IMCI CASE STUDY

INTRODUCTION

Community health nursing is one of the two major fields of nursing in the Philippines; the

other is hospital nursing. Community health nursing primarily works on the promotion and

preservation of the health of the population. The nature of practice is comprehensive, general,

continual and not episodic. Its basic knowledge and skills are anchored on nursing theories and

important concepts form the science of public health. There are different levels of clientele in

community health nursing: the individual, family, population group and community.

Infant and childhood mortality are sensitive indicators of inequity and poverty. Children

who are most commonly and severely ill, malnourished and most likely to die of their illness are

those of the most vulnerable and underprivileged populations of low-income countries. Every

day, millions of parents seek health care for their sick children, taking them to hospitals, health

centers, and the like. These factors along with limited supplies and equipment, combined with

an irregular flow of patients make providing quality care to sick children a serious challenge.

Experience and evidence show that improvements in child health are not necessarily dependent

on the use of sophisticated and expensive technologies but rather on effective strategies that

are based on a holistic approach which are available to the majority of those in need, and which

take into account the capacity and structure of health systems as well as traditions and beliefs in

the community. WHO and UNICEF have addressed this challenge by developing a strategy

called the Integrated Management of Childhood Illness (IMCI).

IMCI is a strategy developed by the World Health Organization's Division of Child Health

and Development and UNICEF. It has been introduced to address morbidity and mortality in

children under five years. The strategy focuses on the child as a whole, rather than on a single

disease or condition. IMCI is a strategy that integrates all available measures for disease

prevention and health problems during childhood, for their early detection and effective

treatment, and for promoting healthy habits within the family and community. IMCI offers the

knowledge and abilities to sequentially evaluate and integrate the status of child health and, in

this way, detect the diseases or problems frequently affecting it according to the epidemiological

patterns of the respective location. A comprehensive examination for general danger signs and

major symptoms of diseases is done for all sick children. The combination of individual clinical

signs leads to a classification rather than a diagnosis. The procedures use a limited no. of

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essential drugs. Encouragement of the active participation of caretakes is done. Counseling of

caretakers is also done.

Based on this evaluation, IMCI gives clear instructions on disease classification and

problems, establishing the treatment that should be administered for each one. The strategy

also provides instructions on how to control the progress of treatment, in order to identify the

need for applying prevention measures as well as how to inform and educate parents on

disease prevention and child health promotion.

On this basis, IMCI is currently regarded as the most efficient strategy for reducing the

burden of disease and disability among the population in this age group. Its main goal is to

contribute to a healthy growth and development during the first five years of life.

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OBJECTIVES

General objective:

By the end of our 4-week IMCI rotation, we will be able to come up with an all-inclusive

mini family case study which aims to present adequate information regarding the general well-

being of our selected family. Our target is to have an acquisition of new knowledge and

enhancement of skills in the application of the community health nursing concepts and

principles reflected on our act of service to our client family.

In specific, we aim to:

select a family that has the qualifications to be subject for this case study;

establish rapport with the family to initiate cooperation in line with the trusting nurse-

client relationship throughout the process;

gather data regarding the family’s over-all status to compose the initial data base for a

more systematized presentation of our chosen family through interviews and

observations using the family assessment guide;

Conduct an IMCI check-up if one of the children has 1 or more of the major symptoms

and if he/she is an infant or 5 years and less.

Assess the family’s coping mechanisms in response to different situations to provide a

basis for estimating the nursing needs of our selected family through the family coping

index;

identify existing and potential problems of the family in their environment, safety,

personal hygiene, finances, resources, social relationships, or spirituality;

Prioritize the recognized crises to determine what should be considered first and what

problems doesn’t need immediate solutions;

Devise appropriate nursing interventions in order to meet the needs of the family

through nursing care plans;

Implement the proposed nursing care plans that will solve the family’s existing

problems, if not, prevent potential problems to occur or to improve the family’s way of

living;

Evaluate the implemented plans whether there was an improvement or otherwise;

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Provide health teachings to the family regarding health, its maintenance and promotion

towards wellness.

Determine the implication of this case study to nursing education, research and

practice.

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INITIAL DATA BASE

A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

DEMOGRAPHIC DATA

Demographic Data

Demography encompasses the study of the size, structure and distribution of

populations, and spatial or temporal changes in them in response to birth, migration, aging and

death.

On November 12, 2012, we, the BSN-2A Group 1 subgroup 2 conducted an interview on

the Encarquez Family, an extended family which is composed of 5 families with a total of 50

members. They are currently residing at Barangay 21C Blk-85 Piapi Boulevard, Davao City.

They have been living on the community for forty-six years. The house was originally owned by

their grandmother but since the latter was dead, they claim the house as their own. The parents

are Roman Catholic and pure Dabawenyos.

FAMILY MEMBERS CHART

FAMILY MEMBERS

FAMILY MEMBERS RELATION

TO HEAD

AGE SEX CIVIL

STATUS

EDUCAT

-IONAL

ATTAIN-

MENT

OCCUPATION

1 Romeo

Encarguez

------- 35 M Married Grade 3 Garbage

Collector Anywhe

re

2 Melinda

Encarguez

Wife 31 F Married Grade 6 N/A N/A

3 Mary Frances

Encarguez

Daughter 14 F Single Grade 6

4 Christian

Encarguez

Son 13 M Single Grade 5

*

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PLACETYPE OF WORK

NO.

NAME

5 Rommel

Encarguez

Son 12 M Single Grade 3 *

6 Chris Mae

Anne

Encarguez

Daughter 10 F Single Grade 1 *

7 Justine

Encarguez

Son 5 M Single

8 Raymond

Encarguez

Son 4 M Single

9 Raymart

Encarguez

Son 4 M Single

10 Reggie

Encarguez

Son 4 M Single

Mr. Romeo Encarguez is 35 years old. He has no stable job because he was not able to

finish his studies. He is working as a garbage collector in CENRO. He drinks alcohol almost

every day and no one can ever stop him even his daughter. His wife left them 2 years ago due

to some family problems. He doesn’t cook or prepare food for the children, only his daughter,

Mary Frances.

Mary Frances is 14 years old. She only graduated grade 6 and was forced to stop

because she is the only one to take care of her siblings because their mother left them in such a

young age. She sacrifices herself for her younger siblings because their father doesn’t care to

his children. She is fully in-charge of whatever necessary things for her siblings such as water

and food supply.

Christian, Rommel and Chris Mae Anne are fortunate enough to avail the program

offered by the government. The government take full responsibility of their basic needs and

currently living in the place where the government supports like bahay pasilungan, Don Bosco

and etc.

Unfortunately, Justine together with the triplets, Raymond, Raymart and Reggie doesn’t

go to school due to financial problems. For the meantime, they’re just enjoying being a kid of

their time.

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PLACE OF RESIDENCE

Encarguez’s family is residing at their own house at Brgy.21C Blk-85 Piapi Boulevard

Davao City.

TYPE OF FAMILY STRUCTURE

The Encarguez family is under the Extended family. 5 families are living there, compose

of their 4 auntie’s family and them. All in all, they are composed of 20 adults and 30 children. In

their family, it only consist of 6 members including the father since the 3 children lives in the

charity.

