pamilya gavino, cherylle mirallo, alfred ngo, martin

PAMILYA

Gavino, Cherylle Mirallo, AlfredNgo, Martin

Outline

I. Index Case ProfileII. The FamilyIII. JournalIV. Family Wellness Plan

INDEX CASE PROFILE

General DataL.G. 28 years old, male separated, Roman CatholicBrgy. Palahanan 2.0, San Juan, Batangas Non- hypertensive, non- diabetic, non-asthmaticModerate to heavy alcoholic beverage drinker for about 1 year

Chief Complaint

Epigastric pain

History Of Present Illness

DOI: 3 days PTC (6/6/09)POI: San Juan high wayMOI: motorcycle crash; patient fell on his L side hitting a hard pavement; he sustained hematoma and abrasions on L face, L UE, L LE; (-) LOC, BOV, vomiting. No consult was done.For 3 days, patient already (+) epigastric pain VAS 4-5, intermittent, non-radiating, no meds taken.

History Of Present Illness

3 hours PTC:(+) epigastric pain, characterizedas parang pinipiga,VAS 8- 9/10, non-radiating(+) pallor, diaphoresis, cold-clammy extremities(+) frequent skipping meals(-)dizziness, fever, chest pain, dyspnea, vomiting, melena, hematochezia, rashes, pruritus

Review Of Systems

(-) weight loss/gain(-) headache, anorexia, seizure(-) blurring of vision, decrease hearing(-) cough, colds, palpitation, orthopnea(-) dysuria, polyuria, urinary/bowel changes,

urgency(-) paresthesia, arthralgia, myalgia, rashes, tremors(-) pedal edema

Past Medical History

No hypertension, diabetes, asthma, hepatitis, cancer, heart or kidney diseaseNo allergiesNo previous hospitalizations/surgeries

Family Medical History

(+) MI- father; 5 cases heart disease on paternal side

(+) diabetes mellitus on siblingNo asthma, hepatitis, cancer, kidney

disease

Personal- Social History

Patient is separated for almost a year now. His ex- wife, Mary Ann, is in Italy with her own family already. Blessed with two children, his youngest is only 7. The patient is currently unemployed and is supported by Tita Linda who took care of JR since childhood and is currently an immigrant in Italy. JR is also waiting for employment abroad. His children will be left under the custody of his mother when the time comes JR will leave. Patient is a non- smoker, moderate alcoholic beverage drinker for 10 years then heavy since last year, denies illicit drug use.

Physical Examination

General: Awake, coherent, in painVitals: BP 130/80 HR 90 RR 26 (tachypneic) T

36.7 BMI 31HEENT: Anicteric sclerae, pale conjunctivae, (-)

tonsillo-pharyngeal congestion/neck vein engorgement/cervical lymphadenopathy

CHEST: Equal chest expansion, clear breath sounds, (-) crackles/wheezes

HEART: Adynamic precordium, distinct heart sounds, regular rate/rhythm, (-) murmurs

Physical Examination

ABDOMEN: Flabby abdomen, normoactive bowel sounds, (-) organomegaly, (+) tenderness on epigastric area, (-) Rovsing’s/Murphy’s sign

EXTREMITIES: Pale to cyanotic nailbeds, full equal pulses, (-) jaundice/edema, (+) bruises and abrasions on L face, L UE/LE

Impression

Acute abdomen secondary to trauma

Obese Class 1Chronic alcoholism

Differential DiagnosisAcute abdomen secondary to trauma probablybleeding

Rule in: history of trauma 3 days PTC, pale conjunctivae, diaphoresis, pale to cyanotic nailbeds

Cannot be ruled out though vitals seem to be normal

Angina pectorisRule in: epigastric pain as anginal equivalent diaphoresis, cold clammy extremitiesCannot be ruled out

Differential Diagnosis

Acute cholecystitis/cholelithiasisRule in: epigastric pain, obesity

Rule out: non- colicky pain, no jaundice, no history of prior epigastric pain nor RUQ pain, (-) Murphy’s

Acute pancreatitis Rule in: (+) epigastric pain, history of moderate to heavy alcohol consumption Rule out: non- radiating pain

Management

• Referred to hospital for further evaluation

• Patient admitted to Mary Mediatrix Medical Center– Holoabdominal UTZ: 800 cc blood in

peritoneal cavity– EL done showed ruptured spleen– Splenectomy was done

Course of Hospitalization

• Upon arrival at the ER, BP was stable at 110/80 with a heart rate of 98, examination of the abdomen revealed tenderness.

