MAHARASHTRA EDUCATION

SOCIETY COLLEGE OF NURSING,

LOTE

SUBJECT: advance NURSING practice

FAMILY CASE WORK WITH MODEL OF

PREVENTION

SUBMITTED TO,
MR. jaivin jaisingh

Associate PROFESSOR

MES COLLEGE OF NURSING

SUBMITTED BY,
MS. SUNITA SARGAR

1ST YEAR MSC NURSING

MES COLLEGE OF NURSING

Family case study
1) Reason for selection of family:

To know about the family’s needs, history and for providing needed medical services to family.
Reason for selection of family is established interpersonal relationship and doing needed
procedure.
2) Name of the Head of the family: Mr. Ram Yadav

3) Address: B – 42 Nandakrishna cooperative Society ,R.A. Road, lote

4) Total members in the family: - Total 04 members present in the family

5) First visit to the family: 15/01/ 2023

6) Family is under care since: - 15/01/2023 -18/01/2023 family is under care since a 3 days.

7) Total number of Home visit given: - 3- visits

AIM:

To maintain and evaluate the health status of the family members at maximum level.

OBJECTIVE:

1. To provide Nursing Care Considering family as a unit of services

2. To build up a good rapport with family members.
3. To identified the factor affecting health in rural area
4. To direct and implement nursing process approach towards stabilizing the individual health
5. To rehabilitate the family and to carry out procedure successfully
6. To carry out assessment of each individual and identical health needs
7. To facilitate use of. Av-aids and able to use appropriate referral system.
DEMOGRAPHIC DATA

Name of the head of the family: Mr. Ram Yadav

Address: : B – 42 Nandakrishna co.oprative Society ,R.A. Road, lote

Occupation: Service

Income: 10,000

Total number of eligible couple: No

Total number of vulnerable groups in the family as follows:-

SN Particular Numbers

1 ANC ----

2 PNC ----

3 Lactated Mother ----

4 New-Born ----

5 Infant ----

6 Toddlers ----

7 Pre-Schoolers ----

8 Old age ----

9 Working Women ----

Type of family: joint family

• Religion: Hindu

Total Income of family:-

SN INCOME CHECK BOX

1 Below-5000 ----

2 5000-10,000 ----

3 10,000-15,000

4 15,000-20,000 ----

5 20,000 and above -----

 Educational Status:-
SN EDUCATIONAL STATUS CHECK BOX

1 Illiterate ----

2 Primary education ----

3 Middle school ----

4 High school

5 Graduation -----

6 Post-graduation -----
7 Any other ----

Transport and communication

A. Transport
1 Own vehicle ----

2 Uses BEST/Private bus/Auto/Taxi

3 Train

4 Any other ----

B. Media
1 Telephone ----

2 Television

3 Radio ----

4 Magazine/newspaper

5 Post and telegram ----

6 Mobile

7 Any other ----

 Language known and understand: Marathi and Hindi

 Mother tongue: Marathi

 Family composition

SN Name Age Sex Relation Educa- Occupa- Income Bad Health

With tion tion Health Problem
Family Habit
1 Ram Yadav 61 M Self 12thpass Service 30,000 No Asthma

2 Rupesh Yadav 35 M Son Graduate Service 20,000 No -----

3 Meera Yadav 34 Fe Daughter 10th pass House ------ No ------

in law wife
4 Rajesh Yadav 13 M Grandson Graduate education ----- No ------

5 Neeta Yadav 12 Fe Grand 12th education ------ No

daughter

 Family Genogram

1
OBJECTIVE DATA:
Environmental Sanitation: Poor

Type of room: Pacca and Own

No of rooms and ownership: 1 living room, 1 kitchen and 1 bed Hall

Type of rooms shared by number of persons: 05

Aeration space: present 550 sq ft

Type of ventilation: Both, Natural as well as electrical by fan

Type of Lighting: Electricity and sunlight

Type of water supply: municipal water supply

Type of water storage facility: They stored water in tank and utensils

Type of sewage disposal: - Open Drainage line

Type of garbage disposal: Daily garbage collected in plastic bag and throw in dust bin

Type of bathroom: Small

Type and number of latrine: l Private Indian toilet.

