Introduction

Community Health Nursing is the synthesis of nursing and public health practice applied
to promote and protect the health of population. It combines all the basic elements of clinical
nursing with public health and community practice. It is essential particularly at this point in time
because it maximizes the health status of individuals, families, groups and the community
through direct approach with them. There are so many factors that can affect the health of a
family in a community. Chronic illnesses, accidents, vices like tobacco smoking, alcoholism and
drug addiction, and environmental changes that affect health are steadily becoming the major
concerns influencing human health in our country.
Hypertension, also referred to as high blood pressure, is a condition in which the arteries
have persistently elevated blood pressure. Every time the human heart beats, it pumps blood to
the whole body through the arteries. Hypertension is considered as the biggest single risk factor
for deaths worldwide. According to the World Health Organization 2012, hypertension causes 7
million deaths every year while 1.5 billion people suffer due to its complications.
I chose Mrs. S’s case because her case is one of the most common disease worldwide
afflicting humans, which is hypertension or high blood pressure. Also it has the highest score
among other problems I found. It is known as silent killer because in the initial stage it presents
no symptoms. It is only after an organ in the body is irritated or damaged, that the consequences
of high blood pressure are realized. Lifestyle nowadays is one of the major precipitating factors
of the condition. These lifestyle factors include high sodium intake, excessive calorie intake, and
obesity, physical inactivity and excessive alcohol consumption. During the course of the nursing
process, we have formulated the following objectives:
 After 12 days of span of nursing care:
 Determine the level of cognition in the determination and prioritization of problems that
exist in the community.
 Develop the skill of intervention prompt to the social health care problem in accordance
with its appropriateness and effectiveness.
 Provide services and facilitate for the better and appropriate solutions present in a
particular community.
And for the specific objectives:
 After 12 days of span of nursing care:
 Apply knowledge and skills on how to give health education to the community in
relation to their identified problem;
 Discuss briefly and explain the etiology of prioritized problem, its causes and effects
and ways on how to eradicate it;
 Established a nursing care plan which would be beneficial to the family, as well as to
the community;
 Formulate a clear and specified plan of action to give solutions to the existing health
problems identified within the community
 Present data and proof about the common health problem of the community residents;
 Relate existing health problems with different nursing theories; and
 Evaluate the effectiveness of the plan of action and the entire program performed in
the community;
 Give summary, evaluation and implication.

II. FAMILY PROFILE

Family S resides at Brgy. Lomboy, Talavera, Nueva Ecija. The head of the family is Mr.
RS he is 72 years old, born on May 07, 1960 and he was born in Talavera, Nueva Ecija. His
highest educational attainment is high school. He is a farmer and a Roman Catholic. Mrs. LS is
the wife of Mr. RS who is 59 years old and born at Talavera, Nueva Ecija, with a highest
educational attainment of elementary graduate and is a housewife. Mrs. LS is living in that house
since 1981; their income per month is about 5,000 pesos depending on the harvest of their crops.

