PFC MATRIX

PGIs: Abella, Banquirigo, Chan, Li Bi, Manaloto, Olo

Patient-Centered Family-Focused Community-Oriented

DATA T.M., a 45 year-old female, married, Filipino, Roman Catholic, nursing The index patient was born on May 18, 1976, as the second of four siblings The index patient has been working as a nursing
assistant, from Lahug, Cebu City, sought consult at the staff clinic on in Bato, Leyte. Her parents were married at the time and remained so. Her assistant for 18 months now. She is assigned at 5B. Her
July 26, 2021 due to back pain. father is a police officer, and her mother is a housewife. She had a good usual working hours would last from 8 to 12 hours. Her
relationship with her parents and siblings during her formative years. responsibilities at work include changing linen and
Brief HPI diapers, preparing bed pans, and mobilizing patients.
Two days PTC, noted onset of back pain in the lower area and in the When the patient first entered grade school, she excelled academically. Overall, she has a good working relationship with her
scapular area of both sides with PS 7/10; intermittent, aching in After finishing high school in 1993, the patient studied engineering for one workmates. Her stressors would include wearing PPEs
character, nonradiating, precipitated by strenuous activities such as semester in Leyte before working as a saleslady in a local pharmacy due to and getting pulled out to different stations. Despite
lifting and washing clothes, and is temporarily relieved with changes in financial constraints. She enrolled in Southwestern University's BS these stressors at work, she mentioned that these do
position. Pain was associated with diaphoresis. No fever, cough, and Pharmacy program in 1996 and graduated four years later. She then took not compromise the quality of work she is able to
dysuria. the pharmacy board exam, which she unfortunately did not pass. provide.
One day prior to consult, back pain persisted so patient self-medicated
with Eperisone hydrochloride (Myonal) 50 mg/tab 1 tablet with noted Patient began working as a factory worker in Taiwan in 2002. Around the Certain occupations carry a higher risk of developing
partial relief of pain to PS 4/10. year 2003, the patient's father died unexpectedly as a result of an asthma low back pain. These include heavy manual work, jobs
Persistence of symptom prompted patient to seek for consult. complication. After that, she decided to return to Taiwan to complete her requiring awkward postures and postures that have to
contract. She met her husband a year later through a mutual friend. By be maintained for prolonged periods or involve
PMH 2006, the patient had married her husband and mentioned that it was the frequent bending and twisting.
Known asthmatic; no known food and drug allergies happiest time of her life. After marriage, the couple attempted to conceive
Adult vaccinations include HPV x 3 doses (2012); Hepatitis B x3 doses + a child but were unable to do so, so the patient sought consultation and a The index patient and her husband are economically
booster (2019) Sinovac x2 doses (March 2021); Flu and Pneumococcal saline hysterogram was performed, which revealed that both fallopian stable, and they are able to use their savings for
vaccines (May 27, 2021). tubes were closed, making pregnancy impossible. The patient was upset medical expenses and bills. They have adequate access
when she heard the news, but she gradually accepted it as she realized she to health care.
OB-GYN wasn't the only one in that situation. As a source of income, the patient
OB score is G0P0; Menarche at 12 years old with regular menses started a business in which she bought and sold various items for 12 years.
associated with dysmenorhea relieved with Eperisone hydrochloride
(Myonal) 50 mg/tab; LMP: June 20, 2021; PMP: February 15, 2021; By 2019, the patient had decided to pursue a career as a caregiver, with
currently on medroxprogesterone acetate; Coitarche at 30 years old plans to work abroad. While she waited for her sister to petition her, she
with one sexual partner in her lifetime. decided to gain experience by working as a nursing aide at Chong Hua
Hospital – Fuente. She was assigned to the COVID ward during the
PSH pandemic and continues to work there.
Patient is a non-smoker, occasional alcoholic beverage drinker, and
denies of illicit drug use; does walking for an hour 3x/week as an
exercise. SCREEM
Diet is unrestricted; drinks 1.5L of mineral water/day; has no difficulty ● Social: Patient can openly communicate with the rest of her
in urination and defecation. family members. She is closest to her mother and is considered
the mediator of the family even if she lives in Cebu while they live
HFD in Leyte.
(+) Hypertension and diabetes mellitus on paternal side ● Culture: The patient is satisfied with his cultural identity.
(+) Asthma on both sides ● Religion: Patient is religious and turns to God at times of
hardships.
Pertinent PE ● Economic: The patient and her husband are able to meet their
Weight: 70kgs necessities through their combined income.
 Height: 5’4” ● Education: Her father was a college graduate and education is
BMI: 26.49 kg/m2 -Overweight (WHO & Asian) adequate among siblings.
Chest & Lungs: clear breath sounds, no rales, no wheeze ● Medical: Patient and her sibling have good health seeking
Back: no tenderness on palpation behavior and understand the importance of annual health check-
Extremities: CRT <2 sec, strong pulses ups. The family does not seek consult from traditional healer.
CNS: within normal limits

