Family Nursing Process

Initial Database

GROUP 3-Cluster 1
Anwar Jan Garaza
Mariz Joy Guillermo
Richard James Oamil
Lyka Mae Imbat
Ellen Gaye Domingo

Mrs. Christine B. Alcoy, RN

Instructor
/2009
 FAMILY NURSING PROCESS
INITIAL DATABASE

A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

Table 1. Demographic Data of the Members of Fuerte Family

Name Relationship Position Age Sex Educational Occupation Place of Religion

to the Head Attainment Residence
of the Family
Bernardo Head Father 78 M High School Pensioner Quiling Sur, Jesus
Navarrete Graduate Batac Miracle
Fuerte Crusade,
Inc

Ester Castillo Wife Mother 47 F High School University -do- -do-

Fuerte Graduate Helper

Ezrael Castillo Son 1st Child 20 M 3rd year High Construction -do- -do-
Fuerte School Worker

Michelle Daughter 2nd Child 17 F Presently 2nd Student -do- -do-

Castillo Fuerte year College,
BSBA-MA,
MMSU

Based on internal organization, Fuerte Family is a nuclear type of family consisting of the father,

mother, and children. The size of their family is small and ideal. Mr. Bernardo Fuerte is 78 years old and

regarded as the head of their family. Mrs. Ester Fuerte is the wife and the breadwinner of the family.

They are blessed with 2 children namely, Ezrael and Michelle. Ezrael, 20, hangs-out with his friends most

of the time, not studying and works as construction worker once a week; and Michelle, 17, is a second

year student of MMSU-CBEA taking up Business Administration Major in Management Accounting.

Fuerte Family is neolocal based on residence; they neither reside with any of their parents. Mr.

Fuerte was born and raised at Gov. Ablan Avenue, Brgy. 5, Laoag City while Mrs. Fuerte originally came

from San Jose, Mindoro. The Fuerte Family had migrated 8 times already, at first, they reside at Laoag
City near Mr. Fuerte’s Father, then they planned to transfer to Manila for Mr. Fuerte to find a better job,

luckily he found one as a security guard. They stayed in Manila for only less than a year in 1987 due to

the rampant killings of security guards at that time so Mr. Fuerte decided to resign from his job and

return to Ilocos Norte. Mr. Fuerte then found a job in Mariano Marcos State University, also as a security

guard, and then he decided that it is much better for the whole family if they live near his job so they

moved to Bacocang Daya at the same year. However they are again subjected to move because of a

typhoon which destroyed their house so they moved to another house, they had rented, but still in the

same sitio in the same year (1987), however they again needed to move because the owner of the

house which they had rented wanted the house to be developed, so the family immediately moved to

Poblacion, Batac near the Marcos Museum at the year 1988, however they needed again to move

because the owner of the house needed to sell the house due to his financial problems. On the same

year (1988) the family moved to Ablan, Batac then stayed there for a few months until the owner of

their residence decided to turn their house into a Tobacco Warehouse so the family is again forced to

find a new place to stay. For the sixth time, they moved to Tabug, Batac (1989) and stayed there for 10

years until they had enough money to build their own house. For the seventh time they moved to

Quiling Sur, Batac at the year 1999, they built a house in a vacant lot owned by a relative, the family had

again resided at that area for another 10 years. However they again needed to move because their

relative decided to sell the land due to financial problems. And for the last time they again migrated to

their present location, still in Quiling Sur, their house is located in a cliff near the Quiaoit River because it

is the only place available for them. It was suggested by their Barangay Captain Nalundasan, since no

one is using the lot, it is owned by a kind-hearted family (Rubio Family) who gave them permission to

build their house and inhabit the land.

 Based on descent, the family is considered to have a patrilineal descent interaction since they

mingle with their relatives in the father side most of the time because the family of orientation of Mrs.

Fuerte is in Mindoro and they have never been there for a visit or formal introduction of their family.

When it comes to decision making, both Mr. and Mrs. Fuerte makes decision, thus they are

egalitarian when basing it on authority. They also said that before deciding on things regarding family

welfare, health care and other family matters and affairs, they must first seek or consult the other

members of the family.

There are no observable conflicts in the family as manifested by their good family ties and

interaction. When we asked Mr. Fuerte if there are misunderstandings or conflicts that run with the

family, he verbalized that they don’t have serious fights but admitted that they also have conflicts

common to any family.

B. SOCIOECONOMIC AND CULTURAL CHARACTERISTICS

The monthly income of the family is coming from the pension of Mr. Fuerte, the salary of Mrs.

Fuerte and their son, Ezrael.

Mr. Fuerte is a former employee of MMSU as a security guard for almost four years from year

1987-1991. He is now jobless and stays at home. Mr. Fuerte receives his monthly pension from SSS

which amounts Php4217.00 and serves as one of the sources of income.

Mrs. Fuerte is now the breadwinner of the family. She works as an employee of MMSU-CAF. She

helps in gardening and maintaining the cleanliness of the college. She works five days a week; her

income is php135/day, receiving a monthly income of Php2700.00 per month.

 Ezrael works occasionally if a job is offered to him. He works as a construction worker at an

average of 4 days a month, earning about php700/month (php175/day)

SOURCES OF INCOME:

Mr. Fuerte- Php4217.00/month (from SSS pension)

Mrs. Fuerte- Php2700.00/month (wage as University Helper)

Ezrael- Php700.00/month (wage as construction worker)

Total: Php7617.00/month

ALLOCATION OF INCOME:

Medicine- Php1095.00 (14%)

Education- Php2400.00 (31%)

Food- Php2804.00 (37 %)

Miscellaneous- Php500.00 (7%)

Transportation- Php468.00 (6 %)

Clothing- Php350.00 (5%)

Total: Php7617.00 (100%)

Figure 1.Monthly Expenses of Fuerte Family

Monthly Expenses of Fuerte Family

7% 6% 14%
5%

Medicine
Education
Food
Miscellaneous
Transportatiion
Clothing
32%

37%

Mrs. Fuerte is in charge in budgeting the money of the family. According to Mr. Fuerte, their

monthly expenses mostly fall on his medicines, allowance of their daughter in going to school and their

food.

