Family_Health_Assessment

Running Head: FAMILY HEALTH ASSESSMENT Family health assessment of a family Doraine Lopex Grand Canyon University NRS-429V Family-Centered Health Promotion Teresa Ortner, RNC, MSNEd Deborah Stucker, BSN December 16th 2011 Abstract Family assessments are used to find out if a family is functionally healthy and to identify problems or potential issues within the family. It is another tool for nurses to acquire information about the patient’s environment. What comprises their family interactions, values, beliefs, and coping mechanisms' This will allow the nurse to gather as much data to provide adequate family care and support, as well as to the patient. Family health assessment of a family According to Edelman and Mandle, (2010), this theory states that,” any change in one family member will affect the entire family unit.” The members of the family that this nurse choose were the Lopex family. Their participation was met with resistance and hesitation. The reason given is that they are a private family and did not want to air problems or potential issues that exist in the family unit. Doraine used as a backdrop for her questions Gordon’s functional health assessment questioner. Background The Lopex family is comprised of Doraine (48 yrs.). Rudy-spouse (47yrs), Emily (22yrs.), Gabriel (21yrs.), Mariah (20 yrs.), Cheyenne (15 yrs.), and Aarron (14yrs.). Doraine and Rudy have been married for 25 yrs. Of the children, two live outside of the home. Emily attends Grand Canyon University doing her undergraduate program in Psychology. Gabriel attends Pima Community College doing his prerequisites for entrance into the University of Arizona. He lives with his girlfriend and is expecting a child in February. Mariah lives at home and attends the University of Arizona majoring in Forensic Anthropology. The Gordon questioner will only involve Doraine, Rudy, Cheyenne, and Aarron. However, there may be some overlap of Gabriel and Emily as they are active in the family and have taken some of the family’s traditions, teachings, and beliefs with them, and have contributed to the problems or potential issues that exist in this family unit. See appendix one for the questions asked. Doraine first administered the questioner to herself and Rudy, and then the children. The answers are a culmination of all participants. Values, health perception The value the family has placed on their bodies is to try to maintain vigilance on predisposition of health issues on both mother and father bloodlines. It is necessary for the children to know what may lurk ahead if they choose an unhealthy lifestyle. The family is greatly aware of health as Rudy is a very sick man, from ailments he acquired in the military and from his bloodline. Doraine’s understandings as well as Rudy’s perception on health are the same. They both believe as well as the children that health is a major part of their lives and will be forever. The children have seen what poor health can do and do to a person. Nutrition The family agreed that meal is just that, food that has either comfort value or eating just to eat. They know what a nutritious meal is but choose to only cut back on certain things in their diets. For example, diet soda instead of regular soda, two percent milk, watching labels for caloric intake, fat content. However, that is far as it goes. Doraine schedule is such; meal preparation is left up to Rudy. He makes meals, not nutritious meals. Doraine continually when she can try’s to influence Rudy’s menu choices to incorporate more of a nutritious meal variance. Sleep/Rest The family sleep patterns are left up to each. With the wide age range between Cheyenne, Aarron, and Mariah each has their own need and requirements for sleep. Cheyenne’s sleep schedule during school days is 9:30 pm. Aarron on the other hand decides on his own when to go to sleep. This is a problem for he is not aware and feels it is stupid to have a set bedtime. Aarron has been counseled by both parents and school curriculum on the benefits of sleep but ignores the recommendations. Therefore, Aarron is sleep deprived in this nurse’s assessment. Rudy sleeps an average of one to four hours a night due to PTSD night terrors even on a Thorzine. Doraine however, requires a full eight hours if not more to function at her best. The family as a whole has chosen this as a way of life. Elimination Typically, in this area each participant has his or her own elimination patterns. Rudy for example eliminates once a day on average, but does go for two or three days without bowel elimination. Doraine, Cheyenne, Aarron, and Mariah eliminate daily. Rudy’s urinary problems mainly consist of day and night incontinence due to his Parkinson’s illness. Rudy’s strength of urinary flow is week and does have start-stop issues. He is undergoing urology tests to identify if there are underlying issues. Activity/Exercise Cheyenne and Aarron both participate in school p.e activities but no more or less. Doraine uses a stair stepper, treadmill, and an elliptical machine daily for her exercise regimen. Rudy does no form of exercise. At his peak, Rudy was 5’5’ tall and weighed 165 pounds with five percent body fat. He still has the stature of physical resemblance to that time long ago, but he has grown soft. He refuses to change. In retrospect, Doraine believes she is the only one that has the exercise lifestyle, as her bloodline is heavy with diabetes, heart issues, and sedentary problems. Cognitive Mental issues run on both sides of the family and the children are quite knowledgeable of this history. On Doraine’s side, depression, suicide, and psychosis are present. On Rudy’s side, depression, bi-polar, and suicide are also present. Emily was diagnosed with Bi-Polar at age fifteen for a suicide comments and cutting. She was admitted for a 72-hour hold that extended to two weeks for further evaluation. Emily is on medication