Family Case PresentationFamily Case PresentationIntern OngkekoIntern Ongkeko

Intern RogacionIntern Rogacion

Intern SamsonIntern Samson

OutlineOutlineIndex patient (Case) -hx pe, Assessment, Plan (kasama yung sa CAMP)!!Index patient (Case) -hx pe, Assessment, Plan (kasama yung sa CAMP)!!

Family Assessment ToolsFamily Assessment Tools

Family IdentificationFamily Identification

CompositionComposition

Social HistorySocial History

Community NeighborhoodCommunity Neighborhood

Health historyHealth history

Roles in the familyRoles in the family

GenogramGenogram

Family life cycle (Stage)Family life cycle (Stage)

APGARAPGAR

Family MapFamily Map

SCREEMSCREEM

Family timelineFamily timeline

Impact of illness on the familyImpact of illness on the family

Rapid community med checkRapid community med check

Individual Health PlanIndividual Health Plan

Family Wellness PlanFamily Wellness Plan

EBM yak!EBM yak!

Index PatientIndex Patient

The patient is J.V. a 30-year old female from Nagsaulay, San The patient is J.V. a 30-year old female from Nagsaulay, San Juan, Batangas. She is a right-handed, Roman Catholic, Juan, Batangas. She is a right-handed, Roman Catholic, housewife.housewife.

Chief Complaint: Referred by BHW for medical check-upChief Complaint: Referred by BHW for medical check-up

History of Present IllnessHistory of Present Illness

Patient Profile: The patient is a non-asthmatic, non-diabetic and Patient Profile: The patient is a non-asthmatic, non-diabetic and non-hypertensive. She was previously diagnosed as a case of non-hypertensive. She was previously diagnosed as a case of polio during childhood.polio during childhood.

During a previous session in the LHC, a BHW asked his patient During a previous session in the LHC, a BHW asked his patient to be seen. Hence this consult.to be seen. Hence this consult.

Review of SystemsReview of SystemsGeneral: (-)fever, (-) weight loss, (-) malaise, (-) anorexia

• Integumentary: (-) easy bruisability, (-) rashes

• HEENT: (-) colds (-) headache, (-) blurring of vision, (-) nasoaural discharge, (-) loss of hearing, (-) dysphagia, (-) dysphonia

• Respiratory: (-) cough, (-) hematemesis, (-) hemoptysis

• Circulatory: (-) easy fatigability, (-) chest pain, (-) palpitations, (-) orthopnea, (-) PND

• Digestive: (-) abdominal pain, (-) nausea/vomiting, (-) diarrhea/constipation

• Urinary System: (-) dysuria, (-) oliguria, (-) hematuria

• Nervous: (-) decreased sensorium, (-) behavioral change, (-)seizures

• MSK: (-) pain, (-) swelling, redness, warmth

Past Medical HistoryPast Medical History

as aboveas above

s/p bitubal ligation (2009)s/p bitubal ligation (2009)

OB-Gyne HistoryOB-Gyne History

Menarche at 13 years old, periods occurring in regular monthly Menarche at 13 years old, periods occurring in regular monthly intervals, lasting for 2-3 days, consuming 2-3 moderately soaked intervals, lasting for 2-3 days, consuming 2-3 moderately soaked cloth pads per day, (-) dysmenorrheacloth pads per day, (-) dysmenorrhea

She is a G4P4 (4004) mother. During her pregnancies, she had She is a G4P4 (4004) mother. During her pregnancies, she had regular PNCU’s c/o the LHC. All her children were FT delivered regular PNCU’s c/o the LHC. All her children were FT delivered via SVD assisted traditional birth attendant without perinatal via SVD assisted traditional birth attendant without perinatal complications.complications.

Family Medical HistoryFamily Medical History

See later slidesSee later slides

No history of DM, hypertension, TB, goiter, cancerNo history of DM, hypertension, TB, goiter, cancer

(+) Osteoporosis - maternal grandmother(+) Osteoporosis - maternal grandmother

No other members with similar problems as the patientNo other members with similar problems as the patient

Personal & Social HistoryPersonal & Social HistoryThe patient is a 30-year old housewife.The patient is a 30-year old housewife.

She was able to reach Grade 1 but is illiterate and has no formal job experience.She was able to reach Grade 1 but is illiterate and has no formal job experience.

No vices (smoking, alcohol, illicit drugs)No vices (smoking, alcohol, illicit drugs)

Usual diet is fishUsual diet is fish

Husband is a fisherman who is presently living with his mother.Husband is a fisherman who is presently living with his mother.

They have four children. The first of whom also lives with her husband’s mother.They have four children. The first of whom also lives with her husband’s mother.

They are first cousins!!They are first cousins!!

They live in a house made of light materials (dried coconut leaves and bamboo)They live in a house made of light materials (dried coconut leaves and bamboo)

Source of water is a public artesian well which is 30m from their homeSource of water is a public artesian well which is 30m from their home

They do not have their own toilet. They use the rest room of their uncle, 15 meters from their home.They do not have their own toilet. They use the rest room of their uncle, 15 meters from their home.

