rle community
TRANSCRIPT
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Name: Antoniette C. Dumdumaya CI: Mrs. Vivian S. Bartolome RN MN
Year/Section: 3K Area: Canelar Health Center
Date: February 14-16/21-23, 2013 Rotation: 4
Terminal Performance Objective:
Acquisition, application and demonstration of proper skills, correct knowledge, right
attitude and values in providing basic health services for beginning professional practice in
Canelar Health Center for clients with problems in inflammatory and immunologic
response, and perception and coordination, as well as problems in maladaptive patterns of
behavior with emphasis on the health promotion and prevention of diseases with
consideration on ethico-legal aspect of nursing practice integrating the eleven key areas of
nursing responsibilities.
Enabling Objectives:
At the end of 48 hours of R.L.E, I will be able to:
1. Orient myself with the physical set-up of the area assigned.
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PLAN OF ACTIVITIES
February 14, 2014-Thursday
TIME ACTIVITIES REMARKS
7:00-7:15
7:15-8:00
8:00-10:00
10:00-10:15
10:15-12:00
12:00-12:30
12:30-2:00
2:00-2:30
2:30-2:45
Arrived at Canelar Health Center andsigned in with CI.
Pre-Conference
Orientation and familiarization of thephysical set-up of the area and members ofthe health care team.
SNACK
Interaction with client through home visits.
LUNCH BREAK
Discussion with CI on informationobtained.
Post Conference
Aft C
students signed in with CI
CI discuss about area andmembers of the health care team
CI oriented student
Student took their snack
Student made home visit.
Student took their lunch.
Students discussed with CI
CI discuss about task fortomorrow
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PLAN OF ACTIVITIES
February 16, 2013-Saturday
TIME ACTIVITIES REMARKS
7:00-7:15
7:15-8:00
8:00-11:00
11:00-12:00
12:00-2:00
2:00-2:30
2:30-2:45
2:45-3:00
Arrived at Canelar Health Center and signed inwith CI.
Pre-Conference
Joined Dengue Zero Motorcade
SNACK/LUNCH BREAK
Discussion with CI on information obtained.
Post Conference
After Care
Signed out/Dismissal
students signed in with CI
CI discuss task for today
Student joined Dengue ZeroMotorcade.
Student took their snack
Student discussed with CI
Student took their lunch.
Students discussed with CI
CI discuss about task fortomorrow
Student cleaned area andsigned out
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PLAN OF ACTIVITIES
February 22, 2013-Friday
TIME ACTIVITIES REMARKS
7:00-7:15
7:15-8:00
8:00-12:00
12:00-11:00
11:00-11:30
11:30-12:30
12:30-2:00
2:00-2:30
2:30-2:45
2 45 3 00
Arrived at Canelar Health Center andsigned in with CI.
Pre-Conference
Performed Health Teaching at community
SNACK
Travel time from community back to thehealth center
LUNCH BREAK
Discussion with CI on informationobtained.
Post Conference
After Care
students signed in with CI
CI discuss task for today
Student discussed health teachingon identified problems.
Student took their snack
Student returned to Health Centerbase.
Student took their lunch.
Students discussed with CI
CI discuss about task fortomorrow
Student cleaned area and signed
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INITIAL DATA BASE
A. FAMILY STRUCTURES, CHARACTERISTICS AND DYNAMIC
FAMILY DATA
Respondent Profile:
Name : Rosie RiveroAge : 52 years old
Sex : Female
Address : Purok IX, Canelar Moret Zamboanga City
Birth Place : Siocon, RT Lim, Zamboanga Sibugay Province
Birth of Date : December 4, 1959
Occupation : Housewife
Civil Status : Married
Nationality : Filipino
Number of Children : Four (4)
Educational Attainment : Elementary Level (Grade Six)
Name of Husband : Mr. Abner Rivero (deceased)
Length of Residency : 13 Years
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The Rivero family resides at Purok IX, Canelar Moret, Zamboanga City. They are a nuclear
type of family that has six members. The respondent Mrs. Rivero, 52 years old, born on December
4, 1959 was originally from Siocon Province, she has just became a widow. She states that her
husband just passed away last month of January 13, 2013. They own the house the live in but not
the lot. They have their own electric connection but buy their water from neighbors, the main
source being the Zamboanga water district. Mrs. Rivero has four children, three boys and a girl.
