Aurora SoliongcoAurora Soliongco

Camus, ErwinChan, VeniceFernando, KimberlyLopez, MelanieMallari, Jansen

General ObjectiveGeneral ObjectiveTo present a family from the

community and apply the principles of being a family physician.

Specific ObjectivesSpecific Objectives• To determine the health care needs

of the geriatric patient with hypertension.

• To determine the impact of illness and age to the family and patient

• To assess and identify the family’s needs

• To assess the capability of the patient and the family to adapt to the changes brought about by the presence of a disease.

General DataGeneral DataA.S95 years old, FemaleFilipinoWidowRoman CatholicRetired Grade school teacherLives in 1114 Carola St.

Sampaloc Manila

History of Present IllnessPatient was diagnosed with

Hypertension Stage 2 ( BP 160/100, with no blurring of vision , nape pain, abdominal pain)

She was maintained on the following medications◦Aspirin 325mg/tab OD◦Telmisartan 80mg/tab OD◦Multivitamins with Vit B complex

Review of SystemsReview of Systems• (+) undocumented weight gain, (-) fever, (-)

anorexia• (-) skin rashes, (-) itchiness• (-) redness of eyes, (-) lacrimation, (-)

blurring of vision• (-) deafness, (-) tinnitus• (-) epistaxis• (-) bleeding gums• (-) cough, (-) colds, (-) dyspnea, (-)

hemoptysis• (-) chest pain, (-)orthopnea, (-) palpitations • (-) abdominal pain, (-) hematemesis, (-)

diarrhea, (-) constipation• (-) dysuria, (-) nocturia, (-) frequency

Past Medical HistoryPast Medical HistoryNo previous illness February 2009 – Patient admitted

because of infected wound in the jaw.

(+) History of fallNo previous blood transfusionsUnrecalled immunization

◦Haven’t received any recent vaccine

Family HistoryFamily History

(+) HPN – father, Grandson(+) CVD – father(+) DM - Grandson(-) goiter(-) BA, allergy(-) Alzheimer’s Disease(-) Cancer

Personal and Social Personal and Social HistoryHistoryMixed diet (prefers vegetables

and fruits)Non-smokerNon-alcoholic beverage drinkerDenies illicit drug use

OB historyOB historyG0P0Menopause at years old (?)

Physical ExaminationPhysical Examination

• Conscious, coherent, ambulatory with assistance, not in CP distress

• BP 140/80 PR 90 bpm• RR 20 cpm T 36.5C• Warm, moist skin, no active dermatoses• Pink palpebral conjunctiva, anicteric sclera• (+) sagging eyelids OU, (+) opaque lens, OU • Moist buccal mucosa, nonhyperemic posterior

pharyngeal wall, tonsils not enlarged

Physical ExaminationPhysical Examination

• Supple neck, no palpable cervical lymph nodes, thyroid not enlarged

• Symmetrical chest expansion, no retractions, clear breath sounds

• Adynamic precordium, AB at 5th LICS MCL, no murmurs

• Flabby abdomen, NABS, soft, nontender, no masses

• No cyanosis, pulses full and equal

Physical ExaminationPhysical Examination

• Conscious, responds to questions appropriately, can follow commands, oriented to 3 spheres

• Pupils 2-3 mm ERTL• (-) Red orange reflex• EOM could not be assessed• (+) corneal reflex• Can smile, can frown, raise• (+) gag reflex• Can raise shoulder against resistance

Physical ExaminationPhysical Examination

MMT: 4/5 on both UE and LECan do APST, FTNT slowlyDTRs ++No sensory deficit (-) nuchal rigidity, (-) babinski, (-) Chaddock’s, (-) Oppenheim’s

AssessmentAssessmentSAH stage 2Cataract, OU

Geriatric Work-upsGeriatric Work-ups

Height : Weight: BMI Midarm circumference: Triceps fold circumference: Mid-muscle circumference:

Clinical Features

(+) Dental caries (+) Age spots

Eating habits and Living environment

House bound Air-conditioned room with a

bathroom and television Sits in her rocking chair most of

the day Has enough money for food and

medication

Functional status

Needs constant assistance in ambulation, Feeding and cleaning self.

Geriatric Depression ScaleGeriatric Depression Scale– are you basically satisfied with your life? Y– Have you dropped many or four activities and interests? Y– Do you feel like your life is empty? N– Do you often get bored? N– are you in good spirits most of the time? Y– are you afraid that something bad is going to happen to you? N– do you feel happy most of the time? Y– Do you often feel helpless? N– do you prefer to stay at home rather than go out and do new things? Y– do you have more problems with memory than most people your age? N– do you think it is wonderful to be alive now? Y– do you feel pretty worthless the way you are now? N– do you feel full of energy? Y– do you feel your situation is hopeless? N– Do you think that most people are better off than you are? N

SCORE NO SIGN OF DEPRESSION

KATZ Activities of Daily KATZ Activities of Daily LivingLivingActivities Score

Bathing Needs help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing

0

Dressing Needs help with dressing self or needs to be completely dressed.

