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Aurora Soliongco

Aurora Soliongco. Camus, Erwin Chan, Venice Fernando, Kimberly Lopez, Melanie Mallari, Jansen. General Objective. To present a family from the community and apply the principles of being a family physician. Specific Objectives.

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Aurora Soliongco

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  1. Aurora Soliongco Camus, Erwin Chan, Venice Fernando, Kimberly Lopez, Melanie Mallari, Jansen

  2. General Objective • To present a family from the community and apply the principles of being a family physician.

  3. Specific Objectives • To determine the health care needs of the geriatric patient with hypertension. • To determine the impact of illness and age to the family and patient • To assess and identify the family’s needs • To assess the capability of the patient and the family to adapt to the changes brought about by the presence of a disease.

  4. General Data • A.S • 95 years old, Female • Filipino • Widow • Roman Catholic • Retired Grade school teacher • Lives in 1114 Carola St. Sampaloc Manila

  5. History of Present Illness • Patient was diagnosed with Hypertension Stage 2 ( BP 160/100, with no blurring of vision , nape pain, abdominal pain) • She was maintained on the following medications • Aspirin 325mg/tab OD • Telmisartan 80mg/tab OD • Multivitamins with Vit B complex

  6. Review of Systems • (+) undocumented weight gain, (-) fever, (-) anorexia • (-) skin rashes, (-) itchiness • (-) redness of eyes, (-) lacrimation, (-) blurring of vision • (-) deafness, (-) tinnitus • (-) epistaxis • (-) bleeding gums • (-) cough, (-) colds, (-) dyspnea, (-) hemoptysis • (-) chest pain, (-)orthopnea, (-) palpitations • (-) abdominal pain, (-) hematemesis, (-) diarrhea, (-) constipation • (-) dysuria, (-) nocturia, (-) frequency

  7. Past Medical History • No previous illness • February 2009 – Patient admitted because of infected wound in the jaw. • (+) History of fall • No previous blood transfusions • Unrecalled immunization • Haven’t received any recent vaccine

  8. Family History • (+) HPN – father, Grandson • (+) CVD – father • (+) DM - Grandson • (-) goiter • (-) BA, allergy • (-) Alzheimer’s Disease • (-) Cancer

  9. Personal and Social History • Mixed diet (prefers vegetables and fruits) • Non-smoker • Non-alcoholic beverage drinker • Denies illicit drug use

  10. OB history • G0P0 • Menopause at years old (?)

  11. Physical Examination • Conscious, coherent, ambulatory with assistance, not in CP distress • BP 140/80 PR 90 bpm • RR 20 cpm T 36.5C • Warm, moist skin, no active dermatoses • Pink palpebral conjunctiva, anicteric sclera • (+) sagging eyelids OU, (+) opaque lens, OU • Moist buccal mucosa, nonhyperemic posterior pharyngeal wall, tonsils not enlarged

  12. Physical Examination • Supple neck, no palpable cervical lymph nodes, thyroid not enlarged • Symmetrical chest expansion, no retractions, clear breath sounds • Adynamic precordium, AB at 5th LICS MCL, no murmurs • Flabby abdomen, NABS, soft, nontender, no masses • No cyanosis, pulses full and equal

  13. Physical Examination • Conscious, responds to questions appropriately, can follow commands, oriented to 3 spheres • Pupils 2-3 mm ERTL • (-) Red orange reflex • EOM could not be assessed • (+) corneal reflex • Can smile, can frown, raise • (+) gag reflex • Can raise shoulder against resistance

  14. Physical Examination • MMT: 4/5 on both UE and LE • Can do APST, FTNT slowly • DTRs ++ • No sensory deficit • (-) nuchal rigidity, • (-) babinski, • (-) Chaddock’s, • (-) Oppenheim’s

  15. Assessment • SAH stage 2 • Cataract, OU

  16. Geriatric Work-ups

  17. Height : • Weight: • BMI • Midarm circumference: • Triceps fold circumference: • Mid-muscle circumference:

  18. Clinical Features • (+) Dental caries • (+) Age spots

  19. Eating habits and Living environment • House bound • Air-conditioned room with a bathroom and television • Sits in her rocking chair most of the day • Has enough money for food and medication

  20. Functional status • Needs constant assistance in • ambulation, • Feeding and • cleaning self.

  21. Geriatric Depression Scale • are you basically satisfied with your life? Y • Have you dropped many or four activities and interests? Y • Do you feel like your life is empty? N • Do you often get bored? N • are you in good spirits most of the time? Y • are you afraid that something bad is going to happen to you? N • do you feel happy most of the time? Y • Do you often feel helpless? N • do you prefer to stay at home rather than go out and do new things? Y • do you have more problems with memory than most people your age? N • do you think it is wonderful to be alive now? Y • do you feel pretty worthless the way you are now? N • do you feel full of energy? Y • do you feel your situation is hopeless? N • Do you think that most people are better off than you are? N SCORE NO SIGN OF DEPRESSION

