CASE PRE (CHN)

7/29/2019 CASE PRE (CHN)

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Concept: Care of Mother, Child, Family, PopulationGroups and Community

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

Group 5BSN II-AP

Joji Castellano, RN, MANClinical Instructor


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Specific Objectives:

After 2 hours of CHN-Case Presentation, we will be able to:

impart the data gathered in the Comprehensive Family Survey.

prioritize the 5 Family Nursing Problems gained from assessment.

categorize the cues/data and Family Nursing Problems through theTypology of Nursing Problems in Family Nursing Practice which

consists of the first and second level assessment. prioritize the 5 Family Nursing Problems through ranking with the

criteria : Nature of the problem, Modifiability of the problem,Preventive Potential, Salience.

formulate the appropriate Family Nursing Care Plan for each Family

Nursing Problem. provide readings or updates about the interventions applicable to

the most prioritized Family Nursing Problem.


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The Lumambas residence is made of concrete and wood, and they are

renting. They are informal settlers. They have electric supply. Their meansof cooking , is through charcoal burning. Their source of water is MCWD.Their medical sources are midwife and doctor. Their way of garbagekeeping is through the use of garbage can and their garbage disposal iscollected by garbage truck. They have excreta disposal pour flush/pailsystem. The number of couples in the family are two, Aniceta and Severino

who is married for 40 years and Rodulfo and Rowena who is married for 12years. They have minimal knowledge about Family planning and theirsource of information are the Barangay heath workers, Student Nurses andmidwife. The type of family planning method they use mostly is pills andtheir reason for choosing the method is that it is affordable and satisfactory.The hereditary diseases common to the history of the family are

hypertension and asthma. Their usual diet are vegetables, fish and rice .Their type of family is extended. Rica Maes weight at birth is 6 lbs and herbrother Randyl is 7 lbs. In their immunization BCG (3 Doses), OPV (3Doses), DPT (3 Doses), Measles and Hepa B vaccines. The type of feedingadministered by the mother to her children during infancy is breastfeeding.


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Rank Family NursingProblem Score1st Foreseeable crisis

situations forpregnancy

4.83

2nd Malnutrition 43rd Hypertension 44th Poor environmental

Sanitation 3 2/35th Presence of Breeding

sites and insects 2 2/3


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First Level of Assessment

(Cues/Data)

Second Level of Assessment

(Family Nursing Problem)

- Family planning is not always practiced

by the couples in the family.

- Mrs. Aniceta Lumambas verbalized

Unsa diay birth space....unsa gane to?

Ah oh birth spacing diay na?...

Contraceptive? Unsa na?...

- Randyl and Rowena , whenever

engaging in sexual intercourse , only

uses condoms when they have the

money to buy.

A. Foreseeable crisis situations for

parenthood and pregnancy1. Failure to utilize community resources

for health care due to:

a. Lack of knowledge of community

resources for healthcare.

b. Failure to perceive the benefits ofhealth care/services.

2.Inability to recognize the presence of the

condition or problem due to:

a. Lack of knowledge

b. Philosophy in life which hinders

recognition.


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(Cues/Data)



- Rica Mae, 11 years old weighs 39 kgs., Looks pale,

lethargenic and apathenic, markedly underweight

and undernourished.

- Grandmother verbalized Naa man gyud panagsa

masakpan na sa akong anak nga kining akong mga

apo perti kayo mukaon ng mga junkfoods imbis gulay

unta ug prutas ang angay ,sus perti jud! Mao sigurong

mukaon ni silag pag ayo wala gihapoy pagtambok.

- Two preschool members usually are left to the school

when parents are working

- Mother and father are very busy helping earn a living

that they could hardly see to the needs of the

children.

- Appetite loss of eating nutritious foods.

B. Malnutrition as a health deficit

1. Inability to recognize the presence of

malnutrition in a dependent member dueto lack of knowledge.

2. Inability to decide about taking

appropriate health action due to failure to

comprehend the nature, magnitude and

scope of the problem

3. Inability to provide adequate nursing

care to a members suffering malnutrition due

to:

a. Lack of knowledge about the health

condition

b. Lack of knowledge on the nature and the

extent of nursing care needed

c. Inadequate resources for care,

responsible family member and financial

constraints.


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(Cues/Data)



- Mrs. Anecita has the following vital

signs:

T- 35.6 C

P- 76 bpm

R- 16cpm

BP- 180/100 mmHg

- Mrs. Anecita verbalized usahay

maliponko basta magdugay ug barog

nya ako rang bira-birahon akong

buhok nya ako sad pislit-pisliton

akong kamot.

- Exposed to the heat of the sun from

7am-3pm everyday while vending

vegetables.

C. Hypertension as a health deficit

1. Inability to recognize the presence of

the condition or problem due to

inadequate knowledge.

2. Inability to make decisions with

respect to taking appropriate health

action due to:

a. Failure to comprehend the nature or

magnitude of the problem or

condition

b. Fear of consequences of actions

specifically:

Economic consequences.


