1. Family care Analysis Ventura, Rolando Jr. Verdolaga, Ria Villanueva, Maureen Elvira Villanueva, Roel Visperas, Joana Franchesca

3. General Information  Felicitas G. Guazon  74 y/o  March 6, 1936  Blk. 5 Magsaysay Village Tondo Manila  Canossa DM Club Treasurer

4. History of Illness  1 year PTC  Patient was advised by her children to undergo a medical check-up at a medical mission in Cavite  Based on ECG and Blood exam she was diagnosed with HPN and DM  Patient sough consult at a private clinic in Cavite for monitoring  Prescribed with metformin 500 mg OD; and Glibenclamide 5 mg OD

5. History of Illness  7 months PTC  Consulted at Canossa Health Facility  Metformin shifted BID  Glibenclamide 5 mg OD  Losartan 50 mg OD taken in the afternoon  Hydochlorothiazide 25 mg OD  Lovastastin 40 mg OD taken at night time  Follow-up and A1c monitoring every 3 months

6. History of Illness 6 months PTC  Enalapril 10 mg OD  B complex OD 5 months PTC  Advised to take captopril if blood pressure >160/100 2 months PTC  referral to ophthalmology for cataract

7. History of Illness  1 week PTC  Patient has experienced hypoglycemic episode  BP monitoring twice a week  Normal BP 140/70; highest reading 160/80

8. Past Medical History  Kidney stones – intake of banaba extract

9. Family History  (+) DM and HPN  (both parents)  (+) Rheumatism  Father  (+) Stroke  Husband, 2 siblings, mother  (+) Cardiac arrest  2 siblings  (+) Arrhythmia  daughter  (+) Hyperlipidemia  Daughter  (+) Goiter  Daughter  (-) Asthma  (-) Cancer  (-) TB

10. OB History  G10 P10 (10-1-0-9)  G6 – Preterm  The rest – term  All by spontaneous vaginal delivery

11. Personal Social  Non-smoker  Non-alcoholic beverage drinker  Ice cream – favorite food  Denies illicit drug use

12. Review of Systems General  (+) weight loss  (-) fever, chills, night sweats Skin  (-) rashes, pruritus, bruising, change in color Head  (-) headaches Eyes  (-) change in visual field, discharge, pain, spots, floaters

13. Review of Systems Ears  (-) change in hearing, tinnitus, discharge Nose  Obstruction, loss of smell, discharge Throat  (-) bleeding gums, dysphagia Respiratory  (-) chest pain, dyspnea, hemoptysis Cardiovascular  (-) palpitations, orthopnea, PND, edema, claudication

14. Review of Systems  Gastrointestinal  (-) dysphagia, diarrhea, melena  Genitourinary  (+) polyuria, nocturia  (-) dysuria, hematuria  Endocrine  (-) polydipsia, polyphagia  Muskuloskeletal  (-) joint swelling, limitation in movement

15. Physical Exam  PR: 64 bpm  Temp: 37  RR: 24 cpm  BP: 140/70  Ht: 4’11”  Wt: 155 lbs  BMI: 31.11

16. Physical Exam  Alert, awake, ambulatory, not in cardio respiratory distress  Pink conjunctiva, anicteric sclerae  (-) CLAD  Trachea midline

17. Physical Exam Cadiovascular Exam  Unremarkable; no deformities, normal heart sounds Respiratory Exam  Unremarkable; (-) crackles, wheezes, rhonchi Gastrointestinal  Normoactive bowel sounds  (-) tenderness

18. Physical Exam Musculoskeletal Exam  Weaker left leg Neurological Exam  CN I: Intact  CN II: (+) ROR; visual fields intact  CN III: pupils briskly reactive to light  CN IV: consensual pupillary reflex  CN V: V1, V2, V3 intact  CN VI-XII: Intact

19. Genogram 6

20. Family dynamics FelicitasRomeo Other Children

21. APGAR  APGAR  Adaptation – 2  Partnership – 2  Growth – 2  Affection – 2  Resolve – 2

22. SCREEM  Social  Membership in a support group (DM Club)  Officer in the DM Club  Cultural  Close family ties, her children takes care of her  Religious  Catholic  Education  High school graduate and a certified paramedic  Economic  Manages a small sari-sari store and her children also gives her monetary support  Medical – Banaba Intake

23. Family Life Stage What stage in the Family Life Cycle is the Guazon family in?  Family in Later Life  Maintain own functioning and interest in face of physiologic decline by still managing her own sari-sari store  Exploration of new social options by joining the DM club and taking the treasurer position  Support now comes more from her children

24. Family Life Stage What does Felicitas (and her family) believe caused the problem and how should it be treated?  Lifestyle is the main reason cited by the patient

25. Illness Trajectory  Stage 1: Prior to contact with health care provider  Having a family history of a wide variety of illnesses the family is very concerned about their health.  The children are very concerned about the health of their mother because it was the children who made their mother to seek consult.

26. Illness Trajectory  Stage 2: Reaction to Diagnosis  She was saddened by the news and was worried of the family’s financial burden

27. Illness Trajectory  Stage 3: Major Therapeutic Efforts  It was established in the family that the children will provide support (financial and emotional) to the mother.  The son who has the same illness also support her through blood sugar monitoring

28. Illness Trajectory  Stage 4: Early Adjustment to Outcomes  Lifestyle changes, favorite foods can’t be eaten anymore

29. Illness Trajectory  Stage 5: Adjustment to Permanency of Outcome  Fear of complication and anxious on the progression of her illness so she is very compliant and strict to herself sometime leading to hypoglycemic episode  Current stage of the family

30. Wellness Plan Screening22-60 y/o>60 y/o BP Annual monitoringWeekly monitoring Cholesterol Annual from age 40Continue Visual Acuity / Glaucoma Annual for acuity and eye pressure; screen for cataract at 50 onwards Continue Breast examination Self exam and MD exam regularly after age 35 Continue

31. Wellness Plan Screening22-60 y/o>60 y/o Pap smear and pelvic exam Annual pap smear after age 40 Continue Occult blood in stool Annually after age 50Continue Urinalysis Annual for GUT disorder PTB screening Annual Chest Xray FBS, A1c Every 2 yearsEvery 3 months

32.  Diet  Continue Medications  Exercise Wellness Plan