and continues to see a therapist monthly. Mariah suffers from situational depression. She is not on medication or but does go to the U of A health center sometimes to speak with their consolers. Cheyenne and Gabriel are the normal one in this area and just lets things go easily and slide off their backs. Aarron is showing all classic symptoms of depression and is scheduled for one on one therapy to get to the root of his issues. Doraine is also normal with a touch of seasonal depression. Rudy is a walking time bomb. He has TBI, BI-Polar, psychosis, extreme depressive disorder, suicidal ideation, and suffers from severe PTSD. Rudy has been hospitalized on three different occasion ranging from a 72-hour hold after a psychotic break during his kidney removal. In addition, two weeks in-patient stays for two failed suicide attempts since retirement. Rudy sees a psychiatrist weekly, does group therapy as well as individual, and is on a high drug cocktail regimen that keeps him mildly stable at best. Some of his mental health problems stem from 24 years in the military such as survivors guilt, personal guilt, religious beliefs, and the aftermath of his actions and what was required of him in his position in the military. He feels dammed. He is scheduled for in-patient treatment for his PTSD at Palo Alto Center Veterans facility in California. This in-patient program is intensive and is a 90-day stay. The program is actually run by Stanford University for the most severe cases the military has to offer. As his wife, Doraine separates her feelings of hopelessness in seeing her husband this way but as a nurse is constantly vigilant to his state of mind. All of the children are at risk for developing mental health issues. Sensory-Perception Doraine had pneumonia two years ago that was bacterial viral. She was forced to resign her ADON position due to the length she would be out to recuperate at home. Even after a month recuperation, she was not at fully ready to go back to work or at the top of her game. Diabetes is seen on both bloodlines. Rudy is the only member that has Diabetes. He takes daily injections but is not consistent with checking his blood sugar or administering his injections. The position Rudy has taken is common for the mentally ill. Rudy does not do foot checks. Self-Perception Overall, Doraine, Emily, Mariah, Cheyenne, and Aarron are comfortable with their image and are within normal BMI standards, perhaps a little on the lower end of the chart. Everyone’s self-esteem is within normal tendencies with perhaps Aarron having some issues. Rudy self-perception is very distorted. Rudy’s self-esteem is this nurse’s observation to be one of the lowest in her career she has encountered. Role Relationship Generally, Doraine is the family health caretaker from the dispensing of Motrin, Tylenol, and such. Rudy requires a little bit more care with all his ailments. Doraine does her best to separate nurse from wife/mother roles but, occasionally she treats Rudy like a patient and this creates tension and friction in their relationship. It has a trickledown effect on the kids as they see their father slip further down the rabbit hole. Sexuality This area is extremely easy to answer for all questioned. Emily has indicated she is not in a relationship or having sex. This is due to her extreme faith in her religious beliefs of no sex until married. Mariah also holds the same values. Aarron and Cheyenne are not dating or courting so it is perhaps safe to say they are not sexually active. Doraine and Rudy’s sexual life is stop and go. Rudy has to go off his meds to have sex. They have to plan for it; Rudy stops his meds for just enough time to gain sexual urges and the ability to accomplish sex, all the while waiting for a lapse in cognitive stability. When on his meds, there is no sex drive due to the side effects of the strong psychotropic drug cocktail he is on to be stable. This creates much tension and friction in their relationship. Rudy has never strayed since marrying Doraine. Coping Individually coping skills fall on each person in the Lopex household. All have their own coping skills and techniques. For example, Doraine does tend to understate what is the family or individual issue. Mariah goes to boxing class to relive her stress by taking out her frustration on an issue metaphorically. Emily goes to church and meets with members of her faith to reach inner resolution. Gabriel works longer hours to avoid the problem. Cheyenne goes to her room and reads books to create a sense of escape. Aarron plays computer games. Rudy deals with his stress by drinking or using tobacco products late at night by himself when no one is around. However, Doraine finds the bottles of vodka and rum. Rudy is a man of integrity and always has been. He knows that Doraine knows he is drinking so he does not hide this fact. The only reason he drinks and uses tobacco products alone when no one is around, he does not want his children to see him intoxicated as Rudy saw his father. As a unit, there is no unit relieving stress techniques. Wellness nursing diagnoses Diagnosis number one: Readiness for Enhanced Nutrition: Nutrient intake that is sufficient for meeting metabolic needs Goals: 1. Patient will demonstrate behaviors to attain and maintain appropriate weight within 1 month 2. Patient will be free of signs/symptoms of malnutrition within 6 months Interventions: Assess patient’s knowledge of current nutritional needs and how patient is meeting these needs. 