Transcript Stage of the Family Life Cycle JR

PAMILYA
Gavino, Cherylle
Mirallo, Alfred
Ngo, Martin
Outline
I. Index Case Profile
II. The Family
III. Journal
IV. Family Wellness Plan
INDEX CASE PROFILE
General Data
L.G.
28 years old, male
separated,
Roman Catholic
Brgy. Palahanan 2.0, San Juan, Batangas
Non- hypertensive, non- diabetic, non-asthmatic
Moderate to heavy alcoholic beverage drinker for
about 1 year
Chief Complaint
Epigastric pain
History Of Present Illness
DOI: 3 days PTC (6/6/09)
POI: San Juan high way
MOI: motorcycle crash; patient fell on his L side
hitting a hard pavement; he sustained
hematoma and abrasions on L face, L UE, L LE;
(-) LOC, BOV, vomiting. No consult was done.
For 3 days, patient already (+) epigastric pain
VAS 4-5, intermittent, non-radiating, no meds
taken.
History Of Present Illness
3 hours PTC:
(+) epigastric pain, characterized
as parang pinipiga,VAS 8- 9/10, non-radiating
(+) pallor, diaphoresis, cold-clammy extremities
(+) frequent skipping meals
(-)dizziness, fever, chest pain, dyspnea, vomiting,
melena, hematochezia, rashes, pruritus
Review Of Systems
(-) weight loss/gain
(-) headache, anorexia, seizure
(-) blurring of vision, decrease hearing
(-) cough, colds, palpitation, orthopnea
(-) dysuria, polyuria, urinary/bowel changes,
urgency
(-) paresthesia, arthralgia, myalgia, rashes, tremors
(-) pedal edema
Past Medical History
No hypertension, diabetes, asthma,
hepatitis, cancer, heart or kidney
disease
No allergies
No previous hospitalizations/surgeries
Family Medical History
(+) MI- father; 5 cases heart disease on
paternal side
(+) diabetes mellitus on sibling
No asthma, hepatitis, cancer, kidney
disease
Personal- Social History
Patient is separated for almost a year now. His exwife, Mary Ann, is in Italy with her own family
already. Blessed with two children, his youngest is
only 7. The patient is currently unemployed and is
supported by Tita Linda who took care of JR since
childhood and is currently an immigrant in Italy. JR
is also waiting for employment abroad. His children
will be left under the custody of his mother when
the time comes JR will leave. Patient is a nonsmoker, moderate alcoholic beverage drinker for 10
years then heavy since last year, denies illicit
drug use.
Physical Examination
General: Awake, coherent, in pain
Vitals: BP 130/80 HR 90 RR 26 (tachypneic) T
36.7 BMI 31
HEENT: Anicteric sclerae, pale conjunctivae, (-)
tonsillo-pharyngeal congestion/neck vein
engorgement/cervical lymphadenopathy
CHEST: Equal chest expansion, clear breath
sounds, (-) crackles/wheezes
HEART: Adynamic precordium, distinct heart
sounds, regular rate/rhythm, (-) murmurs
Physical Examination
ABDOMEN:
Flabby abdomen, normoactive bowel
sounds, (-) organomegaly, (+) tenderness
on epigastric area, (-) Rovsing’s/Murphy’s
sign
EXTREMITIES: Pale to cyanotic nailbeds, full
equal pulses, (-) jaundice/edema, (+)
bruises and abrasions on L face, L UE/LE
Impression
Acute abdomen secondary to trauma
Obese Class 1
Chronic alcoholism
Differential Diagnosis
Acute abdomen secondary to trauma probably
bleeding
Rule in: history of trauma 3 days PTC, pale
conjunctivae, diaphoresis, pale to cyanotic nailbeds
Cannot be ruled out though vitals seem to be
normal
Angina pectoris
Rule in: epigastric pain as anginal equivalent
diaphoresis, cold clammy extremities
Cannot be ruled out
Differential Diagnosis
Acute cholecystitis/cholelithiasis
Rule in: epigastric pain, obesity
Rule out: non- colicky pain, no jaundice, no history
of prior epigastric pain nor RUQ pain, (-) Murphy’s
Acute pancreatitis
Rule in: (+) epigastric pain, history of moderate to
heavy alcohol consumption
Rule out: non- radiating pain
Management
• Referred to hospital for further
evaluation
• Patient admitted to Mary Mediatrix
Medical Center
– Holoabdominal UTZ: 800 cc blood in
peritoneal cavity
– EL done showed ruptured spleen
– Splenectomy was done
Course of Hospitalization
• Upon arrival at the ER, BP was stable at
110/80 with a heart rate of 98, examination
of the abdomen revealed tenderness.
• Scheduled for EL and 2 units of pRBC
prepared, found to have ruptured spleen
hence splenectomy procedure done which
the patient tolerated well.
• Discharged improved after 8 days.
FAMILY ASSESSMENT
Family Assessment Outline
I. Family structure and function
•
•
•
•
Genogram
Type of Family
Stage in the Family Life Cycle
Timeline
II. Family Psychodynamics
• Mapping
• Decision maker
• Primary caregiver
• APGAR
• SCREEM
FAMILY GENOGRAM
Gutierrez-Alcantara
June 17, 2009
Linda, 58 Ade, 58
H
Levy Emma, 56
1996
Bryan,
32
Fe, 30
Ericka, 9
D
Jesse, 31
Erwin, 30 Ana, 28
JR, 28
Ann, 31
2008
2008
Sharmaine, 7 Sharlene, 5 L J, 8
Legend: H-heart disease; D-Diabetes Mellitus
6 siblings
Toto, 7
