Lungs Percussion
and
palpation
Thorax rise and fall
with inspiration and
expiration.
Resonant
percussion
throughout. Breath
sounds normal with
no extra sounds.
Normal
Cardiovascular
System
Palpation
and
auscultation
No extra heart
sounds and no
murmurs heard. No
jugular vein
distention at 45
degree. Point of
maximal impulse
(PMI) palpable in
5th
ICS, MCL left
border of sternum.
Aortic pulsation
normal, no bruits
sounds.
Normal
PULSE
S
RADIAL POPLITEAL DORSALIS PEDIS POSTERIOR
TIBALIS
Right 2+ normal 2+ normal 1+ weak and 2+ normal
14

thread pulse
Left 1+ weak and
thread pulse
2+ normal 2+ normal 1+ weak and
thread pulse
Abdomen Inspection,
auscultation,
percussion and
palpation
Abdomen flat
contour. Negative
spleen
percussion, no
masses or
organomegaly.
No tenderness to
palpation. Kidney
and spleen are
non-palpable.
Normal bowel
sounds with
findings of;
RLQ: 15 soft
clicks/ min
RUQ: 12 soft
clicks/ min
LUQ: 14 soft
clicks/ min
LLQ: 12 soft
clicks/ min
Normal
Genitals/
Inguinal
Rectum/ Anus
(client refused to
assess on this
area)
--- --- ---
15

MUSCULOSKELETAL
Head and neck
It appears regular with no evident masses,
lesions, foreign bodies or other abnormalities. No
tenderness to palpation. Neck and shoulder are
stable. Range of motion and tone are within
normal limits. Strength is 5/5 means muscle is
functioning normally and is able to maintain its
position even when maximum resistance is
applied.
Left Upper Extremity
It appears regular and symmetric with the Right
Upper Extremity. No evident masses, lesions,
foreign bodies or other abnormalities. No apparent
muscle wasting. No tenderness to palpation.
Joints are stable. Range of motion, strength and
tone within normal limits. Strength is 4/5 indicates
that the muscle yields to maximum resistance but
when presses on the body part it is unable to
maintain contraction.
Right Upper Extremity
It appears regular and symmetric with the
Left Upper Extremity. No evident masses, lesions,
foreign bodies or other abnormalities. No apparent
muscle wasting. No tenderness to palpation.
Joints are stable. Range of motion, strength and
tone are within normal limits. Strengths is 4/5
indicates that the muscle yields to maximum
resistance but when presses on the body part it is
unable to maintain contraction.
Spine
It runs midline and straight, without abnormal
thoracic kyphosis or lumbar lordosis, and there are
no evident masses, lesions, foreign bodies or
other abnormalities. Spinal processes are
prominent. No tenderness to palpation range of
motion, strength and tone are within normal limits.
Ribs and pelvis/hips are regular, with no evident
masses, lesions, foreign bodies or other
16

abnormalities. Ribs are prominent. No tenderness
to palpation. No costal vertebral tenderness.
Range of motion and tone of hip muscles are
within normal limits.
Right Lower Extremity
It appears regular and symmetric with
the Left Lower Extremity. Presence of swelling
and tenderness in joints due to arthritis. Strength
is 4/5 indicates that the muscle yields to maximum
Left Lower Extremity
right Lower Extremity. Presence of swelling and
tenderness in joints due to arthritis. Strength is 4/5
indicates that the muscle yields to maximum
17

Family member: Irma Policarpio Crisostomo
Date of birth: April 28, 1954
Age: 60 years old
Gender: Female
HISTORY
Mrs. Irma P. Crisostomo a 60 year old woman who experienced typhoid
fever when she was 9 year old. She has no history of accident/injury and
serious/chronic illness. She never hospitalized. She had her first menstruation
(menarche) at the age of 12 and was menopause at the age of 47. There is a
positive family history of Stroke and Hypertension, where her father died of
stroke and her mother had Hypertension. She has 2 children who lives healthy.
At the age of 45 she was diagnosed of Hypertension where she takes her
maintenance before Amlodipine besylate (calcium channel blocker) – used in
the treatment of high blood pressure.
There is no current medication taken.
18

Age: 60 years old
Gender: Female
Management
when sick she used to go in private
hospital for the Check-up.
Nutrition and Metabolism Eats her meal 3 times a day, eat
fruits and vegetables, she loves to
eat rice and meat. Take 5-8 glass of
water a day.
Elimination Pattern 6 to 8 times of urination in just one
day, she had bowel movement 3 to 4
times in one week. Yellowish color of
urine.
Activity and Exercise Pattern She just staying at home and
consider doing household chores is
her exercise every day.
Cognition and Perception speech well and clear, doesn’t have
any sensory deficit, facial expression
Sleep and Rest Pattern sleep at 8:30 in the evening and
awaken 5:30 in the morning. Sleeps
with one pillow, sometimes taking a
nap during afternoon.
Self Perception and Self Concept -------------------------------------------------
19

Roles and Relationship had a good relationship with her
husband and mother, well-supported
by her husband.
Sexuality and reproduction believe it is normal and natural
aspect of personality related to
attraction between sexes.
Coping and Stress Tolerance cope up with stress by having a
conversation with her husband about
the problem.
Values and Belief Religion; Aglipay, believes in God
and she attend mass once a week.
20

Age: 60 years old
Gender: Female
VITAL SIGNS
 Blood Pressure: 130/90 mmHg
INTEGUMENTAR
Y
Skin
Inspection
and
palpation
Skin color is tan. Has
an equally warm
temperature on both
arms and legs. Good
skin turgor. Absence
of lesions and masses
on the surface of the
skin.
Normal
Hair Inspection Hair color is black with
smooth and fine hair
strands. Absence of
alopecia and
hirsutism.
Normal
Nails Inspection Nail bed texture is soft
and pinkish. Capillary
refill time < 3 sec.
There is no presence
of nail clubbing.
Normal
21