The Fuerte Family, as other normal families, eat 3 times a day excluding their snacks in the

morning and in the afternoon. Their meals consist mainly of vegetable dishes such as “pinakbet”,

“dinengdeng” and vegetable salad (talbos ng kamote) which they buy in the market and some are

harvested from their vegetable garden consisting of papaya, horseradish, sweet potato and atis. They

sometimes buy meat, of either pig or chicken, for their meals. But there are times wherein the food for

the family is not enough especially the “ulam”, for example their vegetable plants are not yet ready for

harvest or there is a financial crisis. A cavan of rice is bought monthly after receiving the pension of Mr.

Fuerte and is consumed for more than a month. The eating time of the family is as follow: around 5:30-7
AM for breakfast, 12-1 PM for lunch except for Ezrael who eat late most of the time (at around 1:30-

2:30 PM) and dinner at around 6-7 PM.

The educational attainment of the family is as follows: Mr. Fuerte is a high school graduate and

took up Commerce at Northwestern University but finished only 1 year due to financial problems while

Mrs. Fuerte is a High School Graduate in a Secondary School in Mindoro; Ezrael only finished up to third

year high school in Batac Junior College; Michelle on the other hand is a high school graduate and

currently taking up BSBA-MA at MMSU-CBEA as a second year student.

The Fuerte family is religiously affiliated to the Jesus Miracle Crusade, Inc. since 1999 located in

Laoag City, through the invitation of their neighbor in Tabug, Batac. They were previously affiliated in

the Roman Catholic Church. They go to church three times a week on Wednesdays, Fridays and Sundays.

They go to church via a jeepney provided by the same institution for free (back and forth), they only

expend money when they go to Ricarte Park as their meeting place. They go to church usually to repent

for their sins, thank and praise God for all the blessings they receive and to ask for guidance, strength,

health and good luck. They also say that they regularly pray three times a day before meals to thank God

for the foods they are consuming in everyday life.

Fuerte family actively participates in their community. They participate regularly in the activities

mandated in their barangay. They help in the Clean and Green Program of the barangay, like

participating in their monthly “YCAP”, and other programs regarding the improvement of their place.

They send Michelle to school for her to be educated, have a better living in the future and in

general to help the whole family, they also said that they consider her education as their only savings.

They also want Ezrael to go to school, but he refuses to study. Mr. Fuerte verbalized that their son

became too preoccupied with his peers thus they decided for him to stop.
 The family enjoys the benefit of low-priced medicines and free health care facilities because Mr.

Fuerte is a member of Medicare and Senior Citizens of the Philippines since 1996. They sometimes go to

Rural Health Unit of Batac for check-up and public hospitals just like the MMMH & MC for further

consultations if ever needed.

They sometimes go to their relatives who reside in the same Barangay when they have time

while Ezrael often go there for a visit. They also have relatives in Laoag but only go there when there are

special occasions.

The family is living peacefully with a lot of friends who help the in times of need and crises. They

have harmonious relationship with their neighbors as shown by the absence of conflicts and

misunderstanding.

The members of Family Fuerte changes clothes when they know it is already dirty. They don’t

usually buy clothes because they said that they have adequate clothing except for Michelle who buys

clothes when needed or if there is any occasion. Mrs. Fuerte is the usual person who sews their clothes

if simple tear is made on them but brings it to the tailors in their neighborhood if it needs further or

more serious repair. The members of the family usually do their washing during their vacant hours. No

one in their family regularly wash clothes for the whole family. Instead, they do their washing

individually. The members of the family usually wash clothes once a week except for Mr. Fuerte who

does the chore every 15 days.

Figure 2.Eco-map of Fuerte Family

Health Care Facilities

Organizations Neighbors

FUERTE FAMILY
Friends

Relatives

Church
School

C. HOME AND ENVIRONMENT

Fuerte Family’s House is located at #16 Quiling Sur, Batac, at the edge of a cliff near the river.

The house of the Fuerte family is a small bungalow type about 4.5m x 7.5m. Its walls and roof were

made of galvanized iron sheets, “plywood” and cloth, only the northern part of their wall is made of

pure “tolda” mostly from the remains of their old house. Most of their flooring is made of sand and

embedded pieces of cement also from the remains of their old house thus making it unequally leveled.

They made use of “tolda” and sacks for the roofing of their kitchen and their receiving area. Their

bedroom, dining room and living room are located inside their house and only separated by curtains;
they have two beds, a dinner table, a cabinet and boxes for their clothes. There are also clothes hanging

and lying around their house, and these clothes can’t be distinguished whether clean or used clothes. A

lot of spider webs are present all over the house.

The family’s sleeping arrangement is like this: Ezrael and Michelle sleeps at the biggest bed, Mr.

Fuerte sleeps at a smaller bed near the door and bed of their children and Mrs. Fuerte sleeps in a small

bed outside the house at the receiving area because she complains that she is not comfortable inside

their house due to the hot weather. Mr. Fuerte would insist that he would be the one to sleep outside

but Mrs. Fuerte is concerned that his cough might get worse if they exchange places

Breeding sites for vectors of diseases, especially mosquitoes, are widely present around. They

are near the river which has stagnant water and they also have water stored on their basins which we

observed bunch of mosquito larvae. The family also complained of large, black mosquitoes at night

that’s why they use mosquito nets. There are cockroaches and rodents that stay and breed inside their

house because their house is not kept well. Used clothes and laundry were hanging and lying around.

Their personal things, such as shoes and belts, were also scattered around their floor. Their beds were

also left unkempt and uncleaned before they leave.

The house doesn’t have a door and window lids, they would only use curtains to cover their

doorways and window openings. The level of their flooring was not flat that’s why there is also a risk for

tripping especially while walking there at night, and Mrs. Fuerte would wake up at 4:00 in the morning

to cook their food and to prepare in going to her job.

They don’t have electricity so they make use of candles as lightings at night. They don’t also

have a refrigerator so they immediately consume the meat products they buy and for the vegetables,

Mrs. Fuerte would keep if on a cellophane then hang it at their kitchen ceiling. They have a steel ladle,
aluminum cooking pots and an improvised cooking stove made of three stones. Their cooking utensils

and eating paraphernalia are kept inside a dish rack and some are not kept well.