3. Determine that age-related and developmental needs are met with special emphasis on nutritional needs throughout the lifespan, differing for each age group (i.e. older adults) need same nutrients but in smaller quantities. Regular check-ups with PCP to determine nutritional status, appropriate weight, and BMI Diagnosis number two: Readiness to gain knowledge of healthy food and fluid choices Goals: 1. Patient will demonstrate knowledge of healthy food choices within 1 month 2. Intervention: Assist with teaching planning of balanced dietary intake of foods and fluids Diagnosis number three : Readiness for enhanced mental health seasonal depression/situational depression Goals: 1. Patient will demonstrate understanding of seasonal depression within 1 month 2. Patient will express interest in making contact one a one-to-one basis or on a mutual—aid 3. Group basis with another person who has experienced a similar situation Interventions: 1. Assess patient’s knowledge and deficient of seasonal depression 2. Referral to counselor who specializes in seasonal depression and light Therapy Referral to support group 3. Diagnosis: Readiness for enhanced mental health mild depression 4. Goals: Patient will demonstrate understand of mild depressive state within 1 month 5. Patient will express interest in making contact one a one-to-one basis or on a mutual—aid 6. Group basis with another person who has experienced a similar situation 7. Patient will be willing to try anti-depressant for treatment of mild depression 8. Intervention: Referral to group therapy for mild depression 9. Referral to psychiatrist medication to treat mild depression 10. Follow-up with doctor for medication management Diagnoses number four: Readiness for enhanced mental health for major depressive disorder Goals: Patient will demonstrate understanding of major depressive disorder within 1 month 1. Patient will see with therapist for talk therapy with or without family 2. Involvement within one month 3. Patient will see psychiatrist for medication within one month Intervention: 1. Patient will be given written materials on major depressive disorder 2. Patient will attend talk therapy with psychologist on regularly scheduled appointments 3. Patient will follow-up with psychiatrist for medication therapy on regular basis 4. Patient will taught side effects of prescribed medications followed up with written Material 1. Patient will report all side effects to doctor Discussion After administering the questions to the Lopex Family, it is concluded that this is a dysfunctional family. Gordon’s eleven questions reveled a health assessment of great concern. It also appears in that even though they are dysfunctional, they have come full circle to normalcy. A paradox has been created here. Doraine already knew what the answers would be as she created the questions. It was rather a validation of what she was already aware of in the family. It causes great turmoil in Doraine that her professional life is intact and thriving. She has been nominated and selected for various awards from her employers as an excellent nurse, professionalism, exceptional diagnostician, and an extremely competent nurse who provides quality care to all patients. Because of her through intake question and documentation, referrals as needed, those that follow her on the other shifts of her patients have substantial information on the patient to continue that quality care. However, the personal life of Doraine Family is in disarray. Conclusion In summary, it is said those who practice a trade usually are very good at it but their own lives are a wreck in their trade. The Lopex Family is an example of this saying. This was by far the most difficult assignment to do and write for this author because it home. References Doebnges, M., Moorhouse, M., Geissseel, A., (2005). Nursing Diagnosis manual, Planning, Individualizing, and documenting Client Care. F.A. Davis Company Grand Canyon University (ND). A list of wellness and family nursing diagnoses at: http://jxzy.smu.edu.cn/jkpg/UploadFiles/file/TF_06928152357_nursing%20diagnoses%2 Grand Canyon University (ND). Gordon's 11 functional health patterns. Rudy & Doraine Lopex (personal communication December 14th 2011) Lopex Children (personal communication December 15th 2011) Appendix one Questions asked of Lopex Family 1. Values, health perception What family values do you wish to pass onto children about their bodies and their health and why' What is your understanding of the health perception term' How does your understanding affect your ideas about your family’s health' 2. Nutrition Describe the difference between a meal and a nutritious meal' What are some ways to influence your family’s that will make a lasting change a lasting change' 3. Sleep/Rest What are your family sleep patterns today' Are those patterns giving your family the rest they need' Why or why not' Do you have set bedtimes' Why or why not' 4. Elimination What are your elimination patterns (bowel) during a typical day' A typical week' What kind of urinary problems if any does your husband have' Stream strength, how often, stops and goes' Appendix one continued 5. Activity/Exercise What kind of P.E activities are your family involved in' How often' Cardio, strength, or both' Do you believe it has become part of their lifestyle or are they are doing it because of external requirements such as school' 6. Cognitive What kind of mental issues (if any) run in your family' Who would you say is at most risk of developing a cognitive deficiency' Why' 7. Sensory-Perception Has anyone in your family have pneumonia' Was it bacterial, viral, aspiration' Was the aspiration silent' Who if any in your family has Diabetes' What is the routine for checking for feet conditions such as ulcers' 8. Self-Perception How do you see your body' Is it the image in keeping with your BMI' What is your self-esteem awareness' Appendix one continued 9. Role Relationship Who in the family is the caretaker of whom' Is their adequate respite for the caregiver in place' Do other family members participate in caregiving' 10. Sexuality What is your sexual health life' Do you and your partner share the same sexual patterns, timing, frequency needs' 11. Coping How do you as an individual deal with anxiety' How does the family deal with stress as a unit'