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College of Nursing Education
3rd
Floor, DPT Building
Matina Campus, Davao City
Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 141
A Family Case Study
Presented
To the
College of Nursing
1

2. In Partial fulfillment of the Requirement in
Community Organizing Participatory Action
Research Family Case Study
Submitted to:
Ms. Arlene D. Layupan, RN
Mr. Henrries Dan Tulas, RN
Mr. Ronald Allan Ramo, RN
Submitted by:
Celedonio, Precy Babe B.
September 21 2013
T A B L E O F C O N T E N T S
I.TITLE PAGE.....................................................................................................1
II.TABLE OF CONTENTS................................................................................2
III.ACKNOWLEDGEMENT...............................................................................3
IV.INTRODUCTION...............................................................................................4
V.OBJECTIVES of the CASE.........................................................................5
VI. IDENTIFICATION OF THE CASE....................................................................6
VII.FAMILY BACKGROUND............................................................................7
VIII.SOCIO- ECONOMIC BACKGROUND............................................................8
2

3. IX.FAMILY MEDICAL and HEALTH HISTORY...................................................9
X.GENOGRAM....................................................................................................10-11
XI.FAMILY APGAR........................................................................................12
XIII.FAMILYCOPING INDEX...............................................................................13-17
XIV.NURSINGTHEORY......................................................................................18-19
XV. MANAGEMENT
A.MEDICAL
MANAGEMENT....................................................................................................20-24
B.NURSING MANAGEMENT
B.1 Problem List (Maslow’s Hierarchy).....................................................25-27
B.2 Problem Identification (Health Threat/ Deficit/ Foreseeable Crisis)...28-29
B.3Family Nursing Care Plan....................................................................30-33
B.4Health Teachings (Three Levels of Prevention)..................................34-35
XVI.IMPLICATION................................................................................................36-37
XVIII.HEALTH
UPDATES.............................................................................................................38-40
XIX.REFERENCES...............................................................................................41
ACKNOWLEDGEMENT
I, would like to express the heartfelt gratitude to the following people for their
professional direction.
To Mr. Ronald Allan Ramo, RN, Mr. Henrries Dan Tulas RN; Miss Analyn
Salamero RN; and Miss Arlene Layupan, RN and for their valuable guidance and
help during the entire community exposure.
3

4. To Dean Ofelia C. Lariego , RN, MAN; for allowing us to have our exposure
and giving us the chance to improve our knowledge and skills in Community Health
Nursing.
To my beloved family, who always there to support me in any problems. For
the financial support that they gave to me in order to attend school and duties.
The fourth year BSN students would like to extend their sincere appreciation
to their individual family for their unstoppable financial support and for unending
prayers to keep us safe during the community exposure.
To the Brgy. Captain Robert Olanolan, for permitting us to conduct the
community exposure.
To all residents who willingly cooperated in all our activities.
And finally, I would like to thank our Almighty God for His guidance and
protection during our activities and difficulties in going to the community.
INTRODUCTION
Hypertension, also referred to as high blood pressure, is a condition in which
the arteries have persistently elevated blood pressure. Every time the human heart
beats, it pumps blood to the whole body through the arteries.
Hypertension is considered as the biggest single risk factor for deaths
worldwide. According to the World Health Organization 2012, hypertension causes 7
million deaths every year while 1.5 billion people suffer due to its complications.
4

5. We chose Ms. XY’s case because her case is one of the most common
disease worldwide afflicting humans, which is hypertension or high blood pressure. It
is known as silent killer because in the initial stage it presents no symptoms. It is only
after an organ in the body is irritated or damaged, that the consequences of high
blood pressure are realized.
Lifestyle nowadays is one of the major precipitating factors of the condition.
These lifestyle factors include high sodium intake, excessive calorie intake, and
obesity, physical inactivity and excessive alcohol consumption.
OBJECTIVES
After 12 days of span of nursing care:
• Determine the level of cognition in the determination and prioritization of
problems that exist in the community.
• Develop the skill of intervention prompt to the social health care problem in
accordance with its appropriateness and effectiveness.
5