ACTIVITIES OF DAILY LIVING

Body Mass Index calculation and corresponding calculation

Family

Member

Weight

(kg)

Heigh

t (m)

BMI Malnourished

<16

Underweight

16-19

Normal

20-25

Overweight

26-30

Romeo 53 kg 1.6 m 20.

55

Melinda N/A N/A

Mary

Frances

36 kg 1.5 m 15.

95

Christian N/A N/A

Rommel N/A N/A

Chris Mae

Ann

N/A N/A

Justine 11 kg 1m 11.

09

Raymond 8.5 kg 0.9 m 10.

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33

Reymart 8 kg 0.9 m 9.7

Reggie 8 kg 0.9m 9.7

Activities of daily living are the tasks of everyday life. These activities include

eating, dressing, getting into or out of a bed or chair, taking a bath or shower and using the toilet

and the like. Instrumental activities of daily living are activities related to independent living and

include preparing meals, managing money, or doing housework.

Eating Pattern

Our body needs energy to get through the day and this energy comes from food. It is

important to eat regular meals to ensure your body gets the energy it needs to perform. Good

nutrition and a balanced diet helps one grow up healthy. To improve and correct nutrition, one

can basically assess from the eating pattern of the Encarguez family.

The table presents the respective Body Mass Index of each family member with its

respective classifying range and interpretation, except with the mother (Melinda) and three other

siblings, which are Chris Mae Ann, Rommel and Christian because we did not have the chance

to see them. The Body Mass Index was computed by dividing the weight of the individual (in

kilograms) by the square of the height (in meters). Based from the calculations Mary Frances,

Justine and the three triplets were classified under malnourished, only Romeo was classified

normal. The factors that can affect the sibling’s malnutrition are starvation, lack of vitamins and

their hyperactivity that is common in children at their age.

The family eats two to three times a day. They don’t have snacks in between meals

because they can’t afford to buy some. They don’t follow the proper timing in mealtime. Take for

example the time they consume their breakfast. They usually eat it for 10 am. They also call it

“brunch” because that meal consists of their breakfast and lunch. They prefer cooking their own

food rather than buying some in the carinderia because it’s costly. They eat the meal right away

because they don’t have a refrigerator in storing their food. They make use of kalan and uling in

preparing their food because it is less expensive. They usually prepare food viands like soup

with accompanying meat and leafy vegetables like kangkong and beans and fried foods. They

seldom buy chicken and pork meat because the price is considerably more expensive. The

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Encarguez family usually take their breakfast at 9:30 am. Lunch is usually served 1 or 2 pm,

sometimes they eat none during this time and dinner is taken by 8 pm.

Mary Frances feeds his younger siblings and usually they do not wait for their father

anymore so they eat their meals ahead of him.

The table below shows the 24 hour dietary recall of the family as mentioned by Mary Francess

our informant.

Eating pattern

24-Hour Dietary Recall

Meal November 11, 2012

Breakfast Rice and kangkong

Lunch Egg and rice

Dinner Pansit canton and rice

As what we can see in the table above, the meals taken by the family as of breakfast are

rice and kangkong. They ate egg and rice during lunchtime. For their supper, they ate instant

noodles and rice.

Leisure Time Activities

Since Mary Frances is the one who take good care of her siblings, they bond with each

other through playing around in the gym or playing with their cousins who also live there. They

also watch television at their neighbour’s. Mary Francess also chats with her friends just around

the corner. The father doesn’t play or interact with his children because he spends more time

with his drinking buddies. They don’t have any educational activities that are good with the

children the fact that his father only finished studying until elementary and also their sister, Mary

Frances who are also graduated in elementary only. They don’t go to church every Sunday.

Their activities of daily living are always the same, no changes.

FAMILY CHARACTERISTICS

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General Family Relationship/Dynamics

In every family unit, it is an unavoidable fact wherein conflicts would arise between

family members. However, even if there are conflicts between each member of their family, they

are still determined to resolve these conflicts. According to Ms. Mary Frances, being hard-

headed of of her siblings is the usual cause of the family’s conflict

CRITERIA STATUS ADDITIONAL INFORMATION

Observable conflicts between

family members

Present Alcohol drinking and smoking by the

father, he forgot to take care of his

children and pass all the

responsibilities to his eldest child, he

have a conflict with his sister-in-law

or their aunt, who helps also to take

care of the children, because of this.

Financial matter is also a problem

since only the father, a garbage

collector and their aunt, a non-

permanent worker, works for their

living that is why sometimes,

problems on budgeting is difficult

since they have many members to

feed and their budget is inadequate.

Characteristics of

communication

Informal Mrs. Mary Lingganon, their aunt,

mentioned that each members talk

to each other everytime problems

occur. She talks to the member

everytime there are issues to tackle

and in one-on-one talk to solve the

issue right away to avoid more

complications. Here are times that

some of the problems like quarrels

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are not being talked and they just

leave it and there will come a day

that the problem will just forgotten

and it just gone and back to normal.

Interaction patterns among

members

Communication

Present

According to their sister,Mary

Frances, they do interact with one

another since they are seeing each

other everyday and their house is

not that big for them to miss each

other. They talked everyday

especially the kids, they play with

one another although there are

times that they quarrel which is

normal, still they make peace

afterwards.

Every family experiences some level of family conflict. The disagreements are a normal

part of any relationship. They happen when people have different needs, wants or beliefs.

However, if these conflicts go unresolved, they can begin to harm relationships in the home.

According to Ms. Mary Frances, they also had incidents of verbal arguments and so far had not

encountered a fight with that lead to physical assault.

B.SOCIOECONOMIC STATUS & CULTURAL CHARACTERISTICS

SOCIOECONOMIC STATUS

Family Income and Educational Attainment

Family

Members

Educational

Attainment

Employment

Status

Occupation Net Income Other

Sources of

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Income

Romeo

Encarguez

Grade 3 Stable

Employment

Garbage

Collector

25 pesos/day N/A

Melinda

Encarguez

Grade 6 Unemployed N/A N/A N/A

Mary

Frances

Encarguez


Christian

Encarguez


Rommel

Encarguez


Chris Mae

Anne

Encarguez


Justine

Encarguez

None Unemployed N/A N/A N/A

TRIPLETS None Unemployed N/A N/A N/A

The undeniable aspect common in the community we worked with is indeed poverty.

Poverty can be manifested clearly with the type of housing facilities, and other indicators.

Common reasons why people are left jobless is their lack of education. Most of the people

haven’t finished their schooling and so, they become jobless leaving the basic needs of the

family unattended.In the case of the Encarquez Family, the sole provider of the family is Mrs.

Romeo Encarquez, who is working 20 days a month and receives his salary of 25php/ day. The

family depends on his earnings from the work and sometimes in their aunts earning from

assisting the missionaries feeding the oppressed. But her job is not permanent. Mr. Encarguez

is working at the Government as a Garbage Collector. He is working 8hrs a day from 6pm-2am,

5 days a week. He is earning 25php/ day amounting to 500php a month, this money provides for

6 persons including the expenses for water which is 7 pesos per drum, gas for their light

because they are just using “lampara” to aid their eyes during night, food and other

miscellaneous. Melinda Encarguez, the mother, left her family 2 years ago due some family

problem. She left all her children in the shoulders of her husband. Mr. Encarguez is a member

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of the newly indorsed program of Phil Health at their barangay. He can receive 500 pesos a

month per child in the family intended solely for the health of his children until 2016. Aside from

this, they are no longer a member of any organization/program. Whenever they are sick they

just avail the Free Health services that is given at the Piapi Health center in Boulevard or get

free medicines whenever there are oppurtunities at the Miniforest health center..

