1.

Family Identity

1.1 Data of the Family

Mr. S’s family consists of 6 peoples, they are Mr. S himself, Mrs. U, their 4
children ((Mr. A, Mrs. S, Mr. I, Mr. B), Mr. S and Mrs. U are Javanese couple who lived
in Kelapa Dua. Mr. S was born in April 7, 1966 and now he is 43 years old. His last
education was senior high graduate and now is working as taxi driver. He working in his
jobs for 5 years with varied salary. Mr. S is a Muslim. His current medical condition
notes that he has Diabetes Mellitus type II since 3 years ago. His Father was also a
diabetic patient. And death in diabetic complication (Heart attack), Mr.S also had a
chronic hypertension, uncontrolled hi-fat and high carbohydrate meals, and habit of
smoking 1 cigarette packs each day. His physical condition appeared well. On physical
examination, his legs were claudicating and have several small scars on his thumb. He
claimed that he didn’t wear sandals or shoes when walking in his home.

Mrs. U was born on January 23, 1969. Her last education was junior high school
graduate and now she work as on-call therapist. She married Mr. S 18 years ago, and she
complain that she have a gout atritis. She complain that her big toe sometimes swelling
and painfull especially in the morning. His finger joint also pianfull after she’s done her
job as a therapist. She begun have this symptoms at her age of 20 and she refuse that she
had already taken any medication for her symptoms. And also she complain that she have
a mild headache, from neck spread to head.

Mr. A, the first son of Mr. S and Mrs. U, was born on March 13, 1984. She was
born as a healthy baby with help of the local midwife. Mrs. A’s last education was senior
high school graduate and is now working on the cingwan restaurant in the supermall
karawaci as a waiters. He a single man. On physical examination, Mr. A was a healthy
man his BMI was of 20.4. Other than his lungs and cardiac auscultations, everything was
found normal. He didn’t smoke, and didn’t like exercise. But sometimes he complain that
he cramp on hands and feets for 5 minutes, because he usually sleep directly into the
floor.
 Ms.S was the second child of Mr. S and Mrs. U who was born on march 9 1988.
She was born in puskesmas with help of the midwife in the puskesmas. She was born
with 2900 grams of wright and 47 cm heights, now she is eight years old and hasn’t
complete vaccination, now she 25 kg and has a proportional height. She in the elementary
school (2nd grade). she is a healty and playfull young girls except she also has symptoms
like her mother.

Mr. I was born on jully 20, 2003. He now in the kindergarden school. And he was
a healty young boy. He was born normal in the puskesmas with help with midwife in the
puskesmas. he was born with 3300 grams weights and 50 cm heights. he is six years old
now and have a incompleted vaccination (BCG, HBV, Polio, and DPT). His last body
weight was 13.3 kg, and he has a good BMI. he was breast-fed for 4 months. He has a
good appetite and he is a heallty and cherfull boy

Mr. B was born on October 30, 2007. he was the last child from Mr.S and Mrs U.
he was born with 3100 grams weights and 51 cm heights. He is 2 years old now and
didn’t have completed vaccination (BCG, HBV, Polio, and DPT). His last body weight
was 10 kg, and he had proportional height. he was only breast-feed for 3 months and now
is eating adult’s food such as rice and baby porridge (Milna pooridge). He has a good
appetite. Her mother claimed that he got flu for two days and also he had fever,
especially was up at night, and resided at morning. he was not taken to the puskesmas ,his
mother buy (“sumeng drugs” that drugs consist of paracetamol) in the little shop around
her house and his fever falling down.

1.2 Family Development Stages

1. The couple married without children.

2. The birth of children, where the oldest child’s age was ranged from 0-30
months old.
 3. A family with pre-school children, where the oldest child’s age was 30
months to 6 years old.

