CHAPTER ONE

ASSESSMENT OF CLIENT

1.0 Introduction

According to Smelter and Bare (2010), assessment is the systematic collection of data to

determine the patient health status and any actual or potential health problems. The first

step in the nursing process is a systematic comprehensive process of collecting data,

organizing and documenting patient’s specific data gathered from various available

sources. It includes the patient’s medical, personal, social and environmental status. This

helps to render the exact nursing care to the patient and family. Information is gathered

from patient and family through interviewing, observation, and reference to past medical

records. It involves patient’s particulars, family medical history and socioeconomic

history. Assessment provides information that forms the patient’s database. Two types of

information are collected which are subjective (data from patients point of view and

include feelings, perceptions and concerns) and objective data (are observable and

measurable data that are obtained through assessment techniques performed during

physical examination and diagnostic test). Patient was the primary source of information;

however, other sources like patient folder, patient relatives etc were not overlooked. The

data gathered is analyzed to arrive at the patient’s problem so that the nurse can determine

the possible ways of nursing the patient for good health and independent life.

1.1 Patient’s Particulars

Patient’s particulars refer to factual demographic data about the client. It include client’s

name, address, age, sex, marital status, occupation, religious preference, health care

financing, and usual source of medical care

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Miss O.P is a 20 year old woman, born to Mr. A.A and Mrs. M.O on the 04/02/1998 at

Nkoranza. Currently she stays at Nkoranza A line with her family in a house number NK 345.

Miss O.P has completed senior high school. She is currently at home awaiting her results.

Miss O.P is single and unemployed. She is a Christian by religion and attends church at the

Baptist Church of Ghana. Miss O.P does not have any child or any dependent. She is the third

and last child of her parents. Miss O.P has two other siblings who are all males. Her next of

kin is her elder brother, Master A.Y. She is a Bono by ethnic group and she speaks English,

bono and little bit of French. Miss O.P is dark in complexion, about 160cm in height, weighs

58kg and has no physical disability or facial marks.

1.2 Family’s Medical History

According to Miss. O.P, there are no hereditary diseases such as hypertension, sickle cell

disease, mental illness and diabetes in her family. According to Miss O.P also, there are also

no history of communicable diseases such as tuberculosis, leprosy or epilepsy in her family.

Both of patient’s grandfathers are deceased. Their deaths were believed to be of natural

cause( due to old age) but the grandmothers are both alive with her maternal grandmother

receiving treatment for blindness. She got blind when a stick pierced her eyes when she went

to the farm. Her paternal grandmother aside the effects of aging has no such disease and she

is in good health. All her other siblings are in good health. Miss. O.P has been hospitalized

due to malaria about a year ago when she in school. She spent three days at the hospital. Her

other siblings have been admitted before on account of malaria and other minor ailments all

at St. Theresah’s Hospital, Nkoranza on few occasions. According to Miss O.P, the family

relies on orthodox and herbal source of treatments in times of illness and the family also use

over the counter drugs occasionally. There are no known allergy to drugs or food in her

family.

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1.3 Family Socio -Economic History

Miss O.P’s family lives harmoniously with each other as well as the people in the community

and support each other in times of need. According to Miss O.P’s, all her family members are

registered members of National Health Insurance Scheme (NHIS) which enable them to seek

health care since it help cut down the cost of hospital bills. Miss O.P’s family is a Christian

family with her father being an elder in their church. They engage themselves in church

activities like cleaning of the church premises, song ministration etc and her parents also

supports families who are bereaved mostly on Saturdays. Her parents are both farmers who

are into cashew and cocoa farming from which they support the family with the income they

earns. The parents also have a taxi which is driven by someone who makes daily sales to

them. They support the family from the extra income they derive from the taxi business also.

According to Miss O.P, she sometimes gets financial assistance from her elderly brother who

is working. The family is a middle income family. During the cashew and cocoa seasons, she

helps her parents with their farming activities. Client also said none of the family members

take alcohol or smoke tobacco or wee. According to Miss O.P, it is a taboo in the community

to steal another person’s farm produce which they abide in order to fit into the community

and they also celebrate Apoo festival. Miss O.P said her parents has taught her to be

discipline and hardworking and as such she tries to live with these life values.

1.4 Patient’s Developmental History

According to Rundell (2017), development refers to the biological, physiological and

emotional changes that occur in human beings between birth and the end of adolescent as the

individual progress from dependency till increasing autonomy.

According to Collin (2010), maturation is the process of becoming completely developed

mentally and emotionally.

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Growth according to Hornby (2010), is an increase in the size, amount or degree of

something.

According to, Miss O.P’s mother Mrs. M.O, she was born on 04/03/1998 in at the St.

Theresah’s Hospital in Nkoranza, in the Brong Ahafo region per spontaneous vaginal

delivery without any complication. Mrs. M.O also said her daughter received immunization

against the six childhood diseases. This was evidenced by the Bacillus CalmetteGuerine

(BCG) scar on her right shoulder. According to Mrs. M.O, client begun to sit when she was

four months old, started crawling when she was eight months old and walked when she was

15 months old. Miss O.P started schooling when she was four years old at Nkoranza Local

Authority School where she had her pre-school education as well as her primary and junior

high education and completed successfully in 2015 which earn her the opportunity into senior

high school. Miss O.P then had her secondary school education at the Bechem Secondary

school in Bechem. She has since completed senior high school and awaiting her result to

further her education. Miss O.P aspires to be a journalist in future and she asserts she will

work assiduously in order to achieve her goals in future. Academically, Miss O.P said she is

an average student and she studies hard to achieve her goals.

Miss O.P started developing her secondary sexual characteristics such as enlargement of her

breast, broadening of her hips, growth of hair on her pubic areas and armpit at 12 years.

Client had her menarche at age fourteen and she usually experiences a 28 days menstrual

cycle which last for six days. Client is in a very healthy relationship with her peers and her

family, she is currently not in any sexual relationship but had a boyfriend a year ago who she

broke-up with because the boyfriend cheated on her. She aspires to get married and have kids

once she start working. Miss O.P has no history of abortion but has use contraceptive twice to

prevent unwanted pregnancy.