The family’s water supply would come from the jetmatic pump of their neighbor across the

road. They use this water for drinking, cooking, washing and bathing purposes. The distance of the

pump from the toilet is approximately 7-8 meters away. Mrs. Rubio also offered their comfort room to

the Fuertes temporarily. Mr. Fuerte is making a pit privy near the river’s bank but whenever he makes

one, the pit is immediately filled with water because of the rains the past days. The Fuerte family would

dispose of their wastes at a pit, dug by Mr. Fuerte and his son, also near the river’s edge. The water

coming from their bathroom and water for dishwashing would drain directly to the river, thus producing

a foul odor aside from the garbage that are stocked near the river.

The house of the family is near the barangay road where a lot of vehicles pass by causing noise

pollution and air pollution in their area.The family lives alone at a side of the road and their nearest

neighbor were the Rubio family at about 10 meters from them across the road. The family owns a cell

phone which is used by Michelle; she would recharge the cell phone at Mrs. Rubio’s house.

The family’s house cannot withstand the strong wind and rain during rainy and stormy seasons

and even earthquakes because it is only made of “tolda” and galvanized iron sheets, producing a very

weak foundation. It is also prone to landslides because the house is situated near the edge of the river

going straight to the Quaioit River. It is also prone to fire because of the “tolda” and pieces of cloth they

used in their house especially that the family only uses candles at night as the source of light.

The family doesn’t keep any first aid kit or any equipment for emergency health needs; even

medicines for usual health complications such as common colds, body aches and fever are not available

in their house. Readily accessible pharmacy or any health facility and office are present in their place.
 The nearest hospital, MMMH & MC, and pharmacies are situated approximately 150 - 200 meters away

from their house.

They communicate with the other members of the family courteously and with due respect,

they talk in a nice and properly toned voice most of the time except when there are conflicts. They

communicate with their relatives far from them with Michelle’s cell phone. They also have good

interaction with their neighbors and friends as proved by the help and assistance they receive from

them specifically the Rubio Family and other concerned neighbors.

D. HEALTH STATUS OF EACH FAMILY MEMBER

Genogram:

Figure 3.Genogram

Justo Fuerte(+) 55 Andrea Fuerte (+)50 Raymundo Enriqueta

Murdered Heart Attack Castillo Castillo
(Hypertensive)

Soledad Amador Juanita Dominador Bernardo Esther Castillo-

Fuerte- Fuerte (+) Fuerte (+) 39 Fuerte 76 Fuerte 46
Fuerte 78
dela Cruz 17 Accident Hypertensive Asthmatic
50 Pneumonia (Slipped)
and
Hypertensive
Legend:

--Female
--Male Ezrael Fuerte 20 Michelle Fuerte 17

+ -- Deceased
 Mr. Bernardo Fuerte is the eldest child of Mr. Justo Fuerte and Mrs. Andrea Fuerte. His father,

Mr. Justo Fuerte was killed by Japanese soldier during the Japanese occupation at the age of 55 while

Mrs. Andrea Fuerte died at the age of 50 due to heart attack. Next to Mr. Bernardo Fuerte is Mr.

Dominador Fuerte, 76 y/o, who is also hypertensive as diagnosed by a doctor, but failed to name the

doctor. The third child is Mrs. Juanita Fuerte , 39 years old, who was 6 months pregnant at that time

when she died due to slipping in their stairs with loosed steps. Mr. Bernardo Fuerte said that she

experience excessive bleeding and was not able to survive. Next to Juanita is Mr. Amador Fuerte who

died at the age of 17. Mr. Bernardo Fuerte said that Amador was playing basketball in their school then

suddenly a heavy rain came and due to their excitement they went home very tired despite the heavy

rain. The morning after the incident, Amador feel sick as manifested by his high fever, he was diagnosed

by Dr. Ofelia Flor of having pneumonia at the provincial hospital. Treatments include blood transfusion

and other medication but wasn’t able to recall them. And the youngest among the children is Mrs.

Soledad Fuerte, 50 years old, was claimed of not experiencing serious illnesses.

Mrs. Ester Fuerte is the daughter of Mr. Raymundo Castillo and Mrs. Enriqueta Castillo.

Mrs. Fuerte can no longer remember the names of her siblings because she said that she went to Manila

at the age of 17 and don’t have connections with her family since then.

Bernardo, the head of the family was diagnosed before of having hypertension by Dr. Ma.

Christina Dulay. His blood pressure then was 150/120 mm/hg. He was prescribed with medicine for his

high blood, Atenolol 50 mg (2x a day). He stopped his medication since he has now normal blood

pressure. At present he is suffering from cough and was diagnosed with asthma last December 2008 by

Dr. Dulay. He is currently taking medicines such as Medifortan- As (Multivitamins + Buclizine Hcl) capsule

for his cough, he take them once a day. He will take these medicines until he feel better. He has also a
Salbutamol Ventolin Rotacap and Rotahaler which can accommodate 200mcg/capsule to use whenever

his asthma attacks. He inserts a capsule, Salbutamol Guaifenesin (SGx) 2mg/100mg, in the Rotahaler.

Mrs. Fuerte has suffered from an unknown disease when she was 26 y/o, but they never go to a

doctor for consultation. Tenderness of the whole body, pain all over the body and falling of hair was

experienced as manifestation of her condition. Paracetamol 500mg, thrice a day, is given to her to ease

the pain she is feeling. By that time she never ate rice, vegetable and meat for she totally loss her

appetite. She only drinks water and juice. Instead of consulting to a physician, they went to a faith

healer. They believed in faith healing and its effectiveness in curing her illness. Truly her illness

disappeared and was cured.

When Ezrael was in Grade 1, he was diagnosed to have meningitis by Dr. Dulay at the MMMH &

MC as manifested by dizziness and headache. Dr. Dulay said that it is caused by the bumping of head by

Ezrael and was immediately supported by Mr. Bernardo “idi ngamin ubing ket mamin-ano nga matnag

ken maitumeg”. He was prescribed with antibiotics and medicines for his headaches and dizziness. Mr.

