BULACAN STATE UNIVERSITY

COLLEGE OF NURSING
City of Malolos

ASSESSMENT DATA BASE

Family Name: Flores

Purok(s):Tabing-Ilog 1, Brgy. San Nicolas,Bulakan,Bulacan

Informant: Gloria Flores Time Started: 9:30am Time Finished: 11:15am

A. Family Structure, Characteristics, and Dynamics

Name of Family Age Sex Civil Position In Place of

Member Status the Family Residence
Mario Flores 44 M M Head San Nicolas
Gloria Flores 41 F M Wife San Nicolas
Gellie Marie Flores 22 F S Daughter Dubai
Mariella Flores 15 F C Daughter San Nicolas
Jared Flores 8 M C Son Cagayan Valley
Johnrem Flores 5 M C Son San Nicolas

Type of family structure

(x) Nuclear ( ) Extended ( ) Dyad
( ) Single- parent ( ) Homosexual/Same Sex
( ) Cohabiting/Communal

The type of their family structure is nuclear, consisting of father, mother and their
children.

Dominant family members in terms of decision making

( ) Patrifocal/Patriarchal ( ) Matrifocal/Matriarchal

(x) Egalitarian ( ) Matricentric

They are egalitarian when it comes to decision making. Mr. Mario and Mrs. Gloria
talk about the problem first and the consequences before ending up to a
conclusion.

General family relationship/dynamics

As we do the home visit, we noticed that there’s no conflict between the family
members.

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B. Socio-Economic and Cultural Characteristics

Family Member Occupation Income Educational Religion

Attainment
Mario Flores Laborer P 7,800 3rd Year Roman
Highschool Catholic
Gloria Flores Volunteered Allowance 3rd Year Roman
Mother Leader only Highschool Catholic

Relationship of the family to larger community

The family actively participates to community activities like zumba, fiesta, feeding
programs for the malnourished, and church procession.

C. Home and Environment

Housing

a. Adequacy of living space

Flores’s family is rent-free in their home. Construction materials used was

mixed which is made up of wood, coco lumber and cement. There is one
room that is used for sleeping. Mrs. Gloria said it was adequate for their living
space but as the student nurse observed it was inadequate.

b. Sleeping arrangement

They were sleeping in accordance to their wants. As Mariella said that she
likes to sleep in their living room together with her family rather in the
bedroom.

c. Presence of breeding or resting sites of vector of diseases

No presence of breeding sites as observed in their environment. The clothes

in their room are not organized and scattered around the roomthat might be
attractable to mosquitoes but cannot be a breeding site.

d. Presence of accident hazard

There is a presence of accident like fire hazards. As observed, their house is

made up of wooden materials. Their kitchen is just inside their homeand
might be a risk especially when coming into contact with flammable materials
on site.

e. Food storage and cooking facilities

When it comes to food storage, it was covered due to different diseases might
get if left exposed. For their storage of food they just leave it over the table
covered. They cook food in gas stove because it’s more convenient to use.
They even used firewood/charcoal for once in a while.

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 f. Water supply

They get their water supply in water district. This is where they use for taking
a bath, washing clothes and use for cooking. They have separate mineral
water use for drinking purposes. They get it from mineral water stores that
deliver onto them house to house. They don’t have storage for water as it was
direct flowing from the faucet or pipe and it is located inside the house.

g. Toilet facilities

They owned one toilet facility and is located inside their house. Type of toilet
is water-sealed. Location from source of water is less than 20 ft.

h. Garbage/refuse disposal

Sanitary condition as observed was generally clean. Two containers of trash

bins were seen behind the two doors of their home that was used as storage
of waste. Waste segregation is practiced by the family. Their garbage is
collected by the barangay officials every Wednesday and Saturday of the
week. They are practicing waste segregation to promote a friendly
environment and for the reason that barangay ordinance is strictly monitored.

i. Drainage System

Sanitary condition was generally clean. An open drainage is present that can
be seen closer to their home. It was flowing and in a good condition.

j. Lighting Facilities

For their lighting facility, it was powered by electricity. Adequate lighting was
observed. There is adequate and good ventilation within every area of the
house.

Kind of Neighborhood

Their neighborhood is not congested but one of their neighbors have visitors and
they usually stay in front of Nanay Gloria’s house, they used to smoke, the smoke
gets inside the house and the family inhales it. Cigarette butts are left outside
Nanay Gloria’s house.

