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Family Case Conference

Family Case Conference. Group 4 Bolintiam , Cruz, Dela Cruz, Lu, Que , Rivera, Sioco , Tai, Valera, Veloso. Outline. Biomedical Health Issues Health Timeline Problem List Family Medicine Family MAP APGAR Genogram SCREEM Family Issues Family meeting Intervention.

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Family Case Conference

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  1. Family Case Conference Group 4 Bolintiam, Cruz, Dela Cruz, Lu, Que, Rivera, Sioco, Tai, Valera, Veloso

  2. Outline • Biomedical • Health Issues • Health Timeline • Problem List • Family Medicine • Family MAP • APGAR • Genogram • SCREEM • Family Issues • Family meeting • Intervention

  3. General Information • JP • 5 y/o • Female • Roman Catholic • Filipino • Ilugin, Pasig City • Informant: Mother

  4. CHIEF COMPLAINT POOR WEIGHT GAIN

  5. History of Present Illness CONSULT

  6. Past Medical History • URTI; Acute gastroenteritis • No previous hospitalizations • No maintenance medications • No allergies to food and medications

  7. Birth and Maternal History • Born full term via NSD to a 21 y/o G1P1 • Attended by the hilot; born in the house • BW: ~ 3 kg • Denies any perinatal or neonatal complications • One prenatal check-up in the health center

  8. Family History • MATERNAL • Sister of grandmother: Hypertension and Diabetes • Cousin of mother: Hypertension and DM • Second cousin: Primary Complex (treated for 3 months; lost to follow-up) • Grandmother: died of hemorrhagic shock secondary to child bearing • PATERNAL • Uncle: Hepatitis

  9. Nutritional History • Breastfed until 2 years old • Weaned at the age of 6 (Cerelac and lugaw) • Food preferences: junkfoods, noodles, candies and chocolates

  10. Nutritional History • 24 hour diet recall

  11. DEVELOPMENTAL HISTORY • At par with age

  12. IMMUNIZATION HISTORY • BCG: 1 dose • DPT/OPV: 2 doses • Hepa B: 3 doses • Measles: 1 dose • Influenza virus: 1 dose

  13. PERSONAL-SOCIAL HISTORY • Patient lives in a shanty house near the riverside in Ilugin. • 5 household members • Father is an elementary graduate • Primary breadwinner (works as plywood delivery assistant) • Mother finished until second year high school • Uncle: works in the soap making factory

  14. PERSONAL-SOCIAL HISTORY • Environment • Water source: boiled tap water • Garbage collected everyday • Has their own restroom • Near the river • Exposure to internal pollution • Cooks inside the home using coal • Father and Uncle smokes inside the house

  15. Physical Examination findings GENERAL APPEARANCE Alert, active, playful, cooperative VITAL SIGNS Normal cardiac rate, respiratory rate, afebrile ANTHROPOMETRIC MEASUREMENTS: • Height: 92 cm (Z score: < -3 – severely stunted) • Weight: 12 kg (Z score: 3 – severely underweight) • BMI: 14.2 (Z-score: >1 – within normal levels)

  16. Physical Examination Findings SKIN warm skin, good skin color and turgor HEENT No scalp lesions, no hair color changes no lesions or matting of the eyelids, no eye discharge, no swellling, anicteric sclerae,pale palpebral conjunctiva No tragal tenderness, no ear discharge,(+) impacted cerumen (bilateral)

  17. Physical Examination Findings HEENT No alar flaring, nasal septum midline, with minimal nasal discharge dry lips, moist tongue, no circumoral cyanosis, no buccal mucosal lesions, no TPC (+) 1.5 cm smooth, movable, nodule on the right anterior cervical area

  18. PHYSICAL EXAMINATION RESPIRATORY No retractions, symmetric chest expansion, clear breath sounds HEART adynamicprecordium, no thrills, heaves or lifts, PMI at 5th ICS, MCL, normal rate, regular rhythm, distinct S1 and S2 sounds, no murmurs

  19. PHYSICAL EXAMINATION ABDOMEN Flabby abdomen, normoactive bowel sounds, soft, no organomegaly, no tenderness EXTREMITIES full and equal pulses, no edema, no cyanosis, no atrophy/hypertrophy, no deformities NEUROLOGIC EXAMINATION Intact cranial nerves, no sensory and motor deficits, normoreflexive, (-) Babinski, (-) clonus