Family Expenses

EXPENSES AMOUNT

Rice 30 pesos

*viand depends on the food preference for the day*

Gulay/ Pansit canton/ itlog 15 pesos

Water 7 pesos

Sometimes, if their father doesn’t have money or wasted by his vices such as

smoking and drinking alcohol, they have nothing to eat. Or sometimes, their aunt shares a some

food for the children.

CULTURAL CHARACTERISTICS

Ethnic Background and Religious Affiliation

FAMILY MEMBER ETHNICITY RELIGION

Romeo Encarquez DABAWENYO ROMAN CATHOLIC

Melinda Encarquez DABAWENYO ROMAN CATHOLIC

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Mary Frances DABAWENYO ROMAN CATHOLIC

Christian DABAWENYO ROMAN CATHOLIC

Rommel DABAWENYO ROMAN CATHOLIC

Chris Mae Anne DABAWENYO ROMAN CATHOLIC

Justine DABAWENYO ROMAN CATHOLIC

Triplets DABAWENYO ROMAN CATHOLIC

DABAWENYO ROMAN CATHOLIC

Mr. Romeo Encarguez’s father and mother are originally from Davao City. Mr. Camoro

and his siblings were raised in Davao City also. Mrs. Melinda Encarguez together with her

siblings came also from Davao.

The children of the couple are pure Dabawenyo since both of them came originally form

Davao City. All of them are Roman Catholic in religion .The family does not go to the mass

every Sunday because of lack of interest

Significant Others

Mary Frances had mentioned that there is any significant other who helps in the family,

and that is her aunt Mary. The children who are not living in the house usually visits during

vacations.

Relationship of the Family to the Larger Community

According to Mrs. Mary Lingganon, there was a minor conflict before between to their

neighborhood because of the canal infront of their house. But later on, they were able to talk

about it and reconcile. Since then, whenever they have misunderstandings, they extend their

patients and try to settle it on a nice and peaceful way.

FAMILY DEVELOPMENTAL TASK

Family with Teen-agers and Young Adults is the fifth stage of developmental task

wherein they should maintain open communication among parents and children and supports

ethical and moral values within the family, balancing freedoms and responsibilities for

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teenagers, releasing adults with appropriate rituals and assistance, strengthening marital

relationships and maintaining supportive home base

In the case of our client, they cannot meet those goals since they don’t a good

foundation within their family. Two years ago, their mother left them due to unknown reason and

their father don’t have the time to communicate properly with them because if he is not

working , he keeps on drinking alcohol together with their neighbour’s.

ENVIRONMENT FACTORS

Home and Environment

Encarguez family has been a resident of Barangay 21C- Blk. 85 Piapi Boulevard

for 46 years. Their house is situated in a congested squatter area. The way leading to their

house is wet and slippery due to the water overflowing from the canal. The available facilities in

the community are Barangay Hall, chapel and health center. Some people in the community

have their own electrical and mechanical appliances like television, radio and cable wires. Most

of the people there don’t have cellphones. Jeep, tricycle, single motorcycle are the main

transportation and pedicab on the sides of the road.

Their house in mainly made up with cement and wooden materials for their wall and

floor. They have a multipurpose house that serves as living room, dinning room and bedroom

for the 50 of them.

With regards to the structure of the house, the lower part of the house has a ceiling

made up of 4x4 wood while the upper part has none. They have medium-sized rooms but its not

suitable for accommodating 10 persons. Their pillows and bed has a covering and a blanket on

top. They have a rack for their eating utensils but it is not neat and organized and a cabinet

wherein their clothes are placed and kept. They have a small mirror in two rooms and use a

lamp for their lighting. They don’t have an electric fan instead they use the conventional fan that

is made up of coconut leaves. There are also some nails coming out of the wooden walls. The

house was untidy because of the kids playing and there wasn’t enough storage for their

belongings; the environment was very dirty because there were trashes scattered all over the

interior and exterior part of the house. Pertaining to the drainage system they have poor

drainage system. The plates are left beside the floor with a basin filled with water, after washing

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they throw the water outside of their house; they also wash the clothes outside. They rely on

buying their water supply from their neighbor about 10 meters away from the house for only 7

pesos per drum. The water they store is placed on a drum and left uncovered. They don’t have

a budget for solane or burner; instead they use cheaper cooking materials such as “kalan” and

charcoal. They have two pet cats and different sorts of pests and insects infiltrates the house

like cockroaches, mosquitoes, houseflies and rats which can cause leptospirosis, dengue, polio

and etc.

Ventilation in the house

There is only one door for entrance which is made up of wood and they have one big

window that is located upstairs on the triplets room. All their windows are not screened nor

draped with curtains. Mary Francess said it gets hot during the night because all the ten of

them are compressing due to small sleeping space. With regards to this, we have computed the

ventilation of their house.

To determine whether the house has good ventilation, we first compute for the total floor area:

TFA = L x W

= 2 m x 2.5 m

= 5 m2

Since they have 2 floors, we multiplied the floor area of the first floor by 2 to get the total floor area of their house:

= 5 m2 x 2

TFA = 10 m2

Then, we get the total window opening of the house through the following:

Window: WO = L x W (no. of windows)

= 1.24 m x 2.5 m

= 6.2 m2 x 1 windows

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WO = 6.2 m2

Door: DO = L x W

= 1.77 m x 0.875 m

DO = 1.549 m2

Total window opening: WO + DO

TWO = 6.2 m2 + 1.549m2

= 7.749 m2

After which, we solve for the ventilation:

Ventilation = Total Window Opening / Total Floor Area x 100

= 7.749 m2 / 10 m2 x 100

= 77.49%

As we interpreted, the Encarguez family has good ventilation because ventilation

above 20% is considered good.

To compute for the overcrowding, we have to identify the Total Floor Area and

the number of household members. In their case, they have TFA of 10 m2 and there

are10 members of the household composed of 3 adults and 7 children. To compute for

the total space requirement of the family, we have:

TSR = (3 x 2.25 m2) + (7 x 1.26 m2)

= 6.75 m2 + 8.82 m2

= 15.57 m2

There is overcrowding since the TFA is lesser than the TSR. The total floor area

is lesser than their total space requirement, therefore there is overcrowding.

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Housing

The family owns the house. The construction material used is mixed and is a two-story

type building. The walls in the room are made up of plywood and some are cemented. There

are five rooms for each of the family to sleep. They sleep either on the floor with a mat and

some in the chair. The room serves both their sleeping and eating area. Their primary source of

light during the evening is a lamp located on the corner of the house. The house is very dirty

and disorganized. Garbage, wastages, unwashed clothes and dishes and empty bottles are

seen inside the house.

Adequacy of Living Space

The house is inadequate for their living space due to its size and the number of person

living. The entire family consists of 50 members. During our interview, Mary Francess said that

they sleep with 8-10 other family members. They have problems sleeping at night because of

the space and how they position themselves in order to have a good rest. Their sleeping area

serves as eating, playing and dressing area.