Social and Health facilities available

We asked her about the Services in the Community and she said that there are
Religious Services, Health services, Livelihood Services, Garbage Collection and
Peace and Order with the help of the assigned councilor and barangay tanods.
Institutional Facilities like Brgy. Hall where the services of the Baranggay officials
are rendered, Health Station such as Health Center where people can seek
medical help.

Communication and transportation facilities available

Mode of Transportation in their barangay are as follows Tricycle, Jeep, Bicycle

and Private vehicles. Mode of Communication, Mrs. Gloria says that Postal
system and Telephone are being used up to this time, Internet and Cellphones
are also of great use. Two way Radios are for the Baranggay Captain and
Tanods so they can easily implement Peace and Order.

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D. Health Status of Family Member

Medical History of Diseases

Name Age Gender Disease

Nutritional Assessment

Anthropometric Measurements
Ag Wt. Ht. BMI Waist Hips Waist
Name e in in (Wt. Rem Circu Circu Hips Rem Mid Rema
in kg. m in kg arks mfere mfere Ratio arks Arm rks
mo / Ht. nce nce (WC/ Circu
s. in (WC) (HC) HC) mfere
m)2 in cm. in cm. nce
Gloria 57kg 167 91cm 55cm 91cm
Flores cm
Johnre 17kg 107 56cm
m cm
Flores

24-hour Dietary Recall

Date Time of the day Food taken
10/09/17 BREAKFAST 1 ½ cups of rice, 2pcs. hotdog, 1pc. egg
SNACK 3 slices of bread and 8oz. of softdrinks
LUNCH 2 cups of rice, 1 cup of sayote, and 1
pritong galunggong
SNACK
DINNER 1 ½ cups of rice, 1pc. pritong tilapia w/
kamatis
MIDNIGHTSNACK

Developmental assessment of infant, toddlers and preschoolers

(See MMDST Tool)
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Risk factor assessment

Cigarette Smoking
Is there a member of the family who is a cigarette smoker?
( ) Yes (x) No ( ) frequency/sticks or packs/day ________

Name Age Age started Reason

smoking

Use of prohibited / dangerous drugs

Is there a member of the family who uses prohibited/dangerous drugs?
( ) Yes (x) No ( ) Types of Drugs : ______/Solvent_________

Name Age Age started using Reason

drugs

Drinks alcoholic beverages

Is there a member of the family who drinks alcoholic beverages? (x)
Yes ( ) No

Name Ag Age started Frequenc Type Reason

e drinking alcohol y
Mario 44 22 moderate beer For leisure
Flores

Physical Assessment
(See Physical Assessment Tool)

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention

Immunization status of family members

Com Inco
G Fully
O O M plete mple
Age e B D D D He He He O Imm
P P ea accor te
Name in n C PT PT PT pa pa pa PV uniz
V V sle ding accd
mos d G 1 2 3 B 1 B 2 B 3 1 ed
2 3 s to g to
er Child
Age Age
Johnr 70 M 08 10 11 12 08 10 11 10 11 12 06 Yes Yes
em mos - - - - - - - - - - -
29 03 07 05 29 03 07 13 07 05 06
- - - - - - - - - - -
20 20 20 20 20 20 20 20 20 20 20
12 12 12 12 12 12 12 12 12 12 13

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Healthy lifestyle practices

Tatay Mario uses helmet whenever he is riding on a motorcycle borrowed from his
friend.

Adequacy of:

Rest and sleep

According to Mrs. Gloria, the family has adequate rest and sleep. Approximately
having 7-8 hours of sleep made them feel relaxed. She said sleep improves
concentration, refreshes body and restores energy.

Exercise/activities

The family also has adequate exercise/activities that includes walking, jogging in
the area. Mrs. Flores said that individuals who participate in physical activities are
healthier in mind and body and have a reduced risk of diseases.

Use of protective measure

Mrs. Flores ensured that her family use adequate footwear in parasite- infested
areas especially her 5 years old child. Mrs. Flores promotes protective clothing for
her children in prevention to malaria and filariasis endemic areas.

Relaxation and other stress management activities

Their forms of relaxation were watching TV together with their children and
preparing foods which are family favorites so as together in times all family
members are at home and it is a form of bonding that can reduce stress.
According to Mrs. Flores, to cope with stress her family planned activities like
going on park or playground for their child enjoyment, a form of bonding. They
involved themselves to barangay activities to zumba that is weekly promoted to
achieve and gain a healthy living. They actively join fiesta, religious procession,
and local cultural practices as a sense of connectedness to self and to others

Use of Promotive-Preventive Health Services

Based on Mrs. Gloria’s subjective information, both of her children received

proper vaccination services from the barangay.