They are all grownups and can take care of themselves her responsibility has gone down to only
guide them in whatever decision they make understanding that her children has their own life to
lead. She still cook for the family and do housework but most of the time she is alone in the house.
Mrs. Rivero is still grieving for the lost of her husband. Her husband used to be the breadwinner ofthe family; he was a vendor of mangoes and a responsible husband to their four children. Now
that his husband is gone, expenses in the house, especially the food and other basic needs are
shared by her two sons who work in a construction and Mrs. Rivero herself by accepting laundry
services from neighbors.
The familys primary dialect is chavacano but they also speak bisaya and tagalog. Only two
of her children are presently in school. Both children are being sponsored by the community as
barangay scholar because they belong to an indigent group of family. Mrs Rivero has four children.
Her eldest and second son works in a construction they are Marlon Rivero, 24 years old and
Maximiano Rivero, 21years old. The third is Analiza Rivero who is now 18 years of age and on her
fourth year in high school. Her youngest son who is a 16 year old is on his sixth grade in
elementary. They have to stop school thats why their age is advance due to financial concerns.
Mrs Rivero is a devoted Christian as well as her four children She said that she goes to church
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IDENTIFYING FAMILY HEALTH PROBLEMS AND COMPUTING AND JUSTIFYING SCORESOF HEALTH PROBLEMS
1. IMPROPER DRAINAGE SYSTEM AS A HEALTH THREAT
Inability to make decision with respect to taking appropriate health action due to lack of
knowledge alternative solution.
CRITERIA COMPUTATION SCORE JUSTIFICATION
NATURE OF THE
PROBLEM
2/3X1 0.67 The problem is a health threat.
MODIFIABILITY OF THE
PROBLEM
1/2X2 1 The problem is partially modifiable. Thecannot do family has no resources to
PREVENTIVE POTENTIAL 2/3X1 0.67 A close drainage system will prevent vectorslike mosquito to breed and any accidentespecially for children playing nearby.
SALIENCE OF THE
PROBLEM
0/2X1 0 The problem does not need immediate
attention.
TOTAL 2.33
2. UNSANITARY GARBAGE DISPOSAL AS A HEALTH THREAT
Inability to recognize the health threat due to lack of knowledge about the condition
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PROBLEM as long as they have shelter.
TOTAL 2.67
4. HYPERTENSION AS A HEALTH DEFICIT
Inability to make decisions with respect to taking appropriate health actions dueto:
- failure to comprehend the nature/magnitude of the problem.- lack of adequate knowledge as to alternative courses of action open to them
CRITERIA COMPUTATION SCORE JUSTIFICATION
NATURE OF THE
PROBLEM
3/3X1 1 The problem is a health deficit in which willcause complications that requires immediateattention and adequate management of ones
blood pressure.
MODIFIABILITY OF THE
PROBLEM
2/2X2 2 The problem is partially modifiable. Thefamily has difficulty of providing themselvesa bigger place to live due to financialresources
PREVENTIVE POTENTIAL 3/3X1 1 Increasing the living space, will reduce thetransferability of communicable diseases,
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Priority Problem Score
HYPERTENSION AS A HEALTH DEFICIT health deficit 5
CIGARETH SMOKING AS A HEALTH DEFICIT health deficit 4.16
INADEQUATE LIVING SPACE AS A HEALTH THREAT health threat 2.67
UNSANITARY GARBAGE DISPOSAL AS A HEALTH THREAT IMPROPER health deficit 2.67
DRAINAGE SYSTEM AS A HEALTH THREAT
health deficit 2.33
NURSE-PATIENT/CLIENT INTERACTION
STUDENT NURSE CLIENT TECHNIQUE USED ANALYSIS
Hello Maam!Goodmornng po!(Smiles)
Ako pala si Antoniette
Maam. Nursing studentsa WMSU. Anoginagamit niyong salita
Maam?tagalog,chavacano, o bisaya?
Goodmorning!
Bisaya ko Day, pero
kabalo man pud ko magtagalong, ugchavacano.
Greeting
Giving information
and givingrecognition andestablishing rapport.
Client acknowledgesand welcomes studentnurse.