TFA = L x W

= 2 m x 2.5 m

= 5 m2

Since they have 2 floors, we multiplied the floor area of the first floor by 2 to get the total floor area of their house:

= 5 m2 x 2

TFA = 10 m2

To compute for the overcrowding, we have to identify the Total Floor Area and

the number of household members. In their case, they have TFA of 10 m2 and there

are10 members of the household composed of 3 adults and 7 children. To compute for

the total space requirement of the family, we have:

TSR = (3 x 2.25 m2) + (7 x 1.26 m2)

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= 6.75 m2 + 8.82 m2

= 15.57 m2

There is overcrowding since the TFA is lesser than the TSR. The total floor area is lesser than their total space requirement, therefore there is overcrowding

Sleeping arrangement

Each of the members sleeps with their own family on five different rooms. The triplets

sleep upstairs with seven other family members, which is their siblings, parents and cousins.

They sleep on the floor laid with two mats and pillows. The triplets usually sleep together with

their sister and father on their sides while their cousins sleep in another corner of the room

together with their cousins.

Adequacy of the furniture

There wasn’t much of furniture inside the house. The only furniture they have is a bed,

cabinet, chair and a table. They do not own any electrical appliances the fact that they don’t

have electricity. They use pot and charcoal to cook their foods. They do not store their foods

properly instead leave it aside with no covers.

Presence of insects and rodents

Since both the exterior and interior part of the house is filled with waste and garbages,

their house is teeming with different types of illness causing pests like mosquitoes, houseflies,

cockroaches and rats which can cause life threatening diseases like cholera and leptospirosis.

Flies and other insect infested their left eating utensils that brings bacteria that cause a disease.

There was a mini canal outside their house, it was not flowing or draining properly because

garbage were blocking its passageways. Stagnant water plus the used bottles containing water

makes a good habitat for mosquitoes to thrive in. The family is unaware of the dangers it may

cause to their health.

Presence of accident hazards

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There are a lot of hazardous things found inside and outside their house. One of which

are broken glass bottles, the children usually tends to walk barefoot. Their slippers are either

rugged or lost a pair of it. They play and run a lot with no slippers on, the old ones are aware the

dangers of it but forget to remind the child to always wear one for their protection. We also

noticed that the entire foundation of the house is not stable, when the children plays upstairs,

that part of the room somewhat moves and the flooring was not intact as well. The stairs also

pose a great harm, Mary Francess once told us that one of their cousins’ fall from it because it

has no side rails. But today, they have one fixed on the side for support, but for us it is still not

stable enough to prevent someone from falling.

Food storage and cooking facilities

Leftover foods are usually uncovered and if it spoils, they wrap it inside a plastic bag

then dispose on the garbage sack. They cook their foods on “kalan” and charcoal, usually they

only eat rice with salt and other flavoring, and sometimes they consume ready to eat foods.

They don’t have refrigerator to preserve or store their food. They mostly eat all their dishes and

if possible there are no food leftovers.

Water supply

The family’s primary source of water is being bought from their neighbor for only seven

pesos. It contains one drum full of water. They use it for bathing, drinking, flushing the toilet,

laundry and dishwashing. They could consume 4-5 drums per day. They spend 28-35 pesos for

their water bill everyday. The water container has no cover and is stored on a multi-purpose

room.

Kitchen

Our client has only one kitchen. It is located inside the house. Since they have no

electrical appliances for cooking, they use conventional methods of preparing their food like the

use of charcoal and “kalan”. They have two areas for cooking; the other one is located outside

and is only used for minor cooking such as boiling noodles and water. Their eating utensils are

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not washed right away after consuming their food instead they soak it on a small basin filled with

water to mollify the hardened food stains.

Toilet facility

They have a comfort room before but through the years, the septic tank became full so

they transferred it to another area inside the house. This time, it doesn’t have any walls or doors

but it has a toilet bowl. They use a pail of water to flush their stools. All five families share the

same toilet bowl for their personal necessities. The toilet bowl is very foul in odor and flies hover

around it.

Domestic Animal

The family owns two cats. The felines usually stay inside the house and sleeps on one

bed of the family. The fur of these animals irritates the lungs when inhaled and triggers asthma

attacks.

Garbage/Refusal disposal

Harley (cousin of the triplets) took charge in throwing the garbage usually early in the

morning. All of their waste is accumulated into one garbage bin without separating the

biodegradable, non-biodegradable and recyclable materials. When we asked the family about

proper segregation, they have the knowledge about it but they do not apply it for themselves.

They use plastic bag to wrap their garbage before disposing it to the bin. Inside their house are

accumulated wastes. From broken glass bottles, used napkins and other dirty items. Their

improper waste disposal can lead to other problems like presence of breeding sites that bring

diseases or source of health complication.

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Drainage system

The kind of drainage system of the family is an open drainage. Water flows into a small

canal located in front of the house. The surrounding area of the canal is wet and muddy

because water overflows on it. Sometimes when they finish doing the laundry, the used water

overflows on the canal’s lining. The most suitable place for microorganisms to thrive are these

kind of conditions. We also noticed that some of the children specifically the triplets walk

barefoot and this would make these harmful microorganisms to stick on their feet.

Kind of Neighborhood

The whole neighborhood is in a slum and congested area. The houses are built closely

together and it was overcrowded and mostly inhabited by poor people. According to Mary

Francess, they have a harmonious relationship with their neighbors and did not have any major

fights or conflicts with each other.

Social and Health Facilities available

The family can identify all nearby facilities within their area. They know about the

services rendered by the Piapi Health center like free immunization and health supplements,

prayer venues such as chapel for Roman Catholics but the family doesn’t attend any prayer

meetings during Saturdays. The family used other health facilities such as Mini Forest when

they suspected Mary Francess to have Koch’s disease and decided to take the Direct Sputum

Smear Microscopy and has shown a negative result.

Communication and Transportation Facilities

Since the family does not have any private-use vehicle, they use public transportation

such as pedicab, single motorcycle and jeep. They usually prefer walking when their place of

destination is near and in order for them to save money. They don’t have problems regarding

their transportation since they mostly go to nearby places like sari-sari stores, eatery and the

Piapi Gymnasium. The only member of the family to have a communication device is Harley. He

uses his cellular phone for calling, texting and listening to the radio.

| 22

Health and Health practices

The triplets had no serious illnesses before except for the common colds, fever and

cough. On 2008, Raymond, Reggie and Raymart were diagnosed with diarrhea before in

Southern Philippines Medical Center and were confined for two days. After discharge, the

siblings were sent home and were advised by the doctor to continue home treatment and health

teachings like increase fluid intake. Their older brother Justine didn’t have any hospitalizations

or was diagnosed with any time of major illnesses. On 2009, Mary Francess was referred by

the Piapi Health Center to Mini Forest when she was suspected to have the signs and

symptoms of Tuberculosis, she was then advised to take the Direct Sputum Smear Microscopy

and shown a negative result. Moreover, we found out that it was a result of her chain-smoking 2

years before. At present, she stopped smoking for good. On the same year, heir father was

once hospitalized for bacterial infection in the gastrointestinal tract and was vomiting for three

days. He was confined for one month and seven days at SPMC. Mr. Romeo also shared that he

could consume 2-4 cigarette packs per day. He often smokes and drinks alcohol. Melinda had

left the house for 2 years now due to an unknown reason but according to Mr. Romeo his wife

was in a state of mental disorder. He stated that “usahay di nako siya masabtan kay magusab-

usab iyang batasan ug kalit pa jud masuko sa amoa maskiy walay rason. Naa pay kaisa na ni-

ingon siya na magpakamatay daw siya”. Mrs. Melinda followed her schedule on prenatal check

up in the Piapi Health Center and has four live children with no abortion. She stopped

breastfeeding the triplets on the age of 1 and continue on with formula feeding for another year.