??, 1
Type of Family
Family Structure
• JR-Anna family is a single-parent
family: ever since failure of
marriage, JR is the sole person
assuming parenthood to 2 sons.
• JR and 2 sons are part of an
extended family, the Levy-Emma
family
Type of Family
Family Social Class Pattern
• Middle class:
• The family believes in hardwork,
initiative, independence,
responsibility, economic security
and self-improvement through
education and schooling
Type of Family
Family set-up
• Democratic:
• parents respect their child’s
decisions and ideas; understanding
and permissiveness prevail
Stage of the Family Life Cycle
Levy-Emma Family
• Launching family to Family in later
years
• Bryan, who is first born and the first to marry,
stays in his parents house with his spouse, Fe, and
their daughter.
• Jesse, 2nd son is still single and lives with the
parents’ house
• JR, who is the youngest and married almost the
same time as Bryan, still stays with his parents
house with his 2 sons.
• Levy, who is the father, passed away when the
family was still in the stage of Family with
Adolescents
Stage of the Family Life Cycle
JR-Anna Family
• Family with Young Children
• JR and Anna have 2 sons: a 9-year old and an 8year old
• Anna went to Italy 3 years ago. JR and Anna are
already separated for a year. Anna who is in Italy
has her own family with 1 child.
• Second order changes:
• Taking on parenting roles.
• JR who is a single parent now is the sole person
assuming the parenting role with the help of his
mother, siblings and other relatives like Balut-Rizza
couple
Stage of the Family Life Cycle
JR-Anna Family
• First order changes:
• Sharing responsibilities within the
extended family and between
members of the growing family.
• Instead of sharing parenting
responsibilities with his spouse; JR
shares it with his siblings, mother,
and other relatives
Stage of the Family Life Cycle
JR-Anna Family
• First order changes:
• Maintaining mutually satisfactory sexual
relationship and planning for the future of
children
• JR being separated from this spouse for 3
years obviously has no sexual relationship;
also he is not in constant consultation with
his spouse regarding the future of their
children
Stage of the Family Life Cycle
JR-Anna Family
• First order changes:
• Cultivating the full potentials of
relationships with relatives within the
extended family.
• JR’s family is very much involved in raising
his 2 sons
Stage of the Family Life Cycle
JR-Anna Family
• Problems encountered by the
parent/s:
• Medical: Episodic medical problems like
the vehicular crash incident that
happened to JR
Stage of the Family Life Cycle
JR-Anna Family
• Problems encountered by the
parent/s:
• Emotional/Social:
– Resort to alcoholism and peer pressure due to
marriage failure; JR started to become heavy
alcoholic drinker when he knew his spouse has
new family.
– The physical and emotional absence of the
mother has a great impact on the children’s
development.
– Job related problems, child-rearing problems,
and communication with in-laws
Jr- Anna Family Timeline
Jr was in 1st year College wen
Jr and
Anna
got married
he eloped
with
Anna
because Anna was then
pregnant
LJ was born
Theborn
couple decided to sell the
Toto was
The
failed to
hence
jeepneybusiness
Jr was driving
put
Anna
decided
to
go
to
up a vegetable business inItaly, LJ
Anna
remittance
Totosends
was 4.
Jr did
Lipawas 6 and
Jr’s inlaws
monthly
until
sheconfirmed
stopped that
not agree
to this
but
left
Anna
has
another
family in
mid
year
of 2007
them nosending
choice
Jr decided
Italy and gave birth.
Start ofto apply for Saudi.
Jr’s heavy alcoholHe is waiting for his VISA until
consumption he had the crash.
1998
1999
2000
2002
2005
2006
2007
2008
2009
FAMILY MAP
Levy
1996
Balut
Rizza
Linda, 58
Ade, 58
6 siblings
Emma, 56
JR, 28
Jesse, 31
Bryan,
32
Erwin, 30
Ann, 31
2008
2008
L J, 8
Toto, 7
??, 1
Decision Maker
• Nanay Emma is the decision
maker of the family together
with Nanay Linda and Nanay
Ade
• Nanay Linda took care of Jr
since childhood
• JR is decision maker for his 2
sons.
Primary Caregiver
• Jesse who is still single is the primary
caregiver when JR was hospitalized
• Absence of Anna had an impact on
this part
FAMILY APGAR
Jr
Almost
always
A
I am satisfied that I can turn to my family for help
when something is troubling me.
P
I am satisfied with the way my family talks on things
with me and shares problems with me.
G I am satisfied that my family accepts and supports
my wishes to take on new activities and directions.
A
I am satisfied with the way my family expresses
affection and responds to my emotion such as anger,
sorrow and love.
R
I am satisfied with the way my family and I share
time together.
TOTAL
Some of
the time





