FAMILY HEALTH CARE PROCESS

Presented by: Santos, Rennell Castillo, Harold Tria, John Louie Carriaga, Rosemerry Velez, Ma.Zophia Sitchon, Ma.Regina Reyes, Arbin Roy Vergara, Nichole Pelayo, Marjorie Reyes, Faye Bernadette Vivo, Kahmille Ypear, Daphne Tolentino, Mary Joe San Sebastian, Lovely Jeffersen Tomelden, Katrina

INTRODUCTION
The

Family is the basic unit of the society. It is a group related by blood, marriage or adoption that shared the same household, emotional bond and common goals. They also perform certain interrelated social tasks. The family has different types, functions and characteristics. There are also family developmental stages that each family will experience.

This

study identifies the different structures of the family including their individual health needs and problems. How they cope up with their activities of daily living and their relationship towards the community. The familys socio- economic data and housing and environmental condition can be also seen in this study, that includes the nursing interventions to the familys health problems and needs.

family nursing care plan is the blue print of the care that the nurse designs to systematically minimize or eliminate the identified the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) nd deliberately chosen set of interventions, resources and evaluation criteria standards, methods and tools.

The

use of the family nursing process will result in a care plan describing the needs and care for each client. An organized sequence of problem solving steps used to identify and to manage the health problems of clients.

GENERAL OBJECTIVE:

At the end of famiy-student nurse relationship the family will be able to improve their health status and become self directed in maintaining their health through appropriate nursing interventions in a given time frame.

SPECIFIC
After

OBJECTIVES:

utilizing the family health care process, the student nurses will be able to: Established rapport and trusst with the student nurse. Participate actively during homevisits and assessment interviews. Identify existing and possible future problem and prioritize it according to the family needs and resources.

 Categorized

the identified nursing problem as health threat, health deficit, forseeable crisis through the assisstance of their student nurse. Prioritized the identified nursing problems with the assistance of the student nurse. Formulate nursing care plan that will serve as their guideline towards a possible interventions towards healthy living

Carry

out the the planned interventions togethere with the student nurse. Perform health teachings taught by the student nurse. Evaluate the effectiveness of the intervention using the set obejectives as basis.

CASE ABSTRACT
The

Family G is considered as a nuclear type of family. A nuclear type is a typical type of family composed of a father, a mother and child/children. The V family resides in Brgy. Lumipa, General Emilio Aguinaldo, Cavite City. They were living in Brgy. Lumipa for almost 20 years.. Their house is made up concrete and woods.

The

measurement of the house is approximately 3.5 square meters wide and 4 square meters long. The total floor area of the client is approximately 14 square meters. The house has 2 big windows and can sustain the adequate ventilation needed by the family. The G family main source of income is coming from Mr. G, stick making and carpentry. Mr. V earns about Php 2,800.00 a month.

 Mrs.

G do some sidelines and work as a helper, she is earning Php 700.00 a month. After working, she in charge of the house and in taking care of the children. According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of the family is Php 3,500.00 is about and when divided among the 6 members,

it

is only Php 583.33, thus, they can be considered poor. The family barely participates in community activities since Mr. and Mrs. G are both working. NAWASA is the familys main source of water, but it is being shared within the neighbors. They wash their clothes and boiled the water for drinking purposes. They put their water in a big container with cover.

The

G Family shares comfort room with 3 other families. The drainage system of the family is an open canal type where in the drainage flows continuously. Last 2006, she was diagnosed with hyperthyroidism. Her last check up was December 2012 at DLSUMC.

She

was advice to get T3 and T4 test but due to financial constraint she wasnt able to do the test. Mrs. G has hypertension as a result of her Hyperthyroidism. Her Blood pressure is monitored and recorded in the health center, but not regularly.

