EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
BSN LEVEL II
COMMUNITY HEALTH NURSING 1
FAMILY HEALTH ASSESSMENT GUIDE
Date of Assessment: 04/10/2022
Source of information/ informant: Verga Family_______________________________________________________
Head of the family: Ramon F. Verga Jr. Contact Number: 09264351963_
Address: Blk 136 Lot 27 Phase 1 Mabuhay City, Dasmarinas City, Cavite_________
Religion: ___Catholic____
Ethnic background: N/A____
FIRST LEVEL ASSESSMENT
I. Assessment of the Family, Home and Environment conditions
Members of household
Family member Relation to sex birthdate Marital Highest Occupation Length of
head status educ. Employment
Rank Name Mont Year Completed Type of place
(initials) h work
Head of Ramon F. Father/ Male 10 1963 Marrie Vocational Janitor Calamba, 13 years
the Verga Jr. Husband d Graduate Laguna
Family
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
Wife Julieta G. wife Female 07 1967 Marrie Highschoo Housewife N/A N/A
Verga d l Graduate
Eldest Jonalie G. daughter Female 12 1992 Single College Accountan Pasay, 8 years
Verga Graduate t Metro
Manila
Second Judy Ann daughter Female 08 1996 Single College Teacher General 5 years
to the G. Verga Graduate Mariano
eldest Alvarez,
Cavite
Second Julienne daughter Female 12 1998 Single College Financial Alabang 1 year
to the G. Verga Graduate Analyst Town
youngest Center,
Muntinlup
a
Youngest Jasmine daughter Female 09 2002 Single College N/A N/A N/A
G. Verga Student
1. Type of family structure: ( ) Patriarchal ( ) Matriarchal
( ) Nuclear ( ) Extended others: _________________
2. Dominant Family members in terms of decision making, especially in matters of health care
(1.) Name: Ramon F. Verga Jr. Age: 59 Sex: Male Relation to head: Father
(2.) Name: Julieta G. Verga Age: 55 Sex: Female Relation to head: Wife
(3.) Name: Jonalie G. Verga Age: 29 Sex: Female Relation to head: Daughter
3. General family relationship/dynamics
Presence of observable conflict between members: ( ) Yes ( ) Sometimes ( ) None
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
If yes/sometimes: state common conflict/s encountered: Financial Problems
How do you resolve conflict? Yes, always.
Socio-economic Characteristics
1. Family monthly income (average) P63,000
2. How much was spent for:
Water (monthly) P300.00 School (fees, materials) P50,000 (per semester)
Electricity P1,000.00 Clothing N/A
Food & grocery needs: P1,000.00 Leisure N/A
Rentals N/A others: _________
3. Who makes decision for money matters: Julieta G. Verga (Mother) specify: Water, Electricity, Food & Grocery,
Rentals, School fees.
Home and Environment
a. Ownership ( ) Owned ( ) Rented ( ) Rent-free
b. Construction materials used ( ) Light ( ) concrete ( ) mixed ( ) makeshift
c. Number of rooms for sleeping: one
d. Lighting facilities: ( ) electricity ( ) kerosene ( ) candle others (specify):_________________
e. Adequacy of living space: ( ) small ( ) enough ( ) spaceous
f. Sleeping arrangement: ( ) in one room ( ) own rooms ( ) others, Specify: Room and Living Room
g. General sanitary condition: ( ) dirty ( ) clean ( ) dusty ( ) polluted /dirty with foul-smelling environment
2. Drinking water supply
a. Source: ( ) private ( ) public
b. Distance from the house: Water supply is accessible inside the house.