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Erik Erikson outlined 8 stages of psychosocial theory of development and patient falls under

identity versus role confusion which is the fifth stage (age 12-20). At this point, development

now depends primarily upon what a person does. An adolescent must struggle to discover and

find his or her own identity, while negotiating and struggling with social interactions and

‘fitting in’ and developing a sense of morality and right from wrong. Some attempt to delay

entrance to adulthood and withdraw from responsibilities. Those unsuccessful with this stage

tend to experience role confusion and upheaval. Adolescent begin to develop a strong

affiliation and devotion to ideals, causes and friends. Upon various interactions with client, it

was concluded that Miss O.P has gained identity since she has a sense of responsibility and is

able to identify right from wrong as well as her role as a female. She is a serious student who

is aiming at becoming a journalist in future.

1.5 Patient’s Obstetric History

According to Miss O.P she has never been pregnant. Miss O.P. said she had her menarche at

the age of fourteen. She narrated that she has a twenty eight (28) days menstrual cycle and

her flow last six (6) days. She also said she experiences mild painful menstruation which

usually occurs on the first two days of her menstruation which she usually takes drugs bought

from the pharmacy to minimise the pain. She has not yet reached her menopausal age and

hence had not exhibited any signs associated with menopause. She confirmed she has use

contraceptives on two different occasions, ‘postinor-2’ to be precise to prevent unwanted

pregnancy.

1.6 Patient’s Hobbies/Lifestyle

According to Miss O.P, she normally wakes up at 5:30am on weekdays and performs her

personal care activities such as emptying her bladder anytime she has the urge, brushing her

teeth and cleaning the compound. She then goes to fetch water and wash cooking utensil used

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the previous evening after which she visits the toilet if she has the urge before taking her

bath. She then takes her breakfast. Since she is unemployed, she normally watch television

and rest throughout the afternoon. During the afternoon, she usually watches telenovelas on

television. Her favourite is “Gangaa” which is shown on Adom television. At 4pm she goes

to the market and buy food items to prepare food for the family.

When it reaches the farming season, she normally join her parents in the farm after taking her

breakfast. On weekends she usually goes for jogging on Saturdays after which she washes her

cloths and take her bath. She goes for church service every Sunday and attend church group

meetings on weekends. She also attends social gathering and ceremonies such as wedding

and funerals. Miss O.P usually reads her bible every evening before going to bed and end’s it

with a word of prayer before finally retiring to bed mostly at 10:00pm. Miss O.P usually has

seven hours of sleep each day. She cooks for the household whenever she is at home. Though

she eats any food, her favourite of them all is rice and stew with chicken and she has no

known allergies to food or drugs. Upon further interaction with Miss O.P she loves volley

ball and she is a good player too. She also likes exploring the internet for news and chatting

with friends on social media’s at her leisure time. She dislikes cheating others. Miss O.P has

a cordial relation with her family and friends and is able to verbalize her feelings

appropriately and she is an extrovert. Client is caring, kind, respectful and humble, and these

are a signs of good upbringing. She is able to communicate with gesture such as eye blinking.

1.7 Past Medical History

According to Miss O.P’s mother, she had no childhood illness like measles, whooping cough,

polio, diphtheria tuberculosis and tetanus. She is not allergic to any food or drug. She has

been admitted at the hospital on three different occasions for malaria, from which she

recovered quickly without complications. Miss O.P said she sometimes suffer mild menstrual

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pain and she treats it with over the counter drugs bought from a license chemical shop.

However whenever she suffers minor ailment like headache and abdominal pains she was

treated on an out-patient basis or sometimes visit the local chemical shop for medication. She

also stated that she prefer orthodox drugs to traditional medicines. There are no difficulties in

accessing health care because she is a registered member of the national health insurance

scheme but She has not being going for medical check-ups because she thinks it is not

necessary since she is not sick. Miss O.P was once involved in an accident when she went to

the farm with her parents, and cut her leg with cutlass. She was treated at the hospital and the

wound healed very well and as such did not suffering from any disability. Miss O.P has never

had any surgery.

1.8 Present Medical History

Patient was well until about three days ago, 26/09/2018 when she started experiencing

abdominal pains. The pain was initially intermittent and dull but later became severe. She

said she also vomited twice, had loss of appetite and a feeling of nausea. Miss O.P she felt

abdominal pain anytime she eats and also felt like vomiting. She said she didn’t take any

medication before reporting to the hospital. On 29/09/2018, she complain to the mother and

she accompanied to the St. Theresah’s Hospital outpatient department. Her vital signs were

checked and recorded as

Temperature 36.8oC

Pulse 85bpm

Respiration 22cpm

Blood pressure 130/90mmHg

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Miss. O.P was seen by Dr. Adu at the outpatient department and was diagnosed of gastritis.

Patient was then admitted to the female ward.

1.9 Admission of the Patient

Miss O.P was admitted around 4:10pm into the female medical ward per ambulatory from the

outpatient department accompanied by a staff nurse and patient’s mother. Miss O.P and her

mother were welcomed and they were offered seat. Miss O.P was in a conscious state and

well orientated to time, place and persons. The nurse handed over a folder with the number

09/4319 and the patient’s name and other particulars were mentioned to confirm the right

patient. On admission patient complained of headache, abdominal pain and vomting. Upon

observation, Miss O.P was found to be anxious and in pains. Miss O.P was diagnosed as

gastritis by Dr. Adu. Patient was then made comfortable in an already prepared simple

unoccupied bed (11) and vital signs was checked and recorded as

Blood pressure 130/70 mmHg

Pulse rate 85 bpm

Respiration 21 cpm

Temperature 36.5 degree Celsius (0C)

The following diagnostic investigations were requested for Miss O.P

Full blood count

Blood film for malaria parasites

Stool for routine examination.

Gastroscopy

Blood sample was taken, the bottles were well labeled and sent to laboratory for the requested

investigations to be done.

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Medications ordered for Miss O.P on admission were;

Suspension Nugel 0 15mls tid for 7 days

Intravenous tramadol 200mg in ringers lactate 500mls

Infusion ringers lactate 1L for 24 hours

Infusion 5% dextrose 1.5L for 24 hours

Intravenous Cefuroxime 1.5 g stat and 750mg tid for 24 hours

All drugs were then procured from the pharmacy department, an intravenous cannula was

established and due medications were administered.

She and her relative were reassured of the readiness of the health team to do their best to

bring about recovery and the effectiveness of prescribed medications to aid in early recovery.

