family visit final .pptx...................

Family visit

1. Family visit Department of community medicine Prepared by: Aayush Ghimire (18024) Prakriti Dhakal (18020)

2. Family visit Name of the locality : Kalika chowk, Bharatpur-10 District : Chitwan

3. GENERAL INFORMATIONS

4. GENERAL INFORMATIONS House hold number: 4165 Name of the head of the family: Uma Nath Dawadi Type of the family : nuclear family . Religion: Hindu Caste : Brahmin Family members: 2 Respondent: Ram Maya Dawadi

5. GENERAL INFORMATIONS Name Relation with the head of the family Age/Sex Marital status Literacy Occupation Addiction Uma Nath Dawadi Head of the family 62/M Married I.A. completed Retired contractor None Ram Maya Dawadi Wife 61/F Married Grade 8 completed Home maker None Remarks Covid vaccine including booster doses received Head of the family is hypertensive since 15 years Family members not present: Son, daughter in law, grandson

6. Income and expenditure

7. Income and expenditure Source of income Remittance: Rs 50,000 per month House lease: Rs 18,000 per month Per capital Income: Rs 34,000 per month

8. Income and expenditure M onthly expenditure House hold Food: Rs 25,000 Fuel: Rs 3,000 Clothing: Rs 8,000 Medical: Rs 5,000 Social and religious functions: Rs 5,000 Education: none Miscellaneous: Rs10,000

9. Income and expenditure Their income meets the expenditure No debts Savings: Rs 10,000 per month (utilized in extra household activities and saved for medical purpose)

10. Kuppuswamy scale Education of head of the family: High School Certificate – score 4 Occupation of the head of the family: Skilled worker – score 4 Monthly income of the family: Rs 68,000/- score – 12 Total score: 4+4+12=20 Family is upper middle class

11. Housing

12. Housing House : Pucca No. Of Rooms: 2 Per capita space: 220 sq. feet Physical Crowding : absent Sex Crowding: absent Built up area ( sq.ft ) : 1100 sq feet Set back ( sq.ft ): 1816 sq feet Floor : pucca Roof :Cemented (Pucca) Height of ceiling: 10 feet

13. Housing Ventilation : Adequate Cross ventilation : Absent. Lighting : Adequate Kitchen : Separate Smoke Out lets : Present Water Supply : Sources for Drinking: municipal water supply For other purpose : municipal water supply Water treatment before drinking : Boiling Refuse disposal : Municipality garbage truck

14. Housing Excreta disposal :Sanitary latrine Live stock / poultry : absent. Drainage present around the house : YES If yes : Adequate Insects Flies : Present Mosquitoes : Present Bugs : absent. Rodent: Absent

15. Diet survey

16. Food stuff Item Quantity (gm) Calories (kcal) Protein Vit-A ( μmg ) Iron (mg) Vit-B (mg) Calcium (mg) Vit-C (mg ) Cereals Rice wheat 420 70 1449 238.7 28.56 8.47 20.3 2.94 3.43 9.24 2.94 42 33.6 Pulse Lentils 70 242.9 17.5 87.5 4.41 2.54 63 Milk products Milk 1000 750 35 1700 2 4 1700 10 Egg/Meat/Fish Fish 200 236 39 24 Oil and fats Oil 100 900 2000 Green leafy vegetables Mustard leaves 250 85 10 6555 40.75 0.75 387.5 82.5 Root and tubers Potato 150 145.5 2.4 36 0.6 2.025 15 25.5 Fruits Banana 150 174 1.8 117 0.45 0.945 25.5 10.5 Total consumption 4221.1 142.73 10515.8 54.58 22.44 2290.6 128.8

17. Diet survey Total protein consumption: 142.73gm Total calorie consumption: 4221.1kcal Total consumption unit in the family: 1 + 0.8 = 1.8 Protein consumption/unit/day: 79.29 gm (adequate) Calorie consumption/unit/day: 2345.05 kcal (adequate)

18. Social aspect of nutrition

19. Food adequacy Do you have cultivable land :No Facilities for food purchased : Shop in the community Quantity of food purchased ( approx ): Rice / week: 3 kg Vegetable / week: 3 kg Dal /week: 250gm Oil / week: 700ml .