Student nurse introduce
self to establish trust orrapport with client andask permission to
interview and whatlanguage she is
comfortable using
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Dugay na mu diri
nagpuyo maam?
Unya maam inyuha naning balay? Inyuha pudang ilaw?
Ang tubig maam?
Ahh mao ba. Asa manimong pamilya
maam?Imonganak ugbana?
Condolence maam.
Nakasabot ko nga saimong gibati run. Maamkung okay lang nimu.Unsa man ang iyangikinamatay?
Thirteen years na mi
diri. Taga Siocon manjud ko. Pero ako bana
taga diri jud.
Uu amua na ning balay.Ug ang ilaw kami pudnagpataud ani.
Gapalit mig tubigsilingan..water district.
Akong duha nga anaknagtrabaho and duha
nag-eskwela . Akongbana bag-o lang
namatay. Katu langlast month January 13.
Diabetic man tu siya.
Naa pud tu sya highblood. Nag inum mantu sila sa gabii diha rasilingan. unya pag-abotdiri sa balay natulog ra
pud siya. Pag-abot
kaadlawun mga alas
Asking information
Asking information
Emphatized with
client. Encouragingor giving broadopenings
Student asked length of
residency of client andother necessary
information aboutclient.
Student emphatized
with client andexpresses deepunderstanding of whatclient feels. And askclient\s
permission/willingness
to talk about her
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Maam mangutanako
tungud sa imong mgaanak? Kinsa man ilang
mga ngalan ug edad?
Maam salamat kaayo sapagdawat sa amua saimong balay. Puhonokay ra gihapun nimu
ang pagbalik namuh diri.
Okay lang maammaghulat lang man midiri kay naa man pud
amuang classmate ngaclient diri
(Client filled in
infomation).
Okay lang pud. Gaadtura ba ku sa lubong saakong asawa kung
buntag.pero muuli ra
man ko.
.
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FAMILY NURSING CARE PLAN
HEALTH PROBLEM FAMILY NURSING
PROBLEM
GOAL OF CARE OBJECTIVES OF CARE NURSING INTERVENTION
METHOD
OF
FAMILY
CONTACT
RESOURCES
REQUIRED
EVALUATION
HYPERTENSION AS
A HEALTH DEFICIT
SUBJECTIVE CUES:
Meron ako High
blood pressure at
tatlong taon na ako
Nagmemaintain ng
Neobloc as
verbalized by the
client.
OBJECTIVE CUES:
Client is seen
smoking
VITALS SIGNS:
BP-140/100
RR- 22
P- 82
Inability to makedecisions with respect totaking appropriate healthactions due to:
1. Failure to comprehendthe nature/magnitudeof the problem.
2. Lack of adequate
knowledge as toalternative courses of
action open to them.
After nursingintervention thefamily will take thenecessary measuresto properly manage,control and lessenthe risk factors ofhypertension.
After nursingintervention the familywill:a. have adequateknowledge aboutproper nutrition thatwill help reducehypertension and
prevent to occurrenceof relative
complications in thefuture.b.be able to determine
the risk factors thatcontribute to
hypertensionc. practice properlifestyle with regards tonutrition and physicalfitness.
Discuss the nature, signs,symptoms and complications thatmight arise due to hypertension.1. Discuss with the family the
risk factors of hypertensionsuch as family history, age,salt and alcohol intake andobesity.
2. Promote a healthy lifestyle
such as:a. encouraging proper food
intake like reduced salt and
fatty foods.b. Prevent obesity through
good nutrition andexercise.
c. Smoking cessation-tobacco or nicotinepromotes atherosclerosisthat may contribute tohypertension both passiveand active smoker.
3. Encourage check-ups andprovide referral with amedical practitioner to lessen
hypertension and modify risk-factors.
HOME
VIS
ITS
Material
Resources:Visual Aids,flyers andcommunitydiscussion.
Time, money
and effort on thepart of the nurse
and family
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DRUG STUDY
NAME OF DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATIONADVERSE REACTION/SIDE
EFFECTS NURSINGRESPONSIBILITIES
Vaccine Hepatitis B
Engerix-BEngerix-B Pediatric
Classification:ImmunizationHepatitis B
The vaccine is made
from inactivatedwhole virus ofhepatitis B. The
inactive virusstimulates your bodyto produce antibodiesto fight hepatitis Bvirus.