All information about Miss O.P was recorded in the admission and discharge book including

the ward state. All necessary documents such as vital signs sheet, medication sheet and

nurses’ continuation sheet were filled and kept in Miss O.P’s folder. All activities carried out

on the ward daily were explained to Miss O.P’ and her mother. They were then orientated to

the ward including the toilet, nurses station, the bathroom. Since there was no dining hall,

patient was encouraged to eat by the bed side. They were then introduced to the other

patients and staff on the ward. Items to be used at the ward during Miss O.P stay at the

hospital such as towel, bucket, spoon and bowl were also mentioned to the mother. She was

encouraged to bring those items from the house.

The hospital policy concerning payment of bills, routine visiting time and times for

medication were also explained to the patient and her mother.

After these interventions, permission was sought from the ward in-charge to use the patient

for my case study and she agreed. Introduction of myself to patient again as a third year

student in the Nurses’ Training College, Sampa who wants to care for her with the aid of

other staff and would like to take Miss O.P in writing of care study. Miss O.P and relative

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were told that, the care study was recommended by the nursing and midwifery council of

Ghana in order for a nursing student to be awarded a license to practice as a nurse. Patient

and relative were reassured that all information taking from them will be kept confidential.

Fortunately, patient and family responded positively to the request as mother of patient said

she believed her daughter will be cured of her illness soon looking at how she is being cared

for. They were thanked for their acceptance. Patient and family ware made to understand

that, hospitalization is temporal and patient will be discharge home once her condition

resolves. Client was chosen based on the fact that acute gastritis mostly occur in men than in

women. I wanted to know the exact cause of Miss O.P condition and to nurse her holistically

till she recovers.

1.10 Patient Concept of Illness

Miss O.P did not attribute her illness to any spiritual cause, though she did not know the

specific cause(s) of the illness. She was anxious because it was the first time she was sick to

be admitted with abdominal pains. She was looking forward to a speedy recovery once she

was receiving treatment so that she can be discharged. I took this opportunity to educate her

on gastritis; its causes, signs and symptoms, treatment, prevention and the need for the

admission.

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1.11 Literature review

Review of anatomy and physiology of the stomach

Diagram of the Stomach (Scalon and Sanders,2010).

According to Grant (2010), the stomach is a J-shaped dilated portion of the alimentary tract

situated in the epigastric, umbilical and left hypochondriac regions of the abdominal cavity. It

is continuous with the esophagus at the cardiac sphincter and with the duodenum at the

pyloric sphincter and it have two curvatures; the posterior lesser curvature and the anterior

greater curvature.

The stomach is divided into three regions: the fundus, the body and the pylorus. At the distal

end of the pylorus is the pyloric sphincter, guarding the opening between the stomach and the

duodenum.

Walls of the Stomach

The walls of the stomach as described by Grant (2010) are formed by four layers of tissue:

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 1. Outermost adventitia or serosa called peritoneum

2. Muscular layer consisting of three layers of smooth muscle fibers;

 An outer layer of longitudinal fibers

 A middle layer of circular fibers

 An inner layer of oblique fibers

3. Sub mucosa consisting of loose areola connective tissue containing collagen and some

elastic fibers, which binds the muscle layer to the mucosa.

4. Mucosa: When the stomach is empty the mucous membrane lining is thrown into

longitudinal folds or rugae, and when full the rugae are ‘ironed out’ and the surface

has a smooth, velvety appearance. Numerous gastric glands are situated below the

surface in the mucous membrane and open onto it. They consist of specialized cells

that secrete gastric juice into the stomach.

Overview Of Acid Secretion/ Gastric Juice And Functions Of The Stomach

According to Waugh and Grant (2010), acid is secreted by parietal cells in the proximal two

thirds (body) of the stomach. Gastric acid aids digestion by creating the optimal pH for

pepsin and gastric lipase and by stimulating pancreatic bicarbonate secretion. Acid secretion

is initiated by food: the thought, smell, or taste of food effects vagal stimulation of the

gastrin-secreting G cells located in the distal one third (atrium) of the stomach. The arrival of

protein to the stomach further stimulates gastrin output. Circulating gastrin triggers the

release of histamine enterochromaffin-like cells into the body of the stomach. Histamine

stimulates the parietal cells via their H2 receptors. The parietal cells secrete acid, and the

resulting drop in pH causes the natural D cells to release somatostatin, which inhibits gastrin

release (negative response mechanism).

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According to Smelters and Bare (2010), acid secretion is present at birth and reaches adult

levels (on a weight basis) by age 2.There is a decline in acid output in elderly patients who

develop chronic gastritis, but acid output is otherwise maintained throughout life.

Stomach size varies with the volume of food it contains, which may be 1.5 liters or more in

an adult. When a meal has been eaten, the food accumulates in the stomach in layers, the last

part of the meal remaining in the fundus for some time. Mixing with the gastric juice takes

place gradually and it may be some time before the food is sufficiently acidified to stop the

action of salivary amylase. The activity of gastric muscle consists of a churning movement

that breaks down the bolus and mixes it with gastric juice and peristaltic waves that propel

the stomach contents towards the pylorus. When the stomach is active the pyloric sphincter

closes. Strong peristaltic contraction of the pylorus forces chime, gastric contents after they

sufficiently liquefied, through the pyloric sphincter into the duodenum in small spurts.

Parasympathetic stimulation increases the motility of the stomach and secretion of gastric

juice; sympathetic stimulation has the opposite effect.

Composition Of Gastric Juice

Grant (2010) described that about 2 liters of gastric juice are secreted daily by specialized

secretary glands in the mucosa and it consists of:

1. Water-produce by gastric gland

2. Mineral salt-produce by gastric gland

3. Mucus secreted by mucous neck cells in the glands and surface mucous cells on the

stomach surface

4. Hydrochloric acid-produce by parietal cells

5. Intrinsic factor Inactive enzyme-parietal cells.

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Functions of Gastric Juice

The functions of gastric juice as outlined by Grant (2010) include;

1. Water further liquefies the food swallowed

2. Hydrochloric acid functions by:

 Acidifies the food and stops the action of salivary amylase

 Kills ingested microbes

 Provide acidic environment needed for effective digestion by pepsin

3. Pepsinogens are activated to pepsins by hydrochloric acid

4. Intrinsic factor (a protein) is necessary for absorption of vitamin B1 2 from the ileum

5. Mucus prevents mechanical injury to the stomach wall by lubricating the contents. It

prevents chemical injury by acting as a barrier between the stomach wall and the corrosive

gastric juice.