20. Cooking method Do you clean rice and dal after purchasing ?: Yes Do you wash rice and dal ? : Yes Number of wash: 3 How do you wash vegetables – Before cutting . How do you cut vegetables ? Medium How do you cook vegetables ? Fry with oil Advice: - clean the rice only once or twice before cooking - steam cooking is more preferable

21. Food storage Where do you store your food grains ? Kitchen What do you store it in? Plastic container Store of salt? Metal container

22. Food safety Do you keep the prepared foods covered ?: Yes Do you wash your hands before handing food ?: Yes Storage of cooked food : Safe Storage of uncooked food : Safe

23. Availability of Food Cereals: Bought Pulses: Bought Vegetables: Bought Meat , Eggs: Bought Milk: Bought Is the milk available in adequate quantity : YES (Milk is available for drinking to all members)

24. Eating habits Frequency per day: 3 Do you think some extra food during pregnancy / lactation is required ? YES If yes, why ? More nutrition is required for the pregnant and lactating women

25. Infant feeding and weaning knowledge How many hrs after delivery, breast feeding should be started? As soon as possible(1 st hour) Do you think colostrum should be given ? Yes Do you know breastfeeding is important for child ? Yes Do you know about exclusive breastfeeding ? Yes How long should breast feeding be continued ? 2 years Frequency of breast feeding? 8-10 times per day

26. Do you think cleaning your breast before each feed is important ? Yes Do you think you should burp after each feed ? Yes Do you know about weaning ? Yes From which age weaning should be started ? 6 months What are the foods you consider suitable for weaning? Soft and mashed foods Whether breast feeding should be continued along with weaning ? Yes If Yes, how long ? 2 years Frequency of complimentary feeding ? 1 time at beginning and increased gradually Do you know about the important of supplementary food ? Yes

27. Nutrition of pregnant and lactating women Do you know the important of increased food intake during pregnancy and lactation ? Yes What type of food do You Consider necessary? Nutritious food (Fruits, meat soups, eggs) Do you think that increased food intake will give rise to bigger baby? Yes Do you think that big size of the baby will create problem in delivery? Yes Did you think you should increase diet when became pregnant / after delivery ? Yes Do you have taboo for some food ? No Any particular social religious believes associated with eating practice? No

28. KNOWLEDGE ATTITUDE & PRACTICE TOWARDS HEALTH

29. STUDY OF KNOWLEDGE ATTITUDE & PRACTICE TOWARDS HEALTH Assessment of knowledge regarding causes of diseases. What do you think causes diseases? She was not sure how diseases were caused

30. ATTITUTE TOWARDS HEALTH Do you consider health as a valued asset : YES Do you believe that most of the diseases are preventable? NOT SURE Do you believe that most of the disease are curable ? YES Do you think any intervention required for recovery from diseases ? YES

31. HEALTH PRACTICES Do you practice any preventive / promotive health care? Yes PERSONAL HYGIENE Do you take bath every day? Yes Do you keep your nails clean ? Yes Do you wash your hands with soap and water before taking food / after coming from toilet? Yes Do you brush your teeth every morning ? Yes

32. HEALTH PRACTICES IMMUNIZATION : Do you consider immunization is important for prevention of diseases? Yes Do you know the important of complete immunization ? Yes Are you children completely immunized? Yes

33. HEALTH PRACTICES ENVIRONMENTALSANITATION: From where do you collect drinking water? Municipal tap water Do you disinfect drinking water ? Yes Do you use sanitary latrine? Yes Where do you dispose off refuse? Yes (Municipal garbage truck)

34. HEALTH PRACTICES CARE DURING ILLNESSES : DIARRHOEA : Do you with draw food and water during diarrhea ? No Do you give more water during diarrhea ? Yes BREAST FEEDING / WEANING: Do you give colostrum? Yes When do you start weaning? 6 months

35. HEALTH PRACTICES Where do you go for medical relief? Private hospitals Do you find any problem in seeking Medical Relief : No Attitude towards Govt. Health services : she was Not sure about govt. health services Have you ever met the local health worker : No.