Since Mrs. Melinda isn’t leaving anymore with the family, Mary Francess took the role of their

mother. She manages their home and takes the responsibility for the family’s health. When one

of the family members is sick, she’s the one who decides whether to relieve it with some drugs

or to consult a physician or any health worker if the ailment becomes severe.

Diabetes, asthma and hypertension are the only hereditary diseases present in the

family. Mary Francess told us that they avoid taking up medicines when they experience

illnesses. For instance, when the triplets is having cough and cold, the only intervention they do

is apply a menthol liniment on the upper chest of the siblings and drink lots of water to relieve

and alleviate the severity of the sickness.

Mary Francess, Justine and the triplets are fully immunized children. They received all

the immunizations at Piapi Health Center.

| 23

ImmunizationDate

1st dose 2nd dose 3rd dose Booster

BCG 09-06-08

DPT 10-15-08 10-12-08 12-10-08

OPV 10-15-08 10-12-08 12-10-08

Hepa B 10-15-08 10-15-08 12-10-08

Measles 06-03-09

Vit.A

During the times when they experience deviations in their health condition, they just

medicate themselves like taking over the counter drugs like Paracetamol (Bioflu and Biogesic)

for fever and Neozep for colds. For consultations, they go to “Tambayan” and Don Bosco Health

Center for free check up.

Rest, Sleep and Exercise

For their sleeping routine, they use their multi purpose room upstairs to sleep. Mary

Francess also said that the triplets sometimes have problems and disturbances during sleep. It

is due to the inadequacy of space and the hot temperature because they only use fans. The

triplets have an adequate time span of rest about 10-11 hours daily except for Mary Francess

and their father. She usually sleeps 11 pm after watching teleseryes from their neighbor’s

television and wakes up early in the morning mostly 5 am to prepare the family’s breakfast. The

triplets usually sleep at the same time together with their cousins Harley, Robert and Thomas at

8-9 pm and rises 6 in the morning and lastly, Mr. Romeo who usually retires 10 pm after his

drinking and smoking session with his buddies then wakes up at around 6 am. He doesn’t have

a regular sleeping pattern and inadequate sleeping hours.

Raymart, Raymond and Reggie usually stay at home when they have nothing to do. But

when they have the time they play with their neighbors. They have adequate exercise because

| 24

they move around constantly. Mary Francess chats with her neighbors during spare time or

either watch television. In the morning, she strolls around the area. It is her only way of

exercising because she usually stays at their house. Their father doesn’t have an adequate

exercise because he either smokes or drinks when he gets bored in the house. He watches

basketball games in the Piapi gymnasium but he isn’t interested in playing the game because

he has a low stamina.

Relaxation and Stress Management Activities

The family doesn’t have the proper coping mechanism. Mary Francess once told us that

if she ever encounters a problem, she usually smoke in order to relieve tension and stress. She

doesn’t ask for advice or guidance from her parents since her father is always out drinking and

smoking and her mother is not in the house anymore. She couldn’t approach her aunts or

uncles because they are too busy minding their own family, rather she goes to her “barkadas”

and then they do all sorts of stuff just to divert her attention or leave her problems behind. Since

she has stopped with her vices two years from now, the only way she could manage her

problem is to just keep it to herself. When she likes to rest or relax, she either sleeps or plays

with her younger siblings. The father of the family, Mr. Romeo, doesn’t cope well when faced

with stress. Drinking alcohol and smoking are the relaxing things he prefers to do to loosen up

and relieve his tensions. Mary Francess told us that their father doesn’t bond with them always.

He is too busy minding others rather than his own family.

IMCI NARRATIVE

Last November 5, 2012 at 8 am, we assessed the child named Reymart Encarguez, 50

months of age. He lives at Barangay 21-C Piapi Boulevard, Davao City. He weighs 8 kilogram

and his temperature is 36.6 degrees Celsius. We asked the sister what’s the child’s problem,

she said he has fever last night but doesn’t know what was the temperature. The child is able to

drink water. He doesn’t vomits everything he eats. He have no convulsions and he’s not

| 25

abnormally sleepy or difficult to awaken. The child doesn’t have cough or difficult to breath. His

respiration is 38 breaths per minute. He doesn’t have any chest indrawing, stridor or wheeze.

He doesn’t have diarrhea. The child has fever last night only, blood smear is not done. He

doesn’t have any signs for measles. With all this data, we classified it as Fever Malaria Unlikely.

He doesn’t have the signs of Dengue Hemorrhagic Fever. We assess his ears, there are no ear

problems present to the patient. Next is, we check for Malnutrition, the child doesn’t have severe

wasting. His MUAC is 15.5 cm. There is no edema present on both feet. We determine his

weight for age, and it is not normal. We classified it as Very Low Weight. So, our patient is

malnourished. The child completed all his immunizations as we checked his record in the health

center. We checked his Vitamin A supplementation, our patient doesnt receive vitamin A for the

past 6 months. The child also doesn’t received albendazole/mebendazole for deworming. The

child was breasfed before by his mother only for 2 weeks before their mother left since he was

an infant. The child eats rice, drinks water and coffee. He ates 3 times a day, but sometimes

twice only if they have no money at all. He uses spoon, plate and glass for eating, but

sometimes, he uses his hands only. His sister feeds him every meal or sometimes, he can feed

his self also. During illness, the child doesn’t changed his feeding.

PHYSICAL ASSESSMENT

GENERAL SURVEY

I. The patient is ectomorph. He stands 91.5 cm, weighs 8 kg. and has BMI of 9.7 . He has

a normal posture and gait. He walks with alternating arms swaying. He is alert when we

receive him but he is not so attentive and does not answer our questions. He has poor

hygiene. He is not oriented to time, place and person while we ask the patient. His vital

| 26

signs for temperature was 36.6 degrees Celsius, pulse rate is 123 bpm, heart rate is

125, Respiration rate is 38 bpm and his blood pressure was 90/60 .

II. SKIN

He has a poor complexion of skin. And it wasn’t smooth but he has a good skin turgor.

When we pinched his skin, the skin comes back to its original position by 0.2sec. His skin

temperature is warm or normal. His skin moisture was dry. There were lesions noted at the left

side of an eyebrow and no edema noted. There was no ulceration noted and his nail was dirty

and untrimmed. His capillary refill is normal by 1 sec.

III. HEAD

The skull is symmetrical. There were no dandruff, lesion and lice noted on the scalp. Normal

distribution of hair noted and the patient has fine hair. The face has symmetrical movements

such as chewing, smiling, and frowning. And there is no edema and masses noted. The muscle

strength of the jaw of the patient is normal. And its measurement is 91.5 cm.

IV. EYES

The eyebrows are aligned and have a symmetrical movement. Eyelids it is symmetrical to

each other. The eyelashes curled outward. Lacrimal ducts are normal and no swelling noted.