Functions Of The Stomach

The functions of the stomach were described by Grant (2010) to include;

1. Temporary storage allowing time for digestive enzymes and pepsin to act

2. Chemical digestion-pepsin convert proteins to polypeptides

3. Mechanical digestion-muscular layers churn food into chyme

4. Limited absorption of water, alcohol and some lipid soluble drugs

5. Non-specific defense against microbes by HCL

6. Preparation of iron for absorption further along the tract due the acidic environment

7. Production and secretion of intrinsic factor needed for absorption of vitamin B12 in

the ileum

8. Regulation of the passage of gastric contents into the duodenum

9. Secretion of the hormone gastrin.

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Definition of Gastritis

Smelters and Bare (2010), describes gastritis as the inflammation of the gastric or stomach

mucosa. It is a common gastrointestinal problem. It may be acute or chronic. However, it

may be the first sign of an acute systemic infection.

Gastritis is an inflammation, irritation or erosion of the lining of the stomach. The

inflammation may be contained within one region or be patchy in many areas. Gastric

structure and function are altered in either the epithelial or the glandular components of the

gastric mucosa. The inflammation is usually limited to the mucosa but some forms involve

the deeper layers of the gastric wall.

Epidemiology

According to the McCann (2009), acute gastritis occurs in men more than women. Chronic

gastritis occurs more frequently in women than in men. About 35% of adults are infected

with H. Pylori.

Types

Smeltzer and Bare (2010), classifies gastritis into two major types:

1. Acute gastritis

2. Chronic gastritis

Acute gastritis: It is a term covering a broad spectrum of entities that induce inflammatory

changes in the gastric mucosa. The inflammation may involve the entire stomach (e.g. pan

gastritis) or a region of the stomach (e.g. antral gastritis). Acute gastritis can be sub-divided

into 2 categories: erosive (e.g. superficial erosions, deep erosions, hemorrhagic erosions) and

non-erosive, generally caused by Helicobacter pylori.

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According to Smeltzer and Bare (2010), acute gastritis lasts for several hours to a few days

and it is often caused by dietary indiscretion—a person eats food that is irritating, too highly

seasoned, or with disease-causing microorganisms. Other causes of acute gastritis include

overuse of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), excessive

alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is

caused by the ingestion of strong acid or alkali, which may cause the mucosa to become

gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis or obstruction.

Acute gastritis also may develop in acute illnesses, especially when the patient has had major

traumatic injuries; burns; severe infection; hepatic, renal, or respiratory failure; or major

surgery. Gastritis may be the first sign of an acute systemic infection.

Causes

1. The main cause of true gastritis as discussed by Longe (2010) is H. pylori infection

and is indicated in an average of 90% of gastritis cases.

According to McCann (2009), acute gastritis has numerous causes, including;

2. Chronic ingestion of (or an allergic reaction to) irritating foods or beverages, such as

hot peppers or alcohol

3. Drugs, such as aspirin and other non-steroidal anti-inflammatory agents (in large

doses), cytotoxic agents, corticosteroids, antimetabolites, phenylbutazone, and

indomethacin.

4. Ingestion of poisons, especially DDT, ammonia, mercury, carbon tetrachloride, and

corrosive substances

5. Endotoxins released from infecting bacteria such as staphylococci, Escherichia coli,

or Salmonella.

Chronic gastritis: According to Smeltzers and Bare (2010), it results from repeated exposure

to irritating agents or recurring episodes of acute gastritis. Prolonged inflammation of the

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stomach may be caused either by benign or malignant ulcers of the stomach or by the bacteria

Helicobacter pylori. According to the McCann (2009), chronic gastritis may be associated

with peptic ulcer disease or gastrostomy, both of which cause chronic reflux of pancreatic

secretions, bile, and bile acids from the duodenum into the stomach. Recurring exposure to

irritating substances, such as drugs, alcohol, cigarette smoke, or environmental agents, may

also lead to chronic gastritis. Chronic gastritis may occur with pernicious anemia, renal

disease, or diabetes mellitus. Pernicious anemia is commonly associated with atrophic

gastritis, a chronic inflammation of the stomach resulting from degeneration of the gastric

mucosa. In pernicious anemia, the stomach can no longer secrete intrinsic factor, which is

needed for vitamin B12 absorption.

Ferris (2011), describes three forms of chronic inflammation of the gastric mucosa as;

1. Superficial chronic gastritis: Is a term used to describe the initial stages of chronic

gastritis, it means that the inflammation is mild and is taking place only at the very

surface of the stomach lining, without affecting deeper layers. It is characterized by

red, edematous surface epithelium, small erosions and decreased mucus content.

However, the gastric glands remain normal.

2. Atrophic chronic gastritis: It is the result of chronic gastritis which is leading to

atrophy (i.e. decrease in the thickness and wasting away) of the stomach lining.

Inflammation extend deeper into the gland area of the mucosa with loss of parietal

and chief cells. Atrophic gastritis further develops into the final stage of chronic

gastritis.

3. Gastric atrophy chronic gastritis: It’s the final stage of chronic gastritis and may

lead gastric cancer. Ferris (2011) classifies gastritis as type A or type B.

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Type A: Is the less common form. It involves the body of the stomach rather than the antrum.

Type B: Is a more common non-autoimmune inflammation of the lining of the stomach. It

primarily involves the antrum but can affect the entire stomach as age increases.

According to Ferris (2011) other forms of gastritis include;

1. Erosive Gastritis: This type of gastritis involves an erosion of the mucus layer of the

stomach and can lead to bleeding and ulcers in the stomach lining.

2. Superficial gastritis (or surface gastritis):

3. Pan gastritis: “pan” meaning “whole” or “entire” is a term used to simply state the

fact that the inflammation is found around all the stomach’s lining.

4. Antral gastritis: It is a term used to describe inflammation in the mucosal lining of

the antrum (the lower portion of the stomach which releases the contents of the

stomach into the duodenum.

5. Bile gastritis: this is a stomach inflammation resulting from bile produced by the

liver refluxing back into the stomach.