The hepatitis B vaccine is given
to children as a series of threeinjections (shots).- The first shot is given to
infants before leaving thehospital. If the baby's mothercarries the hepatitis B virus, thebaby receives the first vaccineshortly after birth.- The second shot is givenbetween 1and 2months of age.- The third shot is given at6months of age.
Most infants who receive the
hepatitis B vaccine have noside effects. Others may haveminor problems, such as
soreness and redness at theinjection site or a mild fever.Serious problems are rare andare mainly due to allergicreactions to a component ofthe vaccine
Diptheria/TetanusToxoids: Pertusis
Vaccine, DTPinjection
Generic Name:Diptheria ToxoidAdsorbed, PertusisVaccine, Acellular(Adsorbed)
Brand names:Adacel (containingDiphtheria, TetanusToxoids, Acellular
Pertussis Vaccine)
Boostrix (containing
Diphtheria, Tetanus
Is used to preventdiphtheria, tetanus,
and pertussisinfections.
- See your health careprovider for all shots of this
vaccine as directed.
- To have protection frominfection, you must have 3shots of this vaccine plusboosters as needed.
- Tell your doctor right awayif you have any serious orunusual side effects aftergetting this vaccine.
Not advisable if you have-blood disorders like
hemophilia-fever or infection-immune system problems-neurologic disease-seizures-an unusual or allergicreaction to vaccines,thimerosal, latex, othermedicines, foods, dyes, orpreservatives-pregnant or trying to getpregnant-breast-feeding
-immune globulin
-medicines that suppress yourimmune function like
Side effects that you should report toyour doctor or health care
professional as soon as possible:-allergic reactions like skin rash,itching or hives, swelling of the face,lips, or tongue-breathing problems-fever of 103 degrees F or more-flu-like symptoms-inconsolable crying-infection-pain, tingling, numbness in thehands or feet-seizures-swelling of arm or leg that was
injected-unusually weak or tired
Side effects that usually do notrequire immediate medical attention
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Toxoids, Acellular
Pertussis Vaccine)
Certiva (containing
Diphtheria, Tetanus
Toxoids, Acellular
Pertussis Vaccine)
Drug Class:Combinations withA Tetanuscomponents.
adalimumab, anakinra,infliximab-medicines to treat cancer-medicines that treat or
prevent blood clots likewarfarin, enoxaparin, and
dalteparin-steroid medicines likeprednisone or cortisone
(report these side effects to yourdoctor or health care professional ifthey continue or are bothersome):-fussy, irritable
-loss of appetite-fever of 102 degrees F or less
-pain, tenderness, redness, swelling,or a 'knot' at site where injected-vomiting
Bacillus Calmette-Gurin (BCG LiveSystemic)VACLASSIFICATIONPrimary: IM100
Commonly usedbrandname(s): TICE
BCG.
Category:Immunizing agent(active/live
vaccine)
A live culture ofattenuated organismsof bacillus Calmette-Gurin (BCG) strainof Mycobacteriumbovis
BCG live vaccine
induces cell-mediatedimmunity againsttuberculosis.
- Bacillus Calmette-Gurin(BCG) live vaccine, intendedfor immunization of uninfected(tuberculin negative) persons toinduce tuberculin sensitivity asa protection against tuberculosisinfection.
- Conditions affecting use,especially: Sensitivity toBCG live
- Other medications,especially anti tubercularagents, corticosteroids,immunosuppressant agents,
or killed or live virusvaccines
- BCG live vaccine should beused with caution inindividuals withasymptomatic HIVinfection and in individuals
known to be at high risk forHIV infection
The initial skin lesions, which aresmall red papules, appear in 10 to 14days and reach a maximum diameterof 3 mm each after 4 to 6 weeks,which may scale and slowly subside.If not an abscess forms, whichusually softens and tends to openspontaneously. The abscess heals
within a few weeks, and, in suchinstances, a scar may form. Theintensity and duration of the local
reaction depend on the depth ofpenetration achieved inadministration and the individualvariation in tissue reaction.