The cornea/lens is clear. The conjunctiva is pinkish. The reaction of the pupil to light is brisk and

reaction to accommodation is uniform. The extra ocular movement is normal. Eyes converge

uniformly. Visual acuity of the patient is normal. He can’t count his fingers that we ask to do it

because he doesn’t know how to count, but he can see the light perception and hand

movements.

V. EARS

The pinna is symmetrical. Foul smell and discharge not noted. The hearing acuity is normal,

he can hear sounds on both ears.

VI. NOSE

| 27

The nasolabial fold is symmetrical. The septum is found at midline. The mucosa

is pinkish. Discharges at the nose are not noted. Both nostrils are patent. There is no

tenderness noses noted in the sinuses.

VII. MOUTH

Lips are symmetrical and pinkish but dry. The tongue is found at the midline. Incomplete

teeth noted and have 6 teeth with cavities. There is tartar present on teeth. The gums, mucosa,

and palette are pinkish in colour. The tongue is whitish. There is no bleeding, tenderness, and

lesions noted.

VIII. PHARYNX

The uvula is found at the midline. The mucosa is pinkish; no swelling and ulceration noted.

Tonsils are not inflamed. Gag-reflex is evident.

IX. NECK

Trachea is found at the midline. The lymph nodes are not palpable. The thyroid is palpable

when the client swallows and bruit sounds are not noted. Range of motion is normal. Jugular

vein distention is not visible. Muscle strength is normal.

X. THORAX

Thorax is symmetrical. Spinal alignment is normal, no tenderness, bulges and lesions noted.

The breathing is effortless. Chest skin turgor is good. Respiratory excursion and tactile fremitus

are symmetrical. Upon percussion of the chest, the sound produced is resonant. When we

assess his chest, there is no chest indrawing, wheezing or stridor heard. Its measurement is

50.5 cm.

XI. HEART

His heart beats normally. There is no unsual sounds heard while assessing.

XII. BREAST

The breasts are symmetrical. No edema and tenderness noted.

| 28

XIII. ABDOMEN

The waist line measures 46 cm. Upon auscultation, the bowel sound is normoactive and

bruit sound is not noted. The bladder is nonpalpable. There is no pain on his stomach when we

assess him.

XIV. GENITO-URINARY

When we assess his genito-urinary, it is all normal. There are no lesions or discharges

noted. The client verbalizes that there is no pain when urinating.

XV. Musculoskeletal system

The patient has ectomorph body structure. As we measure the muscle for its size

with tape measurement, the height is 91.5 cm, the head circumference is 47cm, the

chest circumference is 50.5 cm , waist is 46 cm., and mid upper arm measures 16cm.

And it is symmetrical to each other. Muscle tendon, contractures and muscle tonicity are

not noted. The muscle strength of the patient on the left side can be graded by 5

because it has an active movement against full resistance. And the other side is can be

graded by 5 because it has an active movement against full resistance. As we checked

the strength of the sternocleidomastoid, trapezius, biceps, triceps and hip muscles. The

patient can resist the force when we exert a force, and it appears to be satisfactory.

XVI. Bones

The skeleton structure of the client is normal. Edema and tenderness are not

noted.

| 29

XVII. Joints

The joints are symmetrical to each other. Tenderness, swelling, crepitation of

joints are not noted. Smoothness of movement is noted as we assess the joint range of

motion on both arms.

XVIII. Neurological assessment

The client is well oriented place and person by tactful questioning. The level of

consciousness of the patient (RLS/GCS) is 15/1 – Eye motor is4; verbal response is 5and

the motor function is 6 - alert.

XIX. Cranial Nerves

In assessing the CN 1 (olfactory): The client can determine the different scents such as

unpleasant odor and pleasant odor with eyes closed. In CN 2(optic): for this assessment we

have no opportunity because the child cannot read. For CN

3(oculomotor),4(trochlear),6(abducens): the patient has a normal ocular movements and

both pupils is equally round and reactive to light and accommodation. In CN 5(trigeminal):

When touching the cornea lightly with wisp of cotton, it elicits blink reflex and eyelids blink

bilaterally. In CN 7(facial): the patient was able to smile, frown, shows teeth. Facial

movements is symmetrical. In CN 8(acoustic): the patient was able to hear spoken words. In

assessing the CN 9(glossopharyngeal) and 10(vagus): the movement of the uvula is at the

center and when the client says “ah” there is a symmetrical raise of soft palate and uvula.

Gag reflex is present the tongue blade touches the back of the tongue soft palate. The is no

opportunity to assess the identification taste because the client not cooperative. In CN

11(spinal accessory): when applying force on the patients shoulder, the patient can resist

the force and there is symmetrical, strong contraction of trapezius muscle. There is a strong

contraction of sternocleidomastoid muscle when we ask the patient to turn his head side to

side against the force of the hand. In CN 12(hypoglossal nerve): the patient was able to

protrude his tongue and move it to each side against tongue blade. There is symmetrical

tongue with smooth outward movement with bilateral strength.

| 30

Reflex

XX. Biceps reflex: the biceps contracts 2+(normal) for both sides. And for Triceps reflex: the

elbow extends of 2+(normal) for both sides. For brachioradialis reflex: the elbow flexes

with pronation of forearm, 2+(normal) for both sides. For patellar reflex: the extension of

the knee is +2(normal) for both sides. Achilles reflex: the plantar flexion of foot is 2+ for

both sides.

Motor function

(GROSS MOTOR AND BALANCE TEST)

XXI. The patient was able to walk with steady gait with apposite arm swing. In assessing the

Romberg’s test, we have no opportunity because the child is crying and appears to be

not cooperative.. The patient was not able to perform heel-toe and toe or heel walking

because the child is not cooperative.

(FINE MOTOR TEST FOR UPPER EXTREMITIES)

XXII. FINGER TO NOSE TEST: The client was able to abduct and extend the arms at

shoulder height and touch the nose alternately with one index finger and then the other.

XXIII. ALTERNATING SUPINATION AND PRONATION OF HANDS AND KNEES: the client

was not able to pat both knees with palms of both hands and then the back of the hands

alternately and increasing rate because the child is not cooperative.

XXIV. FINGER TO NOSE AND TO THE NURSE’S FINGER: the client was able to touch the

nose and then nurse’s index finger at about 35cm at increasing rate.

XXV. FINGERS TO FINGERS: the client was not able to bring the fingers together at the

midline with open eyes first and then closed first slowly and then rapidly with spread

arms broadly at shoulder height because the client is not cooperative.

XXVI. FINGERS TO THUMB: the client was able to touch each finger of one hand to the thumb

of the same hand.

(FINE MOTOR TEST FOR LOWER EXTREMETIES)

XXVII. HEEL DOWN OPPOSITE SHIN: there is no opportunity to perform this assessment

because the client is not cooperative.

| 31

XXVIII. TOE OR BALL OF FOOT TO THE NURSE’S FINGER: the patient was able to touch the

nurse finger with the use of the large toe of each foot.

(LIGHT-TOUCH SENSATION)

XXIX. The client was able to identify sensation symmetrically with eyes closed. The client was

able to feel light-touch sensation to these specific areas: forehead, cheek, hand, lower

arm, abdomen, foot, and lower leg.

(PAIN SENSATION)

XXX. For this assessment, we don’t have the opportunity because the client doesn’t know how

to say if dull or sharp.

XXXI. TEMPEARATURE SENSATION: the client was not able to identify “hot” and “cold” water

with eyes closed.