6. • Provide services and facilitate for the better and appropriate solutions present
in a particular community.
SPECIFIC OBJECTIVES:
After 12 days of span of nursing care:
1. Apply knowledge and skills on how to give health education to the community
in relation to their identified problem;
2. Discuss briefly and explain the etiology of prioritized problem, its causes and
effects and ways on how to eradicate it;
3. Determine the families Apgar score and family coping index in assessing the
functioning and potential areas of family strength and resources.
4. Established a nursing care plan which would be beneficial to the family, as
well as to the community;
5. Formulate a clear and specified plan of action to give solutions to the existing
health problems identified within the community
6. Present data and proof about the common health problem of the community
residents;
7. Relate existing health problems with different nursing theories; and
8. Evaluate the effectiveness of the plan of action and the entire program
performed in the community;
9. Give summary, evaluation and implication;
IDENTIFICATION OF THE CASE
Code Name: Mrs. XY
6

7. Nationality: Filipino
Religion: Roman Catholic
Address: Barangay 76-A, Bucana, Davao City
Age: 47 years old
Occupation: Housewife, carpenter
Civil Status: Married
Menarche: 14 years old
Parity: 5
Gravida: 5
Abortion: 0
Menstrual Cycle: Irregular usually her menstrual cycle interval is 2-3 months
Diagnosis: Hypertension (2009)
Date study Begun: August 30, 2013
Date study Ended: September 21, 2013
Informants: Daughter
FAMILY BACKGROUND
The XY family, an extended type of family is the chosen to be the subject of
my case study. They are currently residing at Barangay 76-A, Purok 6-A, Bucana,
7

8. Davao City. Mrs. is 47 years old, a college undergraduate, a housewife but
sometimes works as a carpenter in Bucana earning not less than 3000 a month but
lately experiencing Dizziness. She is also the one making the decision in terms of
their financial budget. Her husband Mr. XY is 48 years old, an elementary graduate,
and works as a trisikad driver in Bucana was diagnosed with hypertension last
2011.Mr. XY is the one making the decision in relation to health, problems in the
family and sometimes the one who budget with regards to financial. They have 5
children but only 2 are still dependent and living with them. Their eldest child is 29
years old, a high school graduate, married with 4 children and work as a domestic
helper at Kuwait. Their 2nd child is 26 years old, also a high school graduate, single
and working as a construction worker. Then, their 3rd
child is 25 years old, married
and works as a farmer at Bucana. Their 4th
child is 23 years old single and works as
a saleslady at Lachmi San Pedro street, Davao City. Lastly, their 5th
child is 17 years
old, still student and studying at Kapitan Tomas.
Their family has owned their house that is made of light wood and cement
with 2 rooms. They have no enough furniture. They have one Television, DVD,
internet, telephone, karaoke and an insufficient lighting facility. They also have a
public water supply, a water sealed type of toilet facility near their kitchen, has also
an open drainage system. They are also composting their garbage and uses
firewood in cooking
SOCIO-ECONOMIC BACKGROUND
Mrs. XY is 47 years old, and is married to Mr. XY who is a Trisikad
Driver in Barangay 76-A, Bucana. She is a housekeeper and a loving mother to her
8

9. five (5) children. The eldest child works as a domestic helper at Kuwait. Their 2nd
child is working as a construction worker. The third child works as a farmer at
Bucana. The fourth child works as a saleslady at Lachmi San Pedro Street, Davao
City. Their 5th
child is 17 years old, still a student and studying at Kapitan Tomas.
According to her, they have a good family relationship; they are close to each other.
Mrs. XY is a college undergraduate. She works in her place as a carepenter, and she
also have small business. They earned P4000 to P5000 per month together with her
husband. They ate 3 times meal in a day. According to XY when there are health
emergencies, her two (2) children give a small amount as financial support. If there is
no support coming from her children, Mrs. X will borrow money from their neighbor
with an interest. The structure of their house is made of wood and cement. It has two
rooms for her children and they have a comfort room. The location of their house is
near to stagnant water. The setting of the houses is much closed and they are prone
to fire cases.
FAMILY MEDICAL and HEALTH HISTORY
9

10. The XY family is residing at Barangay 76-A, Bucana, Davao City is compose
of 7 members; Mr. and Mrs. XY with their five children. The eldest and the 2nd
child
are known smokers and occasional alcohol drinkers. The third, fourth child and the
youngest have no known disease or illness. They experience common colds and
cough especially during rainy season, they usually self-medicate and they do not
have any regular check-up.
Mrs. XY, 47 years old, who experience dizziness especially when she’s
overworked. She is not interested to go for check-up due to lack of financial
resources and at the same time her perceptions of services delivered by the health
care provider in their health center is not appropriate, according to her, the services
are not complete and sometimes they don’t prioritized people.
A 48 year old female client, Mr. XY was diagnosed with hypertension last
2011 in a medical mission within their community. Initial blood pressure was taken
with a reading of 140/100 mmHg. She was then prescribed with Captopril 50 mg OD
@ HS as maintenance medication but he had poor compliance due to lack of
financial resources.
A medical check-up was conducted again last August 30, 2013 and she had
her 2nd
check-up and had the same findings with a blood pressure of 120/100 and
same drug was prescribed.
10