She

was taking Metoprolol to lower her Blood pressure but due to limited resources she stopped taking the medication. The G family is identified to have plenty of environmental problems in which it is evident that they practice poor environmental sanitation. With this situation and family condition, many problems were identified such as health threats

which include fire hazards and electrical burn hazards, poor home and environmental sanitation, and improper drainage system and presence of breeding sites. Another problem was identified and categorized as health deficit, the diagnosis of Hyperthyroidism of Mrs. G. Nevertheless, the family has chances to improve their health condition. There still have that ability to meet

 the

desired characteristics in their structure and maximize their health potential of optimum wellness.. They are cooperative and participative to the different issues and interventions they are confronted. Hence, they are willing to submit themselves for the impartation of information and basic knowledge regarding family health. Together with the family, the student nurse as an agent

has

helped the family through motivation and support to change their lifestyle and improve their health status.. Although the allotted time for the student nurse was not enough to attend to all those problems, the family is now equipped with fair knowledge that they could use anytime as the need arises

HYPERTHYROIDISM
Hyperthyroidism

(overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability.

 Your

thyroid gland produces two main hormones, thyroxine (T-4) and triiodothyronine (T-3), that influence every cell in your body. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of protein. Your thyroid also produces calcitonin, a hormone that helps regulate the amount of calcium in your blood.

HOW IT WORKS:
The

hypothalamus signals your pituitary gland to make a hormone called thyroid-stimulating hormone (TSH). Your pituitary gland then releases TSH the amount depends on how much T-4 and T-3 are in your blood. If you don't have enough T-4 and T-3 in your blood, your TSH will rise; if you have too much, your TSH level will fall.

Finally, your thyroid gland regulates its production of hormones based on the amount of TSH it receives. If the thyroid gland is diseased and is releasing too much thyroid hormone on its own, the TSH blood level will remain below normal; if the diseased thyroid gland cannot make enough thyroid hormone, the TSH blood level will remain high.

REASONS FOR TOO MUCH THYROXINE (T-4)

Graves'

disease Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter, Plummer's disease). Thyroiditis.

LEVEL OF ASSESSMENT

ST 1

FAMILY STRUCTURE AND CHARACTERISTICS

The

Family G is a nuclear family which composed of 6 members which include the husband and wife. The head of the family is Mr. G 43 years old, was born on May 23, 1969. He is a self employed worker who works as a carpenter at their community. Mrs. G, 39 years old, was born on September 27, 1973.

They

have 4 children one son and three daughters. Their eldest son is 18 years old and a high school graduate but was not able to continue in college due of financial problem. Second is a 16 years old and a 3rd year high school. Third child is 12 years old and a 1st year high school

And the youngest is 11 years old and a grade 5 elementary student. family usually sleeps 9 in the evening and wake up 5 in the morning in school days and 7 or 8am in weekends. They usually have 8 to 10 hours of sleep except to the head of the family because sometimes he came home late in the evening if they have over time.

The

According to Mrs. G their usual diet is more on carbohydrates, vegetables, fats and fish she said that she only drink water after eating but only half glass of water

APGAR ASSESSMENT TOOL

WHAT IS FAMILY APGAR

The

family APGAR is a useful instrument to provide reliable family information. Smilkstein define family in terms of commitment and sharing of resources such as time, space and finances.

family in the context of this family APGAR then is a psychosocial group consisting of the patient and one or more persons, children or adults in whom there is commitment for members to nurture each other.
has adequate reliability and validity to measure individuals level of satisfaction measure about family relationships

It

ADAPTABILIT Ability to utilize and share resources Y (intra/extra familial)

PARTNERSHIP Sharing decisions making, solving problems by decision making GROWTH AFFECTION RESOLVE Freedom to grow and change Intimacy and emotional interaction in the family Commitment by other members to the family.

PARAME TERS
A I am Adaptabi satisfied lity that I can turn my family for health when somethin g is troubling me.

ALWAYS SOMETI NEVER MES

P I am Partner satisfied ship with the way my family talks on things with me and shares problem with me.

G Growth

I am satisfied that my family accepts and supports my wishes to take on new activitie s or direction s

A I am Affection satisfied with the way my family expresses affection and response to emotion such as anger, sorrow and love.

R Resolve

I am satisfie d with the way my family and I share time togethe r.