c. Water Storage: ( ) none ( )direct from faucet or pipe ( ) large covered container with faucet
( ) large uncovered container without faucet ( ) others:_______
3. Kitchen
a. Cooking facility: ( ) Electric stove ( ) gas stove ( ) wooden/charcoal
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
b. Sanitary conditions: ( ) clean ( ) dirty ( ) dusty ( ) polluted
c. Drainage facility: ( ) open drainage ( ) blind drainage ( ) none
4. Waste disposal
a. Refuse and garbage
( ) covered container ( ) open ( ) none
Method of disposal:
( ) hog feeding ( ) open burning
( ) open dumping ( ) garbage collection
( ) burried in pit ( ) others; specify:_____________
( ) composting
b. Toilet type:
( ) pail system distance from house:____________________________
( ) over hung latrine ( ) antipolo type
( ) water-sealed latrine ( ) flush type
5. Domestic animals:
Kind Number Place/area where animals are kept
Cat 1 Inside the house
6. Kind of neighborhood:
( ) congested ( ) slums ( ) village/subdivision others, specify:_________________
Relationship with neighbors and larger community: Good Relationship with Neighborhood
7. Communication facilities available
( ) cellular phone ( ) letters ( ) e-mail ( ) others,specify_____________________________
8. Transportation facilities available
( ) Tricycle ( ) Jeepney ( ) personal vehicle ( ) personal motorbike ( ) pedicab ( ) bicycle
others, specify: N/A
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
II. Health status of each family member
Family member: Julieta G. Verga (Mother)
a. Risk factors
__ hypertension
__ physical inactivity
__ sedentary lifestyle
__Cigarette/tobacco smoking
__ elevated blood lipids/Cholesterol
__ obesity
__ diabetes mellitus
__inadequate fiber intake
__ stress
__ alcohol drinking
__ Substance abuse
OTHERS: _________
b. Physical assessment indicating presence of illness (diagnosed or undiagnosed by medical practitioners)
My mother was diagnosed with gouty arthritis.
c. Results of laboratory/ diagnostic and other screening procedures supportive or assessment findings
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
III. Values, Habits,
Practices on health
promotion, Maintenance
and Disease
Prevention
A. Immunization
status of family
members
( children 0-5
years old)
( ) Fully
immunized
( ) Partial / not fully
immunized
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
Name of Child (0-5 years old) Age and birthday List of vaccines received Number of doses
(name of vaccine)
N/A N/A N/A N/A
B. Health & lifestyle practices
( ) maintain a balanced diet
( ) drink plenty of fluid/water
( ) eat fruits and vegetables
C. Adequacy of:
Sleep
How many hours a day: 6-7 hours
Exercise
__yes __no if yes; how many times a week: twice a week
D. Frequent hand washing:
___ yes ___ no
Protective Wears
__ use of footwear when going outside
__ use of mosquito net
__ use of insect repellent lotion
__ use of face mask/face shield
IV. Use of Promotive-Preventive health services
Do you avail the health services in your barangay?
__ yes __ no
If yes; how often? Only when needed
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
State health services available in your barangay:
1. Immunizations
2. Maternal and prenatal care
3. Contraceptive (Injectables)
4. Prevention and Monitoring of Hypertension
5. Communicable Disease Prevention and Monitoring
SECOND LEVEL ASSESSMENT
Validate interview data on realities or experiences regarding performance of the family health tasks:
A. Determine if the family recognizes the existence of the condition/ problem. If the family does not recognize
the presence of the condition/ problem, explore the reasons why.
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
1. What does the family think about your mother’s condition (gouty arthritis)?
“Two years ago, na diagnosed si mama ng gout, through laboratory test nakita na mataas yung uric acid
niya. Sinunod naman payo and reseta ng doctor, pero di maiwasan yung mga bawal na pagkain, kaya lumala
nang lumala hanggang hindi na siya makalakad ”.
2. What do you think is the reason why she appears thin. Why, do you think she lose some weight?
“Pumayat na siya and malaki talagang timbang nabawas sa kanya, sa tingin naming e dahil sa sakit niya
yon, hindi na nakakuha ng enough na sustansya yung katawan niya dahil na din sa sobrang daming bawal na
pagkain sa kanya”.
3. What do you think is happening to your mother?
“Siguro over time lumala na nang lumala yung gout niya, consistent naman siya sa iniinom niyang gamot pero
umakyat na den sa braso at mga kamay niya yung attack ng gout, sa joints ng braso niya di na den niya
maitiklop”.