11. G E N O G R A M
LEGENDS:
Deceased Female Married
Deceased Male Male
Identified Client
Identified Client’s husband Female
11

12. Interpretation
This Genogram shows the family diagram of the XY Family from the 1st
generation to the 3rd
generation. Included in this diagram are the diseases that were
experienced by the selected members of the family.
Mrs. XY can still recall the age of her parents who already died. According to
Mrs. XY her mother died due to hypertension at the age of 72 while her father also
died due to hypertension with the age of 74.
Mr. XY’s parent’s both died last 2007. His parent’s died due to hypertension.
According to Mr. XY, one of her sister died due to cyst in the breast while his other
sibling’s most common illness is hypertension.
The second child complaints also of difficulty in breathing but according to
Mrs. XY they just let his son to have rest and eat plenty. While there 5th
child has
history of asthma since he was 5 years old. But it just triggers when his child is
exposed to dust.
12

13. Family Apgar
Scoring: Total score:
0 point = “Hardly ever” 0-3 = severely
dysfunctional family
1 point = “Some of the time” 4-6 = moderately dysfunctional
family
2 points = “Almost always” 7-10 = highly functional family
13
Adaptation 2 Both parents help each
other in terms of financial
and health problems.
Partnership 2 They have a good
relationship when it comes
to decision making such as
financial concerns. The
couple discussed it
together with their children.
In terms in decision making
to health, the father is the
one who decides and plan
for a good health.
Growth 2 The mother stated that
there were no vices are
practiced in the family. But
her husband drinks
occasionally and so with
her siblings. They can eat 4
times a day together with
snack.
Affection 2 The family always has time
to bond with each other by
doing recreational activities
such watching movies and
videoke.
Resolve 2 The family has no enough
time especially in problems
with their children.
Total 10 The family Apgar result is 9
which mean that their
family is highly functional. It
shows that their family is
able to communicate well
and use the proper
resource present in the
community.

14. FAMILY COPING INDEX
Family: Family XY Date: August 30,2013
Address: Barangay 76-A, Bucana,Davao City
Family Coping Areas Point scales Assessed Problems Justification
1 2 3 4 5 The family is capable of doing their activities of daily living
independently
PHYSICAL INDEPENDENCE X None
THERAPEUTIC
COMPETENCE
X Lack of financial resources to
avail maintenance medication
Mrs. XY has lack of maintenance in medication because
according to her she don’t practiced taking medications
because it has no cure being given and it is expensive.
KNOWLEDGE OF HEALTH
CONDITIONS
X Not enough knowledge in
health conditions.
Mrs. XY verbalized that she lessen her intake of sweets
but she is not aware of increased in salt can contribute to
bad health. She also does exercise in the morning.
APPLICATION OF
PRINCIPLES OF GENERAL
HYGIENE
X . Lack of action in cleaning their
surroundings.
The family have improper disposal of garbage and the
stagnant water is near their house. As we can see the
mosquitos are breeding to the stagnant water.
HEALTH ATTITUDES X They don’t have first aid kit and
they do not have regular check-
up. They don’t trust the
services given by the health
Mrs. X once verbalized that they don’t have enough
money to buy medications especially to their
grandchildren.
14

15. center.
EMOTIONAL COMPETENCE X None Mrs. XY verbalized that whenever they have problems in
the family, they just talk about it. Sometimes they ask for
help through their neighbors if it’s already big problems.
FAMILY LIVING X The family has enough
resources because they also
have small business.
Mrs. XY verbalized that they can still eat 3x a day and can
buy stuffs to their children because their children gave
money also from their job. Mrs. XY’s sister who is in
abroad and gave enough money for their family.
PHYSICAL ENVIRONMENT X Their house is made of
wood and cement.
Stagnant water is near to
their house.
Their house is near in stagnant water and there would be
possibility that mosquito will live there and will attack to
children causing dengue.
15

16. USES OF COMMUNITY
RESOURCES
X Inability to take action to avail
the services in the
healh center.
Mrs. X verbalized “Dili man kaau mi naga adto ug health
center kay dili nila mahatagan tanan na nanginahanglan ug
dili ka mahatagan ug tambal.”
Scaling: 1- no competence, 3- moderate competence, 5- complete competence
16