 SCORING: ALMOST-

TOTAL: 8-10-

2 SOMETIME- 1 NEVER- 0

Highly functional 4-7- Moderately Dysfunctional 0-3- Severely Dysfunctional

INTERPRETATION:
The

Family G shows moderately dysfunctional with a score of 7 out of 10 which implicates that there were some conflicts and misbehavior that occurs in the family like lack of social skills and social interaction with the community, limited financial resources to provide their needs, lack of communication within the family and lack of self care.

B. SOCIO ECONOMIC AND CULTURAL FACTORS

 the

family prioritizes food first. The next is education, followed by house bills, health and then clothing. The G familys main source of income is coming from Mr. Gs carpenter work and barbeque stick making. He earns about Php 2,800 in a month. Mrs. G also do some sidelines and work as a helper. She earns Php 700 in a month.

C. ENVIRONMENTAL FACTORS

ADEQUACY OF LIVING SPACE AND VENTILATION

Mrs.

G and her family, lives in a small wooden/bamboo house, concrete blocks helping support the structure of the house and tin roofing. The house is small for their family which, consist of 6 members. The measurement of the house is approximately 3.5 square meters wide and 4 square meters long. The total floor area of the client is approximately 14 square meters

 Computation: TSR=

INTERPRETATION: TSR>TFA

(A+B) A = 4x3 sq. m = 12 sq.m B = 2x1.5 sq.m = 3sq.m

TSR

= adequate living space TFA<TSR =Inadequate living space

= 15 sq.m

14sq.m<15sq.m = Inadequate Living space

PRESENCE OF BREEDING SITES

The

house looks untidy; that breeding places of insects and rodents are present also there is a presence of bad smell. The family uses mosquito nets and at time katol.

FOOD STORAGE AND COOKING

FACILITIES

Mrs.

G uses wood in cooking. She barely used charcoal. She is the one who is preparing the food. She cooks outside the house. The food that they usually eat is fish, vegetables and at times meat. When it comes to storing their food, they just cover it with a plate.

WATER
The

SUPPLY

family usually gets water from the neighbor, which is NAWASA. They place the water in a big container with cover. They use it for bathing and laundry and boiled the water for drinking.

Toilet Facility Family G does not have their own comfort room. They uses common bathroom nearby the house for urination and bowel elimination, 3 families are sharing it. Drainage System The drainage system of the family is an open canal type where in the drainage flows continuously. It is dirty and it has smell since there are trashes like plastics.

HEALTH PERCEPTION
According

to Mrs. G, she had a check up last 2006 and was diagnose for hyperthyroidism (right side). Her goiter is 2 cm and was advised to get T3 and T4 but claimed that she does not have money. She also has hypertension and has a record at the Barangay health center showing that she should be observed due to an increase blood pressure.

Her

highest BP before December was 170/120 mmHg. During the home visit on Friday January 11, 2013, the following vital signs were taken: BP 130/90 mmHg; T 36.3 c; PR 110/bpm; RR 20/bpm, weight: 45kg (99lbs) and height: 50. Her recent check up was on December 2012 at DLSUMC.

She

stated that she is aware of the food she is not allowed to eat due to her condition. However she still eats some of the food she is not allowed and does not drink enough water and has dry skin. She stopped taking her medication Metoprolol due to lack of income, which is used to treat hypertension and absorbic acid for vitamin supplements.

PHYSICAL ASSESSMENT
TEMPERATURE

36.7 RESPIRATORY 36.5-37 RATE 18 The patient doesnt 16-20 have a fever. The respiratory CARDIAC RATE rate is normal. 114 80-140 The cardiac rate is normal.

WEIGHT
45

kg To know if the height of the patient is appropriate.

HEIGHT
50

To

know if the height of the patient is appropriate.

GENERAL

APPEARANCE With sign of distress. Patient is irritable and sweating,and 2cm enlargement of thyroid.
With

signs of distress, The patient has sign of distress and intolerance to heat and with goiter.

Because

Patient with Hyperthyroidism overproduction of thyroid hormone that increase the body metabolism. An overactive thyroid causes your thyroid gland to develop a goiter, which means the gland has become enlarged.