• Scheduled for EL and 2 units of pRBC prepared, found to have ruptured spleen hence splenectomy procedure done which the patient tolerated well.

• Discharged improved after 8 days.

FAMILY ASSESSMENT

Family Assessment Outline

I. Family structure and function• Genogram• Type of Family• Stage in the Family Life Cycle• Timeline

II. Family Psychodynamics• Mapping

• Decision maker• Primary caregiver

• APGAR• SCREEM

FAMILY GENOGRAM

Gutierrez-AlcantaraJune 17, 2009

Levy1996

HEmma, 56

Bryan,32

Fe, 30 Jesse, 31 Erwin, 30 Ana, 28 JR, 28 Ann, 31

2008

Ericka, 9Sharmaine, 7 Sharlene, 5 L J, 8 Toto, 7

Legend: H-heart disease; D-Diabetes Mellitus

D

??, 1

2008

Ade, 58Linda, 58 6 siblings

Type of Family

Family Structure• JR-Anna family is a single-parent

family: ever since failure of marriage, JR is the sole person assuming parenthood to 2 sons.• JR and 2 sons are part of an

extended family, the Levy-Emma family

Type of Family

Family Social Class Pattern• Middle class:

• The family believes in hardwork, initiative, independence, responsibility, economic security and self-improvement through education and schooling

Type of Family

Family set-up• Democratic:

• parents respect their child’s decisions and ideas; understanding and permissiveness prevail

Stage of the Family Life Cycle

Levy-Emma Family• Launching family to Family in later

years• Bryan, who is first born and the first to marry,

stays in his parents house with his spouse, Fe, and their daughter.

• Jesse, 2nd son is still single and lives with the parents’ house

• JR, who is the youngest and married almost the same time as Bryan, still stays with his parents house with his 2 sons.

• Levy, who is the father, passed away when the family was still in the stage of Family with Adolescents


JR-Anna Family• Family with Young Children

• JR and Anna have 2 sons: a 9-year old and an 8-year old

• Anna went to Italy 3 years ago. JR and Anna are already separated for a year. Anna who is in Italy has her own family with 1 child.

• Second order changes:• Taking on parenting roles.• JR who is a single parent now is the sole person

assuming the parenting role with the help of his mother, siblings and other relatives like Balut-Rizza couple


JR-Anna Family• First order changes:

• Sharing responsibilities within the extended family and between members of the growing family.

• Instead of sharing parenting responsibilities with his spouse; JR shares it with his siblings, mother, and other relatives



• Maintaining mutually satisfactory sexual relationship and planning for the future of children

• JR being separated from this spouse for 3 years obviously has no sexual relationship; also he is not in constant consultation with his spouse regarding the future of their children



• Cultivating the full potentials of relationships with relatives within the extended family.

• JR’s family is very much involved in raising his 2 sons


JR-Anna Family• Problems encountered by the

parent/s:• Medical: Episodic medical problems like

the vehicular crash incident that happened to JR


JR-Anna Family• Problems encountered by the

parent/s:• Emotional/Social:

– Resort to alcoholism and peer pressure due to marriage failure; JR started to become heavy alcoholic drinker when he knew his spouse has new family.

– The physical and emotional absence of the mother has a great impact on the children’s development.