17. Family Coping Index
The score for Physical Independence is 5 because the family is capable of
doing all of their daily living activities independently.
The Therapeutic Competence scored 4 because Mrs. XY has no enough
maintenance in her medication. She is not used and practiced to take any drugs.
Knowledge of Health Education is scored 3 because Mrs. XY used to eat high
in salt foods, she is not aware what would it contribute to bad health. She also does
exercise in the morning.
For the Application of Principles of general hygiene we scored 3 the family
have improper disposal of garbage and the stagnant water is near their house. As we
can see the mosquitoes are breeding to the stagnant water
In Health attitudes we scored 3 because Mrs. XY once verbalized that they
don’t have enough money to buy medications especially to their grandchildren.
For Emotional Competence we scored 5 because Mrs. XY verbalized that
whenever they have problems in the family, they just talk about it. Sometimes they
ask for help through their neighbors if it’s already a big problem.
For Family living we scored 4 because Mrs. XY verbalized that they can still
eat 3x a day and can buy stuffs to their children because their children gave money
also from their job. Mrs. XY’s sister who is in abroad and gave enough money for
their family.
In Physical Environment we scored 3 because their house is near in stagnant
water and there would be possibility that mosquito will live there and will attack to
children causing dengue.
17

18. For the use of Community Resources we scored 2 because Mrs. X verbalized
“Dili man kaau mi naga adto ug health center kay dili nila mahatagan tanan na
nanginahanglan ug dili ka mahatagan ug tambal.”
18

19. Nursing Theory
Florence Nightingale’s (Environmental Theory)
Florence nightingale’s theory talks about how important environment is to our
health. Like the ventilation and warmth, light, cleanliness, health of houses, noise,
bed and beddings, personal cleanliness, variety, chattering hopes and advices,
taking foods, petty management and observation of the sick.
Florence Nightingale’s can be applied to my family case study because the
ventilation of our client’s house is not really good, because they don’t have enough
windows and the light of their house is insufficient. Cleanliness is fair, but they are
risk of having diseases due to the stagnant water near to their house. . The location
of the house is prone to fire cases because the setting of the houses are too near
and many stock water near to it. Mrs. XY cannot have diagnostic test because of the
financial constraints.
Virginia Henderson (14 basic Human Needs)
Henderson conceptualized the 14 Fundamental Needs of Humans, which are:
breathing normally, eating and drinking adequately, eliminating body wastes, moving
and maintaining desirable position, sleeping and resting, selecting suitable clothes,
maintaining normal body temperature by adjusting clothing and modifying the
environment, keeping the body clean and well groomed to promote integument,
avoiding dangers in the environment and avoid injuring others, communicating with
others in expressing emotions, needs, fears, or opinions and worshipping according
to faith. She believes that Health is a quality of life and a basic for a person to
19

20. function fully. It is important for a healthy individual to control the environment but as
illness occurs, this ability is diminished or affected in caring for the sick.
Virginia Henderson’s theory in relation to my family that I chose to study is
essential information because this family has insufficient financial resources that
sometimes they can not even buy medicine if someone is ill. The family doesn’t have
any access to the services given by the health center. In times when there is
problems such as health concerns, they just let the member of the family who is sick
subsides his or her illness but if it get worst they easily take the sick child to the
hospital.Base on Henderson’s theory this family really has an alteration in their 14
Fundamental Needs of Humans.
20

21. Medical Management for Hypertension
Overview of Hypertension
Hypertension or High Blood Pressure, medical condition in which constricted
arterial blood vessels increase the resistance to blood flow, causing an increase in
blood pressure against vessel walls. The heart must work harder to pump blood
through the narrowed arteries. If the condition persists, damage to the heart and
blood vessels is likely, increasing the risk for stroke, heart attack, and kidney or heart
failure. Often called the “silent killer,” hypertension usually causes no symptoms until
it reaches a life-threatening stage. Hypertension is a major risk factor
for cardiovascular disease (CVD) - cerebrovascular event (CVE) and ischemic
heart disease (IHD) and, as such, is one of the most important preventable causes
of premature morbidity and mortality in developed and developing countries. Yet
studies still show that hypertension remains under diagnosed, undertreated and
poorly controlled. The benefits of antihypertensive therapy in reducing the incidence
of CVD depend largely on blood pressure (BP) lowering - so achieving stated BP
targets is important.
Ideal Medical Management
Physicians recommend that people with prehypertension undergo diet and
lifestyle changes, such as losing weight and quitting smoking, in order to prevent a
rise in blood pressure. Some patients can lower their blood pressure by limiting salt
in their diet. Increasing physical activity and reducing alcohol consumption to less
than two drinks per day for men and one drink per day for women may also lower
blood pressure.
For those with stage 1 and stage 2 hypertension, a physician may prescribe diet
and lifestyle changes, as well as one or more drugs known as antihypertensive.
Diuretics are antihypertensive that promote excess salt and water excretion, reducing
21