B. If the family recognizes the presence of the condition/ problem, determine if something has been done to
maintain the wellness state or resolve the problem. If the family has not done anything about it, determine
the reasons why, If the family has done something about the condition or problem, determine if the
solution is effective.
1. What has been done to improve her condition?
“ Nagtatake siya ng gamut and maintenance para mabawasan yung pananakit ng mga tuhod at paa niya”.
2. What is the family’s plan regarding this?
“Pinagiisipan pa naming if ooperahan nalang ba siya, yung joint replacement surgery kaos baka hindi kayanin
ng katawan niya”.
3. What improvements in the condition have been observed?
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
“Sa pagtatake niya ng vitamins at maintenance, nakatutulong naman sa kanya yun para mabawasan yung sakit
and hindi na lumala gabi gabi”.
4. What do you think the family should do about it?
“Napagisipan namin na baguhin yung lifestyle niya and maging strict yung diet and food restrictions niya.
Umiinon den siya ng fruit and vegetable shake para magsilbing anti-inflammatory na natural”.
C. Determine if the family encounters other problems in implementing the interventions for the wellness
state/potential, health threat, health deficit, or crisis. What are these problems?
1. What was the reason of having inadequate sleep?
“Ako kase (Julienne Verga), may trabaho ako pang gabi, kaya ang umaga ko nagiging gabi, s aumaga ako
nakakatulog nang mahaba”.
2. What do you do to improve or fix the sleeping schedule?
“Sinusubukan kong bawiin sa day off ko yung kulang na tulog ko, pero hindi talaga kaya, iba pa den yung 7-8
hours na tulog araw araw”.
3. What are the effects of having lack of sleep?
“Pag kulang tulog ko, mabilis ako mairita, madalas nahihilo ako pag natayo, tas sympre nalilipasan den ako ng
gutom”.
4. What do you think you should do about it?
Nagiba na talaga yung body clock ko, kahit s aumaga out ko di ako makatulog agad kaya umiinom ako ng
melatonin gummies para mabilis ako antukin.
D. Determine how the other family members are behaving towards each other or how they are affected by the health
condition /problem.
1. How are the other members affected by your mother’s arthritis?
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
“Sympre mahirap para samin na makitang hindi na nakakalakad si mama, namayat na din siya. Kahit kami
naststress den sa sakit niya. Pero di naman kami nawawalan ng pag asa na gagaling siya”.
2. How are the other members reacting to your mother’s sudden bed ridden stage?
“Dahil stress na din si mama sa sakit niya, hindi na kami dumadagdag sa ikakainit ng ulo niya, sinisigurado
namin na healthy yung mind niya and hindi mabaon sa lungkot si mama, hindi madali pero kakayanin naming
hanggat gumaling siya”.
Thank you!
_____Jasmine G. Verga______
Name & Signature of Student Nurse
SUBJECTIVE CUES AND DATA FAMILY NURSING PROBLEM
Verga family usually eat ready made from karinderya and
fast-food restaurants due to busy schedule. They often cook Inability to balance nutrition due to lack of knowledge
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
vegetable and fruits on weekends.
Imbalanced Nutrition (Health Threat)
Name: Julienne G. Verga
BP: 90/60 mmHg
“Hindi ako nakakakumpleto ng tulog, kase may work ako pang Insufficient sleep, inadequate quality of sleep due to work
gabi. Kaya yung umaga ko, nagiging gabi kase don lang ako and environment
nakakabawi ng puyat sa gabi” as quoted by one of the members
of the family.
Inadequate Rest and Sleep (Health Threat)
Due Name: Julieta G. Verga
Age: 55 years old
Inability of the patient to continue her medication due to:
BP: 110/70 mmHg
- has high uric acid a. Inability of patient to visit hospital for regular
- eats fruits and vegetables checkup
- has a family history of arthritis b. Inadequate knowledge of the condition
Arthritis (Health Deficit)
A. Imbalanced Nutrition
CRITERIA SCORE JUSTIFICATION
1. Nature of the Problem (Scale 1) It is considered as a health threat since it can
2 X 1 = 0.66 lead to the complication or difficulty of the
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
Health Deficit - 3 3 family's health status, with the imbalanced
Health Threat - 2 nutrition they consume, always consuming high-
Foreseeable Crisis - 1 salt and high-fat foods may cause an increase in
blood pressure.