Those indicating need for medicalattention
INCIDENCE MORE FREQUENT
- Abscesses (accumulation of pus)
- dermatologic reactions (peeling orscaling of the skin)- granulomas (aggregation ofinflammatory cells)- lymphadenitis (inflammation of 1
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or more lymph nodes)- ulceration at site of injection (soresat place of injection)
RARE INCIDENCE
- Allergic reaction or erythemanodosum (skin rash)
- BCG infection,disseminated (fever; cough)
- osteomyelitis (increase in bonepain)
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HEALTH TEACHING PLAN
SUBJECT MATTER: HYPERTENSIONTIME ALLOTMENT: 20 MINUTES
ASSESSMENT LEARNINGNEEDS
TEACHINGOBJECTIVES
CONTENT STRATEGIES RESOURCES EVALUATION
SUBJECTIVECUES: Meron akoHigh blood pressure attatlong taon na akoNagmemaintain ngNeobloc asverbalized by theclient.
OBJECTIVE CUES:
Clients is seensmoking
Vital signs:
BP- 140/100RR-22
P-82
At end of 20minutes the client
will be able to:
Verbalizeunderstanding ofthe diseasecondition.
States the riskfactors ofdeveloping orhaving a high
blood pressure.
Enumerate waysto choose foods
forproper
nutrition andphysical
activities thatwill help reducehypertension
and prevent tooccurrence of
relativecomplications inthe future.
At the end of 20 minutesof community discussionand with client present,the client /communitywill be able tounderstand about thedisease condition, statesthe risk factors ofdeveloping or having ahigh blood pressure, andenumerate ways to
choose foods forpropernutrition and physical
activities that will helpreduce hypertension
and prevent tooccurrence of relative
complications in thefuture.
HIGH BLOOD PRESSURE
- is known as the silent killer because you canhave high blood pressure and not know it.
- High blood pressure is one of several risk factorsthat can increase your chance of developing heart
disease, a stroke, kidney failure and other serious
conditions.
Blood pressure is the force of blood that pushes against
the wall of the blood vessels as the heart pumps. High
blood pressure is also called hypertension.
There are two measurements that are used to assess
blood pressure:
systolic pressure
- is the blood pressure when the heart pumps bloodaround your body.
diastolic pressure
- is the measure of blood pressure when the heart isresting in between beats. The blood pressure
numbers are written with the systolic number
above or before the diastolic number
WHAT BLOOD PRESSURE NUMBERS MEAN:
Less than 120 systolic/Less than 80 diastolic
-Healthy Range(recheck in 2 years)Maintain healthy
lifestyle
130-139 systolic/85-89 diastolic
-Approaching high risk(recheck in 1 year)Begin lifestyle
Communitydiscussion
InternetBooks/flyersMoneyTime andeffort
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changes to prevent full blown hypertension
More than 140 systolic/More than 90 diastolic
-Your blood pressure is high(follow-up with doctor )Work
with your doctor to control your BP
YOU ARE AT INCREASED RISK FOR
DEVELOPINGHIGH BLOOD PRESSURE IF YOU:
1. Are overweight
2. Dont exerciseon a regular basis
3. Eat foods high in salt or sodium4. Dont eat many fruit andvegetables
5. Drink an excess of alcoholic beverages(more than 1 to 2
drinks per day)
6. Have a family history of high blood pressure
7. Are of African descent
8. Are aged over 65
HIGH BLOOD PRESSURE CANT BE CURED,BUT
IT CAN BE LOWERED AND CONTROLLED IF
YOU:
1. Keep to a healthy weight
2. Exercise regularly (30 minutes per day)
3. Eat more fruit and vegetables(five or more servings a
day)4. Cut out added salt and choose sodium free, and low
sodium foods instead
5. Dontsmoke
6. Limit alcohol intake to 2 drinks a day for men and1 for
women
7. Take your blood pressure medication as directed(do not
stop medication without your doctors approval)
8. Get your blood pressure checked at least every twomonths
TIPS TO REDUCE SODIUM INTAKE:
Follow the DASH diet.
This diet includes fruits, vegetables, whole grains,
legumes and nuts, lean meats, and low-fat dairy
products.
Avoid processed, canned and fast foods.
Avoid adding salt during cooking and at the table.
Read food labels to determine sodium content of
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foods and avoid those high in sodium.
The Percentage Daily Value (%DV) tells you whether a
food has a little or a lot of a given nutrient. Foods with:
- 5% sodium DV or less are considered low in sodium
- 15% sodium DV or more are high in sodium.