22. the amount of fluid in the bloodstream and relieving pressure on blood vessel walls.
Beta blockers reduce heart rate and the amount of blood the heart pumps. ACE
inhibitors prevent the narrowing of blood vessel walls to control blood pressure.
Calcium channel blockers slow heart rate and relax blood vessels. Studies show that
two drugs are more effective than one drug at lowering blood pressure to less than
140/90 mm Hg.
Laboratory and diagnostic test for hypertension
Besides taking your blood pressure, your doctor will do a physical exam and
ask you questions about your medical history. Your doctor may also have you get
other tests to find out whether high blood pressure has damaged any organs or
caused other problems. These tests may include:
• Urine tests to check for kidney or liver disease.
• Blood tests to check your levels of potassium, sodium, and cholesterol.
• A blood glucose test to check for diabetes.
• Tests to measure kidney function.
• An electrocardiogram (EKG, ECG) to find out whether there is any damage to
the heart. Your doctor may also check your risk of coronary artery disease.
In some cases, you may be asked to check your blood pressure at home and
keep a record of the readings. If you can't do this, you may need ambulatory blood
pressure monitoring. This means wearing a special device for 24 to 48 hours. The device
automatically takes your blood pressure throughout the day.
22

23. Actual Medical Management
Mrs. XY tell us that she was diagnosed with hypertension by a doctor last
2009.The doctor prescribed her with antihypertensive drug which is Captopril 50 mg.
1 tab per day. Aside from that, she also practices traditional medicine which
is”pinakuluang guyabano” as an alternative if she cannot buy Captopril. She also
practices eating less salty and fatty foods as advised by the doctor.
23

24. Drug Study
Brand Name: Captopril
Generic Name: Capoten
Drug Classification: Anti-hypertensive drug, cardiovascular agent
Indications: Hypertension; in conjunction with digitalis and diuretics in CHF, diabetic
nephopathy
Contraindications: Pregnancy, lactation. Safe use in children not established.
Mechanism of action: Lowers blood pressure by specific inhibition of the
angiotensin-converting enzyme. This interrupts conversion sequences initiated by
renin that lead to formation of angiotensin II, a potent endogenous vasoconstrictor.
Dosage: She took 1 tab Captopril 50 mg. Adult Is PO 6.25-25 mg TID may increase
to 50 mg TID.
Side effects: Hyperkalemia, pruritus, azotemia, nephrotic syndrome, urticarial,
dizziness, photosensitivity
Nursing responsibilities:
1. Monitor BP closely following the first dose. A sudden exaggerated
hypotensive response may occur 1-3 of first dose especially those with
high BP.
2. Advise bed rest and BP monitoring for the first 3 hours after the initial
dose.
3. Monitor therapeutic effectiveness at least 2 weeks of therapy may be
required before full therapeutic effects are achieved.
4. Consult physician promptly if vomiting or diarrhea occurs.
24

25. 5. Report darkening or crumbling of nail beds (reversible with dosage
reaction)
6. Use OTC medications only with approval of the physician.
7. Emphasize the importance of routine follow up exams or check-ups.
25

26. MASLOW’S HIERARCHY OF NEEDS
An interpretation of Maslow's hierarchy of needs, represented as a pyramid
with the more basic needs at the bottom. As one moves to higher levels of the
pyramid the needs become more complex.
Maslow’s Hierarchy of Needs
Physiologic Needs
Food
26

27. The client has inadequate intake of nutritious food such as fruits and vegetables
due to socioeconomic factor such as low financial income and she lacks supply in the
backyard.
Homeostasis
The client usually suffers from headache when she lacks sleep and elevated
blood pressure, thus unable to continue all the household chores in the remaining
hours of the day.
Shelter
Mrs. X’s house is made up of wood and some cement, as we visit their house we
observed that the materials used were already old and brittle.
Safety and Security
Prone to fire and dengue
Setting of the house is not ideal for living. Their house is built near the stagnant
water where mosquitoes can live. The setting of the house is too close to each other,
causing fire.
Mrs. XY is 47 years old. Last 2009 she was diagnosed with hypertension by a
doctor and was prescribed with antihypertensive drug which is Captopril 50mg. This
is the cause why sometimes she suffer headache when performing different
household chores, lacks sleep, and elevated blood pressure. When we took her last
vital signs we noticed that her blood pressure is high 140/90mmHg. She also told us
that when her headache occurs, she took Captopril and after how many minutes she
was relieved.
Financial security
27

