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    Family Assessment Guide: Family Member's Chart

    Uploaded by

    Jean Mercado
    This family assessment summarizes information about an anonymous family residing in Iloilo City. The family has 7 members and has lived in Iloilo City for 23 years. They have a patriarchal and extended family structure. The family experiences some conflicts in communication but respects each other. Several family members have health issues like diabetes, high blood pressure, asthma, and UTI. The family lives in an owned house with some hazards present. They consult both traditional and medical professionals for health issues.

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    © All Rights Reserved
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    Family Assessment Guide: Family Member's Chart

    Uploaded by

    Jean Mercado
    97 views6 pages
    This family assessment summarizes information about an anonymous family residing in Iloilo City. The family has 7 members and has lived in Iloilo City for 23 years. They have a patriarchal and extended family structure. The family experiences some conflicts in communication but respects each other. Several family members have health issues like diabetes, high blood pressure, asthma, and UTI. The family lives in an owned house with some hazards present. They consult both traditional and medical professionals for health issues.

    Original Description:

    Community health nursing

    Original Title

    Chn

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    This family assessment summarizes information about an anonymous family residing in Iloilo City. The family has 7 members and has lived in Iloilo City for 23 years. They have a patriarchal and extended family structure. The family experiences some conflicts in communication but respects each other. Several family members have health issues like diabetes, high blood pressure, asthma, and UTI. The family lives in an owned house with some hazards present. They consult both traditional and medical professionals for health issues.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    97 views6 pages

    Family Assessment Guide: Family Member's Chart

    Uploaded by

    Jean Mercado
    This family assessment summarizes information about an anonymous family residing in Iloilo City. The family has 7 members and has lived in Iloilo City for 23 years. They have a patriarchal and extended family structure. The family experiences some conflicts in communication but respects each other. Several family members have health issues like diabetes, high blood pressure, asthma, and UTI. The family lives in an owned house with some hazards present. They consult both traditional and medical professionals for health issues.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 6

    FAMILY ASSESSMENT GUIDE

    Family Name: ___Anonymous___________ Address: ___Iloilo City_____

    I. Family Data
    Length of residency: 23 years______
    Place of origin: Sta. Barbara, Iloilo__
    Family size: ______7___________
    Religion: Husband- Roman Catholic
    Wife- Roman Catholic____

    Family Member’s Chart

    FAMILY MEMBERS AGE SEX CIVIL POSITION IN RELATIONSH EDUCATIONAL OCCUPATION


    STATUS THE FAMILY IP TO ATTAINMENT
    FAMILY
    HEAD
    1. Aa 48 M M Father Head Elementary Farmer
    Graduate
    2. Bb 40 F M Mother Wife High school Housewife
    Graduate
    3. Nene 23 F S Daughter Oldest High school Sales lady
    Graduate
    4. Nonoy 22 M S Son Second High school Construction
    Graduate worker
    5. Toto 20 M S Son Third College Student
    6. Inday 17 F S Daughter Youngest Senior High Student
    School
    7. Bb 5 F S Grandchild Grandfather Student

    II. Family Characteristics


    Type of Family Structure: Extended _
    Patriarchal

    Tradition: Birthday

    Christmas

    New Year

    Reunion

    General Family Relationship/Dynamics

    CRITERIA STATUS ADDITIONAL INFORMATION


    Observable conflicts between family (-) None
    members
    Characteristics of communication (+) Respect each other
    Interaction patterns among members (-) Not open to communicate

    Family Dietary Habits

    What did you eat yesterday? (24 hours dietary recall)

    Breakfast: dried fish, rice, coffee, water

    Lunch: Rice, tinola, ________

    Supper: Rice, _______________

    Monthly Family Income Source

    Husband : _4000

    Wife : none

    Oldest child : _5400__

    Second chils : 4000

    Monthly Family Income Source

    More than P 13400

    Family Health Status/Health History

    Father: Diabetes, and high blood __

    Mother: High blood_______

    Children: All children have Asthma, Oldest daughter- UTI

    III. Home and Environment


    A. Is your lot owned? No______
    B. Is your house owned? __Yes______
    C. Type of housing materials _Wood_
    D. Is the living space adequate? No______
    E. Sleeping arrangement Separated_
    F. What are the appliances owned by the family?
    ,Television, Electric fan, Radio, _____________
    G. Type of garbage disposal: _Burning_
    H. Type of waste disposal: _Flush____
    I. Type of drainage system: _Open____
    J. Source of water supply: _”Nakiki-igib”____
    K. Drinking water storage: _Jug.
    L. Containers used: _Plastic bottles
    M. Food storage/cooking facilities: Cabinet___
    ___”Kalan”__
    N. Common household pests found at home: Cockroaches, mosquitoes, spiders, mouses,
    and ants
    O. Are there breeding sites of insects, rodents, etc. present? _Yes.
    P. Pets/animals kept in the yard/home: _Dog and cat
    Q. Are there any hazards present? _Yes________

    IV. Health and health practices


    A. Common illnesses encountered for the last 6 months and the treatment applied.
    1. Father: _Diabetes with maintenance_
    2. Mother: _High blood with maintenance
    B. Whom do you consult for health-related problems?
    Manghihilot
    Doctor___
    C. For problems other than health, whom do you consult?
    Family members
    D. Immunization status of the family members
    _Complete immunization
    E. Have you had adequate
    1. Rest and sleep? _Yes__
    2. Exercise _No__
    3. Relaxation activities? _Yes__
    4. Stress management activities? Yes_

    V. Environment

    1. Kind of Neighborhood Rural


    2. Social and health facilities available Brgy. Health Center
    3. Communication and Transportation Cellphone, laptop, Tricycle, Jeep, Motor
    Facilities

    VI. Awareness of community organization


    A. Are you aware of existing organizations in the community? _Yes__
    B. Name all the organization/s you know.
    ___Sangguniang Kabataan (SK)
    ___LGU____________________
    C. Are you a member of any of these organizations? __No________
    D. Are you aware of its activities and projects? __ Yes________
    E. How are you involved in its activities? __Give donations
    F. Name 5 formal and nonformal leaders of the community whom do you think can lead
    the people.
    1. Kapitan
    2. Mayor
    3. Kagawads
    4. SK Chairman
    5. Tanod
    Family
    Assessment

    Submitted to:

    Prof. Annalie Gilongos

    Submitted by:

    Jane Eloisa Gatsulao

    Germaine Sarmiento Gelera

    Carla Martina Mae Horario

    Sophia Loraine Jesura

    Marielle Jover

    Christel Dawn Limsiaco


    Jannah Mae Ma-ang

    Krystian Macuja

    BSN-2D

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