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Patient is a 21 year single male with Sickle Cell Anemia.He is a Johova’s witness and doesnt beleave in blood transfusions. His mom and dad are seperated. They both carry the trait of sickle cell. He has two brothers and two sisters. Hes a highschool graduate of Millford Mill highschool. He has a unsteady gait/walk. A nursing care plan was done for him in previous order. His mental state is like a teen. He’s never had a relationship. He cant receive blood transfusion because of his religion. Hes constantly in pain.
Family Assessment Guide
(Sections I-IV should reflect the historian’s statements only)
I. Identifying Data
Location during interview:
Child (initials, age, diagnosis, grade):
Family members (initials, relationship, sex, age, occupation, education):
Household:
Extended:
Recent additions or loss of members:
Ethnicity:
Religion:
Financial data (sources of income, financial assistance, medical care, expenditures):
Sources of medical and dental care:
Source of referral and/or reason for child’s hospitalization:
II. Individual Health Needs for every family member (household and extended-three generations)
Identified health problems or concerns:
Medical diagnoses:
Recent surgery or hospitalizations:
Medications and immunizations:
Emotional and cognitive functioning:
Coping strategies used:
Substance abuse:
Health screening practices:
Prenatal care (current and/or past):
Family planning used (past or present):
III. Interpersonal Needs
Parent-child interactions:
Spousal relationships:
Sibling relationships:
Concerns about elders:
Are parents/grandparents caring for other dependent members?
Significant others:
IV. Family Needs
A. Developmental
Parents report of children’s development:
Are children responsible for other family members?
Developmental tasks that need to be accomplished:
Daily health-promotional practices for nutrition, sleep, leisure, child care, hygiene, socialization:
B. Loss or Illness
Events or illnesses:
Adjustments family has made:
Roles and tasks being assumed by members:
Any one individual bearing most of responsibility:
Level of anxiety now and usually:
C. Resources and Support
General level of resources and economic exchange with community:
External sources of instrumental support (money, home aides, transportation, medicines, etc.):
Internal sources of instrumental support (available from family members):
External sources of affective support (emotional and social support, help with problem-solving):
Internal sources of affective support (who in family is most helpful to whom?):
Is the family more open or closed to outside?
Is the family willing to use external sources of support?
D. Environment
Type of dwelling:
Number of rooms, bedrooms, bathrooms, stairs, refrigeration, cooking:
Water and sewage:
Sleeping arrangements:
Types of job held by members:
Exposure to hazardous conditions at job:
Level of safety in the neighborhood:
Level of safety in household (violence or aggression, smoke detectors, CO detectors, age of house, safety of house, child-proofed):
Involvement in the community:
Compliance with rules and laws of society:
How are values similar to, or different from those of the immediate social environment? How are these values taught to children?
E. Internal Dynamics
Roles of family members clearly defined?
Authority and decision-making rest where?
Typical patterns of interaction between family members:
Communication, including verbal and nonverbal:
Expression of affection, anger, anxiety, support, etc.:
Problem-solving style:
Degree of cohesiveness and loyalty to family members:
Conflict management:
V. Analysis
What stage is this family in?
What data supports this conclusion?
At what level is this family functioning?
What data supports this conclusion?
Identification of family strengths:
What needs are identified by the family?
What needs are identified by the nurse?
[meteor_slideshow slideshow=”arp2″]
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