COMMUNITY HEALTH NURSING -1L FAMILY FOLDER. (NO. ) Topic :— Modaretat NAME OF STU Sunil + CLASS: =, Q. Sc. Nuwising pa th - TT DATE = FROM _ Eaten: GE Scanned with OKEN Scanner:AMILY PROFILE DAT, Primary Health Centre: holamand Sub Centre »____Mehalp kt dhoni Name of the Village: ___-JRalomang IFICATION INFORMATION Head of family Name: Babulol Pate) Occupation: ——— Enginent Address_ ——Magsta_Nagett ghalewwand —eisscle —____ eee aoe eG Type of family: — Nuclear! Joint“ Religion: Hindu [=] Muslim[——]—Christian(_]_—Any other[__] . HOUSING CONDITION Type ies emer 1] _ Independent| Tileld ~] Sheeted Hull] Owned 4 Rented [ 2. Rooms :Number- [=] Adequatef Inadequate 3. Kitchen :Separate [E=] Attached to room. [—] 4. Fuel Used Gas [] Kerosene [] Firewood [7] electricity 5, Ventilation AdequateSZJ Inadequate [__] 6, BathRoom —: Separate[7] ~— Common [7] 7. Lighting Electricity 7] Oil Lamp—-—] 8. Drainage : Open Close (177 = 9. Water Supply: Tap/Hand Pump Well Chlorined. - Yes/No Open Tank Chlorinated 10 Tollet own BI Public [] Open field [7] 11 Disposal of Waste:Composing 4 Burning Buying 12 Cattle Shed: Separate Within the Hole (G® Scanned with OKEN Scanner3. FAMILY COMPOSITION Relationship ‘Age | Sex [Education [Occupation [ifeatth [ Immun With Head Status } ization of the Family Status [_Babulal patel | SeF | 85 [m4 | ormtuale} Engineer [OMY compte | » Fe ; | Mauicha wife [30 /F | o.e4 tTenckea edi | 801) 18 | | 12% ptudeut Waite Complett Sais 5. 4, TRASPORT AND COMMUNICATION FACILITIES, B, Communication Media A. Transport y= Yes No Own Y&/NoCI Telephone CJ] Oa Tractor“ Tempo [I Wheeler I Television G2 CI Bus (City Bus) RSRTCET Private Radio CA AutosC1Taxies [2 Train GQ —-Newspaper/Magazinesi@_ 1 Post & Telegraph G2 [I LANGUAGES KNOWN Marwadi p= Mewadi-) Gujrat English Hindi pr Any Other = 6. AYNUTRITIONAL PATTERN Vegetarian [2 Non Vegetarian (5 Staple Food :Rice Wheat CQ Ragic] Mixed Vegetables + Grown) Purchased {i Quantity used per day: ......ky Milk : Quantity used per day .......litres ‘Non Vegetarian Dish: Specify Ku... How often ....% GF scanned with OKEN ScannerB) NUTRITIONAL STATUS OF FAMILY MEMBERS [Name of the Member Nourished/Under Nourished [| __ Malnetrition | t E j* Babulal, pate! Newdsher} a | : he Montsha Nowr§ ches} wy) | . | \* Arfeen Nowditheol | { | 7. RECORD OF ILLNESS [ eof the Member) Age | ines? Duratior! Main investigation Characteristics | done i fee | ~ CBC [30 |reale} ‘loye|— ebils | Ror foepyets yout cua = ienkness | — cmerr ANT WOMAN ¢ |Gravida | No. of Children] | be Pare | Living Le wf | 9, ELIGIBLE COUPLES [ Rome T Age Family Planning Metiod opted fwint Family 10. IN CASE OF SI Name/Prima Health Centre |i ICKNESS, WHERE DO YOU GO FOR TREATMED Sub Centre Indiger, ig Home ws Doctor/Dai (CE Scanned with OKEN ScannerNURSING CARE PLAN [Assessment | Nursing Diagnosis _Phicetive’¢ vals 7 [Nursing Int entions Evaluation Qutedinte esi Hesusphyls * Forde moniter 6 | Bleed ta Cough data n gle ts coughs] Hh Skeuly | of TB Si ws eelentee] augh, + raenitey uited Reduces| » | hehe | by peter yp peel 2 7 ertjesieg tent ‘ ef to Pes Gwerks. Prowuls 02 Meaty + cle He, yl » cbjective 7 | i 1 fualens pothe) rH mreelicatron “oud cago prescribe] oat (CE Scanned with OKEN ScannerlAssessment [Nursing Diagnosis Dbjective/ Goals lursing Interventions Evaluation Outcome a iene clata:— pcarpees Ls fear cghyedive loxtou: = he frequnct) Ls fey) ae Fever modiquee * Defictut Krooledge RIE vith the acieee concitey) 2 Dmprove tho. kaowledge te Lefompraity oP poked © Edlacedke He + Teach Regereumy panos Heb pronk Jerk abet wedietTow 4 ibs site atta te +8. * clewe . Keuosslagge rey, fe wales prowiiter bo paheuk 4 patie fe ® Scanned with OKEN Scanner[Nursing Diagnosis Objective’ Goals ursing Interventions Evaluathn Otteome | * Aetiwity | he py] © check, the > physica fnilevonce RIE] actruitey ef | frcehienaf Hee] rage bg choata oY | ppdulnuige Pas of naib yar el- | euldonted 7 Rok F ‘e Apses the teability fede) aga 1 cease eight aly achvily ug ets / EW 1 youd tO Hester de prevent ye) to the patient | en (CE scanned with OKEN Scanner