HEAD
Skull and Face
Inspection
and
palpation
shape with no
apparent lesions,
masses or foreign
bodies. Scalp no
evidence of skin
condition or
infestation, and
exhibited no
tenderness on
palpation. Cheeks are
sunken, facial
movements are all
equal.
Normal
Eyes and Vision Inspection Eyes are aligned,
eyebrow is free of
scaling, pinkish
conjunctiva and white
sclera that is normal.
Extra ocular
movement (EOM) are
intact. There is no
presence of edema
and hollowness. No
evidence of increased
tearing. Pupils equally
light and
accommodation.
Normal
Ears and Hearing Inspection Symmetrical ears and
equal in size aligned
on the outer canthus
of the eye. No
presence of
tenderness, masses
and drainage clogged/
cerumen. Pinna
recoils immediately.
Normal
22

Nose and Sinuses
Inspection
and
palpation
Nose is midline on the
face without swelling,
bleeding or lesions.
Patient can breathe
normally in both
nostril. No presence of
discharge, bumps and
tenderness; no pain
reported.
Normal
Mouth and
Oropharynx
symmetrical, pinkish
and free of cracks. No
suspected lesions or
masses on tongue,
gums, hard and soft
palate and tonsils.
Uvula is in the middle,
tonsils is pink without
hypertrophy. Tongue
easily move in all
directions, pinkish with
presence of whitish
spots, moist and with
gag reflex.
Normal
NECK
and
palpation
Symmetrical with
head in central
position. Symmetrical
movement of neck
muscles. Movement
through full range of
motion without
complaint of
discomfort. Active
ROM; flexion,
extension, lateral
Normal
Lymph nodes Palpation Lymph nodes are non-
palpable.
Normal
23

Trachea and
thyroid gland Palpation In midline position,
non- palpable lobes,
not enlarged and rises
as patient swallows.
Normal
respiratory effort
without use of
accessory muscles.
Normal
Lungs Percussion
and
palpation
Thorax rises and fall
expiration. Resonant
percussion
throughout. Breath
sounds normal with no
extra sounds.
Normal
Cardiovascular
System
Palpation
and
auscultatio
n
No extra heart sounds
and no murmurs
heard. No jugular vein
distention at 45
degree. Point of
maximal impulse
(PMI) palpable in 5th
ICS, MCL left border
of sternum. Aortic
pulsation normal, no
bruits sounds over the
aorta, femoral or
rental arteries.
Normal
PULSES RADIAL POPLITEAL DORSALIS PEDIS POSTERIOR
TIBALIS
Right 2+ normal 2+ normal 1+ weak and
thread pulse
1+ weak and
thread pulse
Left 1+ weak and
thread pulse
2+ normal 2+ normal 2+ normal
24

Abdomen Inspection,
auscultation,
percussion and
palpation
Abdomen flat
contour. Negative
spleen
percussion, no
masses or
organomegaly.
No tenderness to
palpation. Kidney
and spleen are
non-palpable.
Normal bowel
sounds with
findings of;
RLQ: 14 soft
clicks/ min
RUQ: 12 soft
clicks/ min
LUQ: 11 soft
clicks/ min
LLQ: 13 soft
clicks/ min
Normal
Genitals/
Inguinal
Rectum/ Anus
(client refused to
assess on this
area)
--- --- ---
25

MUSCULOSKELETAL
Head and neck
stable. Range of motion and tone are within normal
limits. Strength is 5/5 means muscle is functioning
normally and is able to maintain its position even
when maximum resistance is applied.
Right Upper Extremity. No evident masses, lesions,
foreign bodies or other abnormalities. Joints are
stable. Range of motion, strength and tone within
position even when maximum resistance is applied.
It appears regular and symmetric with the Left
Upper Extremity. No evident masses, lesions, foreign
bodies or other abnormalities. No apparent muscle
wasting. No tenderness to palpation. Joints are
stable. Range of motion, strength and tone are within
normal limits. Strengths is 5/5 means muscle is
Spine
thoracic kyphosis or lumbar lordosis, and there are no
evident masses, lesions, foreign bodies or other
abnormalities. No tenderness to palpation range of
abnormalities. Ribs are prominent. No tenderness to
palpation. Range of motion and tone of hip muscles
are within normal limits.
Lower Extremity. No evident masses, lesions, foreign
bodies or any abnormalities. No tenderness to
palpation. Strength is 5/5 means muscle is functioning
It appears regular and symmetric with the right Lower
Extremity. No evident masses, lesions, foreign bodies
or any abnormalities. No tenderness to palpation.
Range of motion and tone are within normal limits.
26

Strength is 5/5 means muscle is functioning normally
and is able.
Date of birth: June 27, 1949
Age: 65 years old
Gender: Male
HISTORY
Mr. George Crisostomo is 65 year old man, experienced measles and
mumps when he is a child and doesn’t exactly remember when and what age
occurred. There is no known history of accidents/injuries, serious/chronic illness
and hospitalization. He has 2 children who lives healthy. There is a positive
family history of Diabetes.
The client stated that he is not experiencing any problems or disease at
present times and he also said that he rarely acquire a disease.
Management
when sick he used to go in private
hospital for the Check-up.
Nutrition and Metabolism eats meal three times a day, eat fruits
and vegetables, he loves to eat fish, take
8 to 10 glass of water a day.
Elimination Pattern urinate 5 to 7 times a day with no pain in
urination; yellowish color of urine. He
usually had bowel movement once a
day.
Activity and Exercise Pattern doing some household chores
considered as his exercise.
Cognition and Perception speech well and clear, doesn’t have any
sensory deficit, facial expression
27

Sleep and Rest Pattern sleep at 8:30 in the evening with his wife
and awaken 5:30 in the morning. Sleeps
with one pillow. There is no problem in
sleeping.
Self- Perception and Self-Concept -----------------------------------------------------
Roles and Relationship he had a good relationship with her wife
and mother-in-law. He supported both of
them through his monthly pension.
Sexuality and reproduction believe it is normal and natural aspect of
personality related to attraction between
sexes. He has 2 children.
Coping and Stress Tolerance cope up with stress by having a
conversation with his wife about the
problem.
Values and Belief Religion; Aglipay, believes in God and
sometimes he attended mass together
with his wife.
28

