CHAPTER I

INTRODUCTION

A community is a small or large social unit (a group of living things) that has

something in common, such as norms, religion, values, or identity. Communities often

share a sense of place that is situated to a given geographical area (e.g. a country,

village, town, or neighborhood) or in virtual space through communication platforms.

Community Health Nursing is the synthesis of nursing and public health practice

applied to promote and protect the health of population. It combines all the basic

elements of professional, clinical nursing with public health and community practice.

Community health nursing is essential particularly now because it maximizes the health

status of individuals, families, groups and the community through direct approach with

them.

The family is the smallest unit of the society and the natural fundamental core of

the community and consequently, it is considered as the primordial recipient of the

nursing effort, which is contributory to the development, and progress of the community

through active involvement and self-responsibilities of each constituent. It is composed

of persons, male and female, being molded to be as one, working hand in hand to

maintain a good atmosphere among the family members.

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of

energy and or nutrients. Malnutrition can be seen in ‘undernutrition’—which includes

stunting (low height for age), wasting (low weight for height), underweight (low weight for

age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and

minerals). The other is overweight, obesity and diet-related non-communicable diseases

(such as heart disease, stroke, diabetes and cancer). In the Philippines, according to the

National Nutrition Council (NNC) earlier this year, more than 3.8 million children in the

nation are stunted or short for their age, while about 807,057 are wasted or underweight.

This is equivalent to about 33.4 percent and 7.1 percent of children in the country. In

2017, globally, there were 151 million children under 5 year of age were stunted, 51

million wasted, and 38 million overweight.

OBJECTIVES

General Objective:

Student nurses will be able to put into practice the art and concepts of family-

oriented nursing care and be competently able to deliver quality nursing services to the

family. Furthermore, the adopted family will also gain more knowledge about the

identified health problems in the family and maintain their health status by accomplishing

the following specific objectives;

Specific Objectives:

For the family:

 Be knowledgeable on the basic nursing care and prevention of family health

problems.

 To be able to properly manage and maintain a good nutritional routine in their

family.

 To skillfully perform basic nursing care particularly on maintaining good

nutritional routine as well as being able to perform proper management of its

environment independently.

For the community:

 To gain more knowledge about basic nursing care through the health teachings

given.

 To be able to utilize the health services and resources available in the community

to promote their health.

 To be skilled in providing nursing care by utilizing the available resources as well

as being skilled in managing the environment.

For the student-nurse:

 Student nurse should be able to grasp the concept of community health nursing

through understanding the essence of family, community and its relationship in

promoting health.

 Should be able to competently relate the family problem in formulating nursing

interventions relevant to helping students have more skills in critical thinking and

planning nursing care.

 Should be able to make utmost use of the necessary nursing skills to deliver

health services as well as to be an instrument to raise awareness to the

community.
 CHAPTER II

FAMILY PROFILE

Relationship
Family Civil Position in Educational
Age Sex to the Family Occupation
Members Status the Family Attainment
Head

E. G. 36 M Married Head Elementary Stock Clerk

C. G. 26 F Married Wife Wife Elementary Housewife

M. G. 9 M Single Child Son Grade 3 Student

E. G 7 M Single Child Son Grade 1 Student

C. G. 5 F Single Child Daughter Kindergarten Student

Newborn
C. G. F Single Child Daughter

PARAGRAPH FORM
 CHAPTER III

INITIAL DATA

A. Family Structure

The Galvans is under the nuclear type of family. It is composed of six family

members. The couple has four children: two boys and two girls. The mother was raised

in Barangay San Agustin, City of San Fernando. She got married to Engracio Galvan,

who is originally from Palugsi, Limasangan, Bauang, La Union, thus, it is matrilocal type

of family according to residence. The father mostly makes decisions in the family.

There are no conflicts observed among the family members. They communicate

without using foul words and they show respect to each other. The children demonstrate

family values such as practicing “mano”, using “po” and “opo” and patience as evidenced

during our feeding that the siblings are patiently waiting for their turn unlike with the other

kids that they aggressively grab the food.

B. Socio Economic and Cultural Background

The father earns 278 pesos a day, which is 6,888 pesos per month at IQC

Trading Company as manpower. He has been working there since 2010 with no

benefits. The wife stays at home to look after the children, especially now, that there is

an additional member of the family. Their family income is not enough to sustain their

daily needs. According to the mother, “Nu awan iti paggatang mi, apan kami ijay store

umutang, sa min to baydan nu agsweldo jay lakay ko.”

The adopted family's religious affiliation is Roman Catholic. As much as the

family would like to go to the church often, they don't have enough money or other

means.

C. Home and Environment (TO ADD and reflect VECTORS

BREEDING SITE from/to first level of assessment)

The family lives in a congested area in Purok 2A of San Agustin. Their home is

made of concrete and wood with 2 small rooms. It has low ceiling and has poor lighting

and ventilation. They own the house but the land is government-owned property. Rest
room near the house is shared with the other residents. For their household chores, they

fetch water from the communal water pump. In cooking, they use clay pot and firewood

in the morning and at noon, and use gas stove at night.