Physical ExamPhysical ExamGeneral Survey:

• Awake, conscious, coherent, not in cardiorespiratory distress

• Vital Signs:

• BP 110/70

• HR 88 bpm

• RR 19 bpm

• Temp 37.0°C

• Anthropometrics

• Height: 152 cm

• HEENT

• Pink conjunctivae, anicteric sclerae, no cervical lymphadenopathy, (-) neck vein engorgement, no anterior neck mass, no nasal or aural discharge, (-) tonsillopharyngeal congestion, (+) visible cerumen

• Chest/Lungs:

• Equal chest expansion, clear breath sounds, no rales/wheeze/crackles

• CVS:

• Adynamic precordium, (-) heaves/thrills, Apex beat at 5th ICS L MCL, (-)murmurs

• Abdomen:

• Flat, soft, not distended, (+) postsurgical scar normoactive bowel sounds, (-) masses/tenderness

• Skin/Extremities:

• Full and equal pulses, pink nailbeds, dry skin with good skin turgor, (-) edema/cyanosis/clubbing, capillary refill time < 2 seconds, No atrophy

• True Leg Length: R: 31in L: 30in

• Neurologic:

• GSC 15, oriented to time, place, and person; intact cranial nerves I-XII (decreased hearing acuity, AS), no sensory deficits, 5/5 motor strength on all extremities, +2 deep tendon reflexes, no babinski reflex, no cerebellar signs

• OPHTHA:

• VA: OD: can read fine print; OS: counting fingers at 3 feet

• (+) leukocoria OS, pupils equally brisk and reactive to light; full EOMs, (+) visual field defects in inferonasal quadrant, OS

AssessmentAssessment

Congenital cataract, etiology?Congenital cataract, etiology?

Polio (EDIT ME!!!!!!!)Polio (EDIT ME!!!!!!!)

ASSESSMENT FROM CAMPASSESSMENT FROM CAMP

s/p bitubal ligation (2009)s/p bitubal ligation (2009)

PLANPLAN

PLAN FROM CAMPPLAN FROM CAMP

Diet as toleratedDiet as tolerated

Wear thicker slippers on the leftWear thicker slippers on the left

Advised on ophthalmologist consultAdvised on ophthalmologist consult

Daily bath and oral hygieneDaily bath and oral hygiene

Maintain a clean home and surroundingsMaintain a clean home and surroundings

Family IdentificationFamily Identification

Insert PicInsert Pic

Family IdentificationFamily Identification

Jocelyn-motherJocelyn-mother

Alberto-fatherAlberto-father

Jema Rose- eldestJema Rose- eldest

John Carlo- secondJohn Carlo- second

John Lloyd- thirdJohn Lloyd- third

Anika- youngestAnika- youngest

Family IdentificationFamily Identification

Community NeighborhoodCommunity Neighborhood

Look at Chionglo’s community updateLook at Chionglo’s community update

Family IdentificationFamily Identification

Social HistorySocial History

JV was originally from Bicol and transferred to San Juan, JV was originally from Bicol and transferred to San Juan, Batangas when she was 22 years old. Batangas when she was 22 years old.

JV and Alberto are first cousins. Their fathers are brothers. The JV and Alberto are first cousins. Their fathers are brothers. The family is still hesitant to talk about the history of JV’s family.family is still hesitant to talk about the history of JV’s family.

Health HistoryHealth History

Roles in the FamilyRoles in the Family

Breadwinner- AlbertoBreadwinner- Alberto

Decision-maker- LiliaDecision-maker- Lilia

Handles budget- Alberto/LiliaHandles budget- Alberto/Lilia

Disciplinarian- JVDisciplinarian- JV

Primary Caregiver- LiliaPrimary Caregiver- Lilia

GenogramGenogram

Family Life Cycle StageFamily Life Cycle Stage

Family with Young ChildrenFamily with Young Children

Family APGARFamily APGAR

JVJV

Family APGARFamily APGAR

AntonioAntonio

Family APGARFamily APGAR

LilibethLilibeth

SCREEMSCREEM

AspectAspect ResourceResource PathologyPathology

SocialSocial

All their neighbors are All their neighbors are their relatives and help their relatives and help them when they are in them when they are in

needneed

She is looked upon as She is looked upon as kulang sa kulang sa bait. bait. And she is regarded as a And she is regarded as a

burden to the family.burden to the family.

CultureCulture

SCREEMSCREEM

ReligiousReligious

EducationalEducational

EconomicEconomic

SCREEMSCREEM

MedicalMedical

Family TimelineFamily Timeline

WADAHECK!!!!WADAHECK!!!!

Impact of Illness on the FamilyImpact of Illness on the Family

Rapid Community Medicine Rapid Community Medicine CheckCheck

INDIVIDUAL HEALTH PLANSINDIVIDUAL HEALTH PLANS

FAMILY WELLNESS PLANFAMILY WELLNESS PLAN

JOURNAL APPRAISALJOURNAL APPRAISAL

DILEMMADILEMMA

PopulationPopulation Polio patients with leg length Polio patients with leg length discrepancydiscrepancy

InterventionIntervention

OutcomeOutcome

MethodologyMethodology