4. A family with school-age children, where the oldest child’s age was 6-13
years old.

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

6. A family with young adult children, where all of the children were already
left the house to live independently.

7. Middle aged parents, or already retired.

8. Parents in their late age.

2. Genogram

Symbol notes:

: Smoking, Diabetic Male

: Normal healthy male

: Normal healthy female

: Woman with gout arthritis

Environment of the household

Bathroom Kitchen

Family Room

Corridor

Bed Room
 Guest room

Picture 1. Mr. S’s house map

The house is minimalist,have a measurement of 7 meter x 3 meter and divide into five
room with the corridor,the surroundings around the house was unhealthy, very dirty and
have a poor hygiene. The bathroom and washing area were right next to the kitchen, and
looked dirty. Sometimes we found a lot of cockroach in the bathroom, and the wall of
the bathroom have many puddle and also have a damaged floor and door. For the kitchen
is looked dirty and have a poor hygine, we found many gabarge in the floor, very nasty
and for the cooking utensils were looked so dirty and just laid around on a dirty-looking
wooden box near the wall.

They don’t have dining table, so they had their meals by sitting in the guest room or
family room. The family only have one bad (queen size), and it used by the children and
looked so dirty, because they didn’t use anything to cover the bad. For the parent they
sleep only on the carpet in the guest room. The area surroundings the house was many
chickens and cats laying around

The waterworks system

 amount of water required for washing the cloth,plate,glass and for cooking using soil
water and it works by pump machine to supply the water, the quality of water is good,no
color,smell, and clear.

The facility for bathroom

In this family,bathroom has many function,for example: this family using bathroom for
washing the cloth,plate,glass, and also for take a bath. So the bathroom has multifunction.

The banishment feces system

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

4. Problem Within The Family

4.1 Social Problem:

Sometimes there was a conflict in the family,an Economic problem because Mr.S didn’t
have a good salary to fulfill what his family needed. And for the child there no conflict
between them, Mr.A is the oldest son, he is hardworking and sometimes he helping his father
to pay the water an electrical bill, he also sow care to his little brother and sister, They also
helped each other. They was also known good in the neighborhood. They talked nicely and
respect the other.
4.2 Biologic Problem:

o Mr. S suffer a Diabetes mellitus type II

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

o The Mrs. U suffer a gout arthritis

4.3 Psychological Problem:

o Mr. S didn’t take the hypertension and diabetic medication regularly

o Mr. S can’t control her eating behavior

o Mr. S afraid to go to the puskesmas and didn’t control for the blood sugar
regularly

5. The Visits

Date Name Activity Attempts

24/2 Mr. S Anamnesis: Counseling:
- 3 years history of DM - Explaining about DM.
- Smoking - 3 J to control meals.
- History of taking traditional - Splitting meals portion to
medicine for 1 years. smaller portion, but have a
- History of chronic frequent eating.
hypertension and heart attack - Reducing sugar,
in the family. sweets,salt and carbohydrate
- Random blood sugar level: intake. Increasing
230 vegetables.
Physical Examination: - Wearing shoes/sandals
- BP: 170/110 - Regularly check blood
- Inspection: Small scar sugar level on puskesmas
lesions in both soles and his - Reducing cigarretes, if
 right thumb. possible stopping it entirely.
Mrs. U Anamnesis: Counseling:
- History of high uric acid - Explaining about uric acid.
- History of uterine infection - Reducing hi-protein
and uterine cyst (5 years ago) meals.
- History of toothache - Reducing repetitive
- Headache: from neck to head movement of limbs.
- Taking traditional medicine - Check uric acid level on
for uric acid and headache. nearby clinic.
Physical Examination: Stopping any traditional
- BP: 120/90 medicines.
Mr. A Anamnesis: Counseling:
- Cramp on hands and feets for - Reducing repetitive
5 minutes (3 weeks). movements of the limbs.
- Sleep directly on floor. Suggestion to use mats/some
- Smoking (-) layering for sleeping
Physical examination:
- BP: 120/90
Inspection: Normal on inspection.
Mr. I Allo anamnesis: Counseling:
- Incomplete Immunization - Increasing personal
(Only had BCG, HBV, and hygiene.
DPT) Suggestion to continue the
Physical Examination: normal immunization