D. Family Health Status

The only known familial disease is high blood and anemia. They have never

been hospitalized with any severe health problems because the adopted family only

experienced having common health problems such as fever and colds. However, one of

their children suffered from intestinal worm infection.

E. Values Placed on Health

The outlook of the family with regards to health and its promotion is not deemed

as necessary because it is not one of their top priorities due to financial constraints. This

is reflected by the fact that the family is aware of the availability of the services offered

by the Barangay, but they do not make utmost use of the resources. They have

insufficient knowledge about when to consider having checked by a health worker.

PHYSICAL ASSESSMENT SHOULD BE ON

ANOTHER PAGE
Physical Assessment

C.G.’s hair and scalp is dry, black, no scaling and lesions. Her ears have no

lesions and there is presence of earwax. For the eye assessment, pupils are

constricting, and conjunctiva is clear. Mouth is dry and blackish lips, tarnished teeth. Her

arms and hands have dry skin, no lesions, and no clubbing in the nails. Lungs have no

adventitious sounds. Abdomen has stretch marks, no lesions. Legs and feet do not have

lesions, and has dirty untrimmed nails.

E.G.’s hair and scalp is smooth, black hair, no scaling and lesions. His ears have

no lesions and there is presence of earwax. For the eye assessment, pupils constricting

and conjunctiva is clear. Mouth is moist and has pinkish lips and has clean teeth. His

arms and hands have dry skin, no lesions and no clubbing in the nails. Lungs have no

adventitious sounds. Abdomen has no lesions. Legs and foot has no lesions and the

nails are trimmed.

M.G.’s hair and scalp is dry, black hair, no scaling and lesions. His ears have no

lesions and there is presence of earwax. For the eye assessment, pupils constricting

and clear conjunctiva. Mouth is moist and has pinkish lips, dirty teeth and with extra

tooth. His arms and hands has dry skin, no lesions, no clubbing in the nails. Lungs have

no adventitious sounds. Abdomen has no lesions. Legs and foot has no lesions, and has

dirty untrimmed nails with hematoma on the left toe.

E. N. G.’s hair and scalp is dry, black hair, no scaling and lesions. His ears have

no lesions and there is presence of earwax. For the eye assessment, pupils constricting

and clear conjunctiva. Mouth is moist and has pinkish lips, has clean teeth. His arms and

hands have dry skin, no lesions, no clubbing in the nails. Lungs have no adventitious

sounds. Abdomen is enlarged but has no lesions. Legs and feet have no lesions, and

has dirty untrimmed nails.

C.G.’s hair and scalp is smooth, black hair, no scaling and lesions. Her ears have

no lesions and there is presence of earwax. For the eye assessment, pupils constricting
and clear conjunctiva. Mouth is moist and has pinkish lips, has clean teeth. Her arms

and hands has dry skin, no lesions, no clubbing in the nails. Lungs have no adventitious

sounds. Abdomen has no lesions. Legs and foot has no lesions, and has dirty

untrimmed nails.

L.C.G.’s hair and scalp is smooth, black hair, no scaling and lesions. Her ears

have no lesions and there is presence of earwax. For the eye assessment, pupils

constricting and clear conjunctiva. Mouth is moist and has pinkish lips, no teeth yet. Her

arms and hands has dry skin, no lesions, no clubbing in the nails. Lungs have no

adventitious sounds. Abdomen has no lesions. Legs and foot has no lesions, and the

nails are trimmed.

MAKE PX ASSESSMENT EVERYDAY

INCLUDE SIGNS OF MALNUTRITION

 CHAPTER IV

LEVEL OF ASSESSMENT

A. First Level of Assessment

These are the results of the student nurses’ first level of assessment on the

home and environment conditions presented below. Second level of assessment in

these health conditions or problems was done on the preceding part of this chapter.

1. Health Deficit

A. Malnutrition

2. Health Threat

A. Family size beyond what family resources can adequately provide

 Financial instability

B. Poor home/environmental condition/sanitation

 Presence of breeding or resting sites of vectors of disease

3. Foreseeable Crisis

A. Additional member of the family

B. Second Level of Assessment

Nursing Problems Family Nursing Diagnosis

Inability to recognize the presence of the condition or

Malnutrition
problem due to; lack of or inadequate knowledge.

Family size beyond what Inability to provide adequate financial support due to
family resources can inadequate family resources for care, specifically:
adequately provide financial constraints.

Presence of breeding or Inability to make decisions with respect to taking

resting sites of vectors of appropriate health action due to failure to comprehend the
disease magnitude of the problem.

Additional member of the Inability to make decisions due to family size beyond what
family family resources can adequately provide.
 CHAPTER V

FAMILY HEALTH PROBLEMS AND JUSTIFICATION

CUES AND DATA HEALTH PROBLEM

Underweight children Health Deficit
M. G. (9 years old) - Malnutrition
- Height = 1.1m, Weight = 15kg
- 9 years old
- BMI = 12.40
E. G. (7 years old)
- Height = .90m, Weight = 13kg
- 8 years old (13kg)
- BMI = 16.04
-Body build and height not suitable for their age.