8
Never
Nanay Emma
Almost
always
A
I am satisfied that I can turn to my family for help
when something is troubling me.
P
I am satisfied with the way my family talks on things
with me and shares problems with me.
G
I am satisfied that my family accepts and supports my
wishes to take on new activities and directions.

A
I am satisfied with the way my family expresses
affection and responds to my emotion such as anger,
sorrow and love.

R
I am satisfied with the way my family and I share time
together.

TOTAL
Some of
the time


9
Never
Bryan
Almost
always
A I am satisfied that I can turn to my family for help
when something is troubling me.
P

I am satisfied with the way my family talks on
things with me and shares problems with me.
G I am satisfied that my family accepts and supports
my wishes to take on new activities and directions.
Some of
the time



A I am satisfied with the way my family expresses
affection and responds to my emotion such as
anger, sorrow and love.
R I am satisfied with the way my family and I share
time together.
TOTAL

8
Never
Jesse
Almost
always
A
I am satisfied that I can turn to my family for help
when something is troubling me.
P
I am satisfied with the way my family talks on
things with me and shares problems with me.
G
I am satisfied that my family accepts and supports
my wishes to take on new activities and directions.
A
I am satisfied with the way my family expresses
affection and responds to my emotion such as
anger, sorrow and love.
R
I am satisfied with the way my family and I share
time together.
TOTAL
Some of
the time





8
Never
Fe
Almost
always
A I am satisfied that I can turn to my family for help
when something is troubling me.
P I am satisfied with the way my family talks on
things with me and shares problems with me.
G I am satisfied that my family accepts and supports
my wishes to take on new activities and directions.
A I am satisfied with the way my family expresses
affection and responds to my emotion such as
anger, sorrow and love.
R I am satisfied with the way my family and I share
time together.
TOTAL
Some of
the time