Number of people sharing bathroom/ latrine:- 05 people
Any staircase/safety/cleanliness:- Poor cleanliness

Pet animal-Birds: Cat and Dog

Kitchen Garden:- No

Any other Note: No

TOTAL INCOME OF FAMILY: 30,000

Nutrition :-
1) Diet pattern of the family:- family members eat both vegetarian and non-vegetarian food like
dal rite, chapati, bhaji, sweet, chicken, mutton fish and egg.

2) Consumption of Milk:- I lit milk per day.

3) Consumption of food, common preparation: - vegetarian food eg. Dal Roti Rice, bhaji, sweet
chicken, mutton fish and egg etc.

4) Cooking Practices: Good Cooking practice has been followed washing vegetable before
cooking, steaming, Drying and boiling of food

5) Food Hygiene: - fruits and Poor hygiene-maintained vegetables are washed under tap water
before used and cut

6) Food preparation and storage- food is prepared on gas food kept close after cooking and
stored in the gas
  Family planning practice of eligible couple:

SN Name of couple Living child Name of the Since If not reason remark
family planning when
male female method adopted

1. Mr. Rupesh Yadav 1 1 Permanent 2010 --- --

and method
Mrs. Meera Yadav tubectomy done

 VARIOUS TABLES INDICATION THE HEALTH STATUS OF THE FAMILY

AND CHILDREN

SN Name of the person age sex Diseases Diseases Treatment Remark

acute chronic

1 Ram Yadav 61 M Asthama Tab Ongoing

Salbutamol Treatment
4mg

 SOCIAL BACKGROUND SPACE AND PRESENT STATUS:-

1. Community settings which include:-

a) Name of the area:- khaparwadi

b) Taluka and district city: Chiplun

c) Administrative set up:- Ghanekunt lote

d) Address:- : B – 42 Nandakrishna co.oprative Society ,R.A. Road, lote

e) Main caste group:- Family belongs to cast group

 f) Religion:- Hindu.

g) Methods for recording the birth and death: - Birth and death record are maintained
by Municipal Corporation.

 Facilities available in the area: - Government hospital, private hospital

 HEALTH NEED IDENTIFICATION FOR FAMILY: -

 Need to maintain the physical and mental health of patient

 Need to maintain clean and safe environment
 Need to gain knowledge about environmental sanitation
 Need to establish rapport with the family.
 Need to establish therapeutic interpersonal relationship

 PRIORITY WISE NURSING DIAGNOSIS BASED ON IDENTIFIED NEEDS: -

1. Ineffective, breathing pattern related to asthama as evidence by client's having cough.
2. Ineffective airway clearance related to increase in mucous production.
3. Nutritional imbalance less than body requirement related to asthama as evidence by reduce
Client weight.
4. Impaired hygiene related to environmental sanitation d's evidence by open drainage system
5. knowledge deficit related to disease condition as evidence by client asking many questions

OBJECTIVE OF FAMILY ORIENTED CARE:

 To Carry out the assessment of each individual and identify the needs

 To establish good interpersonal relationship with all family members.

 To implement nursing process in the family. orientation Nursing care

 To identity area of health education when even possible.

 SHORT-TERM NURSING CARE PLAN:-

 Patient breathing Pattern needs to improve.

 To maintain establish a good therapeutic relationship with family members

 Needs to clear client’s airway passage.

 Needs to decrease client anxiety.

 Needs to increase clients knowledge about disease condition.

 LONG-TERM NURSING CARE PLAN: -

 To maintain good therapeutic relationship with family mambers.

 To continue .follow ups practice family related health maintenance.

 To give health education to all family members .

 To make family member fear free.

Care plan
 Assessment Nursing Goal Outcome Intervention Rationale Evaluation
Diagnosis

Subjective Objective

Mr. Yadav Mr. Yadav Ineffective Short Term Mr. Yadav Assess the To obtain After proper
verbalized that having cough breathing Goal: able to patient baseline data. nursing
sometimes and increase in pattern related Mr. Yadav will maintain condition. Intervention
I have mucous to asthma as able to normal To clients client able to
breathlessness production. evidence by maintain breathing Assess the breathing breath
due to cough Sometimes he client is having normal pattern and breathing sound for properly
and dyspnea get fatigue, cough and breathing able to sound and assessing the without any
restlessness, through pattern within maintain respiratory abnormalities. disturbances
and dyspnea. observation. 2 days. normal status of and decrease
lifestyle. patient. cough
accumulation.
Long Term Advise patient To increase
Goal: to sleep in semi lungs
In next week fowlers’ Expansion.
Cough position.
accumulation
will be Advise to To decrease
decrease and maintain further
able to breath hygiene complications.
properly.
 Assessment Nursing Goal Outcome Intervention Rationale Evaluation
Diagnosis