SKIN

Presence

of dry skin Light skin, generally uniform except in areas exposed o the sun, no edema, no lesions, good turgor and moist. There is a presence of dry skin, but doesnt any presence of lesions.

HAIR
Fine,

soft hair that is easily falling out. No dandruff, no lesions, normally and even distributed hair. With hyperthyroidism, severe hair loss can also occur, and skin can become fragile and thin.

EYES No

presence of lesion, no edema, equal pupil size. No presence of lesion, no edema, equal pupil size. Her findings are normal.

NOSE Nasolabial fold is symmetrical, and both patent

No

discharge noted or observe. Nasolabial fold is symmetrical, and both patent. findings are normal.

Her

MOUTH
Lips

are pinkish, tongue is in the midline, no inflamed tonsils, speech is intact, and no lesion. Lips are pinkish, tongue is in the midline, no inflamed tonsils, speech is intact, and no lesion. Her findings are normal.

CHEST

AND LUNGS Chest is symmetrical, skin is intact, no masses and no lesion. No use of accessory muscles, no presence of lesion discoloration, no presence of wheezing sounds and no murmur. Normal breathing keeps the body well oxygenated.

HEART

Presence

of palpitation and feels nervousness No use of accessory muscle, and no murmur. . Excess thyroid hormone causes palpitations and some degree of exercise intolerance that is due to an increased heart rate and fatigue.

The

changes in heart rate are a result of a change in the nervous system's control on the heart. With excess thyroid hormones in the body, a heart rate of greater than 90 beats per minute (tachycardia) is common, even at rest and when asleep.

ABDOMEN
with

striae, no scars, uniform color, normoactive bowel sound, and no tenderness. No striae, no scars, uniform color, normoactive bowel sound, and no tenderness. Her findings are normal.Striae gravidarium is normal in patient who have giving birth.

BACK

AND EXTREMITIES The peripheral pulses are symmetrical, the nail beds are pale and dry, and the spine is in the midline, the ROM decreased in the shoulder. There is presence of surgical incision on her right thigh because of previous surgery. The ROM is R/L it should be full, and equally strong.

Patients

muscle show weakness. Chronic periarthritis and calcific tendinitis are also associated with hyperthyroidism. They both tend to occur in the shoulder, causing limitations in a persons ROM, which may progress and lead to adhesive capsulitis. These conditions are both common in people who have endocrine disease.

Bowel

Movement Increase bowel movement 3x a day Bowel movement should be at least 3-4x a week In hyperthyroid, food moves more quickly through your intestines than it used to, and you have more frequent bowel movements or even diarrhea. You may experience nausea and vomiting.

Genitourinary 7x

daily 4-5x in a day As more blood flows, your kidneys filter more, and more urine is produced so you go to the bathroom more frequently. In turn, you feel more thirsty than usual.

Menstrual

cycle 3 days very light menstrual color 5-7 days red to dark red color menstrual flow. Because of the endocrine system, which regulates the creation and distribution of hormones within the body. As a result of this relationship, problems with the menstrual cycle could indicate problems with the thyroid gland -or vice versa.

level of assessment

nd 2

Health Threat 1. Poor home/environmental conditions/sanitation Cues: Sanitation rating is poor Presence of rodents and insects Presence of smell Family does not have their own comfort room. Small house for the family of 6

Identified Problems

ASSESSMENT

1. Inability to provide a home environment conducive to health maintenance and personal development due to: Low salience of the problem Lack of knowledge of preventive measures Ignorance of the importance of hygiene and sanitation

IDENTIFIED PROBLEMS

2. Presence of accident hazards specifically fire and electrical burn Cues: they cook their food inside their wooden house with the use of firewood/charcoal the electrical wirings are within the reach of children

ASSESSMENT

2. Inability to provide a home environment which is conducive to health maintenance and personal development related to: inadequate family resources specifically Financial constraint/limited resources. Failure to see the benefits of investment in home environment

IDENTIFIED PROBLEMS

3. Family size beyond what family resources can adequately provide

Cues: Stated that, she has no enough money to provide for the family needs Family income is Php 3,500. And there ar 6 members in the family. No money for medical check -ups and medications

