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CASE PRESENTATION

CASE PRESENTATION. BAUTISTA, BERNARDINO, PALARCA, RAMOS, ZABALLA. General Information. V.O. 73 year old female November 4, 1941 Widowed Filipino Roman Catholic Gawad Kalinga, Payatas. Chief Complaint: Weakness. Review of Systems. Review of Systems. Review of Systems.

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CASE PRESENTATION

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  1. CASE PRESENTATION BAUTISTA, BERNARDINO, PALARCA, RAMOS, ZABALLA

  2. General Information • V.O. • 73 year old female • November 4, 1941 • Widowed • Filipino • Roman Catholic • Gawad Kalinga, Payatas

  3. Chief Complaint:Weakness

  4. Review of Systems

  5. Review of Systems

  6. Review of Systems

  7. Review of Systems

  8. Past Medical History

  9. Family History

  10. Personal/Social History

  11. Stakeholder's Analysis

  12. PHYSICAL EXAMINATION

  13. HEENT

  14. Respiratory

  15. Cardiovascular

  16. Physical Examination: Abdomen

  17. Physical Examination: Skin and Extremities

  18. Physical Examination Musculoskeletal Exam and Reflexes: good muscle tone (5/5 on all extremities) Neurologic Examination: Cranial Nerves I, II: not assessed III: intact extraocular muscle IV, V, VI: not assessed VII: no facial asymmetry VIII: intact gross hearing IX, X, XI: not assessed XII: tongue midline Motor: 5/5 on all extremities Sensory: no sensory deficits

  19. SALIENT FEATURES

  20. Initial Impression Hypotension probably secondary to Anti-Hypertensive Medication Overdose Congestive Heart Failure NYHA II Hypertension Stage II, controlled

  21. FAMILY PROFILE

  22. GENOGRAM

  23. ORDINARIO FAMILY February 21, 2014 73 5 44 42 22 23 12 10 7

  24. FAMILY STRUCTURE FAMILY LIFE CYCLE

  25. Family with Adolescents • Young children are getting older and turning into more independent individuals

  26. Issues • Shifting of parent-child relationships to permit adolescent to move in and out of the system • Identity, autonomy and sexuality issues • Refocus on midlife, marital, and career issues • Beginning shift towards concern for the older generation

  27. In phase or out of phase? • Out of phase hence the family has higher risk for physical and emotional symptoms • Ate Corra and her husband Danilo who both are head of their household have very little time to focus on themselves • Instead are focused on taking care of the other members of their household • Note: Burden of taking care of the kids and the grandparents.

  28. Developmental Challenges • Shifting of parent-child relationships • Be able to balance giving independence to adolescents at the same time acknowledge responsibility roles • Changes in the caregiver role of the family • The primary caregiver burden will be upon the parents

  29. How it relates to the patient • Important to acknowledge caregiver fatigue • Note that prognosis of the patient’s disease and the degree of care needed by the patient • Expenditures in terms for her health care vs. the adolescents eventual need to go into college.

  30. FAMILY MAP

  31. 23 73 22 44 10 12 42 7

  32. FAMILY APGAR

  33. SCREEM

  34. SOCIAL

  35. CULTURAL

  36. RELIGIOUS

  37. ECONOMIC

  38. EDUCATIONAL

  39. MEDICAL

  40. Family Intervention Tools Home Visits, Family Meetings and Episodic Consults

  41. Pre Home Visit • Date of Visits: February 18,20,24 • Purpose of Visit: • Information gathering • Caregiving check and evaluation • Information gathering • More extensive evaluation • Why the patient needs a home visit? • Poor health seeking behaviour and health practices

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