Family member: George Crisostomo
Date of birth: June 27, 1949
Age: 65 years old
Gender: Male
VITAL SIGNS
 Blood Pressure:120/70 mmHg
INTEGUMENTAR
Y
Skin
Inspection
and
palpation
Skin color is tan. Has
an equally warm
temperature on both
arms and legs. Good
skin turgor. Absence
of lesions and
masses on the
surface of the skin.
Normal
Hair Inspection Hair color is black
with smooth and fine
hair strands.
Absence of alopecia
and hirsutism.
Normal
Nails Inspection Nail bed texture is
soft and pinkish.
Capillary refill time <
3 sec. There is no
presence of nail
Normal
29

clubbing.
HEAD
Skull and Face
Inspection
and
palpation
shape with no
apparent lesions,
masses or foreign
bodies. Scalp no
evidence of skin
condition or
infestation, and
exhibited no
tenderness on
palpation. Cheeks
are sunken, facial
movements are all
equal.
Normal
Eyes and Vision Inspection Eyes are aligned,
eyebrow is free of
scaling, pinkish
conjunctiva and
white sclera that is
normal. Extra ocular
movement (EOM)
are intact. There is
no presence of
edema and
hollowness. No
evidence of
increased tearing.
Pupils equally
light and
accommodation.
Normal
Ears and Hearing Inspection Symmetrical ears
and equal in size
aligned on the outer
canthus of the eye.
No presence of
tenderness, masses
and drainage
clogged/ cerumen.
Pinna recoils
Normal
30

immediately.
Nose and Sinuses Inspection
and
palpation
Nose is midline on
the face without
swelling, bleeding or
lesions. Patient can
breathe normally in
both nostril. No
presence of
discharge, bumps
and tenderness; no
pain reported.
Normal
Mouth and
Oropharynx
symmetrical, pinkish
and free of cracks.
No suspected lesions
or masses on
tongue, gums, hard
and soft palate and
tonsils. Uvula is in
the middle, tonsils is
pink without
hypertrophy. Tongue
easily move in all
directions, pinkish
with presence of
whitish spots, moist
and with gag reflex.
Normal
NECK
and
palpation
Symmetrical with
head in central
position. Symmetrical
movement of neck
muscles. Movement
through full range of
motion without
complaint of
discomfort. Active
ROM; flexion,
extension, lateral
Normal
31

Lymph nodes Palpation Lymph nodes are
non-palpable.
Normal
Trachea and
thyroid gland
Palpation In midline position,
non- palpable lobes,
not enlarged and
rises as patient
swallows.
Normal
respiratory effort
without use of
accessory muscles.
Normal
Lungs Percussion
and
palpation
Thorax rise and fall
expiration. Resonant
percussion
throughout. Breath
sounds normal with
no extra sounds.
Normal
Cardiovascular
System
Palpation
and
auscultatio
n
No extra heart
sounds and no
murmurs heard. No
jugular vein
distention at 45
degree. Point of
maximal impulse
(PMI) palpable in 5th
ICS, MCL left border
of sternum. Aortic
pulsation normal, no
bruits sounds over
the aorta, femoral or
rental arteries.
Normal
PULSES RADIAL POPLITEAL DORSALIS PEDIS POSTERIOR
32

TIBALIS
Right 2+ normal 2+ normal 2+ normal 2+ normal
Left 2+ normal 2+ normal 2+ normal 2+ normal
Abdomen Inspection,
auscultation,
percussion and
palpation
Abdomen flat
contour. Negative
spleen
percussion, no
masses or
organomegaly.
No tenderness to
palpation. Kidney
and spleen are
non-palpable.
Normal bowel
sounds with
findings of;
RLQ: 11 soft
clicks/ min
RUQ: 12 soft
clicks/ min
LUQ: 14 soft
clicks/ min
LLQ: 12 soft
clicks/ min
Normal
Genitals/
Inguinal
Rectum/ Anus
(client refused to
assess on this
area)
--- --- ---
33

MUSCULOSKELETAL
Head and neck
stable. Range of motion and tone are within normal
It appears regular and symmetric with the Right
bodies or other abnormalities. Joints are stable.
Range of motion, strength and tone within normal
bodies or other abnormalities. No apparent muscle
wasting. No tenderness to palpation. Joints are
stable. Range of motion, strength and tone are within
normal limits. Strengths is 5/5 means muscle is
Spine
thoracic kyphosis or lumbar lordosis, and there are no
evident masses, lesions, foreign bodies or other
abnormalities. No tenderness to palpation range of
abnormalities. Ribs are prominent. No tenderness to
palpation. Range of motion and tone of hip muscles
are within normal limits.
palpation. Strength is 5/5 means muscle is functioning
It appears regular and symmetric with the right
34

palpation. Range of motion and tone are within
functioning normally and is able.
E. Health Status of Each Family Member
NAME OF FAMILY
MEMBER
PAST ILLNESS DIAGNOSIS HEALTH ACTION
George
Crisostomo
None ------------ ------------
Irma Policarpio
Crisostomo
High Blood
Pressure
Hypertension Consulted to a
physician
Angelita Magpili
Policarpio
High Blood
Pressure
Swelling and
tenderness in
joints
Hypertension
Arthritis
Consulted to a
physician
35

CHAPTER II
FIRST LEVEL OF ASSESSMENT
Identifying health threats, health deficit and foreseeable crisis/ stress
points:
A. Health Threat conditions that promote disease or injury and prevent people
from realizing health potential. (conducive to disease)
Improper balanced diet consider as a health threat because it may
cause possible illnesses or diseases to a person.
The National Institutes of Health reports that hypertension is one of the
possible outcomes of improper balanced diet. Hypertension, also known as high
blood pressure, is called the silent killer, because it frequently remains
undetected and thus untreated until damage to the body has been done. Eating
too much junk food, fried food, salt, sugar, dairy products, caffeine and refined
food can cause hypertension. Diabetes also can be linked to improper balanced
diet and some forms of the disease can result from consuming a sugar- and fat-
laden diet, leading to weight gain.
Stroke may also occur that is caused by plaque that builds up in a blood
vessel, then breaks free as a clot that travels to brain and creates a blockage can
be linked to poor nutrition an improper balanced diet. Strokes damage the brain
36

and impair functioning, sometimes leading to death. Foods high in salt, fat and
cholesterol increase the risk for stroke.
Gout may also develop, with gout uric acid buildup results in the formation
of crystals in your joints. The painful swelling associated with gout can lead to
permanent joint damage. A diet that is high in fat or cholesterol can cause gout.
Some seafood--sardines, mussels, oysters and scallops--as well as red meat,
poultry, pork, butter, whole milk, ice cream and cheese can increase the amount
of uric acid in your body, causing gout.
Several types of cancer, including bladder, colon and breast cancers, may
be partially caused by poor dietary habits and improper balanced diet. Limit
intake of foods that contains refined sugars, nitrates and hydrogenated oils,
including hot dogs, processed meats, bacon, doughnuts and french fries.
37

