126382905 imci-case-study

FAMILY CASE STUDY| 1
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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
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.

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;
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.

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
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
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
*
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 RaymartEncar
guez
Son 4 M Single
10 Reggie
Encarguez
Son 4 M Single
PLACETYPE OF
WORK
NO
.
NAME

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 bahaypasilungan, 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.
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

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.
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.
33

Reymart 8 kg 0.9 m 9.7 
Reggie 8 kg 0.9m 9.7 

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
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
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
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
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 None Unemployed N/A N/A N/A

Encarguez
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 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
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
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
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
= 6.2m2x1 windows
WO = 6.2m2
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 / 10m2 x 100

= 77.49%
As we interpreted, theEncarguez 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.
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)
= 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
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

FAMILY CASE STUDY| Presence of insectsandrodents 21
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
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.
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.
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 nakosiyamasabtankaymagusab-
usabiyangbatasanugkalit pa judmasukosaamoamaskiywalayrason. Naa pay kaisanani-
ingonsiyanamagpakamatay 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.
Immunization
Date
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
Francessand 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
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 ReymartEncarguez, 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
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
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
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.
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.
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.
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 DOWNOPPOSITE SHIN: there is no opportunity to perform this assessment
because the client is not cooperative.
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
independence
5 We had this rating just
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.
5 We still gave them this
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
MaryFrances was able to
learn something out from it
but they are not applying
the health teachings that
we have rendered to them.
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
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’
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.

love and care.
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
illnesses.
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.

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 threat
3- Wellness state/
health deficit
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
but is receiving treatment. Their
older sister almost had TB if she
did not stop smoking.
MODIFIABILITY OF THE
PROBLEM (2)
0- Not modifiable
1- Partially modifiable
2- 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- Low
2- Moderate
3- 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
problem
1- 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
SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
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.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.
SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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
SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
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
potentiate because of the small
range of living space where the

members of the family could
move.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.
SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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
SCORE
JUSTIFICATION

NATURE OF THE
PROBLEM (1)
1- Foreseeable
crisis/ stress point
2- Health threat
3- Wellness state/
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.
PROBLEM (2)
0- Not modifiable
1- Partially
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.
SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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

SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
health deficit
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
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.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.
SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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

SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
health deficit
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
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.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.

SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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.
3.82
Health Problem: Lack of Proper Toilet Facility
SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
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.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.

SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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.
1.99
INAPPROPRIATE ROLE ASSUMPTION
SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
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.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.

SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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
UNHEALTHFUL LIFESTYLE: POOR PERSONAL HYGIENE
SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
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.
PROBLEM (2)
0- Not modifiable
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.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.
SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
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.
4.32
IMPROPER WASTE DISPOSAL
SCORE
JUSTIFICATION
NATURE OF THE
PROBLEM (1)
stress point
2- Health threat
3- Wellness state/
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.
PROBLEM (2)
0- Not modifiable
2/2 x 2 2 It is easily modifiable since there
is a high chance to improve the
waste disposal management of
the family.
PREVENTIVE
POTENTIAL (1)
1- Low
2- Moderate
3- High
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.
SALIENCE (1)
problem
1- A problem not
needing immediate
attention
immediate attention
0/2 x 1 0 The family does not see this as
a problem because they are
already used to not segregating
their garbage.
3.32
Results
PROBLEMS RESULTS
UNHEALTHFUL LIFESTYLE: POOR
PERSONAL HYGIENE
4.32
HEALTH PROBLEM: PRESENCE OF
BREEDING SITES
3.82
IMPROPER WASTE DISPOSAL 3.32
HOME AND ENVIRONMENT: INADEQUATE
LIVING SPACE
3.32
HEALTH PROBLEM: FIRE HAZARD 3.32
INADEQUATE FOOD INTAKE BOTH IN
QUALITY AND QUANTITY
2.99
ACCIDENT HAZARD: FALLS 2.32
UNHEALTHY LIFESTYLE AND PERSONAL
HABITS/PRACTICES SPECIFICALLY
SMOKING
1.99
Health Problem: Lack of Proper Toilet Facility 1.99
INAPPROPRIATE ROLE ASSUMPTION 1.16

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