6. Phlegmonous gastritis: Is an uncommon form of gastritis caused by numerous

bacterial agents including streptococci, staphylococci, Proteus species, Clostridium

species and Escherichia coli. It usually occurs in individuals who are debilitated and it

is associated with a recent large intake of alcohol, a concomitant upper respiratory

tract infection and AIDS. Phlegmonous means a diffuse spreading inflammatory of or

within the connective tissue. In the stomach, it implies infection of the deeper layers

of the stomach i.e. mucosa and sub mucosa.

Risk Factors of gastritis

The risk factors of gastritis are described by Smeltzers and Bare (2010) to include;

1. Infection with Helicobacter pylori

2. Acquired immunodeficiency syndrome(AIDS)

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 3. Any condition that requires relief from chronic pain using NSAIDs , such as chronic

back pain or arthritis

4. Alcoholism

5. Cigarette smoking

6. Older age

7. Herpes simplex virus or cytomegalovirus

8. Inflammatory bowel disease

Pathophysiology

The pathology as described by Smeltzers and Bare (2010) is that normally, the gastro-

intestinal mucosa is protected by several distinct mechanisms:

(1) Mucosal production of mucus and bicarbonate (HCO3) which creates a pH gradient from

the gastric lumen (low pH) to the mucosa (neutral pH) with the mucus serving as a barrier to

the diffusion of acid and pepsin

(2) Epithelial cells remove excess hydrogen ions (H+) via membrane transport systems and

have tight junctions, which prevent back diffusion of H + ions.

(3) Mucosal blood flow removes excess acid that has diffused across the epithelial layer. In

the presence of factors like stress, chemical substances, like drugs and alcohol, spicy foods,

hot or sour foods, etc., there is sympathetic nerve stimulation, particularly that of the vagus

nerve. The stimulation leads to increased production of hydrochloric acid in the stomach

causing nausea, vomiting and anorexia. There is gastric mucosal cell exfoliation leading to

erosion causing the gastric mucosa to lose its protective property. There is invasion of gastric

mucosa and inflammatory reaction occurs. Mucosal cell loss cause bleeding. With constant

irritation, tissues become inflamed. The gastric mucous membrane becomes edematous and

hyperemic (congested with fluid and blood) and begin to undergo superficial erosion. It

secretes scanty amount of gastric juice with very little acid but much mucous.

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Signs and Symptoms

According to the McCann (2009), after exposure to the offending substance, the patient with

acute gastritis typically reports a rapid onset of symptoms such as;

1. Epigastric discomfort

2. Headache

3. Nausea

4. Anorexia

5. Vomiting

6. Hiccupping, which can last from a few hours to a few days

While some patients remain asymptomatic, the symptoms if present may last from a few

hours few days.

The patient with chronic gastritis may describe similar symptoms as acute gastritis or may

have;

1. Pyrosis (heartburn) mostly after meals

2. Belching or bloating

3. A sour taste in the mouth

4. Some patients may have only mild epigastric discomfort or report intolerance to spicy

or fatty foods or slight pain that is relieved by eating.

5. Patients with chronic gastritis from vitamin deficiency usually have evidence of

malabsorption of vitamin B12 caused by the production of antibodies that interfere

with the binding of vitamin B12 to intrinsic factor.

6. Discomfort after eating (heart burns).

7. Epigastric heaviness after eating.

8. Anemia.

9. Hypochlorhydria (decrease hydrochloric acid secretion).

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Assessment and Diagnostic Findings

According to Smeltzers and Bare (2010), gastritis is sometimes associated with Achlorhydria

or Hypochlorhydria (absence or low levels of hydrochloric acid) or with hyperchlorhydria

(high levels of hydrochloric acid). Diagnosis can be determined by;

1. Clinical manifestation/ history taking

2. Upper gastro-intestinal radiography ( e.g.; Barium meal and barium swallow)

3. Endoscopy of the gastric mucosa (Gastroscopy) (A thin tube with camera and light at

the tip is introduced into the stomach to visualize the stomach )

4. Histologic examination of a tissue specimen obtained by biopsy.

5. Serum vitamin B12 assessment

6. Full blood count to estimate the number of white blood cells.

Diagnostic measures for detecting Helicobacter pylori include;

 Serology testing for antibody of Helicobacter pylori and to check for

anemia

 Culture and sensitivity of gastric secretions.

 Occult stool/ stool for routine examination

 A breath test

 One minute ultra-rapid urease test

Treatment/Management

According to Waugh and Grant (2010) the aims of treating gastritis to include;

1. Reduce the amount of acid in the stomach and allow the stomach lining to heal

2. To relieve symptoms such as abdominal pains and reduce complications

21
 3. To treat the underlying cause of the condition

4. To promote comfort

Medical Management

According to Longe (2010), there are both over the counter and prescription medications for

gastritis.

1. The “eradication therapy” is mostly used in treatment of Helicobacter pylori-related

gastritis which involves the combination of three drugs; a proton-pump inhibitor to

reduce acid production and two antibiotics. Bismuth salicylate (Pepto Bismol) may

be used instead of the second antibiotic. This drug, available over the counter, coats

and soothes the stomach, protecting it from the damaging effects of acid.

Some of the same drugs used for non- Helicobacter pylori gastritis as are used for symptoms

(like indigestion) due to ulcers:

2. Antacids which may relieve heartburn or indigestion. They include;

 Aluminum hydroxide (Asphodel, AlternaGEL)

 Magnesium hydroxide (Philips’ Milk of Magnesia)

 Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta)

3. Histamine 2 (H2) Blockers which reduce gastric acid secretion. They include;

 Cimetidine (Tagamet)

 Ranitidine (Zantac)

4. Proton pump inhibitors which decrease gastric acid production. They include;

 Esomeprazole (Nexium)

 Lansoprazole (Prevacid)

 Omeprazole(Prilosec)

5. Prostaglandin E1 Analogue e.g. Sulcrafate, Misoprostol (Cytotec) protects gastric

mucosa against actions of gastric juice by acting as a barrier

22
The medical management is further described by Smeltzers and Bare (2010) to include;

6. Intravenous (IV) fluids like Dextrose Normal Saline (DNS) may need to be

administered to correct electrolyte imbalance.

7. If gastritis is caused by ingestion of strong acids or alkalis, emergency treatment

consists of diluting and neutralizing the offending agent. To neutralize acids,

common antacids e.g. aluminum hydroxide are used; to neutralize an alkali, diluted

lemon juice or diluted vinegar is used.

