PAMANTASAN NG LUNGSOD

NG MAYNILA
COLLEGE OF MEDICINE

FAMILY AND COMMUNITY MEDICINE

SECTION 1-C

Marin, Junie
Tabobo, Paolo Gabriel
Tabeta ,Christine Joy
Tan, Maria Alayana Andrea
Tanalgo, Babylyn
Turingan, Jamille
Valencia, Aeriel Anne
Zulueta, Aduen Zion

I.

Introduction to Index Patient

a. Patient Profile

Name: Josefina Romaldo Antonio

Occupation: Library
work (retired 1983)
Age: 83
Birthday: January 17, 1932
Gender: Female
Marital Status: Widowed
Spouse: Rodolfo Reyes
Occupation:
Factory worker
Child/ren: 1
Address: 584-51 San Andres Street, Brgy. 704, Malate, Manila
b. Brief History of Present Illness
Mrs. Antonio was confined in Philippine General Hospital at 2007
for her gastric ulcer. She was then found out to have high blood
pressure ranging from 70/90 to 160/90 she also sometimes
complains that she has difficulties breathing and has a peculiar
hunched body posture.
c. Diagnosis and Present Management
Mrs. Antonio has Cardiomegaly and osteoporosis. She mostly
stays at home and sits in a wheelchair she is also under
maintenance drugs:
Spironolactone 25mg 1 tablet/day
Enalapril 5mg 1 tablet/day
Nefopam 50mg tablet 2/day
Isosorbide dinitrate 60mg tablet/day
Aspirin 80mg 1 tablet/day
Simvastatin 40mg 1/day
She also takes Calcium supplements and uses a nebulizer
whenever she has difficulty in breathing.

II. Family Genogram

III. Family Life Cycle Stage

Josefina Antonio, 83 y/o as the index patient belongs to the family that is
currently at the later stage of the family life cycle. The children of Josefina
Antonio have created families of their own and are already responsible for
their own life decisions. Despite this ability, the children of Josefina Antonio
remains to play an active role in the family circle in which they grew up by
contributing to the monetary requirements in their shared household.
It is evident that the shifting of generational goals has occurred
because the children of Josefina Antonio participates in the decision-making
process in their household. Her children also partake in the management of
Josefina Antonios illness. Rosalinda, one of Josefina Antonios children still
consider the opinion of her mother in making decisions. Basically, Josefinas
children were able to make room for the wisdom of their mother, thus
supporting Josefina Antonio without over-functioning for her.

IV. Family APGAR

Palagi
(2)

Tungkol sa aking pamilya

PaminsanMinsan
(1)

Ako'y nasisiyahan dahil nakakaasa ako ng tulong sa aking

pamilya sa oras ng problema.

Ako'y nasisiyahan sa paraang nakikipagtalakayan sa akin

ang aking pamilya tungkol sa aking problema.

*
*

Ako'y nasisiyahan at ang aking pamilya ay tinatanggap at

sinusuportahan ang aking mga nais na gawin patungo sa
mgaa bagong landas para sa aking ikauunlad.
*

Ako'y nasisiyahan sa paraang ipinadadama saakin ng aking

pamilya ang kanilang pagmamahal at nauunawaan ang aking
damdamin katulad ng galit, lungkot, at pag-ibig.

Ako'y nasisiyahan na ang aking pamilya at ako ay

nagkakaroon ng panahon sa isa't isa.

8 -10: Highly Functional

4 - 7 points: Moderately Dysfunctional
0 - 3 points: Severely Dysfunctional

Halos
Hindi
(0)

Total: 7 points

Who lives in your home? How do you get along?

Relationship

Age

Sex

Roberto Reyes

58

Male

Rosalinda Reyes

59

Female

Cyrus Andrew Reyes

33

Male

Ryan Scott Reyes

22

Male

Interpretation:

Well

Fairly
*

Poor

The family of the index patient gets along very well. In fact, the index
patient told us that although they don't have enough monetary resources to
fulfill their needs, their family is still very supportive of each member.
Rosalinda and Cyrus are closer to mommy Josefina due to the fact that they
are more often at home and they help mommy Josefina more often. Roberto
and Ryan spend most of their time at work. Their only main problem can be
attributed to the fact that they are lacking monetary resources. It is evident
that even though they lack money, it is not a hindrance to good
relationships. Each member works very hard to contribute their share of
responsibility to the family. Of course, each member of the family has the
freedom to do whatever they want as long as the family's interests and belief
are not violated. The family is open to each other and it can be observed that
they have respect for each member. Rosalinda told us that due to the fact
that the family is open to each other, there are no verbal or physical
hindrances in showing what they feel towards each other members of the
family and other people. They are really satisfied on how each member of
the family share their time, support, affection, and respect to each other. It
can be hardly observed that this family has problems with other members of
the family. It can also be noted that they exercise their faith and beliefs the
Iglesia Ni Cristo way. The INC are loyal and faithful people. These traits
reflect on the family we have visited.
V. SCREEM

S(Social), C(Culture),
R(Religion), E(Economical),
E(Educational), M(Medical)

S1
S2

C1

C2

Matinding
Sumasangayon
(3)

Sumasangayon
(2)

Kami ay nagtutulungan sa
isat isa sa aming pamilya
Natutulungan kami ng
aming mga kaibigan at
kasamahan sa komunidad