III. INITIAL DATA BASE

A. Family Structure, Characteristics and Dynamics
The S family, an extended type of family is the chosen to be the subject of my case study. They
are currently residing at Barangay Lomboy, Talavera, Nueva Ecija. Mrs. LS is 59 years old, a
elementary graduate, a housewife and was diagnosed with hypertension and mild stroke last
2020. She is also the one making the decision in terms of their financial budget. Her husband Mr.
RS is 72 years old, an high school undergraduate, and works with his son in their own farm. Mr.
RS is the one making the decision in relation to health, problems in the family and sometimes the
one who budget with regards to financial. They have 6 children but only 2 are still dependent and
living with them. Their eldest child is 41 years old, a high school undergraduate, married with 6
children and work as a laborer. Their 2nd child is 40 years old, also a high school graduate,
Married with 3 children and working as a vegetables vendor with his wife. Then, their 3rd child
is 37 years old, married and works as a farmer at Campos, Talavera, nueva Ecija. Their 4th child
is 32 years old single and works as a helper at Gapan. Next is their 5th child is 29 years old,
single. Lastly, their last child is 27 years old single but has 1 daughter and living together with
his parents. Their family has owned their house that is made of concrete wood and cement with 3
rooms. They have no enough furniture. They have one Television, sufficient lighting facility,
they also have a public water supply, a water sealed type of toilet facility near their kitchen, has
also an open drainage system. They are also composting their garbage and uses firewood in
cooking.
B. Socio-Economic and Cultural Background
Mrs. LS is 59 years old, and is married to Mr. RS who is a farmer at Barangay Campos,
Talavera, Nueva Ecija. She is a housekeeper and a loving mother to her six (6) children. The
family generated their income in several of sources. Mr. RS is a farmer. Who plants “palay” and
sometimes he also plants vegetables in their own backyard. They also raise livestock animals
such as ducks, turkeys and chickens as a source of their income. They can provide the needs of
the family especially food because of ducks, turkeys and chickens they raised and vegetables at
their backyard. The family income for their palay is 5, 000 to 10, 000.The income of the family
is enough for their personal expenses and also for paying additional expenses such as loans or
debts.
The family belongs to a Roman Catholic Church; however, they don’t always go to mass on
Sundays because their location is far from the city. They are not active in community programs,
but they are aware of the schedules for their community services and activities. Their social life
involves attending weddings, burial and birthdays within their family, relatives and within the
community too. According to her, they have a good family relationship; they are close to each
other. Mrs. LS is a elementary graduate. They ate 3 times meal in a day. According to LS when
there are health emergencies, her six (6) children give a small amount as financial support. The
structure of their house is made of concrete wood and cement. It has three rooms for her children
and they have a comfort room.

C. Home and Environment

Barangay Lomboy, Talavera, Nueva Ecija, Purok 4 is a walking distance only from the
Barangay Hall. The barangay is agriculturally rich with rice fields and different kinds of
vegetables. For the means of transportation going to town is through public utility jeepney and
single motorcycles.
The land where Mrs. LS house is situated is owned by her 2 sons and they lived in a
compound wherein the house of her 4 other children are situated in the same land. The house of
the family is made up of concrete with a nice yard and a small separated kitchen made up of
cement. There is also a terrace where they can rest with her granddaughter who helps her in
taking her maintenance medicines. They have fruits on their yard like coconuts, pomelo and they
also have eggplant and sweet potato peels. The floor of their house is cemented, and their yard is
rocky. They have appliances such as television and electric fan.
There is a small kitchen at the end part of their house. They make use of firewoods in
cooking. The family practices waste segregation and they dispose their waste at the garbage
disposal. The bathroom that is made from galvanized iron and the toilet is located outside their
house.
D. Family Health
The S family is residing at Barangay Lomboy, Talavera, Nueva Ecija is compose of 8
members; Mr. and Mrs. S with their six children. All of their children are known smokers and
occasional alcohol drinkers. Their eldest and 2nd child also have hypertention. They experience
common colds and cough especially during rainy season, they usually self-medicate and they do
not have any regular check-up. Mrs. LS, 59 years old, who experience dizziness especially when
she forget to take her maintenance. She is not interested to go for check-up due to lack of
financial resources. Mrs. LS was diagnosed with hypertension and mild stroke last 2020 when
she suddenly collapsed at their public Market while selling “kakanin”.
E. Values Placed on Health
The family member consults at the health center and Talavera General hospital for any
illnesses that occur within the family.
PHYSICAL ASSESSMENT
Physical Examination of Mrs. LS
As Mrs. LS was diagnosed with hypertension I assessed her proceeding with her
vital signs result as follows: temperature, 36.7 degree Celsius, Blood Pressure, 130/90,
Respiratory Rate, 26 breaths per minute, and Pulse rate, 70 beats per minute.
Through direct observation; I noticed that her left side of the body was paralyzed, Skin
color is tan. Has an equally warm temperature on both arms and legs. Poor skin turgor. There is
absence of lesions and masses on the surface of the skin. Hair color is gray with smooth and fine
hair strands. There is absence of alopecia and hirsutism. Nail bed texture is soft and pinkish.
There is no presence of nail clubbing. Head is of a regular shape with no apparent lesions,
masses or foreign bodies. Scalp no evidence of skin condition or infestation, and exhibited no
tenderness on palpation. Cheeks are sunken, facial movements are all equal. Eyebrow is free of
scaling, pinkish conjunctiva and white sclera that is normal. Extra ocular movement (EOM) are
intact. There is no presence of edema and hollowness. No evidence of increased tearing. Pupils
are equally rounded and reactive to light and accommodation. Symmetrical ears and equal in size
aligned on the outer canthus of the eye. No presence of tenderness, masses and drainage clogged/
cerumen. Pinna recoils immediately. Nose is midline on the face without swelling, bleeding or
lesions. Patient can breathe normally in both nostrils. No presence of discharge, bumps and
tenderness; no pain reported. Lips are smooth, symmetrical, pinkish and free of cracks. No
suspected lesions or masses on tongue, gums, hard and soft palate and tonsils. Uvula is in the
middle, tonsils are pink without hypertrophy. Tongue easily moves in all directions, pinkish with
presence of whitish spots, moist and with gag reflex. There is presence of denture on the upper
part of the gums. Neck is symmetrical with head in central position.