  22. KATZ Activities of Daily Living

  23. MMSE was not done

  24. Nutritional Health • 1. I have an illness that made me change the kind or amount of food I eat. • I eat fewer than 2 meals per day. • I eat few fruits or vegetable or mild products. • I have 3 or more drinks of beer, liquor or wine almost every day. • I have tooth or mouth problems that make it hard for me to eat. • I don’t always have enough money to buy the food I need. • I eat alone most of the time. • I take 3 or more different prescribed or over-the-counter drugs a day. • Without wanting to, I have lost or gained 10 pounds in the last 6 months • i am not always physically able to shop, cook or feed myself. 0 – No 0 – No 0 – No 0 – No 0 – No 0 - No 0 - No 2 – Yes 2 – Yes 2 - Yes Total: 6 (Good)

  25. IV. Family and Community Assessment

  26. Soliongco Family 1114 Carola St. Sampaloc Manila.

  27. Extended type of family (various granddaughters and grandsons living there occasionally when they are in Manila for school or work) • Good interpersonal relationship with one another, with closer relationship between the siblings.

  28. B. Family Structure • Type: Extended • Social Class: Middle • Set-up: Democratic • Religion: Roman Catholic • No. of Household members: 10

  29. Currently living with 9 people, • her sister Engracia , • adopted son Wilfredo and • his wife Julieta, her grandson Joel. • Also living in the house is her • Niece Lorely who has 3 children namely • Ronaly, • Ace, and • Mary. • She owns the house where there are 11 rooms and 2 bathrooms • There are 5 male/female boarders currently living in the house.

  30. B. Family Profile

  31. B. Family Profile

  32. C. Roles of Each Family Members • Breadwinner/s: • Wilfredo • Julieta • Joel • Decision maker: • Aurora • Julieta • Caregivers: • Julieta

  33. D. Family Life Cycle • Family with Adolescents

  34. Family Lifeline

  35. F. Economic Profile • Income • Comes from • Wilfredo • Julieta • Joel • Rent payment from boarders Expenses: Food – P1400/week Water – P3000/month Medicine – P1500/month Electricity – P3400-3800/month

  36. Location Map

  37. Floor Plan FIRST FLOOR PLAN

  38. Floor Plan Second Floor Plan

  39. G. Household Checklist • Patient’s Beddings • Appliances • Aircon 2 • Electric fans 8 • Television 1 • Super Kalan 1 • Refrigerator 1 • Ironing board 1 • Iron 1 • Radio 1 • Telephone 1 w/extension • Freezer 1

  40. H. Environmental Checklist • House/Room: Owned • Type: Mixed(concrete ,wood) • No. of bedrooms: 11 • Cleanliness/order: Good • Ventilation: Good • Lighting: Good • Lighting Facilities: Meralco • Water: Maynilad • Drinking water: Mineral water • Tap water for drinking, bathing and cooking

  41. H. Environmental Checklist • Toilet type: water-sealed • Garbage collection: collected, segregation done • Collection per week: daily • Drainage: fair • Vermin/insect control: chemical • Vermin/insect type: mosquitoes, rats, cockroaches • Animals: none • (+) stray dogs and cats • Neighborhood: residential / commercial • Accessible by: Walking, Jeepney, tricycle, taxi • 5 minutes from USTH by foot, 2 minutes by car

  42. Positive Perception • Peace and order observed in the neighborhood • Easy access to public transportation, hospital, church etc. • Proper garbage disposal • Concrete roads • Good location • Near Main Road • Food/ Hospital/ Shopping Mall establishment nearby • Access to public transportation • No factory nearby

  43. Negative Perception Mosquitoes present (risk for Dengue) Loitering pets ( Rabies) Noise (neighbors) Narrow Passageway ( car accessibility)

  44. I. Tools for Family Assessment

  45. Engracia = 8 Wilfredo = 6 Julieta = 10 Lorely = 7 Assessment:

  46. SCREEM Social interaction Strenghts Open intrafamilial lines of communication, no animosity/ rivalry; health and supportive intra/extrafamilial relationships Weaknesses Shame on imposing on the lives of their neighbors

  47. SCREEM Cultural pride There are no beliefs or practices that are unacceptable to our culture that would negatively affect way of living. Religion Practices one’s faith and spirituality is positively influencing way of life of the whole family

  48. SCREEM Economic stability economically stable. Her children, as the breadwinner,s can provide for the basic needs of their family However, they have no savings for emergency situations. Education Most of the members of the family reached secondary and tertiary education. Most have stable good paying jobs

  49. SCREEM Medical Health Family gives importance to health care Takes advantage of the proximity of USTH Has regular follow up and check up every 6 months

  50. Draw A Circle Test

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