XXXII. KINESTHETIC SENSATION: with eyes closed, the client was able to identify correctly

the direction of the body part is moved.

(TACTILE SENSATION)

XXXIII. ONE-AND-TWO POINT DESCRIMINATION: with eyes closed, the patient was able to

identify the two points correctly on forearm at 35mm apart, back of 50 to 90mm apart

and fingertips at 3 to 6mm apart.

XXXIV. STEREOGNOSIS: the patient was able to identify the correct familiar object such as

coins, keys and paper clips when placing it in the patient’s palms with eyes closed.

XXXV. EXTINCTION PHENOMENON: the patient was able to feel stimulation in two

symmetrical areas of the body, such as the thighs, the cheeks, or the hands with eyes

closed.

FAMILY COPING INDEX

Categories Admission Discharge

Rate Justification Rate Justification

I. Physical 5 We had this rating just 5 We still gave them this

| 32

independence by observing that the

family is able and each

member of the family

can do the daily

activities of daily living

such walking, eating,

playing and fetching

water except for the

triplets and Justine

since they cannot carry

drum of water. And

also, there is no

bedridden in the family.

rating because we don’t

see any changes that

happened regarding to

their ADL. And there is no

member of the family who

became disable for them

not to do such things such

as their daily routines.

II. Therapeutic

independence

3 The family goes to the

health center when

they got sick but only if

the illness is severe

now. The family carries

out some but not all the

treatments. They often

self-medicate when

they are sick. They

apply efficascent oil if

they don’t feel well, and

they do water therapy.

3 The family still self-

medicate but they

promised us that they will

go to the health center

immediately if they feel

unusual to their bodies

especially the kids.

III. Knowledge of

condition

3 We rated it by 3 since

the family particularly

the sister stated that

she knows her siblings

conditions by stating

that her siblings is

malnourished but they

cannot do anything

about it due to poverty.

3 After some teachings and

sharing our knowledge of

such illness, we are able

to see and assess that

Mary Frances was able to

learn something out from it

but they are not applying

the health teachings that

we have rendered to them.

| 33

IV. Application of

principles of

personal hygiene

1 As we have observed

to our client they don’t

have proper hygiene.

They usually take a

bath during afternoon

and they don’t brush

their teeth. They also

walk bare-footed. With

these observations, we

can say that they

weren’t properly taken

care of.

3 Through our health

teaching and interventions,

we can say that they have

improved during our

exposure in the

community. They now take

a bath early morning, wear

slippers which we have

provided for them.

V. Attitude towards

health care

3 The family sees health

care as important.

They take advices from

health care

professionals and seek

help from health

centers. They accept

treatments warm

heartedly but they

cannot follow it at all

times because of

poverty. They also go

to quack doctors if they

don’t feel well.

3 After our interventions

and health teachings, the

family’s attitude towards

health care is still the

same.

VI .Emotional

competence

1 At the time of our

assessment, we have

observed that the

family is not

emotionally stable.

They look sad and

longing for the love and

care of the mother.

3 The emotional state of the

triplets has improved since

the first time we assessed

them. On the day we left

on their house, we

observe that we have

created a bond between

them. Although we still felt

| 34

that they’re longing for the

love of a mother.

VII .Family living

patterns

1 The parents of the

triplets are separated

due to some family

problems. Their mother

has left them for 2

years already. It is

really visible that the

triplets are sad and

longing for a mother’

love and care.

1 We did not feel the

willingness of the family to

change or improve their

living patterns. After all the

interventions and health

teachings, we did not see

any change in their

practices.

VIII .Physical

environment

1 We can say that the

physical environment

where the family lives

is not suitable for living.

Their living space is not

adequate, their

surroundings are very

dirty and there are

accident hazards all

over the place. Their

cooking area is outside

their house, which is

near to breeding sites

of mosquitoes.

1 The physical environment

of the family has improved

but only for a day after our

intervention. They were

not able to maintain the

cleanliness and apply our

health teachings.

IX. Use of

community

resources

3 The family is aware of

the facilities in their

community and uses

some of it but not all.

They attend feeding

sessions and they go

to the health center if

they have severe

3 Even though we have

rendered a lot of health

teachings and advices, the

family is still the same.

They are hardheaded and

that we are not sure if they

will follow our advices.

| 35

illnesses.

PRIORITIZATION OF FAMILY PROBLEM

UNHEALTHY LIFESTYLE AND PERSONAL HABITS/PRACTICES SPECIFICALLY SMOKING

CRITERIA COMPUTATION ACTUAL SCORE

JUSTIFICATION

NATURE OF THE PROBLEM (1)

1- Foreseeable crisis/ stress point

2- Health threat3- Wellness state/

2/3x 1 0.66 The problem is considered as health threat since the father of the triplets and most of the people in their house may be considered as chain smokers. Their aunt is also positive for TB

| 36

health deficit but is receiving treatment. Their older sister almost had TB if she did not stop smoking.

MODIFIABILITY OF THE PROBLEM (2)

0- Not modifiable1- Partially modifiable2- Easily modifiable

1/2x 2 1 The problem is partially modifiable because it is hard for a smoker to stop smoking. Minimizing sticks per day may be a good strategy. Willingness of the patient is also a factor, the father and other members of the family should have the willingness to change for the betterment of themselves and the other members of the family. Health teachings on the effect of smoking.

PREVENTIVE POTENTIAL (1)

1- Low2- Moderate3- High

1/3 x 1 0.33 The preventive potential of the problem is low since smoking has been the habit of the father for a long time already and we don’t see the willing ness of the father to stop his smoking.

SALIENCE (1)0- Not perceived as a

problem1- A problem not

needing immediate attention

2- A problem needing immediate attention

0/2 x 1 0 The family does not see smoking as a problem because they are already used to it. They have been smoking for a long time already and see it as a normal thing to do.

1.99

INADEQUATE FOOD INTAKE BOTH IN QUALITY AND QUANTITY


JUSTIFICATION




health deficit

2/3 x 1 0.66 The problem is considered as a health threat since it is conducive to diseases. They do not get the proper nutrients they need from what they eat which may cause the weakening of their immune system.

| 37



1/2 x 2 1 The problem is partially modifiable since the willingness and dedication of the family is needed. We may also conduct feeding activities for them, specifically the triplets during our exposure. But we cannot feed them forever; the family should work hard to provide for their needs.



1/3 x 1 0.33 The preventive potential of the problem is low since they do not have enough resources to buy food, but we have observed that they still have the guts to buy cigarettes even though they don’t have anything to eat.





2/2 x 1 1 The family sees their eating habits as a problem which needs immediate attention. The family does not eat on time and is not able to provide the proper food and the proper amount on time.

2.99

HOME AND ENVIRONMENT: INADEQUATE LIVING SPACE


JUSTIFICATION




health deficit

2/3x 1 0.66 We rate this problem as health threat because we observed that their house is lacking on space, the possibility of spreading airborne diseases is high and may be a threat for the health of the family. In addition to this, accidents may also

| 38

potentiate because of the small range of living space where the members of the family could move.



1/2x 2 1 It is partially modifiable since it requires reconstruction increasing a living space may require a lot of financial resources from the family and the family doesn't prioritize this. Hopefully, the knowledge we share to them may decrease the susceptibility of the family to some diseases.