-They both have: enlarged abdomen, dry hair and

skin.
Financial instability Health Threat
- According to the mother, “Nu awan ti - Family size beyond what
paggatang mi apan kami umutang ijay store sa family resources can
min to baydan nu agsweldo ni lakay ko.” adequately provide
- Family income is 287pesos a day.
- Children skip classes due to financial
problems. “Awan balon mi” was verbalized by
the eldest son when he was asked why he
does not come to class.Their absences were
confirmed by the teachers of San Agustin
Elementary School.

Presence of breeding or resting sites of vectors Health Threat

of diseases - Poor home/environmental
- Open drainage condition/sanitation
- “Nu aglab-laba da jay bangir idta nga
mapmapan. As verbalized by the father.

Newborn
- “Sangit nga sangit datoy anak ko nu agdiddidi.” Foreseeable Crisis
As verbalized by the mother.
-“Dumagdag man gastos mi tatta nga adda man - Additional member of the
anak min.” As verbalized by the mother. family
-The baby shows poor sucking.
 CHAPTER VI

FAMILY NURSING DIAGNOSIS

Nursing Problems Family Nursing Diagnosis

Inability to recognize the presence of the condition or

Malnutrition
problem due to; lack of or inadequate knowledge.

Family size beyond what Inability to provide adequate financial support due to
family resources can inadequate family resources for care, specifically:
adequately provide financial constraints.

Presence of breeding or Inability to make decisions with respect to taking

resting sites of vectors of appropriate health action due to failure to comprehend
disease the magnitude of the problem.

Additional member of the Inability to make decisions due to family size beyond
family what family resources can adequately provide.
 CHAPTER VII

PRIORITIZATION OF PROBLEMS (WITH JUSTIFICATION)

MALNUTRITION: Health Deficit

Criteria Score Weight Computation

Nature of the Problem:

Health Deficit 3 1 3/3 x 1 = 1

Modifiability:
Moderate 1 2 ½x2=1

Preventive:
Moderate 2 1 ⅔x1=⅔

Salience of the Problem:

Problem needing urgent attention 2 1 2/2 x 1 = 1

Total Score: 3 2/3

PRESENCE OF BREEDING OR RESTING SITES OF VECTORS OF DISEASES:

Health Threat

Criteria Score Weight Computation

Nature of the Problem:

Health Threat 2 1 ⅔x1=⅔

Modifiability:
1 2 ½ x 2= 1

Preventive:
Low 1 1 ⅓x1=⅓

Salience of the Problem:

Problem needs urgent attention 2 1 2/2 x 1 = 1

Total Score: 3

FAMILY SIZE BEYOND WHAT FAMILY RESOURCES CAN ADEQUATELY

PROVIDE: Health Threat

Criteria Score Weight Computation

Nature of the problem:

2 1 ⅔ x 1 = 2/3
Health Threat
Modifiability:
0 2 0/2 x 2 = 0
Not Modifiable

Preventive:
2 1 ⅔ x 1 = 2/3
Moderate

Salience of the Problem:

Problem not needing urgent 1 1 1/1 x 1 = 1
attention

Total Score: 2 1/3

NEWBORN: Foreseeable Crisis

Criteria Score Weight Computation

Nature of the Problem:

Foreseeable Crisis 1 1 ⅓ x 1 = 1/3

Modifiability:
Not modifiable 0 2 0/2 x 2 = 0

Preventive:
Moderate 2 1 ⅔ x 1 = 2/3

Salience of the Problem:

Problem needing urgent attention 2 1 2/2 x 1 = 1

Total Score: 2
CHAPTER VIII

FAMILY NCP
CHAPTER IX

EVALUATION
 CHAPTER X

SUMMARY OF THE VISITS AND DOCUMENTATIONS

Part of our duty for CHN is conducting home visits. On our first day, we searched

for a potential family to present for our Case study at Purok 2A. We were able to

meet our adopted family on this day and gathered information about their basic

info and current health status through interview. We also assessed the condition

of their house and inspected presence of health threats.

On the next visit, we interviewed the mother about her pregnancy and monitored

her vital signs as well. We accompanied her to go to the Brgy. Health Center to

be checked by the interns who are having a duty at that time.

Our next visit focused more on the assessment of the children from the adopted

family. We went to their house and performed physical assessment on them.

Here, we observed that the first and second child both have dry skin and

enlarged abdomen. We also weigh the children and learned that their height and

weight is not suitable for their age.

On the following visit, we focused on the additional number of the family and

assessed for her vital signs. On this day, we also conducted health teaching

about proper breastfeeding, utilizing of the environment as well as giving care for

the newborn.

We continued monitoring the adopted family’s vital signs and fed the children as

part of the eradicating the problem of malnutrition.

The feeding of the children continued on our next visit and here we gave more

health teachings on healthy food that the family must intake.

On our final visit, we conducted health teachings for reiteration on proper

breastfeeding, nutritional food and herbal plants. We also made ourselves as tool

for raising awareness regarding on the 8