Fuerte said that Ezrael was bitten by a dog five times. First, at the left gastrocnemius muscle, second is in

the right pectoralis major, third is at the left knee, and right vastus lateralis muscle for the 4 th and 5th

time. Most of the dogs that had bitten him were owned by their neighbors and once is their own dog.

They treat it with the traditional way called “suma”. Ezrael also experienced some childhood illnesses

like chicken pox. They fed him with crabs because the family believes that it will make the chickenpox

appear rapidly and fast, thus healing would occur immediately after all the chickenpox has appeared.

On the other hand, Michelle didn’t experience any serious illnesses. All the members of the

family have experienced common cough and colds, which are managed by increase fluid intake, oral

intake of calamansi juice and taking rest and sleep. And fever and body aches which are also manage by
increase fluid intake, intake of medicine such as Paracetamol 500 mg (thrice a day) tablet and taking a

lot of rest and sleep.

Table 2.Anthropometric Data of Fuerte Family

Name Body Mass Height Weight Mid-upper arm Waist Hip Waist Hip

Index (BMI) (cm) (kg) circumference Circumference Circumference Rotation

(cm) (cm)

Bernardo 12.88 174.74 39.46 19.05 71.12 75.24 0.95

Fuerte

Ester 16.55 148.59 36.74 20.32 60.96 64.15 0.95

Fuerte

Ezrael 17.52 176.78 54.88 23.86 72.34 78.59 0.92

Fuerte

Michelle 15.31 152.4 35.38 20.32 60.96 63.82 0.96

Fuerte

Body Mass Index = weight (kg) Waist Hip Rotation = Waist Circumference
height2 (m2) Hip Circumference

Table 3.Body Mass Index Classifications

Classification
BMI Description
18.5 or less Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-34.9 Obese I
35.0-39.9 Obese II
40 or greater Obese III

All the members of the Fuerte Family are considered underweight because their Body Mass

Indices did not reach the range scale for normal. The low BMIs of the family could mean that they don’t
receive the sufficient amount and quality of food every day. This can be due to the inadequate resources

of the family especially financial resources, their budget for the food is only limited that’s why they only

buy the food their budget can accommodate.

Table 4.Dietary History of Fuerte Family

THREE-DAY MEAL

Meal Day 1 (06/27/09) Day 2 (06/28/09) Day 3 (06/29/09)

Breakfast 1 fried egg 1 cup of rice 1 cup of rice

2-3 pieces of pandesal/ ½ ½ cup camote sprouts 200 ml sinigang

cup rice
16 oz coffee/milo 16 oz coffee/milo
16 oz coffee/milo
16 oz water 16 oz water
16 oz water

Lunch 200 ml inabraw 1-2 cup(s) rice 1 cup of rice

1-2 cup(s) of rice 1 cup pinakbet 200 ml sinigang

16 oz of water 16 oz water 16 oz water

Dinner 200 ml dinengdeng 1-2 cup(s) rice 1 cup of rice

1-2 cup(s) of rice 1 cup pinakbet 200 ml sinigang

16 oz water 16 oz water 16 oz water

Snacks: 240 ml coke 240 ml juice 240 ml coke

Morning 1 biscuit 1 biscuit

240 ml juice 240 ml coke 240 ml juice

Afternoon
1 biscuit 1 biscuit
 The other members of the family eat at the right time except for Ezrael who delays his intake of

lunch to 1:30-2:30 in the afternoon. Sometimes, the Fuerte family does not have the enough or required

quantity of food or the viand thus inhibiting them from getting the nutrients needed by their body. The

family’s most usual meal would compose of vegetables; they only have meat once a week due to the

absence of storage facility (refrigerator).

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND

DISEASE PREVENTION
Mr. Fuerte and his wife are not sure if they have received complete immunization when they

were kids but they showed their scar in the right deltoid muscle with approximately 5mm in diameter

which is a proof of their BCG vaccine, however they claimed that Ezrael and Michelle have completed

their required immunizations administered by the Rural Health Unit of Batac: 1 BCG, 3 DPT, 3 OPD, 1

Antimeasles and 3 Anti-Hepa B vaccines. Mrs. Fuerte was not able to show us the yellow card of her

children as a record of their vaccination. Every pregnancy, Mrs. Fuerte has received 2 injections of

tetanus toxoid before and after giving birth. They usually go to public hospital or rural health units

because they cannot afford to go in a private hospital.

The family eats three times a day with intervening snacks in between those meals. They eat

vegetable almost every day in a week and said that they also buy either pig or chicken meat once a

week. They get their food either at the market or from their backyard. They go to the market after

getting Mr. Fuerte’s pension and buy their food. The family has sources of vegetables and fruits from

their backyards and neighbors. Available plants in their surrounding include papaya, horse radish, sweet

potato and atis. Their leftovers are usually left in their table and Mrs. Fuerte packs their uncooked
vegetables in plastics and sprinkles it with water to prevent it from wilting, then hangs it in their kitchen

ceiling. No one smoke or drink alcohol in the family.

The Fuerte family has no specific ways of relaxation. If they don’t have something to do, they

just sit or sleep to relieve stress from their daily works. Added to that, Ezrael often goes out to play

basketball with his friends as his way of recreation. An activity like watching television is only available if

their neighbor, Rubio Family, is at home. They don’t have electric current so Michelle needs to go to

their neighbor to recharge her cell phone.

The members of the family do not have regular exercises except for Mr. Fuerte who said he

would walk from their house until the end of the cemented road of their area which is approximately

500 meters and goes back and he does it every morning for at least 15 minutes. Ezrael often plays

basketball as his way of exercise.

According to Mr. Fuerte, they regularly sleep at night at around 7-8 in the evening and wake up

early in the morning, usually at 5:00-6:30 except for his wife who wakes up earlier than them. Mrs.