Improper garbage disposal it is also consider as a health threat because
it may cause possible illnesses or diseases to a person. It may cause several
problems not only in the health of people but also to the Environment like the
open-burning type of way in garbage disposal.
Based on the Environmental Programs and Strategies, the greatest health
risk from the open burning of garbage at a waste disposal ground would be to
those closest to the fire who may inhale the smoke. Other individuals on-site and
off-site may also be affected, depending on factors such as the distance to the
fire, exposure duration, amount and type of material burned, individual sensitivity,
etc. The pollutants are all toxic to humans, depending on their concentration, and
may cause irritation, skin and respiratory problems; some are carcinogenic.
Those individuals with respiratory problems such as asthma or with allergies may
be even more sensitive to the smoke.
The smoke from open burning may be a major source of complaints from the
public because of its odor and its effects on visibility and the ash, which may be
dispersed by the wind or leached by water, may contain toxic contaminants.
Toxins may be leached from any ash remaining which could lead to the
contamination of surface water or ground water that can harm to people’s health.
38

B. Health Deficits occurs when there is a gap between actual and achievable
health status.
Hypertension is consider as a health deficit because it is already present
to a person.
Doctors have long called high blood pressure “the silent killer” because a
person can have high blood pressure and never have any symptoms. If left
untreated, high blood pressure can lead to life-threatening medical problems
such as stroke, heart attack or kidney failure.
High blood pressure is one of the most common causes of stroke because
it puts unnecessary stress on blood vessel walls, causing them to thicken and
deteriorate, which can eventually lead to a stroke. It can also speed up several
common forms of heart disease. When blood vessel walls thicken with increased
blood pressure, cholesterol or other fat-like substances may break off of artery
walls and block a brain artery. In other instances, the increased stress can
weaken blood vessel walls, leading to a vessel breakage and a brain
hemorrhage.
There are factors that have been linked to high blood pressure including:
A family history of high blood pressure. Age: The incidence of high blood
pressure rises in men after age 35 and in women after age 45. Gender: Men are
more likely to have high blood pressure than women until age 45. From ages 45
to 64, men and women have similar risk. After that, women are more likely to
have high blood pressure. Other factors that can lead to high blood pressure
39

include excess weight, excessive alcohol consumption, diabetes, lack of exercise
and a high-salt diet.
In most people, high blood pressure can be controlled through diet,
exercise, medication or a combination of all three. A diet that is low in salt and
rich in vegetables, fruits and low-fat dairy products may help lower blood
pressure. Recent studies have also shown that increasing potassium intake, (for
example, eating fresh fruits and vegetables), may help lower blood pressure.
40

Arthritis is consider as a health deficit because it is already present to a
person.
According to the Centers for Disease Control and Prevention, arthritis is
more common in women than men and in those that are overweight (CDC).
Arthritis is inflammation of the joints (the points where bones meet) in one or
more areas of the body. There are more than 100 different types of arthritis, all of
which have different causes and treatment methods. The symptoms of arthritis
usually appear gradually but they may also occur suddenly. Arthritis is most
commonly seen in adults over the age of 65 but it can also develop in children
and teens.
The most common symptoms of arthritis involve the joints. Joint pain and
stiffness, mostly in the morning, are typical signs, along with swelling of the
joints. You may also experience a decrease in range of motion of your joints or
redness of the skin around the joint.
There are certain herbs may have anti-inflammatory properties that can
help with arthritis as well as the ability to reduce pain in all forms of the disease.
Aloe vera is one of the most commonly used herbs in alternative medicine.
Known for its healing properties, it is popular for treating small skin abrasions.
You may already have a bottle of aloe vera gel in the medicine cabinet from a
past experience with sunburn for pain relief. This same type of product may be
applied topically to soothe achy joints. This herb is also available in whole form
from the leaves of the plant.
The National Center for Complementary and Alternative
Medicine (NCCAM) says that oral aloe vera can cause decreased blood sugar
and gastrointestinal side effects, such as diarrhea. Topical aloe vera, on the
other hand, does not cause any side effects.
Boswellia is praised by alternative medicine practitioners for its anti-
inflammatory capabilities. It is derived from the gum of boswellia trees, which are
41

indigenous to India. Also called frankincense, this herb is thought to work by
blocking leukotrienes. Leukotrienes are substances that can attack
healthy joints in autoimmune diseases such as rheumatoid arthritis.
The NCCAM acknowledges promising evidence of boswellia in animal studies,
but notes a lack of human trials. Boswellia is available in tablet form, as well as
topical creams.
You may have ginger in your spice cabinet for cooking, but this herb is
also a staple in many alternative medicine cabinets. The same compounds that
give ginger its strong flavor are also the same ones that have anti-inflammatory
properties. The NCCAM says that early studies in reducing joint swelling with
ginger in RA are promising. However, limited human trials have yet to prove the
effectiveness of this treatment.
Green tea is one of the most popular beverages in the world, and has
even been used to reduce inflammation in the body. It is possible that green tea
can be used to treat arthritis inflammation in the form of beverages, tablets, or
tinctures. The NCCAM found in a 2012 study that green tea might help both
osteoarthritis and RA patients. Many more studies are needed to prove the
potential benefits of green tea.
C. Foreseeable Crisis/Stress Point
anticipated periods of unusual demand on the individual or family in terms
of adjustment or family resources.
There is no identified Foreseeable crisis or stress point to Crisostomo Family.
42