Diagnostics:
● Thoracolumbar xray (2017)
o Straightened dorsal kyphosis and lumbar lordosis, most
likely secondary to muscle spasm
o Mild hypertrophic degenerative change of the
thoracolumbar spine

ANALYSIS Patient’s occupation as a nursing assistant is a contributing factor to The index patient is currently a newly married couple. The patient contributes her back pain to the consistent
the patient's back pain as it involves her in lifting heavy objects. heavy lifting involved in her line of work. Her long duty
The patient has a good relationship with her husband, mother and siblings. hours may also affect her capability to recuperate
 They maintain an open relationship with each other. The family is classified because this would give her less time to rest, as she has
as highly functional. to prepare for duty again the following day.

Her relationship with her husband is stable as they are able to provide for The lack in the members of the healthcare team may
their monthly expenses. also affect her back pain since she would have to do
more work than usual.
The patient and her family have good health seeking behavior.
● Problem: Back pain Family Life Cycle : Newly Married Couple Low back pain is a symptom of common occurrence in
o Diagnosis: Muscle spasm APGAR 1: Highly functional family the general population, but is more common between
o Differentials: Smilkstein’s Cycle of Family Function: Family in Functional Equilibrium ages 25-64 years. It is said to affect over half of the
▪ Muscle strain Family Illness Trajectory : Major Therapeutic Efforts (Stage III) working population. Back pain is a common
▪ Muscle sprain occupational disease seen at the workplace.
▪ Contusion The relationship between the index patient and her husband, mother and
siblings are very strong. They all have stable jobs enough to provide for Poor implementation of DOLE-OSHA guidelines
DIAGNOSIS/
their monthly expenses. regarding working hours and occupational guidelines
CONCLUSION for employees involved in manual work.
The patient has an in-depth understanding of health as a health care
worker. Poor adherence to R.A. 11058, an act that aims to
strengthen compliance with occupational safety and
health standards.

● Pharmacologic Therapy: For the patient Comply with 8 hours of work for health personnel, as
o Etoricoxib (Arcoxia) 120mg/tab 1tab OD for 5 days as - Counseling on complications of her muscle spasm per recommended by DOLE. Observe the safety and
needed for pain - Annual General Check-up occupational guidelines set by DOLE-OSHA for
o Eperisone hydrochloride (Myonal) 50mg/tab 1tab TID - Proper diet and exercise employees involved in manual work such as heavy
for 7 days - Annual Pap Smear lifting.
● Nonpharmacologic Therapy: - Annual Influenza Vaccine
o Sick leave: July 26-27, 2021 For her husband Advise proper assignment of tasks and division of
o Heating pads for short-term relief of pain - Annual General Check-up workload, like assigning leaner males to do more of the
o Physical therapy for persisting pain and limited - Proper diet and exercise lifting, or making sure there are more staff to lift
MANAGEMENT/
movement - Annual Lipid Panel heavier patients.
INTERVENTION - Counseling on complications of hypertension
o Weight loss
o Annual physical exam/ wellness check up - Annual influenza vaccine Discourage bed rest and advise to stay active.
o Counselling: alcohol, sexual activity, STI prevention For her mother Encourage daily stretching and proper exercises to
- Annual General Check-up strengthen muscles.
- Proper diet and Exercise
- Annual Lipid Panel
- Fasting Blood sugar
- Counseling on the complications of hypertension