COMMUNITY HEALTH NURSING RLE
PART A. INITIAL DATA BASE
I. CHARACTERS:
A. What is the type of family structure?
Nuclear Single - Parent
Extended Others (specify)
B. What is the type of family based on authority?
Patriarchal
Matriarchal
C. Who makes decisions regarding health care? both
D. What is the present family relationship?
with conflicts between members
without conflicts between family members
E. Activities of daily living:
1. Sleeping pattern:
around 6 am
Retiring/getting up hours
Nap during the day around 4 or 5 pm
Do members sleep together no
2. Eating pattern
How many meals each day? 3
Who appears overweight? none
Who appears underweight? 3rdborn (girl)
3. Leisure time activities
How does each member spend leisure hours? relaxing
Is it appropriate for the sex and age group? yes
What is the effect on the family? being able to release stress
Any joint activity for leisure? cleaning
II. FAMILY INFORMATION
Head of the family: mother
Address: san jose patag smb
Members of the household: 5
NAME RELATIONSHIP AGE EDUCATIONAL ATTAINMENT
kenneth john villareal brother 18 college
kirstene anne villareal sister 16 senior high
kian anthony villareal first born 22 college
evelyn villareal mother 47 college
ricardo villareal father 45 college
/avg 1
III. SOCIO-ECONOMIC AND CULTURAL FACTORS
A. Income
NAME OCCUPATION PLACE INCOME /
MONTH
evelyn villareal hair stylist san jose patag 15k
ricardo villareal seaferer overseas 200k
1. Does the working family member meet the basic necessities?
Yes No
2. Who makes decisions regarding money matters? both
3. Religious affiliation: catholics
4. What roles does the family play in the community? good Neighbour
IV. ENVIRONMENTAL FACTORS
A. Housing
1. Ownership
Owned Rented Rent-Free Others (specify)
2. Construction materials used
Light Mixed Strong
3. Living space
Adequate Inadequate
4. Sleeping arrangement:
5. Adequacy in furniture
Adequate Inadequate
6. Water source
Private Public
7. Food storage
Refrigerator Jars/container Others (specify)
8. Cooking facility
Electric stove Firewood Others (specify)
Gas Stove Kerosene
9. Drainage facility
Open drainage Blind drainage None
10. Toilet facilities/type
Flushed Overhung latrine
Water-sealed latrine Bored-hole latrine
Pail system Others (specify)
11. Sanitary condition
Fair Good Poor
Provide brief description: not entirely an urban area
12. Neighborhood
Congested Slum Other
13. Availability of Health Care Facility
/avg 2
Describe briefly: about 4 baranggays till we reach the nearest hospital
14. Garbage disposal
Dumped at street corner Picked up by garbage collector
Buried Burned then buried Others(specify)
V. HEALTH MEDICAL HISTORY
NAME PAST ILLNESS DIAGNOSED / ILLNESS STATE HEALTH ACTION
UNDIAGNOSED TAKEN
evelyn villareal asthma diagnosed stable maintenance
VI. VALUE PLACED ON PREVENTION OF DISEASE
Vaccinations
NAME AGE COMPLETE INCOMPLETE
evelyn villareal 47 complete
Other preventive practices employed by the family: well cleaned house
Sources of Health Care:
Health Center Government Hospital
Private Hospital Others (specify)
/avg 3
PART B.
DETERMINE AT LEAST 3 FAMILY HEALTH PROBLEMS. IF NONE, DETERMINE THE FAMILY’S PROMOTIVE OR PREVENTIVE
PRACTICES.
FAMILY HEALTH PROBLEMS. TYPOLOGY OF HEALTH PROBLEM
(WELLNESS STATE , HEALTH DEFICIT,HEALTH THREAT,
(IF NONE, FAMILY’S PROMOTIVE OR FORESEEABLE CRISIS)
PREVENTIVEPRACTICES.)
1 asthma health threat
PART C.
DO THE SCALING OF THE 3 IDENTIFIED HEALTH PROBLEMS OR PROMOTIVE PRACTICES OF THE FAMILY.
HEALTH PROBLEM 1: asthma
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
NATURE OF THE PROBLEM 2 0.66
MODIFIABILITY OF THE 0 0
PROBLEM
PREVENTIVE POTENTIAL 1 0.33
SALIENCE 2 1
TOTAL 1.99
HEALTH PROBLEM 2:
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
NATURE OF THE PROBLEM
MODIFIABILITY OF THE
PROBLEM
PREVENTIVE POTENTIAL
SALIENCE
TOTAL
/avg 4
HEALTH PROBLEM 3:
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
NATURE OF THE PROBLEM
MODIFIABILITY OF THE
PROBLEM
PREVENTIVE POTENTIAL
SALIENCE
TOTAL
Villareal, kian anthony N.
Surveyed by _________________________
March 16, 2024
Date ______________________________
/avg 5