10
Never
Family Function
• Family is highly functional.
FAMILY SCREEM
SOCIAL
Resources
Pathology
•The family is close-knit and
•The absence of Anna makes a
good relationships exist
among its members. The
family maintains good
relationships with their
neighbors, who are mostly
their relatives.
great impact on JR, Toto and LJ.
There’s an incidence when LJ did
not want to speak to Anna when
the latter called.
• JR is not open about his
feelings and thoughts about Anna
CULTURAL
Resources
•All family members were born
and raised in San Juan, Batangas
and are proud to be Batanguenos.
•The family also participates in
community activities such as town
fiestas, funerals, brgy
gatherings/meetings.
•In fact, Bryan and Jesse, are
elected Brgy officials
Pathology
RELIGIOUS
Resources
•
All family members were born and
raised as Catholics; they always
attend the Sunday masses and
foster the values like love of
neighbor, hope, and charity.
Pathology
EDUCATIONAL
Resources
Pathology
• Levy and Emma are both
college graduates as well as
their 3 sons except JR. Erika
who is the daughter of
• JR cannot land on a stable
Bryan and Fe is currently in job here because he was
grade 3; while LJ and Toto
unable to graduate College
who are the sons of the
index patient are in Grade 3
and 2 respectively.
ECONOMIC
Resources
Pathology
•Since Mang Levy died, Nanay
Emma became the sole bread
winner of the family
• Currently, the family’s economic
status is stable with Nanay still
into teaching.
* There seems to be no economic
• Bryan who is already married
have stable job as an engineer.
problem within the family; in fact
•Jesse is on application for OFW;
Tita Linda who lives in Italy
•Erwin is leaving for Saudi on
financed JR’s hospitalization.
June 29.
•JR is also applying as an OFW
with his Tita Linda as his
financier; Tita Linda has been
JR’s financier/supporter since his
childhood.
MEDICAL
Resources
•The family seeks consult at
the Rural Health Center or
any private hospital in Lipa
City whenever they have
medical problem.
Pathology
•Jesse, who is the second
child, has been recently
diagnosed to have Type 2 DM.
JOURNAL REPORT
Family Breakup: The Ugly
Side Of Migration
General Data onOFWs
• The annual number of Filipinos
going overseas on officially
processed work contracts rose
sixfold from 36,035 to 214,590
between 1975 and 1980, and more
than tripled again by 1997 to
701,272
• In June 1997, 6 percent of Philippine
households had one or more
members working overseas
Remittances
• The deployment of more than a million Filipino
workers annually is a great boon to the
Philippine economy
• In February 2002, US$1.1 billion were remitted
through formal financial channels (which do not
include those sent through friends and relatives
and informal money remittance channels)
• 20 million Filipinos, ¼ of the population, depend
on the earnings of their migrant relatives
Problems Encountered
• OFWs experience excruciating adjustment
period in foreign territories with strange
customs and laws
• No support system or a caring and
understanding community where the OFW
can seek emotional, legal and technical
assistance
• Oftentimes, they seek help/companionship
from other OFWs
Problems Encountered
• In 1999, the POEA reported 1,439
abandoned families; in 2000, still 1,344
• Government agencies and migrant
organizations focus more on issues dealing
with rights of overseas workers, such as
providing assistance to address labor
malpractices or gender-based violence
• The issue of family separation and
breakdown has not been given due attention
Problems Encountered
• These breakdowns usually occur in
places where there are many restrictions
in mobility and social networking
• Children are caught in the middle; they
suffer enormous emotional and
psychological distress (especially when
the parent left behind starts to
badmouth the OFW parent)
Possible Remedies
• To study the possibility of including in
bilateral agreements between the
Philippines and host countries
mechanisms for both the enforcement of
court judgments and implementation of
provisions for support for families left
behind
Possible Remedies
• To extend legal assistance to aggrieved
spouses and families
• To deploy more social workers abroad
• To prod local government units to
become more involved
• To file legislation to protect abandoned
families
Family Wellness Plan
Wellness Plan for JR
A. Screening:
• Daily personal hygiene
• Monthly BP monitoring
• Biannual dental hygiene
• Annual periodic PE which includes CXR for
PTB screening, flu immunization
• Reduce alcohol intake into moderation: 1
glass/day; smoking cessation
B. Developmental monitoring:
• Obesity counselling
• Mental health
• Marital and family relationship
• OTC for common ailments
Wellness Plan for Nanay Emma
A. Screening:
• Daily personal hygiene
• Monthly BP monitoring
• Biannual dental hygiene
• Annual periodic PE which includes CXR for PTB
screening, flu immunization
• Reduce alcohol intake into moderation: 1 glass/day
• For Bryan: family planning, infertility, having
second child
• For Jesse: blood sugar monitoring
B. Developmental/monitoring:
• Weight/obesity counselling
• OTC medications for common ailments
• Sanitation issues, accident exposure and
prevention
Wellness Plan for Bryan and Jess
A. Screening:
• Daily personal hygiene
• Monthly BP monitoring
• Monthly self breast examination and annual by MD
• Annual PE which includes cholesterol monitoring,
visual examination, pap smear, rectovaginal
examination, occult blood test, urinalysis, CXR
• Biannual dental examination
• DT and flu immunization
B. Developmental/monitoring:
• Obesity counselling
• Mental health
• Marital and family relationship
• OTC for common ailments
• Sanitation issues, accident exposure and
prevention
Wellness Plan for Fe
A. Screening:
• Daily personal hygiene
• Monthly BP monitoring
• Biannual dental examination
• Annual PE which includes breast examination,
CXR, urinalysis
• Family planning, infertility, having second child
B. Developmental/monitoring:
• Weight counselling
• Marital and family relationship
• OTC medications for common ailments
• Sanitation issues, accident exposure and
prevention
Wellness Plan for LJ, Toto , and Ericka
A. Screening:
• Annual fecalysis for intestinal parasitism
• Annual PPD
• Annual PE
• Biannual dental hygiene check up
• Daily personal hygiene
• Health behavior assessment if increase
risk for accident
• Tetanus vaccine booster every 10 years
Wellness Plan for LJ, Toto , and Ericka
B. Developmental/monitoring:
• Growth chart/nutrition/motor dev’t
• Emotional and moral dev’t
• Family relationship issues like sibling and
cousin rivalry
• OTC for common illnesses, vitamins
• Sanitation issues, junk food, accident
prevention
Final Note
“ Deciding to go abroad and leaving your
family behind is not an easy thing to do.
It will have to be a family decision. It’s
not just the money that you have to
count, but the entire wellbeing of the
family members as well.”
Thank You!