IV. Level of Assessment

A. First Level of Assessment

First level of assessment is the process of determining existing and potential health
conditions or problems of the family. Second level assessment identifies the nature or type of
nursing problems the family experiences in the performance of their health tasks with respect to
a certain health condition or health problem.
1. Presence of Health Deficit
 High level of blood pressure it can lead to any further complication if not given
attention
2. Presence of Health Threats: Poor environment sanitation linked to possible
transmission acquisition of diseases.
 Improper drainage system
 Open cans with stagnant water

3. Presence of health Threats: Presence of breeding or resting sights of vectors of

disease.
 Stagnant water from washing dishes and cloths
 Presence of termites inside the walls of one room
4. Foreseeable Crisis: Limited access of first aid hypertension medicines in the Health
Center
 Hypertension medicines are often out of stock in the Health Center
B. Second Assessment
The results of the student nurses’ in depth second level of assessment on the identified
health condition/ problems are presented in the following below. These problems stand as family
nursing problems.
Poor Environmental Sanitation Inability to provide a home environment
conductive health maintenance and personal
development due to lack of inadequate
knowledge regarding preventive measures.
Presence of breeding or resting sights of Inability to perceive it as a health threat for the
vectors of disease. family
 Lack of knowledge what could insects
rodents cause the family’s health
 Lack of skill in carrying out measures
to improve home environment
Limited access of first aid hypertension Inability to provide first aid medication of
medicines in the Health Center hypertension due to lack of medicines stock.
V. FAMILY HEALTH PROBLEMS AND JUSTIFICATION
CUES AND DATA HEALTH THREAT
1. Poor environment sanitation 2. Health Threats
 Stagnant water due to improper  Risk for gastrointestinal health problem
drainage system which leads to the  Linked to transmission of diseases
presence of mosquito and foul odor that such as cholera, diarrhea, dysentery,
is harmful to the body system hepatitis A, typhoid fever, and polio.
Presence of breeding or resting 3. Health Threats
sights of vectors of disease  Stagnant water from washing dishes
and cloths
 Presence of termites inside the walls of
one room
Limited access of first aid hypertension 4. Foreseeable Crisis
medicines in the Health Center  Inability to provide first aid medication
of hypertension due to lack of
medicines stock.

