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Group 4Bolintiam, Cruz, Dela Cruz, Lu, Que, Rivera, Sioco, Tai, Valera, VelosoFamily Case ConferenceOutlineBiomedicalHealth IssuesHealth TimelineProblem ListFamily MedicineFamily MAPAPGARGenogramSCREEM Family IssuesFamily meeting Intervention

General InformationJP5 y/o FemaleRoman CatholicFilipinoIlugin, Pasig CityInformant: MotherCHIEF COMPLAINTPOOR WEIGHT GAINHistory of Present IllnessCONSULTURTI; Acute gastroenteritisNo previous hospitalizationsNo maintenance medicationsNo allergies to food and medicationsPast Medical HistoryBirth and Maternal HistoryBorn full term via NSD to a 21 y/o G1P1Attended by the hilot; born in the houseBW: ~ 3 kgDenies any perinatal or neonatal complicationsOne prenatal check-up in the health center

Family HistoryMATERNALSister of grandmother: Hypertension and DiabetesCousin of mother: Hypertension and DMSecond cousin: Primary Complex (treated for 3 months; lost to follow-up)Grandmother: died of hemorrhagic shock secondary to child bearingPATERNALUncle: HepatitisNutritional HistoryBreastfed until 2 years oldWeaned at the age of 6 (Cerelac and lugaw)Food preferences: junkfoods, noodles, candies and chocolates

Nutritional History24 hour diet recall

BREAKFASTBiscuit or Bread1 glass of chocolate milkMORNING SNACKS1 tahoLUNCH cup of riceNoodlesSNACKSJunkfoods or cookiesDINNER cup of riceSoupDEVELOPMENTAL HISTORYAt par with ageIMMUNIZATION HISTORYBCG: 1 doseDPT/OPV: 2 dosesHepa B: 3 dosesMeasles: 1 doseInfluenza virus: 1 dose PERSONAL-SOCIAL HISTORYPatient lives in a shanty house near the riverside in Ilugin. 5 household membersFather is an elementary graduatePrimary breadwinner (works as plywood delivery assistant)Mother finished until second year high schoolUncle: works in the soap making factory

PERSONAL-SOCIAL HISTORYEnvironmentWater source: boiled tap waterGarbage collected everydayHas their own restroomNear the riverExposure to internal pollutionCooks inside the home using coalFather and Uncle smokes inside the house

Physical Examination findingsGENERAL APPEARANCEAlert, active, playful, cooperative

VITAL SIGNSNormal cardiac rate, respiratory rate, afebrile

ANTHROPOMETRIC MEASUREMENTS:Height: 92 cm (Z score: < -3 severely stunted)Weight: 12 kg (Z score: 3 severely underweight)BMI: 14.2 (Z-score: >1 within normal levels)

Physical Examination FindingsSKINwarm skin, good skin color and turgor

HEENTNo scalp lesions, no hair color changesno lesions or matting of the eyelids, no eye discharge, no swellling, anicteric sclerae, pale palpebral conjunctivaNo tragal tenderness, no ear discharge, (+) impacted cerumen (bilateral)

Physical Examination FindingsHEENTNo alar flaring, nasal septum midline, with minimal nasal dischargedry lips, moist tongue, no circumoral cyanosis, no buccal mucosal lesions, no TPC(+) 1.5 cm smooth, movable, nodule on the right anterior cervical area

PHYSICAL EXAMINATIONRESPIRATORYNo retractions, symmetric chest expansion, clear breath sounds

HEARTadynamic precordium, no thrills, heaves or lifts, PMI at 5th ICS, MCL, normal rate, regular rhythm, distinct S1 and S2 sounds, no murmurs

PHYSICAL EXAMINATIONABDOMENFlabby abdomen, normoactive bowel sounds, soft, no organomegaly, no tenderness

EXTREMITIESfull and equal pulses, no edema, no cyanosis, no atrophy/hypertrophy, no deformities

NEUROLOGIC EXAMINATIONIntact cranial nerves, no sensory and motor deficits, normoreflexive, (-) Babinski, (-) clonus

Clinical IssuesMalnutritionPoor eating habitsExposure to TBDental CariesPoor Hygiene and SanitationHazardous EnvironmentHealth MisconceptionsFAMILY MEDICINEGenogram474320181613111088m292643malnutritionTBHemorrhagic strokebreadwinnerCaregiver (controlling)Index patientFAMILY MAPSCREEMParameterresourcepathologySOCIALThe family has a good relationship with each other and also among the members of the community because the parents have a lot of relatives in the community Although they have good relationships with each other. The father is always out for work which would impair their relationship with each other in the future. Also, the extended family does not share with the familys success. They even envy and try to bring each other down.CULTURALThe family has good kinship practices, they can rely on each other. They believe in traditional practices which make them bonded with the communitySome practices, like hilot, are not helpful in treating severe conditions and a lot of times, it will make the illness worse.24SCREEMParameterResourcePathologyReligiousThe family members are all Roman CatholicsThe family is not active with their practice and does not go to church regularlyEconomicIn the economical aspect, the family can pay and provide for their basic needsThe familys resources are only enough to provide their everyday necessities but when emergencies or crises happen, their finances may not be able to cover for them.25SCREEMparameterresourcepathologyEducationalThe family is able to finish basic education and has access to health education in the health center. Even though they have this basic education, they have health misconceptions which prevent them from seeing the gravity of their health situation. Their knowledge of basic health is inadequate the protect them in their environment.MedicalThe family lives near the health center which makes it easily accessible for them. Also, the Ilugin local government and NGOs have good programs that they can access. The mother is enrolled to Philhealth.For now, there are medical programs which are advantageous to the people and good, but when the time comes that there serious illnesses which cannot be handled by the health center, the family does not have enough resources to seek help from other institutions.26FAMILY APGARFM 1FM 2ADAPTATIONI am satisfied that I can turn to my family for help when something is troubling me12PATNERSHIPI am satisfied with the way may family talks over things with me and shares problems with me22GROWTHI am satisfied that my family accepts and supports my wishes to take on new activities or directions22AFFECTIONI am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow or love22RESOLVEI am satisfied with the way my family and I share time together22OVERALL ASSESSMENT910HIGHLY FUNCTIONALFAMILY ISSUESDifferent parenting stylesFather: permissive Mother: authoritarianConsidered to be one of the main barriers in implementing behavioral change in the childrenMay also result to other problems in the futureFinancial InstabilityINTERVENTIONTHE BIOPSYCHOSOCIAL MODEL

