Transcript family assessment

Family Case Presentation
Baslar, Isa
Belmonte, Celeste
Brillante, Christie
Bulatao, Jose
Cheng, Monina
GENERAL OBJECTIVE
To present a patient with osteoporosis,
Fracture, Right hip
SPECIFIC OBJECTIVES
To identify medical, psychological, social and
economic problems of the index patient and
his family
To analyze the family using the family
assessment tools
To assess the stage of the family in the Illness
trajectory and aid them until they reach the
final stage
To formulate a family health care plan
GENERAL DATA
 F. L.
 81 years old
 female
 Roman Catholic
 Filipino
 Single
 Store owner
 DOB:4/23/28
HISTORY OF PRESENT ILLNESS
• Patient was walking outside the UST church when her umbrella (she uses as a cane)
slippped and she fell. Patient was able to stand and walk after the incident.
• Patient claims to have slight pain and LOM, no edema. No consult done, no
Jan 19, 2009 medications taken
• Due to persistence of symptoms, patient called for a “hilot”. There was increase in
the severity of pain after the massage.
Jan 22, 2009 • edema was noted as well.
• Patient consulted a physician due to increase in severity of pain. An Xray was done
and revealed hip fracture
Jan 29, 2009 • Patient was advised surgery but she refused
CONSULT
REVIEW OF SYSTEMS
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(-) sweats, (-) insomia, (-)anxiety, (-)interpersonal relationship difficulties
(-) color changes, (-) rash, (-) photosensitivity, (-) changes in hair/ nails/skin,
(-) itchiness
(+) blurring of vision, (-)tinnitus, (-)discharge, (-)epistaxis, (-)discharge ,
(-)bleeding gums, (-) throat soreness
(-) hemoptysis, (-)chest pain, (-)cough
(-)nausea, (-)vomiting, (-) hematemesis, (-) melena, (-) hematochezia,
(-) dysphagia,(-)epigastric pain,(-)heartburn
(-) heat/cold intolerance, (-)polyphagia, (-)polydipsia (-) polyuria
(-) muscle pain, (-) joint pain,
(-) varicosities, (-)claudication
(-) dysuria, (-)flank pain, (-)frequency,(-)hesitancy,(-)urgency
(-)headache, (-) seizures
(-) easy bruisability
PERSONAL & SOCIAL HISTORY
Non-smoker
Non-alcoholic beverage drinker
Denies illicit drug use
Diet: Mixed diet (vegetables, fruits, meat)
Store owner, retired teacher
BS Education graduate
Does household chores, goes to churches and
market
PAST MEDICAL HISTORY
Malaria in 1938 (10 yrs old)-treated by a family
physician
(?) Hypertensive since 2005, with BP elevations
of SBP 130-140/ DBP 80-90.
No DM, No Asthma, no PTB
No operations
(+) allergy to medicol
Immunization: Unrecalled
FAMILY HISTORY
 (-) asthma
 (-) allergy
 (-)PTB
 (+)Kidney disease – sister
 (+) HPN – sister
 (-) DM
 (-) Cancer
PHYSICAL EXAMINATION
• GENERAL SURVEY: conscious, coherent, oriented
to 3 spheres, ambulates with assisstance, not in
cardiorespiratory distress
• BP 130/80 mmHg PR 92/min RR 20/min Temp 36.7C
• SKIN: warm, moist, no active dermatoses
• HEENT: pink palpebral conjunctivae, anicteric sclerae,
(+) cataract,OU, no nasoaural discharge, moist buccal
mucosa, non-hyperemic posterior pharyngeal wall,
tonsils not enlarged
• NECK: no palpable cervical lymph nodes, supple neck,
thyroid not enlarged, no other palpable masses
PHYSICAL EXAMINATION
• CHEST: symmetrical chest expansion, no retraction,
clear breath sounds
• HEART: adynamic precordium, regular rhythm, apex
beat at 5th LICS MCL, no mumurs
• ABDOMEN: flat, normoactive bowel sounds, soft,
non-tender, no masses palpated
• (+) gibbus at level of T6-T7, (+) dextroscoliosis
• EXTREMITIES: no cyanosis, no edema, pulses full
and equal
• ROM: (+) limitation in bilateral hip flexion, bilateral
shoulder abduction and extension
NEUROLOGIC EXAMINATION:
 Mental Status: Conscious, coherent, oriented to three spheres
 Cranial nerves: pupils 2-3 mm ERTL, EOMs full and equal,
V1V2V3 intact, can raise eyebrows, can close eyes against
resistance, no facial symmetry, can shrug shoulder against
resistance, can swallow, tongue midline on protrusion
 Motor: no tremors, no muscle fasciculations, MMT: 5/5 on all
extremities
 Cerebellar: Can do APST, finger-to-nose test; no gait
abnormalities
 DTR’s: ++ on all extremities