Subjective Objective
Mr. Yadav Mr. yadav Ineffective Short Term Mr. yadav able Assess the To obtain After proper
verbalized that sometimes airway Goal: to maintain patient baseline data nursing
I felt difficulty having clearance Mr. yadav will clear airway condition. Intervention
in breathing restlessness , related to able to and breathing Assess the To find out the client’s airway
and lethargy increase maintain pattern comes clients abnormalities is clear and
restlessness He having mucus normal airway to normal breathing in patient. able to breathe
difficulty in production pattern within condition. pattern. properly.
breathing. and cough as 2 days.
evidence by Advise client To remove
Mr. yadav has observation Long Term for chest excessive
increase in Goal : physiotherapy. mucous
cough and Mr. yadav will production.
mucus be able to
production. maintain Advise patient To loosen
airway pattern for steam mucus
within a inhalation. production so
weekend. that it can
easily expelled
out.
Advise client To increase
for breathing lung capacity.
exercise .
 Assessment Nursing Goal Outcome Intervention Rationale Evaluation
Diagnosis

Subjective Objective

Client Client was Nutritional Short Term Client able to Assess the diet To know the After proper
verbalized looking imbalance less Goal: feel to eat plan of the patient. cause of weight nursing
that, I am restlessness, than body With the next properly and loss. Intervention
having lethargy , requirement 4-6 hours of will increase Assessing the need Helps to plan client able to eat
poor drowsy , related to nursing weight will be of patient. the diet of the properly and
appetite sometimes asthma as intervention increased in patient. comes to the
day by day breathing evidence by client will one month. Assessing like and goals of patient.
feeling very difficulty and weight of feels to eat dislike of patient. To provide diet
weak. looking patient reduced. properly. plan to the
Providing patient.
Long Term knowledge about
Goal: diet to patient. To decrease
In future the
client will complications.
maintain the
diet plan act
accordingly.
 Assessment Nursing Goal Outcome Intervention Rationale Evaluation
Diagnosis

Subjective Objective

Client By assessing Impaired Short Term The family will Assess the general To know the After proper
family and hygiene related Goal: able to condition of general nursing
verbalized observation to environment The family promote environment. condition. Intervention
that in our there is poor as evidence by will able to environmental family gain
area there sanitation and drainage effectively sanitation. Explain the To provide knowledge
is lot of open drainage system and promote importance of knowledge about
mosquito stem. improper waste environmental Family will healthy about cleanliness and
present. disposal. sanitation. maintain hand environment. environmental maintain health
hygiene. sanitation. hygiene.
Long Term
Goal: The family will Educate the To make
able to keep cleaning of aware the
The family environment environment. family about
will able to clean. importance of
promote cleanliness.
environmental Assess the use
cleanliness mosquitoe net and To reduce
within 3-4 instrument. quantity of
days. mosquito.
 Assessment Nursing Goal Outcome Intervention Rationale Evaluation
Diagnosis

Subjective Objective

Client Family was Knowledge Short Term Family will be Assess the To know Family will able
verbalize asking deficit related Goal: able to gain knowledge about baseline data. to gain
that they question to disease Family adequate disease condition. knowledge
having less repeatedly. condition as should be knowledge within 1-2 days
knowledge evidence by able to gain about disease Provide the health To gain and reduce the
about client asking knowledge condition. Education on diet. knowledge and doubts.
disease many questions within 1-2 give
condition. about disease. hours. information.

Explain the To reduced

Long Term proper diet plan further
Goal: and explain deep complications.
Family breathing
Should able exercises.
to gain
knowledge
and decrease
the doubts.
TECHNIQUE ANS SKILLS IN HOME NURSING PROCEDURE

NAME OF COLLEGE:- MES College of nursing, Lote

Name of Student:- Ms. Sunita Sargar

Subject:- Community Health Nursing

Course:- 1st year MSc nursing

Name of Procedure:- Geriatric assessment

Resson for selection of procedure:- The Family members should have knowledge regarding geriatric assesment.

