KINGDOM OF SAUDI ARABIA المملكة العربية السعودية
Ministry of Higher Education وزارة التعليم
University of Hail جامعة حائل
College of Nursing كليـــة التمريض
KINGDOM OF SAUDI ARABIA المملكة العربية السعودية
Ministry of Higher Education وزارة التعليم
University of Hail جامعة حائل
College of Nursing كليـــة التمريض
PRIMARY CARE NURSING for ADULT/GERONTOLOGY CLINICAL
(NURS 538)
FAMILY ASSESSMENT FORM
FAMILY NAME
ALNassar
NAME OF HEAD OF FAMILY
Fuad
ADDRESS
Dammam
DATE
1-10-2022
RELI-
GION
ISLAM
Type of family
Family extended
1. Family Genogram and Eco-map . (Use different colors for mapping out the function)
Functional charting: — close / overly close / – – distant / ^^^ conflictual
Presence of any readily available conflict between family members (specify) (10)
Genogram 5
b:1952 ahmad b:1954 samera b:1948 fuad b:1950 fatima
d:2012 d:2010
b:1976 asaad b:1976 suha b:1974 d:21014 mohamad
b:2020 ruba b:2009 faya b:2011 ward
: Live male
: Live female
: Dead female
: Dead male
Eco-map 5
: Friends
: Mosque
: Social service
: Work
: County health department
: Non health related community service
: Family
: Extended family
: Strong
: Supportive positive relationship
: Negative
2. Assessing the safety of the environment (home of older adults)
(10)
Illumination and Color Contrast
Is the lighting adequate but not glare producing?
The lighting is a bit dim
Are the light switches easy to reach and manipulate?
The keys are easy to reach because they are close to the floor
Are night-lights used in appropriate places?
The night light is not suitable because it becomes very dark during the night
Is color contrast adequate between objects such as a chair and floor?
The contrast of colors is appropriate and everything appears separately
Hazards
Are there throw rugs, highly polished floors, or other hazardous floor coverings?
Not suitable, the carpet is rough and the floors are slippery
If area rugs are used, do they have a nonslip backing and are the edges tacked to the floor?
The edges of the carpet are bent and not fixed to the floor, which may cause people to fall
Are there cords, clutter, or other obstacles in pathways?
There are some electric charger wires and children’s toys lying on the floor most of the time
Is there a pet that is likely to be running underfoot?
There is a cat in the house that is young and very mobile
Furniture
Are chairs the right height and depth for the person?
The height and depth of the chairs are appropriate for the age, height and health status of the client
Do the chairs have armrests?
Yes, there is armrests for the chairs
Are tables stable and of the appropriate height?
Yes, the height of tables is suitable for the height and movement of the client.
Is small furniture placed well away from pathways?
There are some furniture in the corridors that may hinder movement
Stairways
Is lighting adequate? Are there light switches at the top and bottom of the stairs?
The lighting on the stairs is dim for the client eyesight
Are there securely fastened handrails on both sides of the stairway?
Yes, there is securely fastened handrails on both sides of the stairway
Are all the steps even?
Yes, all steps is even
Should colored tape be used to mark the edges of the steps, particularly the top and bottom steps?
Yes, we have to used mark the edges of the steps, particularly the top and bottom steps
Bathroom
Are grab bars placed appropriately for the tub and toilet?
There are no grab bars in the bathroom
Does the tub have skid-proof strips or a rubber mat in the bottom?
The floor is slippery and there are no pieces or strips to prevent it
Has the person considered using a tub seat?
Yes, the person considered using a tub seat
Is the height of the toilet seat appropriate?
Yes, the height of the toilet seat appropriate
Has the person considered using an elevated toilet seat?
No, no need for that
Does the color of the toilet seat contrast with surrounding colors?
The color of the toilet is similar to the color of the walls and floor
Is toilet paper within easy reach?