8. If corrosion is extensive or severe, emetics and lavage are avoided because of the

danger of perforation and damage to the esophagus.

9. Anti- emetics e.g. Phenergan to reduce vomiting.

10. Analgesics and antipyretics e.g. tramadol to relieve pain and paracetamol for pyrexia

respectively.

11. Antibiotics like Amoxicillin+ Clavulinic acid (Amoksiclav) to help eliminate the

bacteria causing the inflammation.

12. Gastric lavage.

13. Nasogastric intubation to decompress the stomach

According to Smeltzers and Bare (2010), in extreme cases, emergency surgery may be

required to remove gangrenous or perforated tissue. A gastric resection or a

gastrojejunostomy/ Billroth II (anastomosis of jejunum to stomach to detour around the

pylorus) may be necessary to treat pyloric obstruction (a narrowing of the pyloric orifice,

which cannot be relieved by medical management) or phlegmonous gastritis (gangrene of the

stomach).

Chronic gastritis is managed by modifying the patient’s diet, promoting rest, reducing stress,

recommending avoidance of alcohol and NSAIDs, and initiating pharmacotherapy. For

23
chronic gastritis, occurring as a result of excessive gastric acid secretion, vagotomy may be

necessary to decrease parasympathetic secretion of gastric acid.

Nursing Management

Nursing management of gastritis is described by Smeltzer and Bare (2010) to include the

following interventions;

Reassuring the patient

There is the need for continuous reassurance of patient and family about readiness of health

care team to aid in treatment and the effectiveness of available medications and other

supportive treatment modalities in bringing about speedy recovery and remission.

Reducing Anxiety

If the patient has ingested acids or alkalis, emergency measures may be necessary. The nurse

offers supportive therapy to the patient and family during treatment and after the ingested

acid or alkali has been neutralized or diluted. In some cases, the nurse may need to prepare

the patient for additional diagnostic studies (endoscopies) or surgery. The patient may be

anxious because of pain and planned treatment modalities. The nurse uses a calm approach to

assess the patient and to answer all questions as completely as possible. It is important to

explain all procedures and treatments based on the patient’s level of understanding.

Ensuring rest and sleep

The following measures should be implemented to ensure good rest and comfortable sleep to

promote recovery;

24
 1. Restrict or limit visitors when necessary and explain to the patient the need for rest

and sleep in aiding speedy recovery

2. The environment should be properly ventilated and noise minimized to promote rest

and sleep.

3. Put patient in well prepared, comfortable bed and make sure bed is free from creases

and cramps

4. Carry out bulk nursing when applicable

5. Encourage patient to take warm bath after meals and warm drinks before bed

6. If patient has pain-related insomnia, serve prescribed analgesics to relieve pain. Also

serve prescribed hypnotics and sleep inducers and monitor for therapeutic and adverse

effects.

Ensuring elimination

Elimination needs in the patient with gastritis is equally important as is medications in

recovery and remission of signs and symptoms. Assess patients’ elimination pattern and

monitor intake and output of patient. Monitor vomiting and observe vomitus for color,

consistency and content of the vomitus. If vomiting is persistent, prevent dehydration of

patient by rehydrating with prescribed intravenous infusions. Administer prescribed anti-

emetics and monitor for therapeutic and adverse effects. To prevent infection from

elimination, ensure emesis basins, bed pans and commodes served patient to meet elimination

needs, contain disinfectants and such products of elimination are properly discarded.

Ensuring personal hygiene

Ensure patients hygienic needs are equally met as other medical needs of the patient are

established. The following measures can be followed;

25
 1. Ensure patient takes his/her bath twice a day. Assist or carry out bed bath when

necessary

2. Encourage patient to maintain adequate mouth care by brushing his/her teeth at least

twice in a day

3. Teach and encourage patient and relatives to observe hand washing techniques after

visiting the toilet or coming into contact with patient fluids such as vomitus to prevent

spread of Helicobacter pylori bacteria.

4. Ensure patient keeps a short and well-kept nails. Carry out hand and feet care when

necessary.

Observation and monitoring

1. Continuously monitor vital signs including temperature, pulse, respiration and blood

pressure and intervene when appropriate

2. Monitor strict intake and output especially when vomiting persists

3. Monitor patient for therapeutic and adverse effects of administered medications

4. Assess and monitor patient for signs and symptoms of dehydration including, loss of

skin turgor, dry mouth and persistent complains of thirst.

Relieving Pain

Measures to help relieve pain include instructing the patient to avoid foods and beverages that

may be irritating to the gastric mucosa and instructing the patient about the correct use of

medications to relieve chronic gastritis. The nurse must regularly assess the patient’s level of

pain and the extent of comfort achieved through the use of medications and avoidance of

irritating substances.

26
Promoting Fluid Balance

Daily fluid intake and output are monitored to detect early signs of dehydration (minimal

fluid intake of 1.5 L/day, minimal output of 30 mL/h). If food and oral fluids are withheld, IV

fluids (3 L/day) usually are prescribed and a record of fluid intake plus caloric value (1 L of

5% dextrose in water_170 calories of carbohydrate) needs to be maintained.

Electrolyte values (sodium, potassium, chloride) are assessed every 24 hours to detect any

imbalance.

The nurse must always be alert for any indicators of hemorrhagic gastritis, which include

hematemesis (vomiting of blood), tachycardia, and hypotension. If these occur, the physician

is notified and the patient’s vital signs are monitored as the patient’s condition warrants.

Promoting Optimal Nutrition

For acute gastritis, the nurse provides physical and emotional support and helps the patient

manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The

patient should take no foods or fluids by mouth (possibly for a few days) until the acute

symptoms subside if possible, thus allowing the gastric mucosa to heal.

If intravenous therapy is necessary, the nurse monitors fluid intake and output along with

serum electrolyte values. After the symptoms subside, the nurse may offer the patient ice

chips followed by clear liquids. Introducing solid food as soon as possible may provide

adequate oral nutrition, decrease the need for intravenous therapy, and minimize irritation to

the gastric mucosa. As food is introduced, the nurse evaluates and reports any symptoms that

suggest a repeat episode of gastritis.