28. The client is a simple housewife. She cooks one set of viand and sells it for a
living. Her husband is a trisikad driver that earns a monthly income that ranges from
P2000-3000 per month.
Love and Belongingness
Family
Closely knit relationship with the family but with readily conflict between members.
Self-esteem
Self-esteem is low
When we conduct our interview to her she is quite shy though she welcomed us
warmly. She is quite conscious about the condition of their house. And we observed
that she lacks confidence to herself.
Self-actualization
On-going process to reach this stage.
28

29. PROBLEM IDENTIFICATION
(Health Threat, Health Deficit, Foreseeable Crisis)
Health Threats
• The house is made of wood and cement. The houses setting is too near to
each other and they are prone for fire cases.
• The location of the house is prone of diseases because they are near in
stagnant water.
• They do not have proper storage of food like refrigerator or food cabinets,
thus, their food is prone to contact with flies or other pests which might cause
disease.
• Their toilet facility is near their kitchen, there is possibility that flies from the
toilet will come in contact with their food when they are just preparing or
cooking for their meal.
• The father and son are occasional alcohol drinkers.
Health Deficits
• Hypertension (mother of the family is diagnosed last 2009)
• The father also has hypertension and was diagnoses last 2011
Foreseeable Crisis
• Father’s occupation is unstable and does “padyak” for a living; monthly income
ranges from 500-1,000 pesos
29

30. • Mother has token business and a carpenter. With a monthly income of 2,000-
3000 pesos.
LACK OF
FINANCIAL
RESOURCES
INTERPRETATION FORMULA SCORE
Nature of the
problem
Foreseeable crisis = 1 Score/3 x 1 1/3 x 1 = 0.33
Modifiability of the
problem
Partially modifiable = 1 Score/2 x 2 ½ x 2 = 1
Preventive Potential Moderate = 2 Score/2 x 2 2/3 x 1 =
0.66..
Salience Needing immediate
attention = 2
Score/2 x 1 2/2 x 1 = 1
TOTAL SCORE
2.99
30

31. 31
HEALTH
PROBLEM
FAMILY
NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVES
OF NURSING
CARE
NURSING
INTERVENTIONS
METHODS
OF NURING
FAMILY
CONTACT
RESOURCES
REQUIRED
EVALUATION
Hypertension Inability to
recognize
the presence
of health problem
dueto:
A. Lackof
or inadeq
uate
knowledg
e.
B. Inability
to make
decision
with
respect
taking
appropriat
ehealth
actions
After nursing
intervention the
family will
makenecessary
measures
to properly
manage,
control, and
lessen the
risk factors
of hypertension
After nursing
intervention the
family will beable
to:
A. Have adequate
knowledge, agood
proper nutrition
that reduces
hypertension,
preventsthe
occurrence of
relative
complications in the
future.
B. Be able to
determine the risk
factor that
contribute
hypertension such
asfamily history,
and age, salt and
alcohol intake, and
obesity
Practice proper
lifestyle with
regards to
nutrition
and physical
fitness
• Assess the
family level
of understanding
regardingthe
health problem
• Discuss with the
family the nature
signs and
symptoms and
complication that
might arise due
to hypertension
• Discuss with the
family/client the
risk factors
of hypertension
suchasfamily
history, age, salt
and alcohol intake
andobesity.
• Promotehealthy
lifestyle such as
a.Encourage prop
er food intake
like reduce salty
and fatty foods
andinclude DASH
diet plan.
Prevent obesity
through proper nut
rition and
exercise.
c.Smoking
cessation.
• Provideinformation
regarding
community
resources;support
the patient in
making lifestyle
changesand
initiate referrals
Home visit
and
Clinic visit
Material resources:
 Visual aid
 FNAT,NAT
 FCS format
Human resources:
 Time and
effort of the
student
nurse and
family/client.
Financial resources:
Transportation
expenses of the
student nurse to
conduct home visit.
Partially Met
After the nursing
intervention: the
client verbalized
understanding of
dieases process
and treatment. As
evidence by Mrs.
XY verbalization
“Dili nako
magkaon ug mga
bawal na
pagkaon, mga
taba ug mga
parat. “