 Sensory: No sensory deficit
 No Babinski reflex
 No nuchal rigidity, Brudzinski sign, Kernig’s sign
GERIATRIC ASSESSMENT:
Mini Mental State Examination: 30 (normal)
Katz Activities of Daily Living Scale- With
assistance in bathing, dressing, toileting, &
transfer; with occasional incontinence; feeds
without assistance
Clock Drawing Test
Geriatric Depression Scale: 3 (normal)
ASSESSMENT OF INDEX PATIENT
Osteoporosis
Fracture, R hip
Senile Cataract, OU
Dextroscoliosis
FAMILY ASSESSMENT
P. NOVAL
ADELINA ST
X
ELOISA ST
DAPITAN
BARLIN ST
UST
STAIRS
CR
PATIENT’S ROOM
CHAIR
WINDOWS
TV
CHAIR
TABLE
E.FAN
CABINET
PATIENT’S BED
ENVIRONMENTAL HISTORY
 Concrete type, 2-storey building
 House-rented
 patient rents 8 bedrooms (patient occupies only one room and
rents the others)
 Fairly Clean , well-ventilated and well-lit
 Electricity from Meralco
 Water source from NAWASA but drinking water - purified water
 Toilet Type- flush, Drainage is good
 Regular waste disposal, no segregation but regularly collected
 Do not have pets but there are many stray animals and pests in
the neighborhood
 Area is accessible by- taxi, jeep, tricycle
FAMILY TREE- Laganzua Family
Rufo , 72
Inocencia,100
Jose,30
Lorenza,81 Adelaida, 27 Andrea,22 Jesus,60 Asuncion, 60
Henry
Clarissa
Vivian
Carmelita,62 Esteban,65
Odelon
Serrina
MeAnne,33 Ariel,31
Flora, 81
Michael,35 Arlene,32
Seth, 6
Vaughn Matthew,2
Anthony
Mae
Family Structure
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Type of Family- Unilaterally extended
Ordinal Position: Third
Social Class Pattern : Low Income Family
Family Set-Up: Democratic
FAMILY
PROFILE
AGE/
SEX
RELATION
TO HEAD
EDUCATIONAL
ATTAINMENT
OCCUPATION
CURRENT
HEALTH STATUS
Flora
81/F
Aunt
B.S. Education
graduate
Retired teacher,
store owner
Osteoporosis
Fracture, R hip
Senile Cataract, OU
Dextroscoliosis
Me-Anne
33/F
Wife
2nd year- B.S.
Computer Science
Housewife
Arachnoid cyst(?),
s/p spine surgery
(June 2009)
Ariel
31/M
Head
B.S. Nursing
Nurse in San
Lazaro
Essentially Normal
Seth
6/M
Son
Prep
student
Asthma
FAMILY LIFELINE
• 2002- Ariel and MeAnne were married and
rented a room beside Flora’s
• 2003- Seth was born
• 2007- Seth started Nursery school
• 2009– (Jan) Flora had a fall which caused hip fracture
– (June) MeAnne was diagnosed with a spine cyst and
was operated
ECONOMIC PROFILE
Income
PhP 22,000
Expenses
 FOOD
10,000
 EDUCATION
3,000
 MEDICATION
1,000
 MISCELLANEOUS
(electricity, water, house rent) 4,000__
TOTAL EXPENSES:
18,000
Savings:
4,000
Alloc ation of
inc ome
F ood
E ducation
Medication
mis cellaneous
Flora Laganzua
Me-anne
Laganzua
1. Ako’y nasisiyahan dahil nakakaasa ako ng tulong
sa aking pamilya sa oras ng problema.
2
2
2. Ako’y nasisiyahan sa paraan ng pakikipag-usap sa
akin ang aking pamilya tungkol sa aking problema.
2
1
3. Ako’y nasisiyahan at ang aking pamilya ay
tinatanggap at sinusuportahan ang aking mga nais
na gawin patungo sa mga bagong landas para sa
aking ikauunlad
2
2
4. Ako’y nasisiyahan sa paraang ipinadadama ng
aking pamilya ang kanilang pagmamahal at
nauunawaan ang aking damdamin katulad ng galit,
lungkot at pagibig.
2
1
5. Ako’y nasisiyahan na ang aking pamilya at ako ay
nagkakaroon ng panahon sa isa’t-isa.
1
2
TOTAL (Interpretation: 8-10 highly functional,
9
8
FAMILY APGAR
4-7 moderately dysfunctional, <4 severely dysfunctional)
SCALE: 2-Palagi, 1-Paminsan-minsan, 0-Halos hindi
HIGHLY FUNCTIONAL
PARAMETER
SOCIAL
STRENGTH
[ / ] Open intrafamilial lines of
communication
[ / ] Absence of animosity/rivalry
[ / ] Healthy/supportive intrafamilial
relationships
[ / ] Healthy/supportive extrafamilial
relationships
WEAKNESS
[ ] Lack of intrafamilial lines of
communication
[ ] Presence of animosity/rivalry
[ ] Unhealthy intrafamilial relationships
[] Unhealthy extrafamilial relationships
CULTURAL
[ / ] Absence of or very few
beliefs/practices that are
unacceptable to our culture or
negatively affect way of living (e.g.
institutionalization of elderly,
dependency of married children to
parents, value for education, does
not advocate family closeness,
seeking help from traditional
healers, etc.)
