-FIRST- LEVEL ASSESSMENT-

During my visits to the Piano family, I observed that there are risk factors and
conditions that predispose the family to certain diseases, accidents and failure to maintain
wellness condition.
Accident hazards are present w/in their environment. Pointed and sharp objects
are improperly kept, knives and pointed steels are scattered around their house. Pesticides
are improperly stored and kept, they just kept them in their “dirty kitchen (extension of
their kitchen),so it is possible that they will mistakenly take it and use as an ingredient or
in the condition of Ate Imelda, she can possibly play w/ it and she might drink it. In front
of their house is an unused well, w/c is not properly covered and not easily noticed, so
fall on it is possible. The family is also prone to fall hazards because their ‘galba” is
old(“marupok”) and it may fall down when there is heavy rain or wind and may cause
accident to them.
Poor environmental sanitation is also evident to the family. Since the family
primarily generate their income from farming, in front of their house is a an area where
they gather “dayami” hay, some farming equipment, cans, gallons and drums. When it
rains, water is gathered and contained on these containers and become breeding sites of
mosquitoes. The “dayami” and some farming equipments w//c are gathered and crammed
on that area became the breeding sites of roaches and rodents. Additionally, the maneur
of their domesticated animal(cow) causes flies to be numerous w/in that area. In
disposing their garbage, the family don’t have a definite garbage area they just gather
their garbage and then burn it, at times in their backyard and sometimes on the side of
their house The family also have an improper drainage system ,they have an open
drainage system w/c may be the cause of many flies gathered w/in their drainage area,
furthermore, left over foods are collected on said area, causing foul odor. There is also air
pollution, primarily because the family burned their garbage every now and then
including plastics; the maneur of their cow also contributes to the proliferation of
unpleasant odor and it contain methane that when dispose in the air it adds pollution to
the place.
The family performs some unhealthful habits and practices w/c may predispose
them to certain diseases or either aggravate their existing illnesses. Mr. Bonifacio, who
has arthritis is a heavy smoker, he smokes 1 pack of cigarette per day or more. He self-
medicates himself w/ Naproxen, Doclopenac and Celestol .According to him, he decided
to take these medications because the commercial on the television says it is for arthritis.
All of them eat raw meat, fish and beef at times these foods are prepared for their meals.

As predisposed by the faulty and unhealthful practices and habits of the family,
some of the family members experiences disease condition that affects their health and
physical, mental, emotional, psychological and financial aspects of their lives.
Mr. Bonifacio has been diagnosed w/ arthritis(rheumatoid arthritis) when he was
still 40 years old ,but since then he never seek again medical consultation. His arthritis
don’t attack always but only when he happens to eat legumes, beans and meat organs and
might be also aggravated when he smokes. At times of attack of his illness, he
experiences joint pain and swelling on both his legs and arms. He is also hypertensive
since then but undiagnosed by medical practitioner.
His wife, Mrs. Leticia was diagnosed as hypertensive also, he sometimes
experiences nape pain. , Ate Imelda has “altered thought processes” and as also claimed
by her parents “Kasta na talaga nakkong, madi man rikna mi,manipud pay ubing,di
simrek ti elementarya kasta na talagan,kasla ha,an sa unay nagmature , amu minga ada
madi kanyana ngem di mi ammu nu anya talaga,ubing ubing paleng ket 28 nan
nakkong,ngem di mi latta ibilbilangnga sabsabali sunan ah kasla latta normal para
kinyamin”. According to the couple, they refused to seek medical consultation about the
condition of their child because they are afraid to know the real illness or deficiency of
their child and one thing more they lack money, however; they claimed that either their
daughter is sick or what, they still accept, treat and love Ate Imelda the way they treat
their other siblings.

There are foreseeable crisis situations within the family. Hospitalization of a

member could be possible since Mr. Bonifacio who has arthritis doesn’t have check-up at
all since he was diagnosed, he don’t get rid of the things that could aggravate his
condition and one thing more, he just self-medicate himself. Also both the couples
Mr.Bonifacio and Mrs. Leticia who are hypertensive could also be hospitalized since they
don’t take prescribed maintenance medications and so w/ Ate Imelda, who has altered
thought process, she might also be hospitalized if her condition becomes more severe and
furthermore if turns into a more severe mental abnormality.
Kuya Michael,who is a messenger on BPI on a no work no pay policy could
possibly loss his job since sometimes he couldn’t go to work because his place of work is
quite far from their residence and recently he was scolded by his supervisor and lastly the
bank is hiring other applicants as messengers, thus it is possible that he will resign from
work or either he will be fired and be replaced by other applicants.
Harm on other members and fire of their house is also possible, sine Ate Imelda
who is mentally unstable, is often left at home, allowed to cook and stay there all alone
by herself, she could also harm other members of the family as well as their neighbors.