Mr. B Allo anamnesis: Counseling:

- Often catches cold and fever. - Increasing personal
- Incomplete Immunization hygiene.
(Only had BCG, HBV, and - Increasing personal
DPT) hygiene.
- Have taken ”sumeng - Suggestion to continue the
drugs”for every fever, and it immunization
 resided. - Using sandals/shoes when
- Normal bowel movement. playing outside.
- Likes to play in the dirt. - Washing hand before
Physical examination: eating.
- Palpation: mild fever Go to puskesmas if he feels
Inspection: good nutrition unwell
Counseling about house and
Environment observation
personal hygiene.
10/3 Mrs. U Anamnesis: Counseling:
- Athralgia since the night - Suggestion to reduce
before, recurrent. contact with
- Dry cough and cold (2 days), water/cold/damp
no running nose. environment.
- History of feet trauma (1 - Suggestion to have a
week ago) check up on the puskesmas.
- Taking betadine, refanol and - Suggestion to stop taking
antibiotic for the trauma. bath at night, if she can’t,
- Often comes in contact with she might use warm water
water and damp enviroment. when taking bath at night.
- Often take a bath at night. - Wearing sandals/shoes
- Feel stressed about her outside the house.
family economic condition. - Reassuring her not to get
- Stops using over-the- more stressed.
counter-drugs.
- Unknown cholesterol level.
Physical examination:
- BP: 114/70
Drying scar on the right sole
Mr. A Anamnesis: Counseling:
- Cramps on hands and feets Suggestion to stop taking bath at
(+) night, if he can’t, he might use
- Often take a bath at night. warm water when taking bath at
 - Self medication (-) night.
- Never have medical check up
before.
Physical examination:
BP: 115/90
Environment observation Counseling about house and
personal hygiene.
31/3 Mr. S Anamnesis: Counseling:
- Still smoking. - Healthy meals.
- Starting to wear sandals. - Suggestion to check blood
- Reducing sweet, sugary, and sugar level regularly.
salty meals.
- Random blood sugar level:
200
Physical examination:
- BP: 140/110
- Slightly edematous feet.
Mrs. U Anamnesis: Counseling:
- No complaints. - Suggestion to chek the
Physical examination: uric acid level
- BP: 120/90
- Tenderness on right hand
thumb.
Mr. A Anamnesis: Counseling:
- No complaints. none.
Physical examination:
- BP: 120/90
Counseling about house and
- Environmental observation
personal hygiene.

Efforts on ach visits

1st visit : We gained as many information as we can get from Mr S and Mrs U. We also
build a good relationship with the family so we can get more information as they become
 more comfortable with us. We also check for her blood pressure which was a little bit
above normal for the Mrs U(130/90) and for her husband (170/110)
2nd visit : As we got the information that Mrs. Upi had gout symptoms, we recommended
her to check her uric acid level, we gave the laboratory form that we got from Kelapa
Dua Public Health Center. We also gave further information about her disease.
3rd visit : We have another problem that Mrs. U can’t afford to test because of her
economical problem.

6. Results

Mr. S:

- Starting to care about his blood sugar and hypertension, and wearing shoes
(no flipflops) to protect his feet.

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

blood sugar level and replacing rice with steam potato.

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

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

Mrs. U:

- Starting to stop taking bath at night, if she can’t,she try to use warm water when
taking bath at night.
- Wearing sandals/shoes outside the house.
- Starting reducing hi-protein meals.
- Starting reducing repetitive movement of limbs

- Control to clinic if she has complains

- Use mattres if she still sleep on the floor

Mr. A:
 - Increasing personal hygiene.

- Do more exercise

- Starting using carpet if he want sleep at night.

Overall:
- Enhancement of house and personal hygiene. (Burying puddles, cleaning
moss, gutter and animal’s wastes. Washing hand before taking meals.)
- Their house hygiene should be improved, not to eat around the washing
area
- Stop taking over-the-counter-drug but go to clinic instead.
- Enhancement of health awareness and knowledge and go to public health
center if they have complains about their health.