– Job related problems, child-rearing problems, and communication with in-laws

1998 1999 2000 2002 2005

2006 2007 2008

2009

Jr was in 1st year College wen he eloped with AnnaJr and Anna got

married because Anna was then pregnant

LJ was bornToto was bornThe couple decided to sell the

jeepney Jr was driving to put up a vegetable business in Lipa

The business failed hence Anna decided to go to Italy, LJ was 6 and Toto was 4. Jr did not agree to this but left them no choice

Anna sends remittance monthly until she stopped sending mid year of 2007

Jr’s in- laws confirmed that Anna has another family in Italy and gave birth. Start of Jr’s heavy alcohol consumption

Jr decided to apply for Saudi. He is waiting for his VISA until he had the crash.

Jr- Anna Family Timeline

FAMILY MAP

Levy1996

Emma, 56

Bryan,32

Jesse, 31

Erwin, 30

JR, 28

Ann, 31

2008

L J, 8 Toto, 7 ??, 1

2008

Ade, 58Linda, 58

6 siblings

Balut Rizza

Decision Maker

• Nanay Emma is the decision maker of the family together with Nanay Linda and Nanay Ade• Nanay Linda took care of Jr

since childhood• JR is decision maker for his 2

sons.

Primary Caregiver

• Jesse who is still single is the primary caregiver when JR was hospitalized

• Absence of Anna had an impact on this part

FAMILY APGAR

JrAlmost always

Some of the time

Never

A I am satisfied that I can turn to my family for help when something is troubling me.

P I am satisfied with the way my family talks on things with me and shares problems with me.

G I am satisfied that my family accepts and supports my wishes to take on new activities and directions.

A I am satisfied with the way my family expresses affection and responds to my emotion such as anger, sorrow and love.

R I am satisfied with the way my family and I share time together.

TOTAL 8

Nanay Emma

Almost always

Some of the time

Never






TOTAL 9

BryanAlmost always

Some of the time

Never






TOTAL 8

JesseAlmost always

Some of the time

Never






TOTAL 8

FeAlmost always

Some of the time

Never






TOTAL 10

Family Function

• Family is highly functional.

FAMILY SCREEM

SOCIALSOCIALResources Pathology

•The family is close-knit and good relationships exist among its members. The family maintains good relationships with their neighbors, who are mostly their relatives.

•The absence of Anna makes a great impact on JR, Toto and LJ. There’s an incidence when LJ did not want to speak to Anna when the latter called. • JR is not open about his feelings and thoughts about Anna

CULTURALCULTURALResources Pathology

•All family members were born and raised in San Juan, Batangas and are proud to be Batanguenos. •The family also participates in community activities such as town fiestas, funerals, brgy gatherings/meetings. •In fact, Bryan and Jesse, are elected Brgy officials

RELIGIOUSRELIGIOUSResources Pathology

• All family members were born and raised as Catholics; they always attend the Sunday masses and foster the values like love of neighbor, hope, and charity.

EDUCATIONALEDUCATIONALResources Pathology

• Levy and Emma are both college graduates as well as their 3 sons except JR. Erika who is the daughter of Bryan and Fe is currently in grade 3; while LJ and Toto who are the sons of the index patient are in Grade 3 and 2 respectively.

• JR cannot land on a stable job here because he was unable to graduate College

ECONOMICECONOMICResources Pathology

•Since Mang Levy died, Nanay Emma became the sole bread winner of the family

• Currently, the family’s economic status is stable with Nanay still into teaching.

• Bryan who is already married have stable job as an engineer.

•Jesse is on application for OFW;

•Erwin is leaving for Saudi on June 29.

•JR is also applying as an OFW with his Tita Linda as his financier; Tita Linda has been JR’s financier/supporter since his childhood.

* There seems to be no economic problem within the family; in fact

Tita Linda who lives in Italy financed JR’s hospitalization.

MEDICALMEDICALResources Pathology

•The family seeks consult at the Rural Health Center or any private hospital in Lipa City whenever they have medical problem.

•Jesse, who is the second child, has been recently diagnosed to have Type 2 DM.