ASSESSMENT

3. Inadequate family resources, specifically: Limited financial resources

IDENTIFIED PROBLEMS

4. Faulty/unhealthy nutrition/eating habits or feeding techniques/practices: Faulty eating habits Inadequate food/water intake both in quality and quantity

Cues:
Most

of the members of the family does not drink enough water particularly Mrs. G Sometimes, Mrs. G eats food not which is not allowed to eat Does not take medications for hypertension Most of their viands are cooked pork and chicken, they barely eat vegetables

ASSESSMENT
Inability

to recognize the presence of the condition or problem due to: Attitude/philosophy in life which hinders recognition/acceptance of a problem

HEALTH DEFICIT

1. Hyperthyroidism (diagnosed by the doctor) Cues: Advised to get T3 and T4 but no money for it Financial problems Goiter (right side); 2cm Diagnosed of hyperthyroidism since 2006

ASSESSMENT
Failure

to utilize community resources for health care due to: Lack if or inadequate family resources, specifically: financial resources

POOR HOME/ENVIRONMENTAL SANITATION

CRITERIA: 1. Nature of the problem Health Threat COMPUTATION 2/3 x 1 ACTUAL SCORE 0.67 JUSTIFICATION It is a health threat because there is a possibility that a disease may occur from this problem.

CRITERIA 2. Modifiability Partially modifiable COMPUTATION 1/2 x 2 ACTUAL SCORE 0.67

JUSTIFICATION The

problem is partially modifiable because the family doesnt have enough resources to solve the problem but through simple interventions like discussing the preventive measures and importance of proper sanitation the familys perception to solve the problem will increase.

CRITERIA 3. Preventive Potential Moderate COMPUTATION 2/3 x 1 ACTUAL SCORE 0.67 JUSTIFICATION The family does not recognize the problem since they were not aware of the possible consequences they can get from it.

CRITERIA 4. Salience Not perceives as a problem or a condition needing change. COMPUTATION 0/2 x 1

ACTUAL SCORE 0 JUSTIFICATION The family does not recognize the problem since they were not aware of the possible consequences they can get from it.

TOTAL SCORE

2.34

FAULTY EATING HABITS

CRITERIA

1. Nature of the problem -Health Threat COMPUTATION 2/3 x 1

ACTUAL SCORE 0.67 JUSTIFICATION The problem is a health threat since it may affect the familys health.

CRITERIA 2. Modifiability of the Problem Easily modifiable COMPUTATION 2/2 x 1 ACTUAL SCORE 1

JUSTIFICATION The student nurses can provide health teaching regarding the proper eating of nutritious food thus the problem is easily modifiable because there are resources available like.

3.Preventive Potentia High ACTUAL SCORE 3/3 x 1 Computation 1

JUSTIFICATION The problem is highly preventable because simple nursing intervention through health education can be provided by discussing the importance of eating proper food and following the client's diet.

4.

Salience of the Problem CRITERIA Not perceives as a problem or a condition needing change. COMPUTATION 0/2 x 1 ACTUAL SCORE 0

JUSTIFICATION The family doesnt recognize the problem/condition needing change thats why they continuously do their negative habits.

Total Score

2.67

HYPERTHYROIDISM

CRITERIA 1. Nature of the problem:

Health Deficit

COMPUTATION

3/3 x 1

ACTUAL SCORE

JUSTIFICATION The problem is a health deficit since it is an illness that can harm the clients health.

2. Modifiability of the Problem Partially modifiable COMPUTATION 1/2 x 2 ACTUAL SCORE 1

JUSTIFICATION The problem is partially modifiable since the patient doesnt have enough financial resources for the treatment but health teaching can be given so that the hyperthyroidism can be controlled like eating proper food (high protein high calorie food) and avoiding stressful activities.

CRITERIA 3. Preventive Potential moderate COMPUTATION 2/3 X 1 ACTUAL SCORE 0.67

JUSTIFICATION

The problem is moderately preventable since it is already present but the worsening can be prevented if the patient complies with the medication regimen and proper diet.