Ang aming kultura ay

nagpapatatag ng loob ng
aming pamilya
Ang kulturang

Hindi
sumasangayon
(1)

Matinding
Hindi
sumasasang
-ayon
(0)

pagtutulungan at
Pagmamalasakit sa aming
komunidad ay nakatutulong
sa aming pamilya
R1

R2

E1

E2

E1

E2

M1

M2

Ang aming
pananampalataya at
relihiyon ay nakatutulong
sa aming pamilya
Natutulungan kami ng
aming mga kasamahan sa
simbahan o mga grupong
relihiyoso
Sapat ang naipong pera ng
aming
Pamilya para sa aming mga
pangangailangan
Sapat ang kinikita ng aming
pamilya para sa aming mga
pangangailangan
Sapat ang aming kaalaman
upang
Maintindihan ang mga
impormasyon tungkol sa
sakit.
Sapat ang aming kaalaman
upang
Maalagaan ang may sakit.
Madaling makakuha ng
tulong medical sa aming
komunidad.
Natutulungan kami ng mga
doktor, nars, at health
workers sa aming
komunidad.
S4
C4

R6
E3
E4
M3
Total: 24 (Moderately inadequate family resources)

Socioeconomic Status
In the social aspect, the members of the family help one another at all
times. In the community, they also help each others family especially when
someone is sick. The family participates in activities in the community, in its
social groups, and church life.
Culturally, the family does not have a province. They constantly belonged
and belong to their present community. The culture in the community gives
their family strength, and their culture of helpfulness and concern in the
community is helpful to the family.
The religious activities of the family are a significant part of their lives. They
are members of the Iglesia ni Cristo. They are actively involved in their
churchs activities. The whole family attend services regularly and are
involved in all of their religions activities. Their strong hold on their religion
gives strength and courage to the family.
Economically, the familys earnings are able to meet the needs of the
family. Most of the members of the family work and contribute to make ends
meet.
Economic profile:
Total
Monthly
Income
Plumbing:
500/wk
House store:
500/day
Parlor: 8001000/session
Total
Monthly
Expenses
Electricity,
water, landline

~ 15,000 20,000

~ 9,500 14,000
1,500 2,000
6,000 10,000
2,000

Food: 200500 /day

Medications:
500/wk

On the educational aspect, all members of the family are high school
graduates. Their knowledge and education is sufficient for them to take care
of a sick family member.
The medical resources of the family are quite inadequate. For them, medical
resources, like medicines and other needs, are not readily available in the
community. On the other hand, the doctors, nurses, and health workers in
the community are helpful to the family.
VI. Family Illness Trajectory
ULCER and HYPERTENSION
STAGE 1: ONSET OF ILLNESS TO DIAGNOSIS
The nature of the illness was acute and the patient was rushed to the
hospital because she was puking blood. The index patient was diagnosed
having gastric ulcer and hypertension. The index patient and her family was
caught unaware of the sudden severe presentation of the disease. The family
was caught unaware and was faced with a decision of getting the patient to
the hospital.
Stage 2: REACTION TO DIAGNOSIS
A. Emotional Plane
There was anxiety to the index patient and family that diffused
after a few hours. There were also strong emotions that emerged
after they were able to understand the disease as the parents of the
patient were also diagnosed of the same sickness.
B. Cognitive Plane
There was tension and confusion in the family on how they would
solve the problem regarding the admission of the index patient.
They depended to their prayers asking how to solve their problem.
After which they were able to fully assess what is happening to their
family and was able to accept the diagnosis of the disease.
STAGE 3: MAJOR THERAPEUTIC EFFORTS

The family of the patient was having issues because of the fees of the
hospital and medicine. There was stress to the family on how to pay for the
fees and the medicine of the index patient. The family now needs to buy
maintenance medicine for the blood pressure of the patient. The patient felt
guilty, fear and restlessness on how she cannot help her family with the
payments.
STAGE 4: EARLY ADJUSTMENT TO OUTCOME (Recovery Phase)
The patient was able to recover from hospitalization and was allowed
to go home. The patient was not able to completely recover to her previous
health as now she is taking maintenance medicine for her high blood
pressure.
STAGE 5: ADJUSTMENT TO THE PERMANENCE OF OUTCOME
The family of the patient was able to recover from the crisis that
happened to their family. They were able to accept and adjust to their new
routine in the family.

VII. Management Plans/Recommendations of the Group for the

Family
Educating patients is very important. The group intends to give advice on
how to prevent certain disease or to promote general health. Simple things
which should and can be done at home such as proper waste disposal,
promoting good hygiene and proper nutrition. The patient, Josefina should
also be monitored regularly since she has a history of having a very high
blood pressure. A medical diary of the patient can also be done to monitor
the patients blood pressure daily. The family should also make sure that the
patient would take her maintenance medicine. The patient also mentioned
about her enlarged heart in which she should also get regular checkups.
According to some studies, educating patients about their diseases and
treatment plans is a must if you want them to follow through with
medication, new diets and other lifestyle changes. The best results also
come when you combine education with behaviour modification strategies
and emotional support. The patients family was very well supportive with
each other. Based on out interview their only main problem can be attributed
to the fact that they are lacking monetary resources. But even though they

lack money, it is not a hindrance to good relationships. All we can advice is

to save whenever they can.