Keluarga Binaan. Ibu Upi,Yg Print

8/7/2019 Keluarga Binaan. Ibu Upi,Yg Print

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1. Family Identity

1.1 Data of the Family

Mr. Ss family consists of 6 peoples, they are Mr. S himself, Mrs. U, their 4

children ((Mr. A, Mrs. S, Mr. I, Mr. B), Mr. S and Mrs. U are Javanese couple who lived

in Kelapa Dua. Mr. S was born in April 7, 1966 and now he is 43 years old. His last

education was senior high graduate and now is working as taxi driver. He working in his

jobs for 5 years with varied salary. Mr. S is a Muslim. His current medical condition

notes that he has Diabetes Mellitus type II since 3 years ago. His Father was also a

diabetic patient. And death in diabetic complication (Heart attack), Mr.S also had a

chronic hypertension, uncontrolled hi-fat and high carbohydrate meals, and habit of

smoking 1 cigarette packs each day. His physical condition appeared well. On physical

examination, his legs were claudicating and have several small scars on his thumb. He

claimed that he didnt wear sandals or shoes when walking in his home.

Mrs. U was born on January 23, 1969. Her last education was junior high school

graduate and now she work as on-call therapist. She married Mr. S 18 years ago, and she

complain that she have a gout atritis. She complain that her big toe sometimes swelling

and painfull especially in the morning. His finger joint also pianfull after shes done her

job as a therapist. She begun have this symptoms at her age of 20 and she refuse that she

had already taken any medication for her symptoms. And also she complain that she have

a mild headache, from neck spread to head.

Mr. A, the first son of Mr. S and Mrs. U, was born on March 13, 1984. She was

born as a healthy baby with help of the local midwife. Mrs. As last education was senior

high school graduate and is now working on the cingwan restaurant in the supermall

karawaci as a waiters. He a single man. On physical examination, Mr. A was a healthy

man his BMI was of 20.4. Other than his lungs and cardiac auscultations, everything was

found normal. He didnt smoke, and didnt like exercise. But sometimes he complain that

he cramp on hands and feets for 5 minutes, because he usually sleep directly into the

floor.


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Ms.S was the second child of Mr. S and Mrs. U who was born on march 9 1988.

She was born in puskesmas with help of the midwife in the puskesmas. She was born

with 2900 grams of wright and 47 cm heights, now she is eight years old and hasnt

complete vaccination, now she 25 kg and has a proportional height. She in the elementary

school (2nd grade). she is a healty and playfull young girls except she also has symptoms

like her mother.

Mr. I was born on jully 20, 2003. He now in the kindergarden school. And he was

a healty young boy. He was born normal in the puskesmas with help with midwife in the

puskesmas. he was born with 3300 grams weights and 50 cm heights. he is six years old

now and have a incompleted vaccination (BCG, HBV, Polio, and DPT). His last body

weight was 13.3 kg, and he has a good BMI. he was breast-fed for 4 months. He has a

good appetite and he is a heallty and cherfull boy

Mr. B was born on October 30, 2007. he was the last child from Mr.S and Mrs U.

he was born with 3100 grams weights and 51 cm heights. He is 2 years old now and

didnt have completed vaccination (BCG, HBV, Polio, and DPT). His last body weight

was 10 kg, and he had proportional height. he was only breast-feed for 3 months and now

is eating adults food such as rice and baby porridge (Milna pooridge). He has a good

appetite. Her mother claimed that he got flu for two days and also he had fever,

especially was up at night, and resided at morning. he was not taken to the puskesmas ,his

mother buy (sumeng drugs that drugs consist of paracetamol) in the little shop around

her house and his fever falling down.

1.2 Family Development Stages

1. The couple married without children.

2. The birth of children, where the oldest childs age was ranged from 0-30

months old.


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3. A family with pre-school children, where the oldest childs age was 30

months to 6 years old.

4. A family with school-age children, where the oldest childs age was 6-13

years old.

5. A family with teens, where the oldest childs age was 13-20 years old.

6. A family with young adult children, where all of the children were already

left the house to live independently.