JOURNAL REPORT

Family Breakup: The Ugly Side Of Migration

General Data onOFWs

• The annual number of Filipinos going overseas on officially processed work contracts rose sixfold from 36,035 to 214,590 between 1975 and 1980, and more than tripled again by 1997 to 701,272

• In June 1997, 6 percent of Philippine households had one or more members working overseas

Remittances• The deployment of more than a million Filipino

workers annually is a great boon to the Philippine economy

• In February 2002, US$1.1 billion were remitted through formal financial channels (which do not include those sent through friends and relatives and informal money remittance channels)

• 20 million Filipinos, ¼ of the population, depend on the earnings of their migrant relatives

Problems Encountered• OFWs experience excruciating adjustment

period in foreign territories with strange customs and laws

• No support system or a caring and understanding community where the OFW can seek emotional, legal and technical assistance

• Oftentimes, they seek help/companionship from other OFWs

Problems Encountered• In 1999, the POEA reported 1,439

abandoned families; in 2000, still 1,344• Government agencies and migrant

organizations focus more on issues dealing with rights of overseas workers, such as providing assistance to address labor malpractices or gender-based violence

• The issue of family separation and breakdown has not been given due attention

Problems Encountered

• These breakdowns usually occur in places where there are many restrictions in mobility and social networking

• Children are caught in the middle; they suffer enormous emotional and psychological distress (especially when the parent left behind starts to badmouth the OFW parent)

Possible Remedies

• To study the possibility of including in bilateral agreements between the Philippines and host countries mechanisms for both the enforcement of court judgments and implementation of provisions for support for families left behind

Possible Remedies

• To extend legal assistance to aggrieved spouses and families

• To deploy more social workers abroad• To prod local government units to

become more involved• To file legislation to protect abandoned

families

Family Wellness Plan

Wellness Plan for JR

A. Screening:• Daily personal hygiene• Monthly BP monitoring• Biannual dental hygiene• Annual periodic PE which includes CXR for

PTB screening, flu immunization• Reduce alcohol intake into moderation: 1

glass/day; smoking cessationB. Developmental monitoring:

• Obesity counselling• Mental health• Marital and family relationship• OTC for common ailments

Wellness Plan for Nanay Emma

A. Screening:• Daily personal hygiene• Monthly BP monitoring• Biannual dental hygiene• Annual periodic PE which includes CXR for PTB

screening, flu immunization• Reduce alcohol intake into moderation: 1 glass/day• For Bryan: family planning, infertility, having

second child• For Jesse: blood sugar monitoring

B. Developmental/monitoring:• Weight/obesity counselling• OTC medications for common ailments• Sanitation issues, accident exposure and

prevention

Wellness Plan for Bryan and Jess

A. Screening:• Daily personal hygiene• Monthly BP monitoring• Monthly self breast examination and annual by MD• Annual PE which includes cholesterol monitoring,

visual examination, pap smear, rectovaginal examination, occult blood test, urinalysis, CXR

• Biannual dental examination• DT and flu immunization

B. Developmental/monitoring:• Obesity counselling• Mental health• Marital and family relationship• OTC for common ailments• Sanitation issues, accident exposure and

prevention

Wellness Plan for Fe

A. Screening:• Daily personal hygiene• Monthly BP monitoring• Biannual dental examination• Annual PE which includes breast examination,

CXR, urinalysis• Family planning, infertility, having second child

B. Developmental/monitoring:• Weight counselling• Marital and family relationship• OTC medications for common ailments• Sanitation issues, accident exposure and

prevention

Wellness Plan for LJ, Toto , and Ericka

A. Screening:• Annual fecalysis for intestinal parasitism• Annual PPD• Annual PE• Biannual dental hygiene check up• Daily personal hygiene• Health behavior assessment if increase

risk for accident• Tetanus vaccine booster every 10 years

Wellness Plan for LJ, Toto , and Ericka

B. Developmental/monitoring:• Growth chart/nutrition/motor dev’t• Emotional and moral dev’t• Family relationship issues like sibling and

cousin rivalry• OTC for common illnesses, vitamins• Sanitation issues, junk food, accident

prevention

Final Note

“ Deciding to go abroad and leaving your family behind is not an easy thing to do. It will have to be a family decision. It’s not just the money that you have to count, but the entire wellbeing of the family members as well.”

Thank You!

pamilya gavino, cherylle mirallo, alfred ngo, martin

Documents