Fuerte wakes up at 4:00 in the morning to prepare their food and the needs of their family. In

weekends, they just wake up anytime they want. Mr. Fuerte sleeps after dinner at 6:30 in the afternoon

while Michelle sleeps when she is already done with her homework, on the other hand, Ezrael sleeps

usually at the same time with his sister while Mrs. Fuerte at about 9:30 in the evening when everybody

has already settled in their beds. Mr. Fuerte and their children sleep inside their house while Mrs. Fuerte

sleeps outside because she is not comfortable with the heat inside their house. They use mosquito nets

in sleeping to protect them from mosquitoes and other insects that might bite them.

Each member in their family owns a pair of slippers they use when they are inside and outside

their house. According to Mr. Fuerte, no one of them walks around barefooted.
 They go to Rural Health Units and Public Hospitals for consultations and check-up. The family

utilizes health care services such as the Medicare account owned by Mr. Fuerte and his senior citizens

membership card which they use to avail discounts in medical services.

 FIRST LEVEL ASSESSMENT

I. PRESENCE OF WELLNESS CONDITION

Readiness for enhanced capability for:
A. Health Maintenance and Management
Supporting cues: Ezrael and Michelle had their complete immunization: 1 BCG, 3 DPT, 3
OPD, 1Antimeasles and 3 Anti-Hepa B vaccines from the Rural Health
Unit of Batac, thus boosting their immunity and lowers the possibility to
be infected with diseases. All members wear slippers inside and outside
the house and use mosquito nets when sleeping.
B. Healthy Lifestyle
Supporting cues: The family eats more vegetables which are very nutritious. The family
members perform some exercises just like Mr. Fuerte who do his
routine walk every morning for at least 15 minutes and Ezrael often
goes out to play basketball.
C. Spiritual Well-being
Supporting cues: The family is very religious, attending church gathering 3 times a week
and prays regularly before meals.

II. PRESENCE OF HEALTH THREAT

A. Poor Environmental Sanitation
1. Improper garbage disposal and drainage system
Supporting cues: Their house is situated near the river with a lot of garbage and has a foul
odor and added to that their garbage is not properly segregated and
they also have an improper drainage system because their canal directly
drains to the river.

2. Presence of Breeding Sites of Vectors of Diseases

Supporting cues: They are prone to having dengue and malaria because they live near the
river with stagnant water and they have basins with water which are not
drained and these are all breeding sites for mosquitoes. Their things
inside their house are not kept properly and can be breeding places for
cockroaches that can cause diseases.

3. Poor Lighting
Supporting Cues: Poor lighting is experienced by the family as seen by the absence of
electricity in their home.
 4. Poor Ventilation
Supporting Cues: Their house is congested because their things are not organized so there
is poor ventilation.

5. Air and Noise Pollution

Supporting Cues: They are beside the barangay road where many vehicles pass by,
causing noise pollution that can disturb the family especially during
resting hours and air pollution coming from their engines which can lead
to respiratory diseases.

B. Presence of Hereditary Diseases

Supporting cues: The children have risks of hypertension since Mr. Fuerte and his mother
have histories of hypertension

C. Threat of Cross-infection from a Communicable Disease

Supporting cues: Mr. Fuerte’s cough brings a threat to the other member’s health since
they live in a small house, sleep very close with each other and have
poor ventilation.
D. Faulty/Unhealthful nutritional/Eating Habits
Supporting cues: The other members of the family eats at the right time except for Ezrael
who delays his intake of lunch to 1:30-2:30 in the afternoon, his attitude
towards eating on time may affect his health and lead him to develop
gastritis, ulcer and the like. Sometimes, the Fuerte family does not have
the enough or required quantity of food or the viand thus inhibiting
them from getting the nutrients needed by their body.
E. Accident Hazards
1. Fire Hazards
Supporting cues: The family uses candle at night because they do not have electric
connection. Since their house is mainly made up of combustible
materials (unorganized galvanized iron sheets, plywood, “tolda”, and
some pieces of clothes), high probability of fire is expected.
2. Fall/Trip Hazards
Supporting cues: The flooring of their house is not leveled equally because it is only made
up of sand with embedded cement which they got from their old house.
They also don’t have electricity and only use candles at night making
them prone to falling or tripping.
3. Pointed Sharp Objects
Supporting cues: Their walls and roof which are not high enough and are made of
galvanized iron sheets and woods/bamboo which are not properly
 arranged are very pointed and sharp. These objects can cause injuries to
the members of the family.
4. Collapse of the House
Supporting cues: The house is not resistant to earthquakes and typhoon making it prone
to collapsing due to its poor foundation. Another is their house is
located in a cliff of the river and is very dangerous due to records of
landslide and soil erosion.

III. PRESENCE OF HEALTH DEFICITS

Supporting cues: The head of the family is suffering from chronic cough as diagnosed by a doctor.

IV. PRESENCE OF FORSEEABLE CRISIS SITUATIONS

A. Financial Constraints
Supporting cues: The monthly income of the family amounts just enough to meet the
basic needs of all its members. Unexpected expenses like needs of
Michelle in schooling may affect all the other needs of the family
B. Presence of Adolescent
Supporting cues: The presence of adolescent in the family hand-in-hand includes new
needs and further stretching of their budget, time and effort.
Misunderstandings between parents and children may occur and needs
of the child as an adolescent may add to the expenses (e.g. personal
hygienic needs)
 Scale for Ranking Family Health Problem According to Priorities

Presence of Breeding Sites of Vectors of Diseases

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 Their house is located near the river
Problem with stagnant water and there are
(Threat) also basins full of water inside the
house and was found out to have
mosquito larvae, the family is prone
of having dengue and malaria. Their
house is not kept well so
cockroaches are present and may
cause diseases
Modifiability of 1/ 2 x 2 1 Partially Modifiable because there
the Problem is no other place available for them
(Partially to stay except near the river, so
Modifiable) even they drain the possible
breeding sites of mosquitoes such
as their basins and they clean their
house, still there is the stagnant
water of the river as nests for
mosquitoes and the garbage in the
river as home for cockroaches.
Preventive 2/3 x 1 0.67 The problem has only moderate
Potential preventive potential because future
(Moderate) problems such as malaria, dengue
and other diseases caused by
mosquitoes, cockroaches and
rodents cannot be totally
prevented but can only be
minimized.
Salience of the 2/2 x 1 1 The family perceived the problem
Problem as a problem needing immediate
(Needing attention or resolution because it
Immediate threatens the health of the
Attention) members of the family
TOTAL 3.34
Poor Lighting