32. HEALTH
PROBLEM
FAMILY NURSING
PROBLEM
GOAL OF
CARE
OBJECTIVES OF
NURSING CARE
NURSING
INTERVENTIONS
METHOD
S OF
NURING
FAMILY
CONTAC
T
RESOURCES
REQUIRED
EVALUATIO
N
Insufficient
income to
provide all
the needs of
every
member in
the family
Inability to provide a
home environment
conducive to health
maintenance and
personal
development due to:
a. Inadequate
family
resources,
specially:
 Financial
resources
 Physical
facilities, i.e.
living space
and water
 Health
maintenance
The family
will decide
on
appropriat
e action(s)
and
alternative
solution to
properly
manage
the
problem
related to
inadequat
e family
income.
After the nursing
intervention the
family will be able
to:
a. Enumerate
the various
ways of
livelihood
plan.
b. Explain the
importance
of having
health
action with
the readily
available
resources.
c. Plan a
budget for
their health
maintenanc
e.
• Discuss the
implication
of
insufficient
income in
the family.
R: Awareness on
the effect of not
having a budget
for their health.
• Encourage
attendance
at
appropriate
educational
program,
i.e.
pangkabuh
ayan and
other
livelihood
programs.
Home visit
and
Clinic visit
. Material resources:
 Visual aid
 FNAT,NAT
 FCS format
Human resources:
 Time and
effort of the
student nurse
and
family/client.
Financial resources:
Transportation
expenses of the
student nurse to
conduct home visit.
The patient
was able to
verbalize
understandin
g of the
disease
process and
treatment
regimen.
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33. R: other sources of
income
• Discus with
the family
the courses
of action
that they
have
identified.
R: Lead into a
successful
planning.
• Discus the
consequen
ces of
failure to
take
appropriate
action to
the
problem.
R: Lack of
knowledge lead to
heath deficit.
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34. HEALTH TEACHINGS
• Diet
• Encourage the family members to eat a well-balanced diet, minimizing the intake
of fatty, oily and salty foods. Explain the risk factors and causes of hypertension.
Emphasize to the client the importance of reducing sodium intake or to have a
low salt diet, in any case, salt should not exceed more than three grams or about
half a teaspoon per day.
• Exercise
Emphasize the family members the importance of increasing aerobic physical activity
(30-45 minutes most days of the week) like brisk walking which promotes proper
blood circulation. Regular exercise has been shown to be a powerful tool in the
prevention of hypertension.
• Unhealthy Habits
Educate the family members on the disadvantages of smoking and intake of alcohol
and its effect to the body.
• Sleep/Rest Pattern
Emphasize to thefamily membersthat each of them must have an adequate rest or
sleep everyday which is very important to prevent fatigue, exhaustion and stress that
can be a predisposing factor to some diseases like hypertension.
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35. • Environmental Sanitation
1. Teach the family members the importance of proper hand washing and its benefit
to our health.
2. Emphasize the importance of exposing the pillows and foams to the sunlight.
3. Teach the family members the importance of proper waste disposal or having a
proper toilet facility.
4. Teach the family members about oral care and proper grooming.
5. Tell client to cover the water containers as well as to cover their garbage
containers.
• Encourage the client to get her whole family involved in her care plan as well as
to remind the other family members how important it is to be sensitive to client’s
present situation
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36. IMPLICATION OF THE STUDY
• NURSING EDUCATION
The nursing family case study enlightens us to the real scenario in the
community. It also gave us the opportunity to know that community health nursing is
important so that nursing students would be able to experience how it works.The
availability of health services is necessary in the community. It gave us the view that
every community must have two public health nurses to accommodate each family.
The maintenance of the ability of both public health agencies and private
provides to manage day to day operations and the capacity to respond immediately to
the community should always be accessible.
Through nursing family case study we were able to assess the health needs of
the family, plan, implement, and evaluate the impact of health services in the community.
It gave us the basic knowledge and skills in community health nursing that one that
formulate policies and develops on nursing aspect of specific program such as health
teaching of hypertension.
• NURSING PROFESSION
In the nurse profession, competence, credibility, commitment and knowledge are
needed in the profession. The dedication of a nurse to serve in the community is
remarkable and outstanding. However, nurses must continuously enhance their
knowledge and skills to explore the capability to be used in the community.
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37. The nurse and the community must collaborate in order to achieve the nursing
intervention when dealing with diseases like hypertension and smoking habits. This
nursing case study will give the public health nurse the awareness of how the community
does the home management in their disease.
For a Nurse should enhanced the knowledge like political science helps the nurses
to understand the health care delivery system for them to better respond to clients and
use academic principles like sociology and psychology to know better on how to
understand the community.
• NURSING RESEARCH
Hypertension is one of the most common worldwide diseases; 17.1 million
deaths per year are caused by hypertension. The major causes of hypertension are
physical inactivity, an unhealthy diet and through family history. Philippines reported that
around 12.6 million of Filipinos have hypertension.
This research found out that the people in the community resolve to deal with
hypertension on their own rather than seeking medical help. This is because of their lack
of knowledge, ignorance and poverty. The researches therefore recommend that future
studies in hypertension cases in community should focus on determining tangible ways
to educate the people about the disease and the value of medical treatment in general.
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38. Health Updates
Uncontrolled Hypertension Is Common, but Untreated, Worldwide
Sep. 3, 2013 — A global study has found that many patients don't know they
have hypertension and, even if they do, too few are receiving adequate drug therapy for
their hypertension.
This is true in high income countries, like Canada, as well as middle and low
income countries, say an international team of researchers led by the Population Health
Research Institute (PHRI) of McMaster University and Hamilton Health Sciences
.
The report, which was published today by JAMA, the journal of the American
Medical Association, is part of the PURE (Prospective Urban Rural Epidemiological)
study.
"Our study indicates over half of people with hypertension are unaware of their
condition and, amongst those identified, very few are taking enough treatment to control
their blood pressure," said Dr. Clara Chow, lead author, a member of PHRI and an
associate professor of medicine of Sydney University and the George Institute for Global
Health in Australia.
Dr. Salim Yusuf, senior author and professor of medicine of McMaster
University's Michael G. DeGroote School of Medicine, added that drug treatments that
work to control hypertension are well known, however this study found only about a third
of patients who are aware of their condition were achieving target blood pressure
control.
"Blood pressure lowering drugs are generally inexpensive and commonly available
treatments," said Yusuf. "However only a third of patients commenced on treatment are
on enough treatment to control their blood pressure. This is worst in low income
countries, but significant in high and middle income countries too."
This is important because hypertension or high blood pressure is the leading
cause of cardiovascular disease, which is associated with at least 7.6 million deaths per
year worldwide.
Participants in the PURE study included 154,000 adults between 35 and 70 years old,
with and without a history of heart disease or stroke, from 17 high, middle and low-
income countries.
Each participant had their blood pressure measured and medication use
recorded, along with information about their age, gender, education, and key risk factors,
including whether they knew they had hypertension. The study found 46.5% of those
with hypertension were aware of the diagnosis, while blood pressure was controlled
among 32.5% of those being treated.
The authors could only guess at potential solutions for the poor detection and
inadequate treatment of hypertension.
"The findings are disturbing and indicate a need for systematic efforts to better detect
those with high blood pressure," said Yusuf. "Early use of combination therapies, that is,
38