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(Cues/Data)



- Garbage collection initiated through

barangay garbage truck is notfollowed and complied by the family.

- Mrs. Anecita verbalized Among

mga ginagmay na basura diha ra sa

kilid-kilid ilabay labi na kanang mgachichirya nga basuranah! Akong

mga apo ana gyud.

- They clean their house only every

Sunday.

D. Poor Environmental Sanitation

1. Failure to utilize communityresources for health care due to:

a. Failure to perceive the benefits of

health care/services.

1. Inability to provided home

environment conducive to healthmaintenance and personal

development due to:

a. Inadequate knowledge of preventive

measures.


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(Cues/Data)



- Water containers are uncoveredand stored water is stagnant.

- Mrs Anecita verbalized Mag

stock mi ug tubig gamit among

drum ug balde

- Mosquitoes are abundant in their

residence because of the presence

of breeding sites.

-

E. Presence of Breeding sites and

insects1. Inability to make decisions with

respect to taking appropriate

health action on the health threats

due to:

a. Failure to comprehend the natureof the problem

b. Inability to provide a home

environment conducive to health

maintenance and personal

development due to: Ignorance of preventive measures

Inadequate family resources

specifically:

^ Financial resources


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CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of theproblem

1/3x1 0.33 It is aforeseeable

crisis.

1. Modifiability of

the problem

2/2x2 2 Resources are

available and

interventions arefeasible.

1. Preventive

Potential

3/3x1 1 Their ability to

prevent the

problem is high.

1. Salience of the

Problem

1/2x1 1/2 The problem

does not need

change.

TOTAL SCORE 4.83


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1. Nature of the

problem

2/3x1 1 It is a health

deficit that

requires

immediate

management to

eliminate

untoward

consequences.

1. Modifiability of

the problem

2/2x2 2 The problem is

easily modifiable.

1. Preventive

Potential

3/3x1 1 Susceptibility to

other diseases

and infectionscan be prevented

if malnutrition is

eliminated.

1. Salience of the

Problem

0/2x1 0 It is not a felt

problem.

TOTAL SCORE 4


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1. Nature of the

problem

3/3x1 1 The problem is a

health deficit and

requires more

immediate

intervention.

1. Modifiability of the

problem

2/2 2 The resources and

interventions needed

to solve the problemare available to the

family.

1. Preventive

Potential

3/3 1 The possibility of

complications can be

prevented if HPN

situations are

reduced.

1. Salience of the

Problem

0/2 0 The family does not

recognize the

existence of the

problem

TOTAL SCORE 3


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CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION1. Nature of the

problem

2/3x1 2/3 It is a health

threat.

1. Modifiability of

the problem

2/2 2 Resources are

available and

interventions are

feasible.

1. Preventive

Potential

3/3 1 Occurrence of

parasitism and

other

communicable

diseases can be

reduced

1. Salience of the

Problem

No data

available

No data

available

TOTAL SCORE 2 2/3


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CRITERIA COMPUTATION ACTUAL

SCORE

JUSTIFICATION

1. Nature of the

problem

2/3 x 1 2/3 Presence of Breeding

sites and insects is a

health threat.

1. Modifiability of

the problem

1/2 x2 1 The resources are

partially available and

interventions are

feasible.

1. Preventive

Potential

2/3x 1 1 The communicable

diseases that insects can

transfer has low rate of

prevention.

1. Salience of the

Problem

0/2 x 1 0 The family perceives it

as a problem needing no

attention.

TOTAL SCORE 2 2/3


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Intervention Plan


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Health

ProblemFamily Nursing

ProblemGoal of Care

(SMART)Nursing

Intervention

Intervention PlanNursing

InterventionsMethod of

Nurse Family

Contact

Resources

Required

Foreseeable crisis

Situations forPregnancy

Inability torecognize the

presence of thecondition or

problem due toattitude and

philosophy in lifetowards acceptingthe magnitude of

the problem

After nursingintervention the

family will beable to realizethe post threatof foreseeable

crisis situationsfor pregnancy as

well as to beable to choose

the mostapplicablemeasure to

them.

Short Term:After 2-3 hours

of Home visit andhealth teaching thefamily will be able to

identify thepresence of the

problem and wayson how to alleviate

the problem asevidenced by thediscussion of the

family.

Long Term:After 4 days

of home visit, the

family will be able tocomply anddemonstrate the

health teaching ofthe student nurses

such as to find wayson how to preventcases of pregnancy.

Assess the

general/livingcondition of the

family and aswell as their

perceivehindrances informulating

solution to theproblem.-

Present to themthe consequences

of the presentcondition-

Identifyalternatives ways

on how toincreaseknowledge on

family planningto meet the

needs of all themembers

Home VisitPlan

-Time andeffort

of thestudentnurses&

thefamily-

Participation and

cooperation of thefamily-

Skills andknowledge

of thestudentnurse

I t ti Pl


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Health

ProblemFamily Nursing

ProblemGoal of Care

(SMART)Nursing

Intervention


InterventionsMethod of

Nurse Family

Contact

Resources

Required

using contraceptivesand practicing birth

spacing- Present to the motherand father the availablecontraceptive methodsavailable provided by thecommunity.-Educate the

advantages and

disadvantages of thevarious contraceptivespresented.-Present thevarious risks broughtabout by proper birthspacing.-Emphasize

the risks presented bythe inability to provide

for the needs of thefamily members.