Name of Supervisor: Mr. Lingaraju. A.R

Venue:- Community

Date:- 19/01/2023

Group: Geriatric people

Aim:- To identify the health status of client
To provide therapeutic nursing care to client and their family.
To estimate the reason of procedure to family members

Article required for the procedure:-

SN Article's required Rational

A bag contain

1 Handwashing kit To prevent cross infection

Soap
Nail brush
Towel
Plastic bag
2 Geriatric assessment article
Weighing machine
Measuring tape
Torch
BP apparatus
Stethoscope
Thermometer
Watch
Paper bag
Kidney tray
Two bowl
Savlon solution
3 Documentation chart To record and report
SN Steps of procedure Rational

1 Select the work area and safe place To place the bag
2 Spread the newspaper at the flat surface to place the bag To prevent from dust on bag

3 Remove the handwashing articles

4 Open the front button of bag To open easily
5 Do clean hand washing To prevent cross infection
6 Take out necessary articles To perform the procedure
The procedure from the bag and place it on clean surface without touching
unclean area
7 Explain the procedure to client To gain confident and co-operation
8 Check the anthropometric measurement (Height, Weight, Age) To know the BMI level
9 Monitor vital parameters To know the vital sings of patient
10 Assessment of elderly head to foot examination To know any abnormalities
11 After performing the procedure record each and every reading and To maintain record
abnormalities of client
12 Replace the article, wash , clean and wipe the articles To keep maintainace of articles
13 Do hand washing with soap and water properly To prevent infection
13 Discard all waste properly according to biomedical waste management To prevent infection
14 Inform the family about the assessment and next visit To build rapport
DRUG STUDY: -

1) Name of Drug: Tab Salbutamol 4mg

2) Content: Tab Salbutamol 4mg its salbutamol sulphate

Salbutamol is used to relive symptoms of asthma and COPD.

3) Dose: usually starting dose 4 mg daily once after breakfast.

4) Action: It works by relaxing the muscles of the airways into the lungs, which makes it easier to breathe

5) Adverse reaction/effect of Drug system wise: - headache , Muscle Cramp, heartburn, nervous tension.

6) Indication: -

1) Asthma

2) Chronic Obstructive Pulmonary Disease.

7) Contraindication: -
1) pregnant women
2) Hypersensitivity
3) Tachycardia
4) Lactation

Diet plan

Mr. Ramakant Solkar - He should take diabetic diet

He should eat fresh food and vegetables.
Other family members take well balanced diet

Breakfast

Time Menu Amount

9am Milk 1glass

Poha 1plate
Boiled egg 2 psc
11 am Fruits/green salad 1 apple/ 1 plate
Lunch

Time Menu Amount

1pm Dal 1 cup

Chapati 2 psc
Vegetable/chicken 1plate
Curd 1 cup
salad 2 slice
4pm Mutton soup 1 cup

Dinner
Time Menu Amount

8pm Rice 1 cup

Dal 1 cup
Chapati 2 psc
Vegetable/egg 1plate
salad 2 slice
10pm Mushroom soup 1 glass
 Evaluation of Home Nursing care: -

1) Short term Nursing care plan: -

 Knowledge deficit related to disease condition as evidence by client and family members are worried.

 Difficulty to establish rapport with family as evidence by family were not responding well to the questions.

2) Long term nursing care plan: -

 Impaired hygiene related to poor sanitation as evidence by open drainage system.

 Evaluation of Home visit: -

 I was posted in community for Community health nursing I practical experience in community area

 I took one family for nursing care study total 3-4 visit were given to family.

 The head of the family diagnosed with asthma. I have given nursing care to family according to the needs.
 HEALTH TEACHING

NAME OF COLLEGE: MES College of Nursing, Lote

Name of Student Teacher: - Ms Sunita Sargar

Studying in: - 1st year MSc nursing

Subject: - Community health nursing

Topic for health education: - Deep Breathing Excercise

Need for topic: - As the client in family suffering from asthma . it is needed to increase lung capacity.

Name of Supervisor: Mr. Lingraju A. R.