Using the biopsychosocial model in identifying what are the main problems that are contributory to the patient. With this, we can create interventions that would address all problems contributory to the patients condition30SYSTEMS THEORY

Creating interventions that would address the problems in each system to address the medical problems of the patient31Medical IssuesInterventionMalnutritionIdentify other medical causes of malnutrition (including TB, parasitism, dental caries, etc.)Changing eating behaviourEducate the child and the whole family regarding healthy eating habitsDiscourage giving money as a rewardDiscourage buying food from outsideEncourage variation in food choices

33InterventionMalnutritionChanging eating behaviorFind cheap and healthy alternatives Teach meal planning and budgetingTeach creative cooking. Make eating time a pleasurable activity (e.g. good food presentation, incorporate games, encourage eating together, etc.)Awareness of importance of growth and development monitoring

34InterventionMalnutritionEncourage involvement in government or non government programs to address malnutritionReligiously attending the feeding program set by the community center

35InteventionExposure to TBScreening for TB for all relatives and possibly neighbors tooEncourage and emphasize compliance with treatmentEducate the family regarding truths about TB, how its spread, its treatment and its complicationsEducate family about importance of BCG vaccineInterventionDental CariesReferral to DentistDecrease intake of sugar-rich foodsTeach proper dental hygiene (including proper toothbrushing)Poor hygienePoor hygieneEducate the family regarding good hygienePromote handwashing and sanitation to prevent spread of diseasesEducate family how to sterilized and store of their drinking water

INTERVENTIONHazardous environmentAdvise alternative cooking methodsUse of mosquito nets Main goal: Encourage them to transfer to a safer and conducive place to liveInterventionsAddressing other social IssuesHealth misconceptionsEducateCreate programs teaching all families regarding truths on health (including pulongs on health, health counseling, focus group discussions, etc.)FAMILY INTERVENTIONSInterventionFamily issuesEstablish a unified parenting styleCall for a family meeting or dialogue with the parentsEncourage good communication between partners and children Advice good parenting styles

Suggestions for Improved ParentingBased on the Lecture Building Families with Young Children by Mrs. Maribel Sison Dionisio42ABCs of ParentingAttention givingBuilding self-esteemCommunicating regularly and wellDisciplining with loveEnhance couple relationshipAttention givingRegular fun time (30 minutes to 2 hours per child per day)Once a week date per child

Building Self-EsteemPositive actions on the child that build his self-esteem:Being praisedBeing listened to, being spoken to respectfullyGetting attention and hugsExperiencing success in sports or schoolLoving trustworthy friends

Building Self-EsteemNegative actions on the child that does not build his self-esteem:Being harshly criticized Being yelled at or beatenBeing ignored, ridiculed, or teasedBeing expected to be perfect all the timeExperiencing failures

Self-esteem influences:How our child does in schoolWhat our chld schooses to do w/ his lifeHow and what our children achievesHow well and who our children loves

Ways to be encouraging:Demonstrate acceptanceShow confidenceAffirm contribution

Communicating Regularly and Welleye to eye so bring yourself to the level of the child. Active Listening is:Listening to thoughts and feelings.Listening to body language, tone of voice, and facial expresions.Reflecting backClarifying and checking for understanding. Empathizing putting ourselves in the shoes of the other person Responding openlyacknowledges childrens right to their feelings by demonstrating that the listener accepts what they feel as well as what they say NOT: denies child a right to their feelings by demonstrating listeners unwillingness to accept and understand Disciplining with loveDiscipline is not punishment, threat or humiliation. A learning processMeans to teach, guide and empower our children to behave constructively and appropriately Disciplining with loveHOW TO DISCIPLINE:Agree on house rules then implementIf agreements are not met then impose logical consequences.Offer choices within the limitsNo matter how small, teach the child the consequences.Enhance Couple RelationshipCalendar: once a week dateCARING: thoughtful actsCOMMUNICATION: kind and loving words of affirmationMarriage has to be happy or else kids become worried and distracted.

InterventionFamily issuesFinancial InstabilityHelp them set financial goals for the familyTeach proper budgeting including savings Offer livelihood alternatives for the mother (e.g. small businesses)