The nurse discourages the intake of caffeinated beverages, because caffeine is a central

nervous system stimulant that increases gastric activity and pepsin secretion. It also is

important to discourage alcohol use. Discouraging cigarette smoking is important because

27
nicotine reduces the secretion of pancreatic bicarbonate, which inhibits the neutralization of

gastric acid in the duodenum (Suzuki, Matsuo, Ito, et al., 2006). When appropriate, the nurse

initiates and refers the patient for alcohol counseling and smoking cessation programs. Also

ensure patient takes in a bland diet and serve small meals at frequent intervals

Nutrition and dietary Supplements

Following these nutritional tips may help reduce symptoms:

1. Eating antioxidant foods, including fruits (such as blueberries, cherries and

tomatoes), and vegetables (such as garden eggs and cucumber)

2. Avoid refined foods such as white breads, pastas, and sugar

3. Use healthy oils, such as olive oil

4. Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as

cookies, crackers, cakes, onion rings, donuts and margarine.

5. Avoid beverages that may irritate the stomach lining or increase acid production

including coffee (with or without caffeine), alcohol and carbonated beverages.

6. Drink 6 to 8 glasses of filtered water daily

7. Identify and eliminate food allergies

The following supplements may help with digestive health:

1. A multivitamin daily, containing the antioxidant vitamins A, C, E, the B vitamins,

and trace minerals, such as magnesium, calcium, zinc and selenium.

2. Omega-3 fatty acids, such as fish oil, may help decrease inflammation. Fish oil may

increase the risk of bleeding.

3. Probiotic supplement (containing Lactobacillus acidophilus). Probiotics or friendly

bacteria may help maintain a balance in the digestive system between good and

28
 harmful bacteria, such as Helicobacter pylori. Probiotics may help suppress

Helicobacter pylori infection, and may also help reduce side effects of taking

antibiotics, the treatment for a Helicobacter pylori infection. People who have

weakened immune systems, or who are taking immune-suppressive drugs, should

take probiotics only under the direction of their physician (Vitor et al 2011).

Education

1. Educate patient/family about the condition

2. Educate patient/family on the need to take prescribed medications

3. Educate patient/family on the restriction of offending agents like alcohol or highly

seasoned foods

4. Educate patient on the need to ensure rest

5. Educate patient/family on the need for follow-up

Promoting Home and Community-Based Care: Teaching Patients Self-Care

According to Smeltzers and Bare (2010), the nurse evaluates the patient’s knowledge about

gastritis and develops an individualized teaching plan that includes information about stress

management, diet, and medications. Dietary instructions take into account the patient’s daily

caloric needs, food preferences, and pattern of eating. The nurse and patient review foods and

other substances to be avoided (e.g. Spicy, irritating, or highly seasoned foods; caffeine;

nicotine; alcohol). Consultation with a dietician may be recommended. Providing information

about prescribed antibiotics, bismuth salts, medications to decrease gastric secretion, and

medications to protect mucosal cells from gastric secretions may help the patient to better

understand why it is important to follow information given.

29
Prevention

According to Ferris (2011), certain simple points can be followed to reduce the risk of

developing gastritis. These include:

1. Wash your hands with soap and water regularly and before meals. This can reduce the

risk of being infected with helicobacter pylori

2. Cook foods thoroughly. This also reduces the risk of infection

3. Avoid alcohol or limit your alcohol intake

4. Avoid NSAIDs or only use them infrequently. Consume NSAIDs with food and water

to avoid symptoms.

Complications

The complications of gastritis were described by Seltzers and Bare (2010) to include;

1. Stomach Ulcer mostly from chronic gastritis

2. Anemia (Vitamin B12 deficiency anemia): This occurs as a result of

destruction of intrinsic factors.

3. Pyloric stenosis mostly occurs from malignant changes of gastric mucosa

4. Malignant changes of gastric mucosa

5. Hemorrhage or bleeding from an erosion or ulcer

6. Gastric Outlet Obstruction due edema limiting the adequate transfer of food

from the stomach to the small intestine

1.12 Validation of Data

Validation of data is the process of determining whether information gathered during the

process of collection is complete and accurate( Turnbull e’tal,2010)

30
To ensure that the data gathered was accurate and complete, the information’s were gathered
methodically and were cross checked severally. Those given to me by Miss O.P and her
accompanying mother were compared with those in the patient’s folder. My visit to the
client’s house also confirmed most of what Miss O.P had told me. The data collected from
client, health workers (medical team and staff nurses), patient’s folder, laboratory
investigations and physical assessment were checked with literature review to ensure that
information collected was free from errors, bias and misinterpretations.

Patient was also reassessed when symptoms had abated to confirm information provided on

admission. This therefore makes the data valid for the study since no difference was seen in

the entire sources.

31
 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction

Analysis according to Hornby (2010), is the detailed study or examination of something in

order to understand more about it. This is the second step in the nursing process .This chapter

entails a critical and scientific study of all information gathered from the patient, the family,

other health team members and the literature review. It deals with the comparison of the data

collected with standard, causes, clinical manifestations, treatment, pharmacology of drugs

and complications. It also looks at the patient and family’s strengths, health problems and

nursing diagnosis.

2.1 Comparison of Data with Standard

This is where the data collected on the health of the patient is compared with those in the

literature review. These include diagnostic investigations, causes, signs and symptoms,

treatment and complication.

a. Diagnostic Investigation/Tests

A diagnostic investigation is a procedure performed to confirm or determine the presence of

disease in an individual suspected of having the disease usually following the report of

symptoms or based on the results of other medical tests.

The following tests were carried out on patient;

 Blood for full blood count (FBC).

 Blood film for malaria parasites

 Stool routine examination for occult blood

32
  Gastroscopy

Table one below shows the comparison of diagnostic tests carried out on client and

those listed in literature review.

Table 1: Diagnostic tests/investigations in literature review compared with those

carried out on patient.

Diagnosed Test outlined in literature Diagnostic Test carried out on Miss O.P
review
Upper gastro-intestinal radiography Investigation was not requested for patient

Endoscopy of the gastric mucosa Investigation was ordered for patient

(Gastroscopy)

Serum vitamin B12 assessment Test was not requested for patient

Serology testing for helicobacter pylori Test was ordered for patient

Histologic examination of a biopsy tissue Not requested for client

specimen

Occult stool/ stool for routine examination Test was ordered for client

Full blood count Full blood count was ordered and done

Clinical assessment and history taking Clinical assessment was done.