Venue: - Ghanekunt peer lote
Date: -21/02/2023
Group of people: - To all family members
  Content in shorts:
 Introduction of asthma
 Introduction to deep breathing Exercise
 Type of Deep breathing exercise.
 Precaution should be taken before and after exercise.
 How it helpful to client
 For how much time it should be carried out

A.V. Aids:-

 Flash Chards
 Poster
 Flip chart

 Evaluation:

 The client and other Community Client’s gain knowledge about deep breathing exercise.
 Bibliography:-

 k. Park Preventive and social medicine, 26th edition, Bhanot publication.

 k. k. gulani Community health nursing.

 Brunner and Siddharth’s textbook of medical and surgical nursing south asian edition.
Family Case work with Model of Prevention.
A model is theoretical way of Understanding concept or ideas.
Concept of Prevention :
Prevention is a set of action aimed at eradicating, eliminating, and minimizing the impact of disease and disabilities.

Types of Models of Prevention:

1. Health Belief Model
2. Holistic Health Model
3. Levels of Prevention Model
4. High Level Wellness Model
5. Basic Human Needs Model
6. Health Promotion Model
7. Role Performance Model

Goals of Levels of Prevention Model:

1. Reduce the burden of suffering for the major preventable diseases.
2. Control expenditures by reducing the need for intensive management of late-stage illness.
3. These goals extend to individuals, their families, communities, and the whole population.
 The community health priority practices are based on the concept of levels of prevention in relation to natural history of
disease as put forth by Level and Clark. These levels of prevention include primary level prevention, secondary level
prevention and tertiary level prevention.
 Model of Prevention it has been defined in terms of four levels:.
 Primordial prevention.
 Primary prevention.
 Secondary prevention.
 Tertiary prevention.
 1. Primordial prevention:

 Primordial prevention refers to avoiding the development of risk factors in the first place.
 The client and Family should take care of development of disease and avoid risk factor which will help for the development of
disease the main aim of primordial prevention is risk factor reduction targeted towards an entire population through a
focus on social and environmental conditions.
 Client and Family should avoid risk factor such as avoiding smoking, physical inactivity, obesity, poor diet, hypertension,
high cholesterol, and diabetes, is associated with less incident heart failure and vascular disease.
 Such measures typically get promoted through laws and national policy.
 Client and Family should identify the risk factor related to Asthma and avoid that risk factor to decrease illness or disease.

2. Primary Prevention:
 The primary level prevention is in the pre-pathogenesis phase of disease or health problem and includes all those measures
specific protective measures, reporting early when sick or undertaking prescribed treatment and precautions for spread of
disease to others and for occurrence of relapse.
 Provide Primary Prevention to the Client and Family which promote general health and wellbeing of people and protect them
from specific diseases and health problems eg, healthful living, environmental level preventions are in the pathogenesis phase
of a disease.
 Primary prevention includes those preventive measures that come before the onset of illness or injury and before the
disease process begins.
 Examples of Primary prevention is legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos)
or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g.
eating well, exercising regularly, not smoking)
 Client and Family should take preventive measures to reduce asthma i.e. control the use of hazardous products.
3. Secondary Prevention:
 Secondary level prevention includes all those measures which help in arresting the disease process, restore health
and control further spread of disease.
 Secondary level prevention plays important role to treat patient eg. early diagnosis and treatment, health education,
immunization of population at risk, safe Modes of disposal and disinfection of infected excrements, infected
equipments and supplies etc.
 It includes regular examination and screening tests to detect disease in its earliest stages (e.g. mammograms to
detect breast cancer) daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or
strokes.
 Client and Family Should Control asthama by doing Early Diagnosis and Treatment and screening.

4. Tertiary Prevention:
 The tertiary level of prevention includes all those measures Two modes of delivery which help in minimizing
suffering, reducing identified by limiting the impairments and disabilities .
 These include promoting adjustment to disabilities e.g. medical rehabilitation, vocational, social and psychological
rehabilitation etc.
 Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.
 Client and family take any kind of Rehabilitation if needed to improve abilities and activities of daily living.
 Example of Tertiary Prevention cardiac or stroke rehabilitation programs, chronic disease management programs
(e.g. for diabetes, arthritis, depression, etc.)
 Client and Family should take Medical and psychological rehabilitation Execices to improve activities of daily
living and also reduce anxiety.