CRITERIA 4. Salience of the problem - a condition or problem not needing immediate attention COMPUTATION 2/2 x 1 ACTUAL SCORE 1

JUSTIFICATION

The family recognizes the problem but due to luck of financial resources

Total Score 3.67

FAMILY SIZE BEYOND WHAT FAMILY RESOURCES CAN ADEQUATELY PROVIDE

CRITERIA 1. Nature of the problem

Health Threat

COMPUTATION 2/3 x 1 ACTUAL SCORE 0.67

JUSTIFICATION

The problem is a health threat since it may affect the familys health.

CRITERIA 2. Modifiability of the Problem

Not modifiable

COMPUTATION 0/2 x 1 ACTUAL SCORE 0

JUSTIFICATION

The problem is not modifiable since the family can barely sustain their needs in a month with just Php 3,500. Another is, members of 6 cannot be reduce to smaller number instead

CRITERIA 3. Preventive Potential Low COMPUTATION 1/3 x 1 ACTUAL SCORE 0.33

JUSTIFICATION

The problem cannot be prevented with the current number of family members in the household and with their financial status. Health teaching can be provided regarding family planning thus allowing family to see the importance of it in sustaining their needs.

CRITERIA 4.Salience of the Problem perceived as a problem not needing immediate action COMPUTATION 1/2 x 1 ACTUAL SCORE 0.5

JUSTIFICATION

The family recognizes the problem but due to lack of resources they cant provide immediate actions.

Total Score 1.73

PRESENCE OF ACCIDENT HAZARDS

Criteria 1.Nature of the Problem Health Threat Computations 2/3 x 1 Actual score 0.67

Justification

It is a health threat since the family is very prone to accidents inside and outside of their house.

Criteria 2. Modifiability of the Problem. Partially modifiable Computations 1/2 x 2 Actual score 0.5

Justification

The problem is partially modifiable since it will need financial resources to change the problem but through simple health teaching the likelihood of accident hazards is minimal.

Criteria 3. Preventive Potential. High Computations 2/3 x 1 Actual score 0.67

Justification

The health problem can be highly prevented or reduced if the family will given proper health teaching regarding the prevention of accident hazards inside and outside the house.

Criteria 4. Salience of the Problem a condition or problem not needing immediate attention Computations 0/2 x 1 Actual score 0

Justification

The family do not recognize the problem and doesnt see that they were prone to accident hazards like fire and electrical burns.

Total Score 1.84

PRIORITY SETTING
Rank: Identified Problem: Score

Hyperthyroidism

3.67

Faulty eating habits

2.67

Poor home/environmental sanitation

2.34

Presence of accident hazards

1.84

Family size beyond what family can adequately provide

1.73

FAMILY NURSING CARE PLAN

Health Problem Presence of Health Deficit - Hyperthyroidism (diagnosed by the doctor) Family Nursing Problem Failure to utilize community resources for health care due to: -Lack of or inadequate family resources specifically: financial resources

Goal of care After nursing intervention, the family will decide on appropriate action(s) to help maintain the normal function of the thyroid gland, which will produce normal levels of thyroid hormones based on healthy living with a limited resources available

Objectives of Care After intervention, the family Can find ways to maintain the illness with the limited resources available

will select the appropriate food within their budget

Interventions: Nursing Interventions Explain to the patient about the importance of health care towards the illness:
Analyze the budget and available resources from the family and community Discuss the proper diet for hyperthyroidism patient

Method of Nurse Family Contact Home Visit Resources Required Material Resources: Visual Aids Human Resources: Time and effort of the nurse and the family.

Health Problem Poor Environmental sanitation Family Nursing Problem Inability to provide a home environment conducive to health maintenance and personal development due to:
Lack of knowledge of preventive measures Ignorance of the importance of hygiene and sanitation

Goal of care

After 2 weeks of intervention the family will know the importance of proper sanitation

Objectives of Care After 2 weeks of intervention: a. the family will clean the surroundings regularly b. the family will impose ways to reduce the presence of insects, rodents and mosquitoes c. the family will practice proper waste disposal

Interventions Nursing Interventions Discuss the importance and purposes of proper sanitation.