CHAPTER III:
Second Level of Assessment
LIST OF PROBLEM IDENTIFIED
43

44
SUBJECTIVE CUES AND DATA FAMILY NURSING PROBLEM
Family Crisostomo usually eat meat
and frozen foods, they often times to
eat fruit and vegetables.
Imbalanced Nutrition (Health Threat)
Inability to balanced nutrition due
to lack of knowledge about the
problem
“Sa dami ng basurang naiipon minsan
sinusunog namin ito o di kaya
hinahayaan nalang nakatambak sa
labas ng gilid ng aming bahay
hanggang sa kunin ito ng garbage
collector,” as quoted by one of the
member of family.
The way of the family in garbage
disposal is open burning and
sometimes it is place in an open
container
Improper Garbage Disposal
(Health Threat)
Inability to decide about taking
appropriate actions due to failure
to comprehend the nature and
scope of the problem.
Name: Irma Policarpio Crisostomo
Age: 60 year old
BP: 130/90 mmHg
-loves to eat meat and frozen foods
-once a week to eat fruits and
vegetables
-has a family history of Hypertension
Hypertension (Health Deficit)
Inability to recognize the presence
of health problem due to:
a) Lack of or inadequate
knowledge.
b) Failure to comprehend the
nature/ magnitude of the
problem
Name: Angelita Magpili Policarpio
Age: 84 year old
BP: 140/90 mmHg
-loves to eat meat and frozen foods
-once a week to eat fruits and
vegetables
- has a maintenance of Amlodipine
besylate
Hypertension (Health Deficit)
Inability of the patient to
continue taking her medication as
prescribed due to:
a) Unable to remind herself for
taking due medication.
b) Inadequate knowledge on
preventive measures.
c) Inability of patient to visit
RHU/clinic for regular

CHAPTER IV
SCALE FOR RANKING
A. Criteria
CRITERIA SCORE WEIGHT
1 Nature of the problem
Health Deficit
Health Threat
Foreseeable Crisis
3
2
1
1
2 Modifiability
Easily
Moderate
Not modifiable
2
1
0
2
3 Preventive/potential
High
Moderate
Low
3
2
1 1
4 Salience of the problem
Problem needing urgent attention
Problem not needing urgent attention
Not perceive as a problem
2
1
0
1
45

B. Scoring
1. Decide on a score for each of the criteria.
2.Divide the score by the highest possible score and multiply by the
weight.
Score
---------------------- X Weight
Highest Score
3.Sum up the scores for all the criteria. The highest score is 5, equivalent
to the total weight.
4.The higher the score (near 5 and above) of a given problem, the more
likely it is taken as a PRIORITY.
5.With the available scores, the nurse then RANKS health problems
accordingly.
46

CHAPTER V
RANKING AND SCORING OF EACH HEALTH
PROBLEM
List of Health Problems Ranked According to Priorities
HEALTH PROBLEMS SCORE
1. Nutritional Imbalanced 4.16
2. Improper garbage Disposal 3.66
3. Hypertension 3.16
4. Arthritis 3.5
47

A.Imbalanced Nutrition
CRITERIA SCORE JUSTIFICATION
Health Deficit
Health Threat
Foreseeable Crisis
2 X 1 = 0.66
3
It is considered as a health
threat because it can contribute
complication/ problem to the
health status of the family; with
the imbalanced nutrition they
take, always eating high-salt
and high-fat foods may cause
an increased blood pressure.
2 Modifiability
Easily
Intermediate
Not modifiable
1 X 2 = 2
2
It is intermediate modifiable
because we informed them the
importance of proper food
intake in daily living such as in
eating fruits and vegetables.
The family recognized what are
the risks to their health status of
eating an imbalance nutrition
through our nutritional health
education.
High
Moderate
Low
3 X 1 = 1
3
It is highly preventive because
as we observed our chosen
family they practiced on how to
keep their living becomes
healthy by lowering their salty
and fatty foods intake.
1 X 1 = 0.5
The family is oriented on the
problem of eating an unhealthy
48

Problem needing urgent
attention
Problem not needing
urgent attention
2 food and still they considered it
as a problem not needing an
urgent attention.
B.Improper Garbage Disposal
Health Deficit
Health Threat
Foreseeable Crisis
2 X 1 = 0.66
3
threat because with an
improper garbage disposal
insects/vectors has a chance to
breed and may cause disease
to a person like dengue. And
also the smoke from open
burning may cause respiratory
problems to an individual such
as asthma.
2 Modifiability
Easily
Intermediate
Not modifiable
2 X 2 = 2
2
It is easily modifiable since the
family is cooperative and follow
health education in proper
garbage disposal.
High
Moderate
Low
3 X 1 = 1
3
It is highly preventive since we
had health teaching to the
family about the importance of
proper garbage disposal they
practiced on how to segregate
non-biodegrable and
biodegrable materials.
0 X 1 = 0
2
It is not perceived as a problem
of the family because they can
manage to live in it and still no
49
TOTAL SCORE: 4.16

attention
Problem not needing
urgent attention
one had an illness because of
that problem.
C.Hypertension
Health Deficit
Health Threat
Foreseeable Crisis
3 X 1 = 1
3
deficit since that there is a
presence of problem.
2 Modifiability
Easily
Intermediate
Not modifiable
1 X 2 = 1
2
It is intermediate modifiability
because the family able to
practice balanced nutrition since
we emphasized them on how to
deal with low-salt and low-fat
diet during our health education.
High
Moderate
Low
2 X 1 = 0.66
3
It is considered as a moderate
preventive because the family
practiced the proper balanced
nutrition by eating fruits and
vegetables.
4 Salience of the
problem
attention
Problem not needing
urgent attention
1 X 1 = 0.5
2
The family recognized this as a
problem not needing an urgent
attention, because they can still
manage their health condition.
50
TOTAL SCORE: 3.66

D.Arthritis
Health Deficit
Health Threat
Foreseeable Crisis
3 X 1 = 1
3
deficit since that there is a
presence of problem.
2 Modifiability
Easily
Moderate
Not modifiable
1 X 2 = 1
2
It is intermediate modifiable
because Mrs. Angelita M.
Policarpio is cooperative. We
educate her on how to relieve/
minimize pain such as apply
warm, moist compresses to
affected joints.
High
Moderate
Low
3 X 1 = 1
3
It is considered as a high
preventive since Mrs. Angelita M.
Policarpio has medication on this
problem.
-Voltaren (emulgel) 75ml
-Diclofenal NA (voren) 50mg BID
attention
Problem not needing
urgent attention
1 X 1 = 0.5
2
The family recognized this as a
problem not needing an urgent
attention since Mrs. Angelita M.
Policarpio has medication on this
problem.
51
TOTAL SCORE: 3.16