2. Modifiability (Scale 2) It is easily modifiable because they can be
2 X2=2 educated the value of adequate food intake in
Easily Modifiable - 2 2 daily life, such as eating fruits and vegetables.
Partially Modifiable - 1 Through our nutritional health education, the
Not Modifiable - 0 family recognized the risks to their health of
eating an imbalanced diet.
3. Preventive Potential (Scale 1) It is highly preventive because, as I observed on
High - 3 3 X1=1 my family, we practiced how to maintain a
Moderate - 2 3 healthy lifestyle by limiting their intake of salty
Low - 1 and fatty acid meals.
4. Salience of the problem (Scale 1)
A serious problem, needing
immediate attention - 2 The family is oriented on the problem of eating
1 X 1 = 0.5 unhealthy foods, but they see it as a minor issue
A problem but not needing 2 that does not require immediate attention.
immediate attention - 1
Not a felt need / problem – 0
TOTAL SCORE: 4.16
B. Inadequate Rest and Sleep
CRITERIA SCORE JUSTIFICATION
1. Nature of the Problem (Scale 1)
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
2 X 1 = 0.66 It is considered as a health threat since it can
Health Deficit - 3 3 lead be risk to serious health conditions such as,
Health Threat - 2 high blood pressure and anemia.
Foreseeable Crisis - 1
2. Modifiability (Scale 2)
1 X2=1 It is partially modifiable because they can be
Easily Modifiable - 2 2 educated about the value of completing 7-8
Partially Modifiable - 1 hours of sleep every night which can be
Not Modifiable - 0 beneficial to mental and physical wellbeing.
3. Preventive Potential (Scale 1) It is moderately preventive because as I
High - 3 2 X 1 = 0.66 observed the family member, she tries to have
Moderate - 2 3 complete sleep on rest days.
Low - 1
4. Salience of the problem (Scale 1)
A serious problem, needing
immediate attention - 2 The family member is oriented on the problem of
1 X 1 = 0.5 inadequate rest and sleep, but she sees it as a
A problem but not needing 2 minor issue that does not require immediate
immediate attention - 1 attention.
Not a felt need / problem – 0
TOTAL SCORE: 2.82
C. Arthritis
CRITERIA SCORE JUSTIFICATION
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
1. Nature of the Problem (Scale 1)
3 X1=1 It is considered a health deficit because it is
Health Deficit - 3 3 already diagnosed by a medical practitioner and
Health Threat - 2 the patient is disabled.
Foreseeable Crisis - 1
2. Modifiability (Scale 2)
1 X2=1 It is partially modifiable because the family can
Easily Modifiable - 2 2 be educated on the intervention to manage the
Partially Modifiable - 1 problem physically.
Not Modifiable - 0
3. Preventive Potential (Scale 1) It is lowly preventive because the condition of
High - 3 1 X 1 = 0.33 the patient has gotten worse over time, and it
Moderate - 2 3 already affected different parts of her body.
Low - 1
4. Salience of the problem (Scale 1)
A serious problem, needing The family member is oriented on the problem
immediate attention - 2 or condition of the family member and they see
2 X1=1 it as a serious problem that needs immediate
A problem but not needing 2 attention.
immediate attention - 1
Not a felt need / problem – 0
TOTAL SCORE: 3.33
RANKING AND SCORING OF EACH HEALTH PROBLEM
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EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat St., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42 [Link]
SCHOOL OF NURSING
ISO 9001:2015 CERTIFIED
QUALITY MANAGEMENT SYSTEMS
List of Health Problems Ranked According to Priorities
HEALTH PROBLEMS SCORE
1. Imbalanced Nutrition 4.16
2. Inadequate Rest and Sleep 2.82
3. Arthritis 3.33
After collecting and computing the database on the criteria, the top and should be the priority of Verga’s Family
Health Problems is the Imbalanced Nutrition.
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