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 The problem in poor lighting as

Problem seen with the absence of electricity
(Health Threat) is a health threat because having
poor lighting might lead to bumping
or tripping accidents for the family
or may lead to eye problems.
Modifiability of 0/ 2 x 2 0 The problem cannot be modified
the Problem because of the lack of resources
(Not available (financial)
Modifiable)
Preventive 1/3 x 1 0.33 The problem has a low preventive
Potential (Low) potential because of the
unavailability of financial resources
to support the electrical
connection.
Salience of the 1/2 x 1 0.5 The family considers it as a
Problem (A condition /problem not needing
condition or immediate attention because they
problem not are more focusing on things like Mr.
needing Fuerte’s medicines, for Michelle’s
immediate schooling and the food for the
attention) whole family.
TOTAL 1.5

Poor Ventilation

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 Poor ventilation is a health threat

Problem as evident with their congested
(Threat) house due to unorganized things,
and it may cause difficulty in
breathing and due to poor air
circulation heat stroke are very
prone to happen.
Modifiability of 2/ 2 x 2 2 The problem is easily modifiable
the Problem since they have the human
(Easily resources and they have the
 Modifiable) knowledge on how cleaning and
organizing their house could
improve the circulation/ventilation
of their house.
Preventive 3/3 x 1 1 It has a high preventive potential
Potential (High) since they have human resources
and does not need a big amount of
money to solve the problem.
Salience of the 1/2 x 1 0.5 The family perceived the problem
Problem (Not as a problem not needing
Needing immediate attention or resolution
Immediate because there is no time for them
Attention) to clean and organize their things in
the house.
TOTAL 4.17

Improper Garbage Disposal and Drainage System

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 The problem is a health threat

Problem because it may cause certain
(Threat) diseases that would come from the
improperly segregated garbage and
from the improper drainage system
of the family. Some of these
diseases are respiratory diseases
which are cause by the foul odor of
the garbage and the water from
their drainage system.
Modifiability of 0/ 2 x 2 0 The problem is not modifiable since
the Problem they don’t know the importance of
(Not segregating garbages, no one in the
Modifiable) family has the time to segregate
garbage and make a good drainage
system.
Preventive 1/3 x 1 0.33 They have inadequate knowledge
Potential (Low) regarding the problem and no one
in the family has the time to resolve
the problem.
Salience of the 1/2 x 1 0.5 The family perceived the problem
Problem (Not as a problem not needing
Needing immediate attention or resolution
 Immediate because there is no time for them
Attention) to segregate garbage and make a
good drainage system.
TOTAL 1.5
Fire Hazards

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 The problem is a threat to the

Problem family’s safety and health. This is
(Threat) because their house is mainly made
up of combustible materials
(unorganized galvanized iron
sheets, plywood, tolda and pieces
of clothes).
Modifiability of 1/ 2 x 2 0.5 Partially Modifiable because they
the Problem have enough knowledge in the
(Partially prevention of fire, the only problem
Modifiable) is inadequate resources of the
family and financial constraints in
changing the composition of the
house.
Preventive 2/3 x 1 0.67 Prevention of fire would be
Potential moderate because the family can
(Moderate) be extra careful when using candles
despite the combustible materials
around them.
Salience of the 2/2 x 1 1 The family considers it as a problem
Problem needing an immediate action
( Needing because they believe that fire is
Immediate very dangerous that can cause
Attention) accident to the members of the
family and even death.
TOTAL 3.17

Noise and Air Pollution

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 The vehicles that pass by their area
Problem are sources of noise and air
(Threat) pollution as they emit loud sounds
and smokes so it is a threat to the
family’ health because air pollution
 can cause illnesses in the
respiratory system and noise
pollution disturbs the family when
resting or relaxing especially when
they are sleeping.
Modifiability of 0/ 2 x 2 0 Not modifiable because they
the Problem cannot do anything with regards to
(Not the vehicles that are passing by in
Modifiable) their area and they cannot find any
place that is available and far from
pollution.
Preventive 1/3 x 1 0.33 The problem has a low preventive
Potential (Low) potential since the family cannot
find any place where they can
transfer temporarily and lacks
financial resources for them to
build their own house which will be
far from pollution.
Salience of the 2/2 x 1 1 The family is also concerned with
Problem their present situation and
( Needing considers the problem to have
Immediate immediate attention .
Attention)
TOTAL 2

Fall and Trip Hazards

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 Their flooring is not leveled equally

Problem because it is made up of sand and
(Threat) embedded pieces of brocken
cements and this increases the risk
for tripping and falling and is
considered as threatening to their
health.
Modifiability of 0/ 2 x 2 0 Not modifiable since they don’t
the Problem have any means of reconstructing
(Not their flooring due to financial
Modifiable) deficiency and the lack of human
resources.
Preventive 1/3 x 1 0.33 The problem has a low preventive
Potential (Low) potential since they don’t have the
 manpower as well as the money to
make some modifications on their
flooring.
Salience of the 1/2 x 1 0.5 The family consider it as a problem
Problem ( Not not needing an immediate
Needing attention since they are prioritizing
Immediate the food for the family, medicine of
Attention) Mr. Fuerte and the education of
Michelle.
TOTAL 1.5

Pointed Sharp Objects

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 While standing, reaching for an

Problem object and specially walking, there
(Threat) is a high risk of bumping to the very
sharp galvanized iron sheets and
not well-arranged woods of the
walls and not those high roofs. The
embedded cements of the floor are
also very sharp and may also cause
injuries to the legs and feet.
Modifiability of 0/ 2 x 2 0 It is not modifiable because they
the Problem don’t have money to reconstruct or
(Not repair their house.
Modifiable)
Preventive 1/3 x 1 0.33 The problem has a low preventive
Potential (Low) potential because of insufficient
budget for the repair of the house.
Salience of the 1/2 x 1 0.5 The family perceives it as a problem
Problem ( Not although they don’t give necessary
Needing action to it such as its repair
Immediate because there are more important
Attention) things needed by the family that
they must attend first.
TOTAL 1.5
Collapse of the House

