family assessment

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Running ahead: Family Health Assessment

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Family Health Assessment

Family Health Assessment

Patricia Lopez Fernandez

Community Health Nursing

Professor: Eddie Cruz, RN MSN

Florida National University

Abstract

A family health assessment is a tool that focused on the family as the unit of care was developed. The tool adapted Gordon's 11 functional health pattern typology and categorized data using interview, observation, and measurement methods.

This assessment is an integral part of a holistic view of the family and can help the nurse determine where to focus. Health organizations, government and public health mainly focuses on health issues, the prevention of illness and the strategies to help people promote health and wellness.

Family Health Assessment

I chose a Latin family to do my family health assessment. Garcia’s family is an extended family composed for 6 members. The extended family structure consists of two or more adults who are related, either by blood or marriage, living in the same home. In this case this family consists in: two grandparents (Mr. and Mrs. Garcia), (Mr. Garcia Jr. and his wife) and two children. Mr. Garcia is a gentleman of seventy two-years-old and his wife is sixty five-years old lady, both are Peruvian origin where they had their two children, Mr. Garcia junior who came to this country and was raised here and a women who still lives in Peru. Mr. Garcia junior is thirty six-years-old man who got married, his wife is thirty two-years-old, both are Peruvian origin, this marriage had two little girls Emma and Anna, both are aged ten and five-years old, both girls were born here, so they are American, but since their parents and grandparents are Peruvian they are raised also with part of Peruvian culture.

I initiated my family health assessment with Mr. Garcia; he is the one who stay at home the majority of the time. When assessing family members’ role performance, we as nurses need to be aware that role behaviors are learned according to the culture values of the family. In this case as a Latin family, the leader of the family is Mr. Garcia, as a retired gentleman is the men of the house, who oriented the family, manage the finance bills in the house, and after discuss the situation give the last decision, everyone in the family consult with him before do anything. The primary provider in this moment is Mr. Garcia Jr., who work as a paramedic in a private company, also his wife helps him as a provider in the house. She works as an accounting in a taxes company. Both spend the majority of the day working, and the grandparents are the ones who pick-up the girls in the school and stay with them until their parents come to home. Even though the parents of the two girls work hard, there is a very good relationship between the parent and the children. Both parents participate in the infants Homeworks and projects, go to the schools’ meeting and have an active relation with their children education, growth and development.

Mr. Garcia suffers of heart failure; he was diagnosed when he was young. This was the reason why he became retired; right now he feels sometimes a little tired, but the condition is controlled with medications. Mrs. Garcia was recently diagnosed with type II Diabetes Mellitus, but she is very careful with her diet and the scheduled medications, so now she is controlled. Both Mr. and Mrs. Garcia go to Leon Medical Center every week to check their conditions, as part of their retired program. I got the opportunity to know Mr. Garcia Jr. because he arrived early that day, and I could ask him a couple of question to complete my assessment. According to him his weight is 230 lb. and his height 5.6 in., so he has a BMI 37.1 of obesity. He says we works so many hours during the week and under a lot of stress, and also does not have time to eat at the right time, and to sleep the necessary hours. His father Mr. Garcia is helping him with a diet; he prepared him every day his lunch with healthy options and some snack for the rest of the day.

When I assessed the individual family member’s accomplished age-appropriate developmental task, was well defined. All the members know each responsibilities and rolls that must be achieved inside the family according to their age during each stage of its lifecycle to successively meet the health and developmental needs of its members. There is not any problem of family member’s developmental states that create stress in the family, as I said before there is a well-defined developmental task between all the family members. The family is now in Developing Developmental Stage, the children are in the first years of the school, the family tries the activities focuses outside the home, the time is limited for each activity, and they share and manage duties well according to each member.

According to Mr. Garcia he does not have any history of genetic predisposition to disease, either his wife. But Mr. Garcia Jr.’s wife do have, her father recently died after suffer for a very long deterioration from a heart failure disease. All the immunization status of the family are actualized so far, the kids have all the immunizations according to their ages, and Mr. Garcia and his wife recently got the flu shot for the season. Observation of a family’s communication patterns yields valuable information about the meaning accorded to various family members as well as the clarity of interpersonal boundaries. This family has a very good and affective pattern of communication, they try to communicate between them with positives feelings, they listen to each other, and always aloud each other to express any problem or concern of anything and try to find a solution, when the little girls have question about anything their parents or grandparents always try to explain them with the right words what is it or what is going on in the situation. Decision making is central to the fulfillment of family responsibilities in meeting members’ health and developmental needs. When the family is going to make a decision, all of the members always use to ask the advice of Mr. Garcia as a leader of the family, but he always let the person who is concern try to do the last decision after his advice. Nursing assessment of the family’s decision-making processes focuses on identifying strengths or limitations in the information-processing function as well as the generation of alternative solutions. There is not sign of violence inside the family; this is a very traditional family, where all the members speak in a very low tone voice, they respect each other, and try to live as happy as possible. As they are from Peru, but Mr. Garcia Jr. was growth up here since he was a child and their kids was born here, they have a mix of culture, because they do not they cultures beliefs and values from Peru, but they also integrated some as American, they all practice the catholic religious.

Family goals are very important. By asking what the family hopes to gain from the intervention, the nurse assists the family to focus on its own goals and priorities. Right now as a family their goals are focuses in a success growth and development of the two little girls, Mr. Garcia said they are the one that needs more attention for now. It is important for the nurse to carefully assess the role strain and conflict occurring within the family because tension and conflict may negatively impact members’ emotional wellbeing. In this family there is not present any role conflict, they all know very well each role and responsibilities and try them to do in the better way.