VI. FAMILY NURSING DIAGNOSIS

Problem Family Nursing Diagnosis
1. Possibility of water contamination Inability to recognize the presence of the
condition or problem due to lack of or
inadequate knowledge regarding
2. Presence of breeding or resting Inability to perceive it as a health threat for the
sights of vectors of disease family
 Lack of knowledge what could insects
rodents cause the family’s health
Lack of skill in carrying out measures
to improve home environment
3. Limited access of first aid medicines in Inability to provide first aid medication of
the Health Center hypertension due to lack of medicines stock.

VII. PRIORITIZATIONS OF PROBLEMS

1. Presence of breeding or resting sites of mosquitoes and termites
COMPU- ACTUAL
CRITERIA JUSTIFICATION
TATION SCORE
a. Nature of the It is health threat because the family is at
2/3 X 1 0.67
Problem risk from vector-borne diseases.
b. Modifiability of the 2/2 X 2 2 It is highly modifiable because the
Problem resources and interventions needed to
solve the problem are available to the
family.
The problem is highly preventive because
occurrence of dengue, malaria and other
c. Preventive Potential 3/3 X 1 1 communicable diseases can be reduce or
minimized through environmental
sanitation.
The family perceives this as a problem
d. salience of the because they are aware of the possible
2/2 X 1 1
Problem outcomes but they don’t have the initiative
to make/take an action.
TOTAL 4.67

2. Lack of financial constraints

COMPU- ACTUAL
CRITERIA JUSTIFICATION
TATION SCORE
It is health threat because it restricts the
b. Nature of the
2/3 X 1 0.67 family from spending and investing on
Problem
something that they really need.
It is easily modifiable because the family
b. Modifiability of the can increase their financial income by
2/2 X 2 2
Problem agricultural development and improved
livelihoods.
The problem is highly preventive because
c. Preventive Potential 3/3 X 1 1 the family resides in a livelihood wherein
you can plant different crops.
The family perceives the situation as a
d. salience of the
2/2 X 1 1 problem but doesn’t have means for
Problem
immediate action.
TOTAL 4.67

3. Family History of Hypertension

NURSING EDUCATION
The nursing family case study enlightens us to the real scenario in the community. It also
gave us the opportunity to know that community health nursing is important so that nursing
students would be able to experience how it works. The availability of health services is
necessary in the community. It gave us the view that every community must have two public
health nurses to accommodate each family. The maintenance of the ability of both public health
agencies and private provides to manage day to day operations and the capacity to respond
immediately to the community should always be accessible. Through nursing family case study
we were able to assess the health needs of the family, plan, implement, and evaluate the impact
of health services in the community. It gave us the basic knowledge and skills in community
health nursing that one that formulate policies and develops on nursing aspect of specific
program such as health teaching of hypertension.
NURSING PROFESSION
In the nurse profession, competence, credibility, commitment and knowledge are needed
in the profession. The dedication of a nurse to serve in the community is remarkable and
outstanding. However, nurses must continuously enhance their knowledge and skills to explore
the capability to be used in the community.
The nurse and the community must collaborate in order to achieve the nursing
intervention when dealing with diseases like hypertension and smoking habits. This nursing case
study will give the public health nurse the awareness of how the community does the home
management in their disease. For a Nurse should enhanced the knowledge like political science
helps the nurses to understand the health care delivery system for them to better respond to
clients and use academic principles like sociology and psychology to know better on how to
understand the community.
NURSING RESEARCH
Hypertension is one of the most common worldwide diseases; 17.1 million deaths per
year are caused by hypertension. The major causes of hypertension are physical inactivity, an
unhealthy diet and through family history. Philippines reported that around 12.6 million of
Filipinos have hypertension. This research found out that the people in the community resolve to
deal with hypertension on their own rather than seeking medical help. This is because of their
lack of knowledge, ignorance and poverty. The researches therefore recommend that future
studies in hypertension cases in community should focus on determining tangible ways to
educate the people about the disease and the value of medical treatment in general.