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 Their house is made up of scraps

Problem from their old house producing a
(Threat) very weak foundation against
strong rains and winds during a
typhoon and during earthquakes. It
is also near the cliff of the river so
there is a high risk of soil erosion
and landslide thus very hazardous
on the part of the family.
Modifiability of 0/ 2 x 2 0 It is not modifiable because they
the Problem don’t have money to reconstruct or
(Not repair their house.
Modifiable)
Preventive 1/3 x 1 0.33 The problem has a low preventive
Potential (Low) potential because of insufficient
budget for the repair of the house
and for the construction of their
house in a different place.
Salience of the 1/2 x 1 0.5 The family perceives it as a problem
Problem ( Not although they don’t give necessary
Needing action to it such as its repair and
Immediate reconstruction because there are
Attention) more important things needed by
the family that they must attend
first.
TOTAL 1.5

Hereditary Diseases

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 Their family shows a history of

Problem hypertension so Ezrael and
 (Threat) Michelle are at risk of inheriting this
disease.
Modifiability of 1/ 2 x 2 1 It is partially modifiable because
the Problem they have a knowledge on what is
(Partially hypertension and its causes so they
Modifiable) can do precautionary measures to
lessen the occurrence of
hypertensions, this include their
healthy lifestyle.
Preventive 2/3 x 1 0.67 The problem has a low preventive
Potential potential because of insufficient
(Moderate) budget for the repair of the house
and for the construction of their
house in a different place.
Salience of the 0/2 x 1 0 The family doesn’t perceive it as a
Problem ( Not problem since they said that it is
perceive as a not present yet.
problem
needing a
change)
TOTAL 2.34

Threat of Cross Infection from a Communicable Disease

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 The problem is a threat to the

Problem (Threat) health of the family since cough can
be easily transferred from one
person to another.
Modifiability of 1/ 2 x 2 1 The condition is partially modifiable
the Problem because the family has a positive
(Partially attitude in improving their
Modifiable) ventilation to lessen the risk for
cross-infection. They can achieve a
well-ventilated house through
willingness and effort to clean their
house. The only problem is the
close interaction they engage in,
which cannot be avoided.
Preventive 2/3 x 1 0.67 Preventive potential is moderate
Potential since they have human resource
(Moderate) and manpower available for them
to do the task of cleaning their
 house to improve their ventilation.
Salience of the 1/2 x 1 0.5 The family considers the condition
Problem (A as a problem but is not giving much
condition/problem attention to it because they think
not needing they could easily treat it.
immediate
attention)
TOTAL 2.84

Faulty Nutritional Habits and Unhealthful Eating Habits

Criteria Computation Actual Score Justification

Nature of the 2/3 x 1 0.67 The family don’t have enough food
Problem sometimes and Ezrael eats late
(Threat) during lunch time, so it is a health
threat because it may cause
malnutrition among the members
of the family and may cause
gastritis and ulcer respectively.
Furthermore it may aggravate their
present illnesses and affect their
work and activities of daily living
Modifiability of 1/ 2 x 2 1 The problem is partially modifiable
the Problem because they know the effects of
(Partially eating nutritious foods and not
Modifiable) eating on time but their only
problem is financial.
Preventive 2/3 x 1 0.67 The preventive potential of the
Potential problem is moderate since they
(Moderate) have the knowledge regarding the
right nutrition they must get from
the food they eat and the effects of
not eating on time.
Salience of the 2/2 x 1 1 The family perceived the problem
Problem as a problem needing immediate
(Needing attention or resolution because it
Immediate threatens the health of the
Attention) members of the family.
TOTAL 3.34

Presence of Cough
 Criteria Computation Actual Score Justification

Nature of the 3/3 x 1 1 The problem is a health deficit

Problem(Health because it already exists and affects
Deficit) the functioning of Mr. Fuerte who
is suffering from the disease. It
affects the way he lives and his
activities such that he can no longer
perform tasks he need to do for his
family.
Modifiability of 1/ 2 x 2 1 The condition can only be modified
the Problem partially because although Mr.
(Partially Fuerte religiously takes his
Modifiable) medicine, their environment takes
a great role in his recovery of the
illness.
Preventive 2/3 x 1 0.67 The condition may be moderately
Potential prevented since Mr. Fuerten is
(Moderate) taking his medicines to treat the
illness.
Salience of the 2/2 x 1 1 They perceive it as a problem
Problem needing immediate attention
(Needing because it makes Mr. Fuerte suffer
Immediate too much.
Attention)
TOTAL 3.67

Financial Constraints

Criteria Computation Actual Score Justification

Nature of the 1/3 x 1 0.33 The problem is a foreseeable crisis

Problem(Foreseeabl because the monthly income of the
e crisis) family amounts just enough to
meet the expenses of the whole
family. It may be a problem in the
future if there are emergencies the
family would meet.
Modifiability of the 0/ 2 x 2 0 It is not modifiable since they
Problem (Not cannot avoid the different
Modifiable) expenses of the family and there
are no other income generating
activities of the family.
 Preventive 1/3 x 1 0.33 The problem has a low preventive
Potential(low) potential because the family
cannot make their financial
resources to be stretched because
of the many expenses of the
family.
Salience of the 2/2 x 1 1 The family perceives it as a
Problem (Needing problem needing an immediate
Immediate attention because they are very
Attention) much bothered with the times that
they have no meals and if they
don’t have any money when
emergency arises.
TOTAL 1.66

Presence of Adolescents

Criteria Computation Actual Score Justification

Nature of the 1/3 x 1 0.33 The problem is a foreseeable crisis

Problem(Foreseeabl because the presence of
e crisis) adolescents in the family hand-in-
hand includes new needs and
further stretching of their budget,
time and effort. Misunderstandings
between parents and children may
occur and needs of the child as an
adolescent may add to the
expenses of the family.
Modifiability of the 1/ 2 x 2 1 The problem cannot be changed or
Problem (Partially modified completely but the family
Modifiable) effects of it can only be minimized
through getting ready for its
possible effects.
Preventive 2/3 x 1 0.67 The problem in only moderately
Potential(moderate) prevented because adolescence is
a stage of human life that is really
critical and faces a lot of problem
that may include the family but
considering the effects before it
happens is very important.
Salience of the 0/2 x 1 0 The family does not perceives it as
Problem (Not a problem needing attention
perceived as a because they said that they will
problem) thick of it when the time that the
 presence of adolescent will give
them a problem.
TOTAL 2