Nursing diagnoses and care plan for the family:

1- Decreased cardiac output related to heart failure as evidence by feeling of weakness. (Nursing diagnosis for Mr. Garcia)

Assessment:

· Note skin color, temperature, and moisture.

· Check for any alterations in level of consciousness.

· Assess heart rate and blood pressure.

· Check for peripheral pulses, including capillary refill.

· Assess heart sounds for gallops (S3, S4).

Goals and outcomes:

· Patient demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain.

· Patient exhibits warm, dry skin, eupnea with absence of pulmonary crackles.

· Patient remains free of side effects from the medications used to achieve adequate cardiac output.

· Patient explains actions and precautions to take for cardiac disease.

Nursing Interventions:

· Record intake and output. If patient is acutely ill, measure hourly urine output and note decreases in output.

· Closely monitor fluid intake including IV lines. Maintain fluid restriction if ordered.

· Assess oxygen saturation with pulse oximetry both at rest and during and after ambulation.

· Assess for reports of fatigue and reduced activity tolerance.

2- Deficient knowledge related to recently diagnosis. (Nursing Diagnosis for Mrs. Garcia)

Assessment:

· Assess the patient’s history. To determine if there is presence of diabetes, assessment of history of symptoms related to the diagnosis of diabetes, results of blood glucose monitoring, adherence to prescribed dietary, pharmacologic, and exercise regimen, the patient’s lifestyle, cultural, psychosocial, and economic factors, and effects of diabetes on functional status should be performed.

· Assess the body mass index and visual acuity of the patient.

· Perform examination of foot, skin, nervous system and mouth.

· Laboratory examinations. HgbA1C, fasting blood glucose, lipid profile, microalbuminuria test, serum creatinine level, urinalysis, and ECG must be requested and performed.

Goals and outcomes:

· Acknowledge factors that lead to unstable blood glucose.

· Maintain glucose in satisfactory range.

· Verbalize plan for modifying factors to prevent or minimize shifts in glucose levels.

· Achieve timely wound healing.

· Identify interventions to prevent or reduce Risk for infection.

· Regain or maintain the usual level of cognition.

Nursing Interventions:

· Educate about home glucose monitoring. Discuss glucose monitoring at home with the patient according to individual parameters to identify and manage glucose variations.

· Review factors in glucose instability. Review client’s common situations that contribute to glucose instability because there are multiple factors that can play a role at any time like missing meals, infection, or other illnesses.

· Encourage client to read labels. The client must choose foods described as having a low glycemic index, higher fiber, and low-fat content.

· Discuss how client’s antidiabetic medications work. Educate client on the functions of his or her medications because there are combinations of drugs that work in different ways with different blood glucose control and side effects.

3- Imbalanced nutrition more than body required related to overweight as evidence by a BMI of 37.1. (Nursing diagnosis for Mr. Garcia Jr.)

Assessment:

· Note weight, waist circumference, and calculate body mass index (BMI).

· Evaluate patient’s physiological status in relation to weight control.

· Know patient’s knowledge of a nutritious diet and need for supplements.

· Determine patient’s motivation to lose weight, whether for appearance or health benefits.

Goals and outcomes:

· Patient claims ownership for current eating patterns.

· Patient designs dietary modifications to meet individual long-term goal of weight control, using principles of variety, balance, and moderation.

· Patient verbalizes accurate information about benefits of weight loss.

· Patient verbalizes measures necessary to attain beginning weight reduction.

· Patient states related factors contributing to weight gain.

Nursing Interventions:

· Initiate a patient contract that includes rewarding and reinforcing progressive goal attainment.

· Negotiate with the patient regarding the aspects of his or her diet that will need to be modified.

· Advise patient to measure food regularly.

· Review patient’s current exercise level. With patient and primary healthcare provider, design a long-term exercise program.

Conclusions

The family health assessment revealed a family with low risk for serious health concerns but areas for improvement. The most common health disparities displayed appear to be linked to a lack of self-care brought on by general stresses in life.

All negative health concerns noted are ones brought on by the common stresses commensurate with a family of this income level and cultural background. The family is well educated on health issues and is introspective enough to recognize deficits and possesses a willingness to change patterns of behavior. As such, with minimal interventions to sleep, diet, and self-perception, the family would see and improvement in function and quality of life.

References

Koerner, A. F. (n.d.). Family and Marital Schemas and Types. Encyclopedia of Communication Theory. doi:10.4135/9781412959384.n141

Solomon, D., & Theiss, J. (2012). Interpersonal communication: Putting theory into practice. Routledge.

Dacey, J. S., Fiore, L. B., & Brion-Meisels, S. (2016). Your Child's Social and Emotional Well-Being: A Complete Guide for Parents and Those Who Help Them. John Wiley & Sons.

Florez, J. C. (Ed.). (2016). The Genetics of Type 2 Diabetes and Related Traits: Biology, Physiology and Translation. Springer.

Hello Dailyn;

I enjoyed very much your family health assessment. Family is the basic unit of society. A family is a set of interacting individuals related by blood, marriage, cohabitation, or adoption who interdependently perform relevant functions by fulfilling expected roles. Health practices are those activities performed by individuals or families as a whole to promote health and prevent diseases. 

Thank you.

References

Koerner, A. F. (n.d.). Family and Marital Schemas and Types. Encyclopedia of Communication Theory. doi:10.4135/9781412959384.n141

Hello Heidys;

You did a very good assessment on your family. A family health assessment tool that focused on the family as the unit of care was developed. The tool adapted categorized data using interview, observation, and measurement methods.

Thank you.

References

Koerner, A. F. (n.d.). Family and Marital Schemas and Types. Encyclopedia of Communication Theory. doi:10.4135/9781412959384.n141