Baslar, Isa Belmonte, Celeste Brillante, Christie Bulatao, Jose Cheng, Monina

1. Family Case Presentation Baslar, Isa Belmonte, Celeste Brillante, Christie Bulatao, Jose Cheng, Monina

2. GENERAL OBJECTIVE • To present a patient with osteoporosis, Fracture, Right hip

3. 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

4. GENERAL DATA • F. L. • 81 years old • female • Roman Catholic • Filipino • Single • Store owner • DOB:4/23/28

5. HISTORY OF PRESENT ILLNESS CONSULT

6. REVIEW OF SYSTEMS • (-) 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

7. 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

8. 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

9. FAMILYHISTORY • (-) asthma • (-) allergy • (-)PTB • (+)Kidney disease – sister • (+) HPN – sister • (-) DM • (-) Cancer

10. 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

11. 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

12. 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

13. 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)

14. ASSESSMENT OF INDEX PATIENT • Osteoporosis • Fracture, R hip • Senile Cataract, OU • Dextroscoliosis

15. FAMILY ASSESSMENT

16. UST BARLIN ST P. NOVAL X ELOISA ST ADELINA ST DAPITAN

17. STAIRS CR PATIENT’S ROOM

18. CHAIR CHAIR TV WINDOWS TABLE E.FAN PATIENT’S BED CABINET

19. 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

20. FAMILY TREE- Laganzua Family Rufo , 72 Inocencia,100 Jose,30 Adelaida, 27 Lorenza,81 Andrea,22 Jesus,60 Asuncion, 60 Carmelita,62 Esteban,65 Henry Odelon Clarissa Vivian Serrina MeAnne,33 Ariel,31 Anthony Mae Flora, 81 Seth, 6 Michael,35 Arlene,32 Vaughn Matthew,2

21. Family Structure • Type of Family- Unilaterally extended • Ordinal Position: Third • Social Class Pattern : Low Income Family • Family Set-Up: Democratic

23. 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

24. 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

25. HIGHLY FUNCTIONAL

28. MODIFIED CAREGIVER STRAIN INDEX • Me-anne Laganzua • Madalas- 2 • Minsan – 1 • Halos Hindi - 8

29. FAMILY LIFE CYCLE STAGE Family with young children- starts with pregnancy for the 1st child to emergence of adolescents.

30. FIRST ORDER CHANGE • . • . • . • . • . • 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

31. SECOND ORDER CHANGE • . • . • . • Accepting marital system to make space for children • Taking on parenting role • Re-alignment of relationship with extended family to include parenting and grandparenting roles

32. Family with young children – UNILATERALLY EXTENDED FAMILY ASSESSMENT

33. STAGE IN THE ILLNESS TRAJECTORY STAGE V: • Adjustment to the permanency of the outcome.

34. 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

35. FAMILY HEALTH CARE PLAN: Index Patient

36. FAMILY HEALTH CARE PLAN: Other family members