2/3 x 1 0.66 Preventive potential is moderate since the client knows ways on how to prevent widespread of diseases like covering their mouth whenever they cough or sneeze.





2/2 x 1 1 The family sees this as a problem needing immediate action since they have lack of space in the room where they sleep and that it is hard for them since 10 members of the family sleeps together.

3.32

ACCIDENT HAZARD: FALLS


JUSTIFICATION




health deficit

2/3 x 1 0.66 The problem is a health threat since it may lead to accidents. Their stairs is not safe to use since it does not have a strong support and does not have railings.

| 39


0- Not modifiable1- Partially

modifiable2- Easily modifiable

½ x 2 1 It is partially modifiable because it is hard to reconstruct the house, sufficient money and manpower is also required in this kind of plan. We student nurses shared some tips on how to minimize the risk or the actual problem that may affect the health and safety of the family.



2/3 x 1 0.66 The preventive potential of the problem is moderate since there are ways to prevent accidents through safety precautions and renovation of the stairs. It is only moderately preventable because the willingness of the family is a factor.





0/2 x 1 0 The family does not perceive this as a problem since they are already used to it and does have any intention in changing/renovating their stairs.

2.32

HEALTH PROBLEM: FIRE HAZARD


JUSTIFICATION



2- Health threat

2/3 x 1 0.66 This problem is a health threat that possess to a strong risk to fire incidents since their house is made of light materials such as wood/ Also their

| 40

3- Wellness state/ health deficit

neighbourhood is congested. The houses nearby are made up of wood and fire could cause a major destruction if improper handling of candles and other fire-causing materials is observed.



½ x 2 1 The problem is partially modifiable because the house of the family is made of flammable materials (i.e. wood) and that they use lamps and candles at night since they do not have electricity.



2/3 x 1 0.66 The preventive potential is moderate since they have lack of resources. The interior of their house is not properly arranged and it is messy.





2/2 x 1 1 The family perceives fire hazard as a problem that needs immediate attention because they have almost lost their house due to fire. They are afraid that it will happen again.

3.32

HEALTH PROBLEM: PRESENCE OF BREEDING SITES


JUSTIFICATION



2/3 x 1 0.66 Insects, rats and pests in the environment could inflict a lot of diseases especially to the family members living in a malaria risk

| 41


health deficit

area. They could acquire airborne and vector acquired diseases, such as malaria and dengue which could possibly contribute to their illness condition. This is a health threat that may cause diseases to the client and her family since there is presence of rats, mosquitoes, and rodents that can cause rabies, dengue, and food contamination.



2/2 x 2 2 The family can modify the condition easily through applying measures of eradicating vectors of diseases that can be taught by the nurse. Their willingness to cooperate, learn and acquire knowledge about the diseases that they may get through this can possibly help in this kind of problem. Simple cleaning and maintaining good environment can be a good strategy in eradicating those pests that can affect the health of the client.



2/3 x 1 0.66 The preventive potential is moderate since the family has no experience in pests and mosquito related illnesses and had also not used spray insecticides yet. The availability of resources could also be a factor since they have financial constraints, the materials needed like insecticides and mosquito repellent materials cannot be easily provided yet, frequent cleaning is really the best way to prevent the problem to worsen which is affordable and easy to do.




2- A problem needing

½ x 1 0.5 The family perceives the presence of breeding sites as a problem not needing immediate attention. They are aware that those breeding sites may cause diseases but they are not doing anything to clean/prevent it.

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immediate attention

3.82

Health Problem: Lack of Proper Toilet Facility


JUSTIFICATION




health deficit

2/3 x 1 0.66 The problem is a health threat since their toilet is located near their entrance and they only use a small piece of plywood to cover it. It is totally unhygienic and they may get diseases from it.



½ x 2 1 It is partially modifiable because it needs to be planned and requires money. Moreover the need of manpower is greatly needed in order to build a Comfort Room in their house.



1/3 x 1 0.33 The preventive potential is low because they still need to renovate it, but that is not their priority because they do not have enough money.





0/2 x 1 0 The family does not perceive it as a problem because they are already used to it. It has been part of their day-to-day life and they do not care about it anymore.

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1.99

INAPPROPRIATE ROLE ASSUMPTION


JUSTIFICATION




health deficit

1/3 x 1 0.33 The problem is a foreseeable crisis because taking care of children is a major responsibility of the mother and father and not of the sister.



0/2 x 2 0 The problem is not modifiable since their mother has already left them and that they do not have contact with their mother due to family problems.



1/3 x 1 0.33 Its preventive potential is low since even though it is hard for their older sister to take the responsibility of being the mother for the triplets, she doesn’t really have a choice since their mother is not around.





½ x 1 0.5 They see it as a problem but does not need immediate action because they know that the possibility of the mother to come back is low.

1.16

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UNHEALTHFUL LIFESTYLE: POOR PERSONAL HYGIENE


JUSTIFICATION




health deficit

2/3 x 1 0.66 It is a health threat since poor personal hygiene would result to dysfunctions of some body parts if these will not be taken good care of. Also, prolonged negligence in taking care of one’s self might result to severe complications.



2/2 x 2 2 The modifiability of the problem is high. The willingness of the family is change and improves their personal hygiene. They just need to have motivation and health teachings.



2/3 x 1 0.66 It is on moderate preventive potential because of the interventions implemented by the student nurses were giving health teachings on the important things to remember in proper hygiene and the importance of it. Members of the family especially the children are willing to participate in conducting the intervention. However, it can’t be assured that those actions done will be maintained.





2/2 x 1 1 The family sees the problem as a problem the needs immediate attention. The triplets really need a mother figure, someone that will care for them and just be there to guide them through their growth.

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4.32

IMPROPER WASTE DISPOSAL


JUSTIFICATION




health deficit

2/3 x 1 0.66 It is a health threat since there would be unexpected consequences of this problem. It may cause illnesses to the family which will give them more stress.



2/2 x 2 2 It is easily modifiable since there is a high chance to improve the waste disposal management of the family.



2/3 x 1 0.66 it is moderately preventive since the student nurses were able to give interventions like giving information about proper garbage disposal and effects of improper disposal of wastes. The family helped in implementing this proper disposal of garbage and able to segregate each type of waste. However, it can’t be assured that the family can maintain the proper ways in garbage disposal.





0/2 x 1 0 The family does not see this as a problem because they are already used to not segregating their garbage.

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3.32

Results

PROBLEMS RESULTS

UNHEALTHFUL LIFESTYLE: POOR PERSONAL HYGIENE

4.32

HEALTH PROBLEM: PRESENCE OF BREEDING SITES

3.82

IMPROPER WASTE DISPOSAL 3.32HOME AND ENVIRONMENT: INADEQUATE

LIVING SPACE3.32

HEALTH PROBLEM: FIRE HAZARD 3.32INADEQUATE FOOD INTAKE BOTH IN QUALITY AND QUANTITY

2.99

ACCIDENT HAZARD: FALLS 2.32UNHEALTHY LIFESTYLE AND PERSONAL HABITS/PRACTICES SPECIFICALLY SMOKING

1.99

Health Problem: Lack of Proper Toilet Facility 1.99INAPPROPRIATE ROLE ASSUMPTION 1.16

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IMCI CASE STUDY

Documents

Transcript of IMCI CASE STUDY