36. SOCIOCLINICAL CASE

37. Name :Uma nath Dawadi Age : 62 Sex : Male Locality : Urban District : Chitwan Zone : Bagmati Name of the Head of the Family : Uma Nath Dawadi Religion : Hindu Type of the Family : Nuclear Caste : Brahmin

38. Economic aspect of the family i ) Total income of the family : 68000 ii) Per capita income of the family : 34000 iii)Expenditure per month : a. Food : 25,000 b. Clothing : 8000 c. Education : None d. Housing : None e. Medical care : 5000 iv) Amount of debt : None

39. Dietary habit of the family : Non–vegetarian Environmental Sanitation a. Housing : Pukka house b. Refuse disposal : Municipality vehicle c. Water supply: Municipality supply d. Drainage : Adequate e. Excreta disposal : Sanitary latrine f. Livestock & poultry: None

40. Chief complaints No any chief complains History of Present illness According to the patient he had no complains. He was diagnosed with chronic hypertension 15 years back while doing regular health check up incidentally. He had no history of headache, nose bleeds, chest pain, fatigue, blurring of vision, unusual sensation of heart beat, shortness of breath, facial flushing, dizziness, difficulty breathing during sleep, irregular heart beat, blood in urine, sweating and trouble sleeping. He was also recently diagnosed with Cholelithiasis during his regular health checkup which was confirmed via USG and is planning to undergo surgery. He had no history of abdominal pain, nausea, vomiting, jaundice and pain in right shoulder.

41. History of past illness a. Illness in the childhood: None b. Other illness : Recently diagnosed with cholelithiasis c. Chronic Illness : Hypertension d. Treatment availed: Drugs ( Amlodipine 5mg and Losartan 50mg) e. Past surgical history for tibia fracture No history Diabetes Mellitus, Tuberculosis, COPD, Thyroid disorders and blood transfusion

42. Personal History : a) Smoking : Smoker for past 35 years Pack years = (35*15)/20 = 26.25 pack years b)Alcohol Consumption : 180 ml Vodka per day No of units = (180*42)/1000 = 7.56 units c) Bowel and bladder frequency are normal d) Appetite is normal e) Sleep is normal f) Diet is mixed

43. Patients father and both siblings suffer from hypertension No family members has COPD, tuberculosis, diabetes mellitus and thyroid disorders FAMILY HISTORY

44. Socio economic history Lives in pukka house Education up to I.A. level Home life is harmonious without disputes Relationship among family members is good There is good community support Education : High School Certificate – score 4 Occupation : Skilled worker – score 4 Monthly income of the family: Rs 68,000/- score – 12 Total score: 4+4+12=20 Family is upper middle class

45. Drug and allergy history There is no any known allergy Drug Dose Indication Side effects Amlodipine 5 mg Hypertension None Losartan 50 mg Hypertension None

46. General Examination Vitals BP – 130/80 mm Hg %SpO 2 = 98% Pulse- 86/minute RR – 18 times/minute T emp: 97 ̊F (Right axilla)

47. BMI Weight = 76 kg Height = 5 feet 6 inch (1.67m) BMI = The patient is overweight  

48. On examination Pallor: absent Icterus: absent Lymphadenopathy: absent Clubbing: absent Cyanosis: absent Oedema: absent Dehydration: absent

49. Cvs examination Pulse : 1. Rate : 86 2. Rhythm: Regular 3. Volume : Normal volume 4. Condition of the arterial wall : Normal 5. Comparison between two radial pulses : No radio radial delay 6. Other peripheral pulses : palpable

50. Examination of the heart precordium 1. Inspection Chest is symmetrical, Apical impulse not visible, No any visible scars, No engorged veins, No scar present, No peripheral impulse present 2. Palpation Apical impulse palpable 3. Auscultation S1, S2 heard No extra heart sound heard

51. ABDOMINAL EXAMINATION 1. Inspection Slightly distended abdomen, Globular in shape, umbilicus Central in position , no engorged veins vissible, no vissible scars, No vissible pulsations 2. Palpation Warm on palpation, No tenderness, No palpable mass, No hepatomegaly, Spleen not palpable 3. Percussion Tympanic percussion sound 4. Auscultation Bowel sound normal

52. Case summary 62 years old male with no apparent symptoms and no chief complaints has been suffering from chronic hypertension for 15 years and is under medication. His vitals were as BP=130/80 mmHg, RR = 18/min , pulse rate= 86/min, and %SpO 2 = 98%. On examination there was no specific findings.

53. Advice to the patient Reduce the salt intake Do regular exercise Go for regular health checkups