CHAPTER VI
Family Nursing Care Plan Chapter
HEALTH
PROBLEM
FAMILY
NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVE OF
CARE
INTERVENTION PLAN
Nursing Intervention Method of Resources
Nurse-Patient require
Contact
EXPECTED
OUTCOME
Health Threat
Imbalanced
Nutrition
Inability to
balanced
nutrition due
to lack of
knowledge
about the
problem
The family
will be able
to practice
the
importance
of proper
balance diet/
nutrition.
The family will
be able to
identify the
foods that are
healthy such as
the vegetables
and fruits and
they will be able
to practice the
proper food
intake to
prevent
imbalanced
nutrition.
Assess the family’s Establishing Visual aid
perceptions rapport through for discussion.
regarding to home visit. (pamphlet)
Nutritional Balanced (make a good
to acknowledge the eye to eye
family concerns and contact)
in order to promote
cooperation. Health teaching
regarding
Identify the family’s Nutritional
perceptions of the Balanced
needed diet modifi-
cation to determine
their outlook in pro-
per balance diet.
Emphasize to the
family to be more
aware of nutritional
The family
will be able
to practice
taking
balance
nutrition by
eating fruits
and
vegetables
to prevent
possible
disease.
53
TOTAL SCORE: 3.5

habits that may
contribute an illness/
disease such as
Hypertension,
Diabetes, etc.
Discuss to the family
about the impor-
tance of fruits and
vegetables that are
rich in essential nu-
trients needs of our
body tostrengthen
thehealthcondition.
Explain to the family
that adequate
intake of nutrients
is necessary to
maintain physical
and emotional health
so that the family
will grasp the signi-
ficance of the advi-
sed for their health.
54

HEALTH
PROBLEM
FAMILY
NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVE OF
CARE
INTERVENTION PLAN
Contact
EXPECTED
OUTCOME
Health Threat
Improper
Garbage
Disposal
Inability to
decide about
taking
appropriate
actions due
to failure to
comprehend
the nature
and scope of
the problem.
The family
will be able
to determine
the
importance
of practicing
on proper
methods of
garbage
disposal.
The family can
recognize the
possible effects
of garbage
burning;
verbalize
understanding
about the
importance of
practicing
proper waste
disposal.
Assess the family’s Establishing Visual aid
perceptions rapport through for discussion.
regarding to home visit. (pamphlet)
proper garbage (make a good
disposal eye to eye
acknowledge the contact)
family concerns and
in order to promote Health teaching
cooperation. regarding
proper garbage
Discuss with the disposal.
family the possible
risk factors that
will result with the
occurrence of the
problem such as
dengue, and in open
burning may cause
respiratory problem
like asthma.
Emphasize tothefamily
theimportanceof
solving theproblem
andonmaintaining the
environment clean
to develop the fami-
After 2-3
home visit,
the family
will be able
to identify
the different
ways on
proper
garbage
disposal of
garbage
such as;
A.use of
compost pit
with cover.
B.segregate
the non-
biodegrable
and
biodegrable
materials.
55

lies ability and
commitment to pro-
vide nursing care to
the family and on
taking actions to
solve the problem.
Provide information
in the family about
the proper ways on
waste disposal such
as segregation of
biodegradable from
non-biodegradable
wastes and demons-
trate the method of
waste disposal.
Emphasize the impor-
tance of practicing
proper garbage dispo-
sal with the family so
that the family will
grasp the signifi-
cance and demons-
trate interest in
initiating lifestyle
modification.
C.recycling
of some
waste
materials.
D.selling of
some
garbage like
cans, bottles
and plastic.
56

Age: 60 years old
Gender: F
HEALTH
PROBLEM
FAMILY
NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVE OF
CARE
INTERVENTION PLAN
Contact
EXPECTED
OUTCOME
Health Deficit
Hypertension
Inability to
recognize
the presence
of health
problem due
to:
A. Lackof
or inadequat
e knowledge.
B. Failure to
comprehend
the nature/
magnitude of
the problem.
The patient
will make
necessary
measures
to properly
manage,
control, and
lessen the
risk factors
of hypertension
. The patient
will have
adequate
knowledge
about good
proper nutritio
n that reduce
hypertension
and prevent the
occurrence of
The patient will
be able to:
a.) Educate her
family measures
about the
importance of
regular check-
up.
b.)Explain
importance of
proper diet or
food intake.
c.)Enumerate
the diseases
that might
develop if
hypertension is
not prevented
Assess the patient Establishing BP apparatus
level of understand- rapport through Visual aid
ding regarding to the home visit. for discussion.
health problem. (good eye (pamphlet)
to eye contact)
Discuss the nature
signs and symptoms Health teaching
and complication regarding
that may arise due Hypertension
to hypertension
Discuss with the
client the risk factors
of hypertension
such as family
history, age, and
salt/ fats intake for
the awareness of
the patient.
Promotehealthy lifestyle
The patient
will be able
to verbalize
the
understand-
ding of
disease
process and
treatment
regimen.
57

relative
complications in
the future.
earlier.
d.)Educate
patient on the
Do’s and Don’ts
of hypertension.
such as:
a.) Encourage proper food
intake like reduce salty
and fatty foodsand include
DASH (Dietary
Approaches to Stopping
Hypertension) diet plan.
b.)Prevent obesity through
proper nutrition and
exercise.
c.)Encourage patient to
decreaseoreliminate
drinking caffeine like coffee,
softdrinks, teaandcola.
58