0

Toilet Needs help transferring to the toilet, cleaning self

0

Transfer Needs help in moving from bed to chair or requires a complete transfer.

0

Continence Is totally incontinent of bowel and bladder. 0

Feeding Needs partial or total help with feeding 0

TOTAL PATIENT VERY DEPENDENT 0

MMSE was not done

Nutritional HealthNutritional Health 1. I have an illness that made me change the kind or

amount of food I eat. I eat fewer than 2 meals per day. I eat few fruits or vegetable or mild products. I have 3 or more drinks of beer, liquor or wine almost

every day. I have tooth or mouth problems that make it hard for

me to eat. I don’t always have enough money to buy the food I

need. I eat alone most of the time. I take 3 or more different prescribed or over-the-counter

drugs a day. Without wanting to, I have lost or gained 10 pounds in

the last 6 months i am not always physically able to shop, cook or feed

myself.

0 – No

0 – No

0 – No

0 – No

0 – No

0 - No

0 - No

2 – Yes

2 – Yes

2 - Yes

Total: 6 (Good)

IV. Family and Community IV. Family and Community AssessmentAssessment

GregorioCunan

Soliongco

MariaPamintuan

MilagrosSoliongco

ArbinioSoliongco

LourdesSoliongco

1914

AuroraCunan

94

VicenteSoliongco

FelicianoSoliongco

1974

Wilf redoSoliongco

35

TrinidadLasatin

SaturninoLasatin

1924

EngraciaLasatin

85

MarceloLasatin

anna

1972

Lorely

37

Mr

1995

Ronaly

14

1998

Ace-burg

11

2001

Mary

8

1956

JulietaSoliongco

53

1988

JoelSoliongco

21

Soliongco Family

1114 Carola St. Sampaloc Manila.

Extended type of family (various granddaughters and grandsons living there occasionally when they are in Manila for school or work)

Good interpersonal relationship with one another, with closer relationship between the siblings.

B. Family StructureB. Family StructureType: ExtendedSocial Class: MiddleSet-up: DemocraticReligion: Roman CatholicNo. of Household members: 10

Currently living with 9 people, ◦ her sister Engracia , ◦ adopted son Wilfredo and ◦ his wife Julieta, her grandson Joel.

Also living in the house is her ◦ Niece Lorely who has 3 children namely ◦ Ronaly,◦ Ace, and ◦ Mary.

She owns the house where there are 11 rooms and 2 bathrooms

There are 5 male/female boarders currently living in the house.

B. Family ProfileB. Family ProfileName Age/

Sex Civil Statu

s

Health

Status

Educational Attainment

Relationship to Patient

Job

Aurora 95/F Widow Good College Graduate Index Patient

Wilfredo 62/M Married Good College graduate Son Retired Bank employee, Barangay tanod

Julieta 53/F Married Good Highschool Graduate

Daughter in Law

Manages boarders, seamstress

Joel 21/M Single Good BS Commerce Grand son Landbank employee

B. Family ProfileB. Family Profile

Name Age/Sex

Civil Statu

s

Health

Status

Educational Attainment

Relationship to Patient

Job

Lorely 37/F Separated

Good Highschool Graduate

Niece Housewife

Ronaly 14/F Single Good Highschool student

Grandaughter

none

Ace-Burg 11/M Single Good Gradeschool student

Grandson none

Mary 8/F Single Good Gradeschool student

Grandaughter

none

C. Roles of Each Family C. Roles of Each Family MembersMembersBreadwinner/s:

◦Wilfredo◦Julieta◦Joel

Decision maker: ◦Aurora◦Julieta

Caregivers: ◦Julieta

D. Family Life CycleD. Family Life CycleFamily with Adolescents

Family Lifeline

F. Economic ProfileF. Economic ProfileIncome

◦Comes from Wilfredo Julieta Joel Rent payment from boarders

Expenses:Food – P1400/week Water – P3000/month

Medicine – P1500/month Electricity – P3400-3800/month

Location MapLocation Map

Floor PlanFloor Plan

FIRST FLOOR PLAN

Floor PlanFloor Plan

Second Floor Plan

G. Household ChecklistG. Household ChecklistPatient’s Beddings Appliances

◦ Aircon 2◦ Electric fans 8◦ Television 1◦ Super Kalan 1◦ Refrigerator 1◦ Ironing board 1◦ Iron 1◦ Radio 1◦ Telephone 1 w/extension◦ Freezer 1