Ranking of Health Problems

Problem Fall and Trip Hazards

Poor Ventilation Poor Lighting

Health Deficit Improper Garbage Disposal and Drainage

System
Faulty Nutritional Habits and Unhealthful
Eating Habits

Presence of Breeding Sites of Vectors of

Diseases
Total Score
Fire Hazards
4.17
Threat of Cross Infection from a Communicable
Disease 3.67

Hereditary Diseases 3.34

Noise and Air Pollution

3.34
Presence of Adolescents

Financial Constraints 3.17

Collapse of the House 2.84

Pointed Sharp Objects

2.34
 1.5
2
1.5
2
1.5
2

1.5

1.5

Second Level Assessment

Poor ventilation

-Inability of the family to provide a home environment conducive to health maintenance and personal
development due to inadequate family resources for house maintenance and the absence of human
resources (responsible member who can maintain a clean environment)as manifested by the
unorganized condition of their house which adds to the congestive situation of their house thus
preventing proper ventilation of the house.

Presence of Breeding Sites of Vectors of Diseases

-inability of the family to provide a home environment conducive to the health maintenance and
personal development due to members preoccupied with their own concerns/interests and absence of
good place to build a house and lack of knowledge of importance of hygiene and sanitation as
manifested by the unorganized condition of the house which can be resting sites for cockroaches and
the river that could be breeding sites of mosquitoes

Presence of Poor Lighting

-Inability of the family to provide a home environment conducive to health maintenance and personal
development due to inadequate family resources specifically financial resources as manifested by the
use of candles for lighting purposes by the family at night time and inability to provide an electrical
connection at their house.

Presence of Air and Noise Pollution

-Inability to provide a home environment conducive to health maintenance and personal development
due to lack of knowledge of the importance of hygiene and sanitation as manifested by the windows
without cover for them to minimize the air and noise pollutants that enters the house that are produced
by vehicles passing by their place and the garbage that are in the river.

Faulty nutritional Habits and Unhealthful Eating Habits

-Inability to meet body’s daily nutritional requirement due to lack of resources and faulty eating time as
manifested by their body size and condition and their low BMI.

Fire Hazards

-inability to provide a home environment conducive to health maintenance and personal development
due to the risk of fire in their house as manifested by the combustible materials that make up the house
and the use of candles at night.

Pointed Sharp Objects

-inability to provide a home environment conducive to health maintenance and personal development
due to lack of skill in carrying out measures to improve home environment as manifested by the
unarranged galvanized iron sheets and woods for their walls and not high roofs.

Financial Constraints

-Inability to earn enough money to support and provide for the family’s basic needs due to a lot of
expenses shouldered by the family as manifested by the absence of meals(sometimes), absence of
electricity and own water supply.

Fall/Trip Hazards

-Inability to provide a home environment conducive to health maintenance and personal development
due to inadequate resources specifically financial resources that can be used for the
repair/reconstruction of the house as manifested by unequally leveled floor due to its components: sand
with embedded pieces of cements.

Cross Infection of Communicable Disease (Cough)

-Inability to provide a home environment conducive to health maintenance and personal development
due to insufficient knowledge to avoid exposure to infected persons as manifested by the close contact
of the other members of the family to Mr. Fuerte who is suffering from cough.

Presence of Adolescent

-Inability to make decisions with respect to taking appropriate health action due to low salience of the
problem/condition as manifested by the low attention given to the adolescent.
 Family Coping Index
AREA RATE JUSTIFICATION

Physical Independence 5 All the family members have the

ability to meet all their needs
independently without
interruption or undue delay
They are able to do their ADL
and are able to provide care to
themselves and other members
of the family.

Therapeutic Competence 5 The family members are able to

carry out prescribed treatments
safely and efficiently with the
understanding of the principles
involved as shown by
knowledge of proper intake of
medications prescribed to him
and takes them on time at the
right amount; he is also able to
manipulate the Rotahaler given
to him.

Knowledge of Health Condition 3 The family knows general

information regarding their
health condition yet there are
necessary data they do not
know about that certain
condition. Their cultural
backgrounds how they look at
their health conditions
especially the reason behind it.
Application Of Principles of
General Hygiene
3 The family is able to meet some
of the principles of proper
hygiene but generally they did
not meet the necessary hygiene
measures.
The Fuerte family can’t meet or
provide the balanced diet and
adequate amount of nutrients,
they also do not practice proper
handling of food, and however
the family had secured a
complete immunization for the
children.

Health Attitude 5 Understand and recognizes

needs for medical care in illness
is for the usual preventive
services; accepts illness calmly
and recognizes the limits it
impose while doing all possible
to effect recovery and
rehabilitation.
The family their need for
assistance and consultations
from health care facilities and
thus all the possible measures:
limiting themselves from
harmful practices so as to
promote wellness.

Emotional Competence 3 Almost all the members of the

family shows a degree of
integrity and maturity yet not all
of them have the same string of
emotional integrity because of
peer influence. Mr. and Mrs.
Fuerte aspire for their children
to have a happy and fruitful
living.

Family Living 3 The family interacts with each

other with enough respect for
each member; they can
understand one another but do
not do everything together.
Ezrael, the son, do not usually
participate in the family affairs
 and has habits, specifically
always going out with friends,
which interfere with the unity of
the family.

Physical Environment 1 The family resides in a weak

house with a weak foundation
and poor sanitation. They do
not have an environment suited
for a wellness condition. It
actually one of the aggravating
factors of their poor health
conditions; it has poor
ventilation, poor lighting,
improper drainage, improper
waste management and the
like.

Use of Community Facilities 3 The family is aware of and uses

some but not all of the available
community resources that they
need. The family is aware of
community resources and
health care facilities and makes
use of these facilities in case of
health problems.