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 GENOGRAM

AR II ZR

76 79 81 84 85

GR JR GR JR AR I

FF LF

70 72 74 81

FF AF MF AMF

94 ‘01 ‘09 ‘12

GMF MGF JF JrF

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ECOMAP

BARANGAY
CHURCH Work: Volunteered
Motherleader

MF GR

Work: JF JrF
LABORER GMF MGF

SCHOOL
NEIGHBORHOOD

FRIENDS

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First Level Assessment

Cues/Data Health Condition

A. Health Threat

The family has 4 members, 1Family size beyond what family resources can
their income is P300.00 a day adequately provide
and 2 children are studying.

The house is made up of 2Accident hazards like fire hazards

wooden materials. They use
“kusinilya” in cooking. And the
kitchen is just inside their
home.

“Sa dami ng basurang naipon 3Poor home/environmental condition/sanitation –

minsan sinusunog namin ito o specify: improper garbage/refuse disposal
kaya hinahayaan nalang
nakatambak sa labas ng gilid
ng aming bahay hanggang sa
kunin ito ng garbage collector”
as quoted by Mrs. Gloria, the
mother of the family.

B. Health Deficit

Mrs. Gloria verbalized 1Inadequate food intake in quantity

“kadalasan kulang ang pera
kaya pinagkakasya lang namin
ang pagkain.”

Lack of knowledge of right 2 Unhealthy lifestyle and personal habits/practices-

drugs to be administered in specifically:
times of sickness
a. Self-medication

C. Stress Points/Foreseeable Crisis

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Mrs. Gloria verbalized “sa
ngayon walang trabaho ang
mister ko dahil tapos na ang
project na ginagawa nila”
Second Level Assessment
Health Condition
A. Health Threat
1 Family size beyond what
family resources can
adequately provide
2 Accident hazards like fire
hazards
3 Poor home/environmental
condition/sanitation –
specify: improper
garbage/refuse disposal
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1Loss of job
Family Nursing Problem
Inability to make decisions with respect to taking
appropriate health action due to:
a. Feeling of confusion, helplessness, and
resignation brought about by the perceive
magnitude of the problem.
Inability to provide a home environment conducive to
health maintenance and personal development due
to:
a. Lack of family income
b. Ignorance of preventive measures
Inability to decide about taking appropriate actions
due to failure to comprehend the nature and scope of
the problem.
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 B. Health Deficit

1Inadequate food intake in Inability to recognize the presence of the problem

quantity due to:
a. Lack of adequate of knowledge

b. Fear of consequences of diagnosis of problem

specifically:

1. Economic cost implications

c. Attitude/philosophy in life which hinders

recognition/acceptance of a problem.

Inability to make decisions with respect to taking

appropriate health action due to:
a. Failure to comprehend the nature of the
problem

b. Low salience of the problem

Inability to recognize the presence of the problem

due to:
a. Lack of adequate knowledge

b. Attitude/philosophy in life which hinders

acceptance of a problem

Inability to provide adequate nursing care to the sick

or at risk member of the family due to:
a. Lack of adequate knowledge about child
development and care

b. Lack of necessary facilities, equipment and

supplies for care
2 Unhealthy lifestyle and
personal habits/practices- c. Inadequate family resources for care,
specifically: specifically:

a. self-medication 1. financial

C. Stress Points/Foreseeable Crisis

1 Loss of job

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2

Scoring & Prioritization

A. Inadequate financial resources

Criteria Computation Actual Justification

Score
1. Nature of the 2/3 x 3 2
problem
2. Magnitude of 4/4 x 4 4
the problem
3. Modifiability of 1/3 x 3 1
the Problem
4. Preventive 2/3 x 3 3
Potential
5. Social 2/2 x 2 2
Concern
Total Score 12

B. Fire Hazards

Criteria Computation Actual Justification

Score
1. Nature of the 1/3 x 3 1
problem
2. Magnitude of 3/4 x 4 3
the problem
3. Modifiability of 1/3 x 3 1
the Problem
4. Preventive 2/3 x 3 2
Potential

5. Social Concern 2/2 x 2 2

Total Score 9

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C. Burning of garbage

Criteria Computation Actual Justification

Score
1. Nature of the 1/3 x 3 1
problem
2. Magnitude of 3/4 x 4 3
the problem

6. Modifiability of 1/3 x 3 1
the Problem
3. Preventive 2/3 x 3 2
Potential
7. Social Concern 2/2 x 2 2

Total Score 9

Prioritization of Problems

Rank Score Problem

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Documentation

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