Yes, toilet paper within easy reach
Temperature
Is the temperature of the room(s) comfortable?
No, the rooms is cold
Can the person read the markings on the thermostat and adjust it appropriately?
There is no thermostat, they use traditional heating methods
During cold months, is the room temperature high enough to prevent hypothermia?
No, Heating devices used do not cover the entire house
During hot weather, is the room temperature cool enough to prevent hyperthermia?
No, because they use traditional methods
Overall Safety
How does the person obtain objects from hard-to-reach places?
They use affixed table
How does the person change overhead light bulbs?
They use affixed table
Are doorways wide enough to accommodate assistive devices?
The entrances are wide and accommodate assistive devices
Do door thresholds create hazardous conditions?
There is a high threshold on the outside door
Are telephones easily accessible, especially for emergency calls?
Everyone in the family carries a cell phone and knows how to use it well
Would it be helpful to use a cordless portable phone or a cellular phone?
They basically use it
Does the person wear sturdy shoes with nonskid soles?
They go around the house without shoes
Does the person keep a list of emergency numbers by the phone?
The client phone has a favorite list in case of emergency, in addition to the fact that the phone does not have a secret number
Bedroom
Is the height of the bed appropriate?
Yes, the height of the bed is appropriate to the health status and he using small Staircase
Is the mattress firm at the edges to provide enough support for sitting?
Yes, the mattress firm at the edges to provide enough support for sitting
When side rails are in the down position, are they completely out of the way?
Yes, side rails are in the down position, and they completely out of the way
Is the pathway between the bedrooms and illuminated, particularly at night?
The corridor is dimly lit
Kitchen
Are storage areas used to the best advantage (e.g., are objects that are most frequently used in the most accessible places)?
Yes, there is a maid who arranges everything according to use and also takes into account the ease of access to it
Are nonslip mats used in front of the sink?
No, they don’t use nonslip mats used in front of the sink
Are the markings on stoves and other appliances clearly visible?
I didn’t notice any signs
Are the markings on stoves and other appliances clearly visible?
No, but the maid does it
Assistive Devices
What assistive devices are used?
Crutch and walker
Is a call light available, and does the person know how to use it?
There is no call lights
Would the person benefit from any assistive devices that are not being used?
Yes, he may use a wheelchair if he is very tired or dizzy
Are assistive devices being used safely and properly, or do they present additional hazards?
Yes, assistive devices being used safely and properly
3. Family Health Care Plan (10)
Types of Care
Family member
Problem
Recommendations
WELLNESS
Ahmad
Samera
Fuad
Fatima
Asaad
Suha
Mohamad
Ruba
Faya
ward
Bad(old age,health status)
Bad(health status)
Bad(health status)
Bad(old age,health status)
Good( medically free)
Bad(health status)
Good( medically free)
Good( medically free)
Good( medically free)
Good( medically free)
Provide a nurse
She was dead
He was dead
Provide a nurse
Frequently checkup and sport
Helthy diet and sport
He was dead
Frequently checkup and spot
Frequently checkup and sport
Frequently checkup and sport
MEDICAL
Ahmad
Samera
Fuad
Fatima
Asaad
Suha
Mohamad
Ruba
Faya
ward
HTN, CVA
Cancer
MI
HTN
Medically free
DM
Medically free
Medically free
Medically free
Medically free
Monitor BP, Monitor medication taking
Dead
Dead
Monitor BP, Monitor medication taking
Frequently checkup
Monitor blood sugar reading before each meals and at bed time, monitor medication taking
Frequently checkup
Frequently checkup
Frequently checkup
Frequently checkup
PSYCHOSOCIAL
Ahmad
Samera
Fuad
Fatima
Asaad
Suha
Mohamad
Ruba
Faya
ward
Non
Non
Non
Dementia
Non
Non
Non
Non
Non
non
non
non
non
don’t let her alone and monitor medication taking
non
non
non
non
non
non
1
1
1