39. two or more types of blood pressure-lowering treatments taken together, may be
required."
Yusuf is the executive director of the PHRI which initiated the PURE study, the only
multi-country study of its kind. The study was funded by more than 25 organizations
including the Canadian Institutes for Health Research, the Heart and Stroke Foundation
of Ontario, similar organizations in several countries and by unrestricted grants from
several pharmaceutical companies.
39

40. REACTION
This article shows the uncontrolled hypertension is common, but untreated,
worldwide. The study shows that the global study has found that many patients did not
know they have hypertension and even if they do, too few are receiving adequate drug
therapy. As we know that hypertension is a silent killer type of disease, so it is very
dangerous for us to self medication. That’s why it is necessary for us to consult a
physician if signs and symptoms occur. This will facilitate us to know the recommended
medication, diet and lifestyle.
As a health care provider, we know that prevention is better than cure. As much
as possible. Give health teaching to the people you may encounter especially if they are
at risk of having hypertension. Health teaching to them includes, low salt and low fat diet,
proper exercises, treatment regimen and also good sleep may help. Our teaching is
already a big help to them so that they can work on through their lifestyle and change it
for the good of their health.
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41. References
Mendez- Chacon et al (2008, August 5).Factors associated with hypertension
prevalence, unawareness and treatment among Costa Rican elderly.BMC Public Health,
8;275.Bio Med Central Ltd.
http://sciencedaily.com
McMaster University (2013, September 3). Uncontrolled hypertension is
common, but untreated, worldwide. Science Daily. Retrieved September 20, 2013, from
http://www.sciencedaily.com/releases/2013/09/130903193651.htm
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