-SECOND - LEVEL ASSESSMENT-

The family is facing several problems, both unknown and known by them. The
family may perceive the presence of some of these problems and the need to take action,
however; they refuse to face to do something about these situation.

I. Inability to recognize the presence of a problem due to:

Inadequate knowledge about healthy lifestyle practices and personal habits,
proper environmental sanitation and wellness state, thus then family is unaware or
either unacquainted to the problems arising w/in them as well as to their surrounding.
And as a result of inadequate knowledge about these things that could contribute to
healthy living, they have poor environmental sanitation as evidenced by presence of
breeding or resting sites of vectors of diseases, improper garbage disposal and improper
drainage system; they are also prone to accident hazards from improperly kept pointed
and sharp objects and pesticides and “marupok na galba”and improperly covered well;
unhealthful lifestyle and personal practices such as cigarette smoking, self-medication
and eating raw meat and fish.

II. Inability to make decisions w/ respect to taking appropriate health action due to:
 Failure to comprehend the nature and magnitude of the problem. Ate Imelda
who has altered thought process as per observed and claimed by her parents wasn’t been
brought to the hospital for medical consultation and proper diagnosis and management to
her condition since she started to act and think differently compared to other normal
individual because her parents fail to comprehend the real nature of her condition. Her
parents as well as other members of the family just knew that something is wrong to her
but they don’t claim that she is sick, that’s why medical consultation should be seek to
know her real disease or condition for proper management.
Conflicting opinions among family members and significant others regarding
action to take. Both the parents are determined not to seek for medical consultation
regarding the condition of their daughter, while Kuya Michael often insist that they
should consult medical practitioners or specialist.
Fear of consequences of action, social consequences; the family in general is
afraid or rather ashamed as to what and how other people will react to whatever will be
the diagnosed disease of Ate Imelda. And also the family is not emotionally prepared to
whatever will be the diagnosis and prognosis just in case they seek for medical
management.
Inaccessibility of appropriate resources for care, specifically, financial
constraints .Another reason why the family couldn’t decide as to whatever health action
will they do is that they lack money to use for medical diagnosis and management of Ate
Imelda’s condition. In addition, that’s why they failed to seek for medical consultation
regarding Mr. Bonifacio who has arthritis and hypertensive and Mrs.Leticia who has
hypertension also.

III. Inability to provide adequate nursing care to the sick member due to:
Inadequate knowledge about the disease (nature, severity, complications,
prognosis and management). The family specifically the couple failed to seek for
adequate nursing care and medical consultation because they are not aware of the
possible complications that could happen if they don’t pay much attention to their
diseases and also w/ Ate Imelda, they failed to seek or provide adequate nursing care for
they aren’t aware of the possible complications or risk if it will be undiagnosed and not
managed properly.
As I have said on the earlier part, they are not financially stable or they are
suffering from financial constraint so they failed to provide nursing care to the family
members who are sick. Furthermore, responsible member or knowledgeable member in
providing nursing care is not present, just like in assessing the blood pressure of the
couple who are both hypertensive, nobody among the family members knows how to do
so.
IV. Inability to provide an w/c is conducive to health maintenance and personal
development due to:
Lack of adequate knowledge of the importance of sanitation. One of the
problems of the family is the poor environmental sanitation as manifested by presence of
breeding or resting sites of vectors of diseases, improper garbage disposal and improper
drainage system. They are not equipped w/ appropriate knowledge on sanitation that’s
why these problems arises.
Inadequate knowledge of preventive measures. The family is prone to accident
hazards because they lack knowledge on safety precautions and preventive measures as
pointed and sharp materials and pesticides are improperly kept and the presence of
“marupok na galba” and improperly covered well .

V. Failure to utilize community resources for health care due to:

Failure to perceive the benefits of health care or services. The family is not
aware of the health care services or community health care services since they do not
have time to visit their RHU because they spent most of their time in the farm, so
although the barangay health workers offer health services they don’t benefit from it.
Feeling of alienation or lack of support from the community. The family is
apprehensive to utilize community resources for health care because they fear that in the
condition of Ate Imelda, they could possibly be out cast, laughing stock of the
community or either the community will have a bad notion or feedback not just to Ate
Imelda but to the whole family.