Age: 84 year old
Gender: Female
HEALTH
PROBLEM
FAMILY
NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVE OF
CARE
INTERVENTION PLAN
Contact
EXPECTED
OUTCOME
Health Deficit
Hypertension
Inability of
the patient
to continue
taking her
medication
as
prescribed
due to:
a.) Unable
to remind
herself for
taking due
medication.
b.)
Inadequate
knowledge
on
preventive
The patient
will be able to
remind
herself in
taking of her
medication
and also the
importance of
having
regular
check-up.
The patient will
be able to:
a.) Educate her
family measures
about the
importance of
regular check-
up.
b.)Explain
importance of
proper diet or
food intake.
c.)Enumerate
the diseases
that might
develop if
hypertension is
not prevented
Assess the patient’s Establishing BP apparatus
Individual perceptions rapport through Visual aid for
of their health home visit. discussion.
problem. (make a good (pamphlet)
eye to eye
Assess patient’s contact.)
confidence in her
ability to perform Health teaching
desired behavior. regarding
Hypertension
Inform patient of
the benefits of adhe-
rence to prescribed
regimen.
Discuss the nature
signs and symptoms
and complication
that may arise due
to hypertension.
Promotehealthy lifestyle
The patient
will be able
to verbalize
the
understand-
ding of
disease
process and
treatment
regimen.
59

measures.
c.) Inability
of patient to
visit
RHU/clinic
for regular
check-up.
earlier.
d.)Educate
patient on the
Do’s and Don’ts
of hypertension.
such as:
a.) Encourage proper food
intake like reduce salty
and fatty foodsand include
DASH (Dietary
Approaches to Stopping
Hypertension) diet plan.
b.)Prevent obesity through
proper nutrition and
exercise.
c.)Encourage patient to
decreaseoreliminate
drinking caffeine like coffee,
softdrinks, teaandcola.
60

Age: 84 year old
Gender: Female
HEALTH
PROBLEM
FAMILY
NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVE OF
CARE
INTERVENTION PLAN
Contact
EXPECTED
OUTCOME
Health Deficit
Arthritis
Inadequate
knowledge
about the
problem
The patient
will be able
to
understand
the curative
measures of
the problem
The patient will
be able to
identify and
demonstrate
interventions to
relieve pain.
Establish rapport. Establishing Visual aid for
rapport through discussion
Suggest patient home visit. (pamphlet)
assume position of (make a good
comfort while in eye to eye
bed or sitting in contact)
chair. Promote bed
rest as indicated. Health teaching
regarding
Encourage frequent Arthritis
changes of posi-
tion. Advise the
family member to
assist patient to
move in bed,
supporting the joints
above and below,
avoiding jerky
movements.
The patient
will be able
to apply
those
intervention
to
experience
gradual relief
of pain in
her health
problem.
61

Advise the patient to
provide gentle
massage.
Recommend that
patient take warm
bath or shower on
arising and/or at
bedtime. Apply
warm, moist
compresses to
affected joints several
times a day.
Encourage use of
stress manage-
ment techniques, e.g.,
progressive relaxation,
biofeedback, visuali-
zation, guided
imagery, self-hypnosis,
and controlled
breathing. Provide
therapeutic touch.
Inform the family
member to assist the
patient with active/
passive ROM and
resistive exercises and
isometrics when able.
62

CHAPTER VII
SUMMARY, CONCLUSION AND
RECOMMENDATION
A. Summary
Sitio Asana II, Barangay Santisima Cruz, Sta. Cruz Laguna is the area where
Crisostomo Family resides. They are composed of three members (Mrs.
Angelita Policarpio- wife’s mother, Mrs. Irma Crisostomo- the wife and Mr.
George Crisostomo- the husband); considered as a type of extended family that
couple lives to the wife’s parent. This family has no problem in financial since
Mr. George is a Retired Chief Police which he received a monthly income of
35,000 – 45,000.
As we visited them during Community Health Service, first thing we did is to
recognize those factors that affects their health with the use of survey form.
Therefore, we found out the potential problem that may occur in this family such
as the way they dispose their garbage which they prefer in an open-burning and
sometimes just place it in an open container. On the other hand, in terms of their
nutrition we recognized they had an imbalanced intake of it as verbalized by one
of the member of family “Minsanan lang kami kumain ng gulay at prutas.” In this
data, it is a health threat to the health status of the family that may result to
possible disease.
When we interviewed each member of the family for the history taking, we
recognized the present illness of them; Mrs. Angelita had arthritis and
hypertension while Mrs. Irma also had hypertension which is health deficit.
Through our findings and thorough assessment, we implemented interventions
that will help this family in providing good quality of health in prevent disease/
illness. We had health education to them about in proper disposal of garbage by
segregating non-biodegrable and biodegrable materials or selling some waste
materials like cans, bottles and plastics. Then also, we educate them on how to
balanced nutrition by having a low-salt and low-fat diet and emphasized to them
about the importance of fruits and vegetables in order to prevent disease such as
hypertension, diabetes, stroke, etc.
63

B. Conclusion
As we handle our chosen family and identified their health problem, it is true
that all problems has its solution and it is always need a change for a better
condition.
We concluded that this Community Health Nursing Service has a great impact
in every lives of an individual that promotes good health and prolonging life. We
observed that Crisostomo Family was practiced those health education that
we’ve said to them such as in proper disposal of garbage. They had different
options on it like by using a compost pit with cover, segregating non-biodegrable
and biodegrable materials, recycling or selling of the cans, bottles or plastics.
Also, especially when it comes to a balanced nutrition the family had a
realization that those food with high cholesterol can make their life shorter. They
are aware on the diseases may get and with that they practiced on how to eat
vegetables, fruits and low their salty and fatty foods intake.
64

C. Recommendation
We all know it isn't easy to change someone’s perception when you know
it becomes as their habit. But through our health education during home visit, we
gave them an important information on how to adopt a healthy diet. We
emphasized the importance of lifestyle treatments have the potential to improve
blood pressure and prevent taking such as medication.
We advised to the Crisostomo family to prevent salty foods. It is really
important to read nutrition labels; almost all packaged foods contain sodium
especially with those foods with more than 150 mg of sodium in each portion and
every time they will prepare or eat a packaged food, know how much sodium is in
one serving.
We told them that eating a diet that is rich in whole grains, fruits,
vegetables and low-fat dairy products and skimps on saturated fat and
cholesterol can lower their blood pressure by up to 14 mm Hg and this eating
plan is part of the Dietary Approaches to Stop Hypertension (DASH) diet.
We instructed the family on how to recognize signs and symptoms of high
blood pressure, although it is frequently asymptomatic, like blurring of vision,
fatigue, dizziness or headache; for them to know of monitoring their health
condition.
We suggested that the low-salt and low-fat diet is the very useful to do to
prevent increase blood pressure of the individual. Eating a heart-healthy diet,
including potassium and fiber will help to control the blood pressure and have a
high chance to live with a healthy living.
APPENDICES
65