[ ] Presence of some beliefs/practices that
are unacceptable to our culture or
negatively affect way of living (Specify
these practices):
RELIGIOUS
[ / ] Spirituality is positively
influencing way of life
[ / ] Practicing one’s faith, enduring
because of his faith
[ ] Spirituality is negatively or not at all
influencing way of life
[ ] Not practicing one’s faith
Others: Religious activity is not a
significant aspect of their family life
PARAMETER
STRENGTH
WEAKNESS
EDUCATIONAL
[ / ] Level of education is not a
hindrance to achievement,
livelihood, success
[ / ] Level of education facilitates
comprehension of most
challenging circumstances
[ ] Level of education is a hindrance to
achievement, livelihood, success
[ ] Level of education hinders
comprehension of most challenging
circumstances
ECONOMIC
[ / ] Ability to allocate funds [ ] Inability to allocate funds appropriately
appropriately
[ ] Inability to make ends meet most of
[ / ] Ability to make ends meet the time
most of the time
MEDICAL
[ / ] Good compliance with
medical management
[ ] Timely and appropriate
medical consultation
[ / ] Aware and practices wellness
and environmental sanitation.
[ ] Poor compliance with medical
management
[ /] Inappropriate medical consultation
[ ] Not aware / does not practice wellness
and environmental sanitation
MODIFIED CAREGIVER STRAIN INDEX
Me-anne Laganzua
• Madalas- 2
• Minsan – 1
• Halos Hindi - 8
FAMILY LIFE CYCLE STAGE
Family with young children- starts
with pregnancy for the 1st child to
emergence of adolescents.
FIRST ORDER CHANGE
1.
2.
3.
4.
5.
6.
7.
8.
Supplying adequate space , facilities and equipment for the
expanding family
Meeting predictable and unexpected costs of family life with
small children
Sharing responsibilities within the extended family and
between members of the growing family
Maintaining mutually satisfactory sexual relationship and
planning for the future children
Creating and maintaining effective communication system in
the family
Cultivating the full potentials of relationship with relatives
within the extended family
Tapping resources, serving needs, and enjoying contracts
outside the family
Facing dilemmas and reworking philosophies
 .
 .
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 .
SECOND ORDER CHANGE
1. Accepting marital system to make
space for children
2. Taking on parenting role
3. Re-alignment of relationship with
extended family to include parenting
and grandparenting roles
 .
 .

.
FAMILY ASSESSMENT
Family with young children –
UNILATERALLY EXTENDED
STAGE IN THE ILLNESS TRAJECTORY
STAGE V:
• Adjustment to the permanency
of the outcome.
Adjustment to the permanency of the
outcome
 the family realizes that they must accept & adjust to
a permanent disability
pattern believed to be temporary must be accepted
as permanent outcome
FAMILY HEALTH CARE PLAN: Index
Patient
TYPE OF CARE
PROBLEM
WELLNESS {promotive, Patient maintains a balanc
preventive}
diet
Last immunization: unrecalled
RECOMMENDATIONS
For immunization: Tetanus,
Pneumococcal, Influenza
Encourage ROM exercises daily
MEDICAL
For Rehabilitation therapy
For orthopaedic consult
For Ophthalmologic consult
For Hypertensive work-up
PSYCHOSOCIAL
Osteoporosis with Fracture , R
hip
Senile Cataract, OU
With
episodes
of
BP
elevations
Patient is unable to go out of
the house because of her
condition. She said that she
goes to different churches
everyday before the accident.
It is also one of the reasons
why she could not follow-up
at the OPD clinic.
Encourage the other family
members to talk to her more
often.
A wheelchair would be beneficial
to be able to go out and meet
other people.
FAMILY HEALTH CARE PLAN: Other
family members
TYPE OF CARE
PROBLEM
WELLNESS
{promotive,
preventive}
FAMILY
MEMBER
Me-Anne
Ariel
Seth
MEDICAL
Me-Anne
s/p spine surgery for For ff-up with Neurology
arachnoid cyst(?) June
2009
Asthmalast
attack Avoid triggers
unrecalled
Seth
PSYCHOSOCIAL
Me-Anne
RECOMMENDATIONS
Maintain balance diet
Update immunization
Daily exercise
Stopped working after the She could join organization
operation and decided to and do activities other than
be a housewife
household chores and caring
for her aunt.