Suggest alternative methods that would eliminate the breeding sites of vectors.
Explore with the family the ways of improving home sanitation considering its limited resources. Emphasize to the family the proper storage of foods that may attract the vectors.

Method of Nurse Family Contact Home visit Observation

Resources Required Material Resources: Visual Aids Human Resources: Time and effort of the nurse and the family.

Evaluation Criteria: a. proper sanitation Standard: After 2-3 home visits: a. reduction of insects, rodents, and mosquitoes with the use of insecticide and pesticide b. proper waste disposal and home maintenance is observed according to instructions given

Health Problem Unhealthy Nutrition/Eating habits or feeding technique related Inadequate Family Resources and Compliance.
Family Nursing Problem 1.Failure to comply the restrictive diet designated to patient condition. 2.Lack of inadequate family resources to provide a healthy variety of food.

Goal of care After a nursing intervention the family will have compliance in foods preference that applicable within the family income.
Objectives of Care After a nursing intervention the family will be to: a. Comply the food preference of client condition based on family income. b. Will consult the nurse after delivery for guidance in food after a discussion.

Nursing Interventions 1.Explain to the patient the importance of diet and their restriction to maintain her health.
2.Analyze the budget and available resources of the family to provide nutritious food within the family resources. 3.Discuss the proper diet for hyperthyroidism.

4.Provide a list of food preference for hyperthyroidism in a use of pamphlet or visual aids. 5.provide information on consultation about the diet.

Method of Nurse Family Contact Home visit

Resources Required Material Resources: Pamphlet and Visual Aids on methods in regulating restrictive diet within family resources. Time and Effort of both nurses and the family.

Health Problem Family size beyond what family resources can adequately provide. Family Nursing Problem Inability to make decisions with respect to taking appropriate health action due to lack of knowledge as to alternative courses of action open to the family.

Goal of care

After 1 hour nursing interventions, the family will decide on appropriate action to maintain family size based on a sense of responsibility for life and love.

Objectives of Care After a nursing intervention,the couple; a. can explain what planning the family is all about. b. can enumerate the various ways of maintaining the size of the family. c. will select a method most appropriate for them d. will consult the nurse after delivery for guidance on the alternative/method choosen.

Nursing Interventions
1.Analyze with the couple critical issues related with marital relationship and the parents responsibility for love and life as basis for maintaining family size. 2.Discuss with the couple the alternative courses of action.

3.Analyze with the couple the advantages of each alternative method to encourage better decision making on the best option given the familys situated possibilities.
4.Explore with the family especially with the couple ways of encouraging growth-promoting activities to enchance marital relationship for family life education. 5.Provide information on the consultation hours of the student nurse.

Method of Nurse Family Contact Home Visit

Resources Required Material Resources: Visual Aids on methods of regulating fertility Human resources: Time and effort of the student nurse and family

Health Problem 1.Presence of Accident Hazards: specifically fire and electrical burns. Family Diagnosis Inability to provide a home environment which is conducive to health maintenance and personal development related to: inadequate family resources specifically Financial constraint/limited resources. Failure to see the benefits of investment in home environment improvement.

Goal of Care

After 2-3 hours of rendering nursing interventions, the family will be able to recognize the problem and know some measures to lessen the risk for accidents.

Objectives of Care After 2-3 hours of rendering nursing interventions, the family will be able to:
recognize the presence of environmental hazards as a threat identify ways to modify their environment and make it less vulnerable to cause accidents enumerate some safety measures to lessen, if not to avoid, the occurrence of accidents.

Interventions

1. Assist the family members in identifying those accidental hazards present in their environment to let them aware that these are treats in their health. 2. Discuss with the family the changes that they may do in the environment to decrease the cause of accidents such as to place the earthen stove in a nonfire prone area.