  20. Clinical Issues • Malnutrition • Poor eating habits • Exposure to TB • Dental Caries • Poor Hygiene and Sanitation • Hazardous Environment • Health Misconceptions

  21. FAMILY MEDICINE

  22. Genogram 47 43 20 18 16 13 11 10 8 8m 29 26 malnutrition TB 4 3 Hemorrhagic stroke

  23. breadwinner Caregiver (controlling) Index patient FAMILY MAP

  24. SCREEM

  25. SCREEM

  26. SCREEM

  27. HIGHLY FUNCTIONAL

  28. FAMILY ISSUES • Different parenting styles • Father: permissive • Mother: authoritarian • Considered to be one of the main barriers in implementing behavioral change in the children • May also result to other problems in the future • Financial Instability

  29. INTERVENTION

  30. THE BIOPSYCHOSOCIAL MODEL

  31. SYSTEMS THEORY

  32. Medical Issues

  33. Intervention • Malnutrition • Identify other medical causes of malnutrition (including TB, parasitism, dental caries, etc.) • Changing eating behaviour • Educate the child and the whole family regarding healthy eating habits • Discourage giving money as a reward • Discourage buying food from outside • Encourage variation in food choices

  34. Intervention • Malnutrition • Changing eating behavior • Find cheap and healthy alternatives • Teach meal planning and budgeting • Teach creative cooking. • Make eating time a pleasurable activity (e.g. good food presentation, incorporate games, encourage eating together, etc.) • Awareness of importance of growth and development monitoring

  35. Intervention • Malnutrition • Encourage involvement in government or non government programs to address malnutrition • Religiously attending the feeding program set by the community center

  36. Intevention • Exposure to TB • Screening for TB for all relatives and possibly neighbors too • Encourage and emphasize compliance with treatment • Educate the family regarding truths about TB, how it’s spread, its treatment and its complications • Educate family about importance of BCG vaccine

  37. Intervention • Dental Caries • Referral to Dentist • Decrease intake of sugar-rich foods • Teach proper dental hygiene (including proper toothbrushing) • Poor hygiene • Poor hygiene • Educate the family regarding good hygiene • Promote handwashing and sanitation to prevent spread of diseases • Educate family how to sterilized and store of their drinking water

  38. INTERVENTION • Hazardous environment • Advise alternative cooking methods • Use of mosquito nets • Main goal: Encourage them to transfer to a safer and conducive place to live

  39. Interventions • Addressing other social Issues • Health misconceptions • Educate • Create programs teaching all families regarding truths on health (including pulongs on health, health counseling, focus group discussions, etc.)

  40. FAMILY INTERVENTIONS

  41. Intervention • Family issues • Establish a unified parenting style • Call for a family meeting or dialogue with the parents • Encourage good communication between partners and children • Advice good parenting styles

  42. Suggestions for Improved Parenting

  43. ABCs of Parenting • Attention giving • Building self-esteem • Communicating regularly and well • Disciplining with love • Enhance couple relationship

  44. Attention giving • Regular fun time (30 minutes to 2 hours per child per day) • Once a week date per child

  45. Building Self-Esteem • Positive actions on the child that build his self-esteem: • Being praised • Being listened to, being spoken to respectfully • Getting attention and hugs • Experiencing success in sports or school • Loving trustworthy friends

  46. Building Self-Esteem • Negative actions on the child that does not build his self-esteem: • Being harshly criticized • Being yelled at or beaten • Being ignored, ridiculed, or teased • Being expected to be perfect all the time • Experiencing failures

  47. Self-esteem influences: • How our child does in school • What our chld schooses to do w/ his life • How and what our children achieves • How well and who our children loves

  48. Ways to be encouraging: • Demonstrate acceptance • Show confidence • Affirm contribution

  49. Communicating Regularly and Well • eye to eye so bring yourself to the level of the child. • Active Listening is: • Listening to thoughts and feelings. • Listening to body language, tone of voice, and facial expresions. • Reflecting back • Clarifying and checking for understanding. • Empathizing – putting ourselves in the shoes of the other person

  50. Responding openly • acknowledges children’s right to their feelings by demonstrating that the listener accepts what they feel as well as what they say • NOT: denies child a right to their feelings by demonstrating listener’s unwillingness to accept and understand

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