Intervention Plan


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HealthProblem

Family NursingProblem

Goal of Care(SMART)

NursingIntervention

Intervention Plan

NursingInterventions

Method ofNurse Family

Contact

Resources

Required

Hypertensionas healthdeficit

Inability of thepatient to continue

taking hermedication as

prescribed due to:a.) Always keeping

self busy.b.) Unable to

remind herself for

taking duemedication.

c.) Inadequateknowledge on

preventivemeasures.

d.) Inability ofpatient to visitRHU/clinic for

regular check-up.

>After effectivenursing

interventions,the patient will

be able toremind herselfin taking of hermedication and

also the

importance ofhaving regularcheck-up.>Thepatient will able

to impart herknowledge to

her familymembers the

things that willbe discussed

regardingpreventive

measures byhealthcareprovider.

After effectivenursing

interventions, thepatient will able

to:a.) Educate herfamily measures

about theimportance of

regular check-up.b.) Explain

importance ofproper diet orfood intake.

c.) Enumerate thediseases that

might develop ifhypertension isnot prevented

earlier.d.) Educate

patient on theDos and Dontsof hypertension

Re-iterate otherpeople who aresmokers and aswell as alcoholdrinkers to atleast limitconsumptionof liquors or tostop it together

with smoking.Encourage themto considerlifestylemodification fortheir benefits.Teach them onhow to takeblood pressureon their own.Educate themthe proper wayof taking goodcare of theirhealth and food

intake

Establishing rapport

(Good eye-to-eye

contact).Home visit.

Healthteachingsregarding

hypertension

BPapparatus.Medication .Visual

aid fordiscussio

n

Intervention Plan


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HealthProblem

Family NursingProblem

Goal of Care(SMART)

NursingIntervention


InterventionsMethodof NurseFamilyContact

ResourcesRequired

A. POORENVIRONMEN

TALSANITATION:ImproperGarbageDisposal

1. Inability to decideabout taking

appropriate actionsdue to failure tocomprehend the

nature and scope ofthe problem

Withinproper nursi

nginterventions, the familywill be able

todetermine

theimportanceof practicingproper methods on waste

disposal

Short Term: Afterone Home visit and

health teaching thefamily will be able to

demonstratecompliance with the

health teachingsgiven as evidenced by

the cooperationof the family.

Long Term: After 4-5days of home visit,

the family willpractice and

maintain a goodenvironmental

sanitation

-Assess the familys

environmentalsanitation- Assessthe levelof understanding ofthe family regardingto the problem-Educate the familythe effects ofimproper garbagedisposal suchoccurrence ofdiseases- Discusshow garbage couldcause illnesses.>Explore with the

family theadvantages anddisadvantages of thedifferent methodsof waste disposal

HomeVisit Plan

Time andeffort

of thestudentnurses&

thefamily-

Participation and

cooperation of thefamily-

Skills andknowledge of thestudentnurse


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Emergency Contraception (EC): A Safe and Effective Way to Prevent UnplannedPregnancy

04.01.06 - It is estimated that over three million American women have unplannedpregnancies each year, and over half of these end in abortion. Emergencycontraception (EC), sometimes called the "morning-after pill," is an effective methodof preventing unwanted pregnancy.1

EC is Safe and Effective to UseEC prevents pregnancy via a course of hormonal contraceptive pills taken in one- or

two-dose regimens. EC is most effective if the first dose is taken within 24 hours afterunprotected sex; however, it can be effective up to 5 days after intercourse. If theregimen is started within 24 hours, EC can be 95% effective.

EC is well tolerated by most women, including those who have had trouble usingoral contraceptives regularly. Reported side effects are generally mild, includingheadache, nausea and stomach discomfort, and vary with the brand used.

Because EC can be used at all stages of a woman's menstrual cycle, its mode of actionvaries. After intercourse, EC may prevent pregnancy by preventing ovulation, blockingfertilization or possibly preventing implantation of a fertilized egg.

Link:

http://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancy
http://reproductiverights.org/en/our-issues/contraception/emergency-contraceptionhttp://reproductiverights.org/en/our-issues/contraception/emergency-contraceptionhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/document/emergency-contraception-ec-a-safe-and-effective-way-to-prevent-unplanned-pregnancyhttp://reproductiverights.org/en/our-issues/contraception/emergency-contraceptionhttp://reproductiverights.org/en/our-issues/contraception/emergency-contraception


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Maglaya, Araceli. (2004) Nursing Practice in the Community : fourth

edition. Philippines : Argonauta Corporation. Pages 66-73 & 89.

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CASE PRE (CHN)