Methods of Contact Home visit Resources Human: Health Care Provider

Evaluation Standard: After 2 hours of rendering nursing interventions, the family was able to minimize the risk factors to accidents. Criteria: After 2 hours of nursing intervention, the family was able to: enumerate those accidental hazards present in their environment 2.name possible changes in their environment that are accident hazards 3.list safety precautions to employ in order to minimize risk for accident.

SUMMARY, EVALUATION AND RECOMMENDATION

Presented in this case study is the different characteristics and health condition of family G. This case study presents the family structure, socio-economic and cultural factors, home and environmental factors, health assessment of each member. It also contains data about identified problems on the living condition of the family.

SUMMARY AND EVALUATION

The Family G is considered as a nuclear type of family. A nuclear type is a typical type of family composed of a father, a mother and child/children. The V family resides in Brgy. Lumipa, General Emilio Aguinaldo, Cavite City. They were living in Brgy. Lumipa for almost 20 years.. Their house is made up concrete and woods. The measurement of their house is approximately 3.5 x 5 square meter. In order for the house to be considered as adequate, the total floor area should be divided among the total members of the family and each should at least have 3.5-meter square.

The house has 2 big windows and can sustain the adequate ventilation needed by the family. The G family main source of income is coming from Mr. G, stick making and carpentry.

Mr. V earns about Php 2,800.00 a month. Mrs. G do some sidelines and work as a helper, she is earning Php 700.00 a month. After working, she in charge of the house and in taking care of the children. According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of the family is Php 3,500.00 is about and when divided among the 6 members, it is only Php 583.33, thus, they can be considered poor..

The family barely participates in community activities since Mr. and Mrs. G are both working. NAWASA is the familys main source of water, but it is being shared within the neighbors. They wash their clothes and boiled the water for drinking purposes. They put their water in a big container with cover. The G Family shares comfort room with 3 other families. The drainage system of the family is an open canal type where in the drainage flows continuously

The G family is identified to have plenty of environmental problems in which it is evident that they practice poor environmental sanitation. With this situation and family condition, many problems were identified such as health threats, which include fire hazards and electrical burn hazards, poor home and environmental sanitation, and improper drainage system and presence of breeding sites.

Another problem was identified and categorized as health deficit, the diagnosis of Hyperthyroidism of Mrs. G. Nevertheless, the family has chances to improve their health condition. There still have that ability to meet the desired characteristics in their structure and maximize their health potential of optimum wellness.

They are cooperative and participative to the different issues and interventions they are confronted. Hence, they are willing to submit themselves for the impartation of information and basic knowledge regarding family health. Together with the family, the student nurse as an agent has helped the family through motivation and support to change their lifestyle and improve their health status. Although the allotted time for the student nurse was not enough to attend to all those problems, the family is now equipped with fair knowledge that they could use anytime as the need arises.

RECOMMENDATIONS
The student nurse have identified and prioritized problems and needs with the family. The student nurse has also created a care plan on how to deliver the best nursing care for the family to address their needs. The following below are suggestions and recommendations recognized by both the student nurse and family:

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The Gabinga family should maintain a healthy and clean environment. They must clean their surroundings to avoid the presence of vectors of diseases. They must also reorganize their cooking practices in terms of food preparation and handling as well as keeping their kitchen utensils in a covered storage to avoid getting it contaminated by insects or pests. In addition to that, they should also cover their food storage. The family should also be advised to not wait for the ailment to become severe before seeking medical help.

4. The family should be aware that organizations in the community are open and present for their problems to be addressed properly 5. They should be encouraged to verbalize their concerns with regard to the community so that resolutions can be made.

EVALUATION

Based on our assessment, the G family needs more orientation and knowledge regarding health issues that was seen by the student nurses during home visit. The family does not think it is a health threat in their life.

After identifying the problem of G Family, we prioritized their health issues from hyperthyroidism being the number one health priority which is health deficit followed by health threats which are poor environmental sanitation, poor eating habits and family size beyond what family resources can adequately provide. With these problems the family should be aware about the concerning issues identified.

Based on evaluation the health requirements of the family are not being met due to inadequate family income and resources. And also lack of knowledge about the threat and possible complication of the existed diseases.