7. Middle aged parents, or already retired.

8. Parents in their late age.

2. Genogram

Symbol notes:

: Smoking, Diabetic Male


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: Normal healthy male

: Normal healthy female

: Woman with gout arthritis


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Environment of the household

Bathroom Kitchen

Family Room

Corridor

Bed Room


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Guest room

Picture 1. Mr. Ss house map

The house is minimalist,have a measurement of 7 meter x 3 meter and divide into five

room with the corridor,the surroundings around the house was unhealthy, very dirty and

have a poor hygiene. The bathroom and washing area were right next to the kitchen, and

looked dirty. Sometimes we found a lot of cockroach in the bathroom, and the wall of

the bathroom have many puddle and also have a damaged floor and door. For the kitchen

is looked dirty and have a poor hygine, we found many gabarge in the floor, very nasty

and for the cooking utensils were looked so dirty and just laid around on a dirty-looking

wooden box near the wall.

They dont have dining table, so they had their meals by sitting in the guest room or

family room. The family only have one bad (queen size), and it used by the children and

looked so dirty, because they didnt use anything to cover the bad. For the parent they

sleep only on the carpet in the guest room. The area surroundings the house was many

chickens and cats laying around

The waterworks system


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amount of water required for washing the cloth,plate,glass and for cooking using soil

water and it works by pump machine to supply the water, the quality of water is good,no

color,smell, and clear.

The facility for bathroom

In this family,bathroom has many function,for example: this family using bathroom for

washing the cloth,plate,glass, and also for take a bath. So the bathroom has multifunction.

The banishment feces system

Be located 5 meter from house and have own location outside the house.

4. Problem Within The Family

4.1 Social Problem:

Sometimes there was a conflict in the family,an Economic problem because Mr.S didnt

have a good salary to fulfill what his family needed. And for the child there no conflict

between them, Mr.A is the oldest son, he is hardworking and sometimes he helping his father

to pay the water an electrical bill, he also sow care to his little brother and sister, They also

helped each other. They was also known good in the neighborhood. They talked nicely and

respect the other.


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4.2 Biologic Problem:

o Mr. S suffer a Diabetes mellitus type II

o Mr. S suffer a hypertension (170/110mmhg)

o The Mrs. U suffer a gout arthritis

4.3 Psychological Problem:

o Mr. S didnt take the hypertension and diabetic medication regularly

o Mr. S cant control her eating behavior

o

Mr. S afraid to go to the puskesmas and didnt control for the blood sugarregularly

5. The Visits

Date Name Activity Attempts

24/2 Mr. S Anamnesis:

- 3 years history of DM

- Smoking

- History of taking traditional

medicine for 1 years.

- History of chronic

hypertension and heart attack

in the family.

- Random blood sugar level:

230

Physical Examination:

- BP: 170/110

- Inspection: Small scar

lesions in both soles and his

Counseling:

- Explaining about DM.

- 3 J to control meals.

- Splitting meals portion to

smaller portion, but have a

frequent eating.

- Reducing sugar,

sweets,salt and carbohydrate

intake. Increasing

vegetables.

- Wearing shoes/sandals

- Regularly check blood

sugar level on puskesmas

- Reducing cigarretes, if


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right thumb. possible stopping it entirely.

Mrs. U Anamnesis:

- History of high uric acid

- History of uterine infection

and uterine cyst (5 years ago)

- History of toothache

- Headache: from neck to head

- Taking traditional medicine

for uric acid and headache.

Physical Examination:

- BP: 120/90

Counseling:

- Explaining about uric acid.

- Reducing hi-protein

meals.

- Reducing repetitive

movement of limbs.

- Check uric acid level on

nearby clinic.

Stopping any traditional

medicines.

Mr. A Anamnesis:

- Cramp on hands and feets for

5 minutes (3 weeks).

- Sleep directly on floor.

- Smoking (-)

Physical examination:

- BP: 120/90

Inspection: Normal on inspection.

Counseling:

- Reducing repetitive

movements of the limbs.

Suggestion to use mats/some

layering for sleeping

Mr. I Allo anamnesis:- Incomplete Immunization

(Only had BCG, HBV, and

DPT)

Physical Examination: normal

Counseling:- Increasing personal

hygiene.

Suggestion to continue the

immunization

Mr. B Allo anamnesis:

- Often catches cold and fever.