A. PICTURE GALLERY
During home visit to Crisostomo family.
66

This living space of family is adequate for the three members. It consist of 2
bedrooms.
67

COMMUNITY HEALTH SURVEY FORM
Head of the Family:____________________________ House No.:____ Date
Assessed:_______
Family Member
Relation
to Head
Sex Age
Marital
Status
Educational
Attainment Occupation
Monthly
Income
No. Name
CHILDREN’S IMMUNIZATION
NO. NAME AGE SEX BCG DPT OPV HEPA B MEASLES
1. Type of Family: [ ] Nuclear [ ] Extended [ ] others,
specify:_______
2. Home:
Ownerships: [ ] Owned [ ] Rented [ ] others,
specify:_______
Construction materials used:
[ ] Wood [ ] Mixed [] Concrete
[ ] others, specify:________
Numbers of rooms used for sleeping:____
70

Lighting Facilities: [ ] Electricity [ ] Kerosene [ ] others,
specify:_______
General Surroundings:[ ] Clean [ ] Dirty
3. Water Supply:
Source: [ ] Artesian well [ ] Deep well [ ] MAWASA [ ] others,
specify:_____
Storage of Drinking Water: [ ] Covered [ ] Uncovered [ ]
Refrigerated [ ] others, specify:_____
Sanitary Condition:_________
Kitchen:
Cooking Facility: [ ] Electric Stove [ ] Gas Stove [ ]
Firewood/Charcoal
Sanitary Condition:_________
Drainage Facility: [ ] Open [ ] Blind [ ]
None
4. Domestic Animals
KIND NUMBER WHERE KEPT
5. Pest/ Insect:
[ ] Mosquito [ ] Lizards [ ] Flies [ ] others, specify:_______
6. Garbage Disposal
Container: [ ] Covered [ ] Open [ ] None
Method of Disposal: [ ] Hog Feeding [ ] Open Burning
[ ]Open
Dumping
71

[ ] Garbage Collection [ ] Burial in Pit [ ]Composting
[ ] others, specify:______
7. Toilet Facility
Sanitary: [ ] Flush Type [ ] Pit Privy/ Communal [ ] with
septic tank
Ownership: [ ] Owned [ ]Shared
Unsanitary: [ ] Ballot System [ ] others, specify:_______
8. Nutrition
Food Preference:[ ] Meat [ ] Fish [ ] Fruits/ Vegetables [ ] Mixed
Common Food: [ ] Rice and Egg [ ] Rice and Noodles
[ ]Rice and Sardines [ ] others, specify:________
9. Food Storage
[ ] Covered [ ] Uncovered [ ] Refrigerated [ ] others,
specify:______
10. Gardening
[ ] Fruit Bearing [ ] Vegetables [ ] Herbal [ ] others,
specify:______
11. Whom do you consult in time of illness?
[ ] Private [ ] Rural Health Midwife [ ] Traditional, e.g.
Herbularyo [ ] others, specify:________
12. Common illness encountered within 6 months:
[ ] Malaria [ ] Amoebiasis [ ] Influenza
[ ] Dengue Fever
[ ] Tuberculosis [ ] Asthma [ ] Typhoid Fever [ ]others,
:____
13. Plan to utilize Health Service:
[ ] Hospital [ ] Health [ ] Clinic [ ] others, specify:_______
14. Do you utilize your Health Center?
72

[ ] Yes [ ] No
15. Reasons for utilizing Health Center:
[ ] Post – Natal [ ] Pre – Natal [ ] Immunization [ ] Morbidity
[ ] Health Counseling [ ] others, specify:________
16. Environment
Kind of Neighborhood
Social and Health Facilities Available
Communication and Transportation
Available
Assessed by:
________________________
Student’s Signature over Printed Name
Noted by:
__________________
Clinical
Instructor
BIBLIOGRAPHY
Castillo, G., and Pua, J. (1963). "Research Notes on the Contemporary
Filipino Findings in a Taglog Area." University of the Philippines Digest 2(3):29–
30.Retrieved: October 28, 2014
http://family.jrank.org/pages/1277/Philippines.html
Alan Weidner, I. A. (JUNE 18, 2013), The Importance of Extended
Family to Building Strong, Healthy Families. Retrieved: October 27, 2014
http://www.amberalertgps.com/the-importance-of-extended-family-to-building-
strong-healthy-families-part-2-of-5
73

Robert Wood, J.F., (March 2013), Healthy Policy Snapshot Series.
Retrieved: October 27, 2014 http://www.rwjf.org/en/research-publications/find-
rwjf-research/2012/12/why-does-education-matter-so-much-to-health-.html
Health Impact Assessment (HIA) – World Health Organization Retrieved:
October 27, 2014 http://www.who.int/hia/evidence/doh/en/
Mcmichael A.J., Campbell-Lendrum D.H., Corvalán C.F., Ebi K.L., Githeko
A., Scheraga J.D., Woodward A., Environmental Factors Affecting Health,
Athena Global. Retrieved: October 27, 2014
http://www.athenaglobal.com/pdf/7_environmental_factors_affecting_health.pdf
Ripa Ajmera , (October 21, 2013) , The Effects of Poor Nutrition on
Health., Retrieved: (October 28,2014) http://www.livestrong.com/article/31172-
effects-poor-nutrition-health/
Conservation and Water Stewardship > Environmental Programs &
Strategies .Retrivedfrom:http://www.gov.mb.ca/conservation/envprograms/airqual
ity/brochures/waste_burning_e.html
National Stroke Association, Retrieved:
http://www.stroke.org/site/PageServer?pagename=HighBloodPressure
Brindles Lee Macon, August 20, 2012. , Health line. , Retrieved: October
28, 2014 http://www.healthline.com/health/arthritis#Overview1
74

Family Diagnosis *CHN

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a Family Diagnosis *CHN

Similar a Family Diagnosis *CHN (20)

Más de RoxanneMae Birador

Más de RoxanneMae Birador (20)

Último

Último (20)

Family Diagnosis *CHN