H. Environmental H. Environmental ChecklistChecklistHouse/Room: OwnedType: Mixed(concrete ,wood)No. of bedrooms: 11Cleanliness/order: GoodVentilation: GoodLighting: GoodLighting Facilities: MeralcoWater: MayniladDrinking water: Mineral water

◦ Tap water for drinking, bathing and cooking

H. Environmental H. Environmental ChecklistChecklist

Toilet type: water-sealedGarbage collection: collected, segregation

doneCollection per week: dailyDrainage: fairVermin/insect control: chemicalVermin/insect type: mosquitoes, rats,

cockroachesAnimals: none

(+) stray dogs and catsNeighborhood: residential / commercial Accessible by: Walking, Jeepney,

tricycle, taxi

5 minutes from USTH by foot, 2 minutes by car

Positive PerceptionPositive Perception Peace and order observed in the neighborhood Easy access to public transportation, hospital,

church etc. Proper garbage disposal Concrete roads Good location

◦ Near Main Road◦ Food/ Hospital/ Shopping Mall establishment

nearby◦ Access to public transportation◦ No factory nearby

Negative PerceptionNegative PerceptionMosquitoes present (risk for Dengue)Loitering pets ( Rabies)Noise (neighbors)Narrow Passageway ( car accessibility)

I. Tools for Family I. Tools for Family AssessmentAssessmentAPGAR Engracia Wilfredo Julieta Lorely

Ako’y nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng problema

2 1 2 2

Ako’y nasisiyahan sa paraang nakikpagtalakayan sa akin ang aking pamilya tungkol sa aking problema.

1 1 2 2

Ako’y nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking ikauunlad.

2 1 2 1

Ako’y nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot at pag ibig.

2 1 2 1

Ako’y nasisiyahan dahil sa ang aking pamilya at ako ay nagkakaroon ng panahon sa isa’t isa.

1 2 2 1

Engracia = 8Wilfredo = 6Julieta = 10Lorely = 7

Assessment:

SCREEMSCREEM

Social interaction◦ Strenghts

Open intrafamilial lines of communication, no animosity/ rivalry; health and supportive intra/extrafamilial relationships

◦ Weaknesses Shame on imposing on the lives of

their neighbors

SCREEMSCREEM

Cultural pride◦There are no beliefs or practices that are unacceptable to our culture that would negatively affect way of living.

Religion◦Practices one’s faith and spirituality is positively influencing way of life of the whole family

SCREEMSCREEM

Economic stability◦ economically stable. Her children, as the breadwinner,s

can provide for the basic needs of their family◦ However, they have no savings for emergency

situations.

Education◦Most of the members of the family

reached secondary and tertiary education.

◦Most have stable good paying jobs

SCREEMSCREEM

Medical Health◦ Family gives importance to health care◦ Takes advantage of the proximity of USTH ◦ Has regular follow up and check up every 6

months

  

Draw A Circle TestDraw A Circle Test

Draw a Family TestDraw a Family Test

Reasons why the family Reasons why the family should be re-enrolled in should be re-enrolled in FHCPFHCPHelp in adapting the family to

Aurora’s diseaseTo prevent complication of the

diseaseFollow up compliance to

medicationAsses quality of Life of the

patientFor regular check-ups

Family Health Care PlansFamily Health Care PlansAurora

TYPE OF CARE PROBLEM RECOMMENDATION

Wellness Lack of physical activitiesWeight ManagementDiet

-Tailor exercise regimen fit for patients age-Diet prescription

Medical Hypertension - Encourage follow-ups- update on vaccines- watch out for complications-BP monitoring-Educate family about warning signs

Psychosocial Lack of interaction with other family members

- Encourage interaction among family members

Engracie

TYPE OF CARE PROBLEM RECOMMENDATIONS

Wellness Lack of Physical activitiesDiet

- Encourage to engage in exercise program

Medical No Regular check-up

Encourage check-up with a physician

Psychosocial

Wilfredo

TYPE OF CARE PROBLEM RECOMMENDATION

Wellness Weight ManagementSmokingArthritis

-encourage to engage in an exercise program-Help patient quit smoking-Laboratory work-up

Medical No regular check-ups

- Encourage a check-up with a physician

Psychosocial

Lorely

TYPE OF CARE PROBLEM RECOMMENDATION

Wellness Weight ManagementAsthma

-encourage to engage in an exercise program

Medical No regular check-ups

- Encourage a check-up with a physician

Psychosocial

Plans Plans SAH Stage ICataract, OU

TreatmentTreatmentPharmacologicNon pharmacologic

SAH Stage 2SAH Stage 2DiureticsACE inhibitorsCalcium channel blockerARB

Non pharmacologicNon pharmacologicEducationSupport groupsExercise and physical therapySpeech therapyNutrition

JNC 7JNC 7

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. (2003). American Medical Assoication