- Incomplete Immunization

(Only had BCG, HBV, and

DPT)

- Have taken sumeng

drugsfor every fever, and it

Counseling:

- Increasing personal

hygiene.

- Increasing personal

hygiene.

- Suggestion to continue the

immunization


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resided.

- Normal bowel movement.

- Likes to play in the dirt.


- Palpation: mild fever

Inspection: good nutrition

- Using sandals/shoes when

playing outside.

- Washing hand before

eating.

Go to puskesmas if he feels

unwell

Environment observationCounseling about house and

personal hygiene.

10/3 Mrs. U Anamnesis:

- Athralgia since the night

before, recurrent.

- Dry cough and cold (2 days),

no running nose.

- History of feet trauma (1

week ago)

- Taking betadine, refanol and

antibiotic for the trauma.

- Often comes in contact with

water and damp enviroment.

- Often take a bath at night.

- Feel stressed about her

family economic condition.

- Stops using over-the-

counter-drugs.

- Unknown cholesterol level.


- BP: 114/70Drying scar on the right sole

Counseling:

- Suggestion to reduce

contact with

water/cold/damp

environment.

- Suggestion to have a

check up on the puskesmas.

- Suggestion to stop taking

bath at night, if she cant,

she might use warm water

when taking bath at night.

- Wearing sandals/shoes

outside the house.

- Reassuring her not to get

more stressed.

Mr. A Anamnesis:

- Cramps on hands and feets

(+)

- Often take a bath at night.

Counseling:

Suggestion to stop taking bath at

night, if he cant, he might use

warm water when taking bath at


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- Self medication (-)

- Never have medical check up

before.


BP: 115/90

night.

Environment observation Counseling about house and

personal hygiene.

31/3 Mr. S Anamnesis:

- Still smoking.

- Starting to wear sandals.

- Reducing sweet, sugary, and

salty meals.

- Random blood sugar level:

200


- BP: 140/110

- Slightly edematous feet.

Counseling:

- Healthy meals.

- Suggestion to check blood

sugar level regularly.

Mrs. U Anamnesis:

- No complaints.

Physical examination:- BP: 120/90

- Tenderness on right hand

thumb.

Counseling:

- Suggestion to chek the

uric acid level

Mr. A Anamnesis:

- No complaints.


- BP: 120/90

Counseling:

none.

- Environmental observation Counseling about house andpersonal hygiene.

Efforts on ach visits

1st visit : We gained as many information as we can get from Mr S and Mrs U. We also

build a good relationship with the family so we can get more information as they become


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more comfortable with us. We also check for her blood pressure which was a little bit

above normal for the Mrs U(130/90) and for her husband (170/110)

2nd visit : As we got the information that Mrs. Upi had gout symptoms, we recommended

her to check her uric acid level, we gave the laboratory form that we got from Kelapa

Dua Public Health Center. We also gave further information about her disease.

3rd visit : We have another problem that Mrs. U cant afford to test because of her

economical problem.

6. Results

Mr. S:

- Starting to care about his blood sugar and hypertension, and wearing shoes

(no flipflops) to protect his feet.

- Reducing sugar intake, Re-arrangement of his eating habbit to reduce the

blood sugar level and replacing rice with steam potato.

- Reducing cigarettes intake from 1 packs into 0,5 pack a day.

- His random blood sugar level was reduced from 230 to 187 for 6 weeks.

Mrs. U:

- Starting to stop taking bath at night, if she cant,she try to use warm water when

taking bath at night.

- Wearing sandals/shoes outside the house.

- Starting reducing hi-protein meals.

- Starting reducing repetitive movement of limbs

- Control to clinic if she has complains

- Use mattres if she still sleep on the floor

Mr. A:


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- Increasing personal hygiene.

- Do more exercise

- Starting using carpet if he want sleep at night.

Overall:

- Enhancement of house and personal hygiene. (Burying puddles, cleaning

moss, gutter and animals wastes. Washing hand before taking meals.)

- Their house hygiene should be improved, not to eat around the washing

area

- Stop taking over-the-counter-drug but go to clinic instead.

- Enhancement of health awareness and knowledge and go to public health

center if they have complains about their health.

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