On the day of admission, blood sample was taken and sent to the laboratory for full blood

count and to rule out infection.

Stool specimen for routine examination was also taken and sent to the laboratory to rule out

infection with Helicobacter pylori and occult blood.

Even though malaria test was not in the literature review, it was done to rule out malaria

parasites in the blood causing malaria.

33
Although gastroscopy was ordered, it was not carried out because there was no machine at

the Hospital for it to be done and also patient could not afford the cost.

Details of the test carried out on the patient have been presented in table 2.

34
 Table 2: Diagnostic investigations carried out on Miss O.P

DATE SPECIMEN INVESTIGATION RESULTS NORMAL INTERPRETATION REMARKS

VALUES
29/09/2018 Blood Malaria parasites Negative There should be no Normal, no malaria parasite No treatment was given.
malaria parasite in was seen in the blood.
the blood.

29/09/2018 Stool Stool for routine Macroscopic: Formed There should not The gastritis is helicobacter IV Cefuroxime 750mg
examination (R/E) specimen be any spiral pylori-related
intestinal
Microscopic: Intestinal flagellates in stool
spiral flagellates seen
29/09/2018 Blood White blood cells 12.3 x109/L 4.0-10.0 x109/L WBC count was slightly IV Cefuroxime 750mg
high indicating infection given to combat
infection.

Red blood cell count 4.6 x 10/l 3.9 -6.5 x 10/l Normal No treatment was given

Neutrophils count 46% 40-75% Normal No treatment was given

Haemoglobin levels 13.1 g/dl 11.-16.5g/dl Normal No treatment was given

Hematocrit 42% 40-54% Normal No treatment was given

35
 B. Causes of Patient’s Condition

Miss O.P’s condition was caused by infestation with Helicobacter pylori as revealed by

diagnostic investigation (stool R/E).

Also, according to Miss O.P, uses over the counter drugs like EFPAC and diclofenac as first

line of treatment for menstrual pains and other minor ailments on regular basis. EFPAC and

diclofenac are all NSAID, both of which predisposes to gastritis.

c) Clinical Features/ Signs and Symptoms

Comparison of clinical features exhibited by client with those listed in the literature review

Table 3: Clinical Features Manifested By Patient Compared With Those In Literature

Review.

Clinical features of literature review. Client features presented by Miss O.P.

1.Pyrosis(heartburns) Client did not have heartburns.

2. Abdominal discomfort Client complained of abdominal (epigastric)

discomfort.

3. There is headache. Client was experiencing headache on admission.

4. There is lassitude or lethargy Client did not experience lassitude or lethargy

5. Patient experiences nausea. Client complained of feeling nausea.

6. There may be vomiting Client had vomited two times in the morning on the
day of admission.

7. There is anorexia. Anorexia was present.

8.There may be hiccupping Client did not experience hiccupping

The table above shows that Miss O.P showed most of the signs and symptoms discussed in

the literature review such as vomiting, epigastric discomfort, headache, nausea and anorexia.

36
Patient did not experience lethargy/lassitude and hiccupping due to the interventions put in

place to relieve patient of her ailment.

(D) Treatment of Patient

Weller (2009) defines treatment as the management of someone or something.

The drugs below were prescribed for Miss O.P to treat her condition throughout her period of

hospitalization;

Suspension Nugel 0 15mls tid for 7 days

Intravenous tramadol 200mg in ringers lactate 500mls

Infusion ringers lactate 1L for 24 hours

Infusion 5% dextrose 1.5L for 24 hours

Intravenous Cefuroxime 1.5 g stat and 750mg tid for 24 hours

Tablet paracetamol 1g tid for 5 days

Tablet cefuroxime 500mg bd for 7 days

Capsule Omeprazole 20 bd for 7 days

Table 4 below shows the treatment given Miss O.P compared with those in the literature
review

37
 Table 4: Comparison of treatment outlined in the literature review with those given to
Miss O.P

Treatment according to literature review Patient’s drug administered

Antibiotics, example; Ciprofloxacillin, IV Cefuroxime 1.5g stat, then 750mg tid for 24 hours, Tablet
Benzyl Penicillin, Metronidazole, Cefuroxime 500mg bd for 7 days was ordered for patient.
Amoxicillin, cefuroxime

Analgesics and antipyretics, example; Tablet Paracetamol 1gram three times daily x 5 days and
Paracetamol, Aspirin, Diclofenac, tramadol Injection Tramadol 100mg stat

Antacids, example; Aluminium hydroxide, Suspension Nugel 0 15millitres three times daily x 7days
Magnesium hydroxide

Intravenous fluids, example normal saline Infusion ringers lactate 1L and Infusion 5% dextrose 1.5l
were ordered.

Histamine 2(H2) Blockers, example; None was ordered for Miss O.P.
Cimetidine, Ranitidine

Anti- emetics e.g. Phenergan None was ordered for Miss O.P

Proton pump inhibitors, example; Intravenous Omeprazole 80mg stat, then 40mg bd for
Esomeprazole, Pantoprazole, Omeprazole 24hours, Capsule Omeprazole 20mg twice daily x5days

Prostaglandin Analogue e.g. Sulcrafate, None was ordered for Miss O.P
Misoprostol (Cytotec)

Antispasmodic eg. Buscopan Tablet Buscopan 20md tds for 5 days was prescribed.

From the table above, most of the drugs in literature review were prescribed for patient.

Drugs such as analgesics, antacids, proton pump inhibitors, antispasmodic, antibiotic and

intravenous fluids were all prescribed. Prostaglandin Analogue, Anti- emetics and Histamine

2(H2) Blockers were not ordered.

38
None of the surgical procedures stated in the literature review was carried out on Miss O.P

because the gastritis was acute and remission was attained upon treatment.

With reference to the literature review, it can be concluded that Miss O.P’s treatment met the

approved treatment modality which helped her to recover early and fully.

Table 5 shows the pharmacology of the drugs given to Miss O.P

39
 Table 5.0: Pharmacology of Drugs given to Miss O.P

Drug Dosage/Route of Classification Desire effect/Action Actual effect Side effect Remarks
administration of Drug

Omeprazole 80mg stat, then 40mg Proton pump Reduces hydrochloric Patient ’s condition Headache, No these effect was
intravenously twice daily inhibiter anti- acid secretion improved due to constipation, observe
x 24hours, secretary reduction in her diarrhea, nausea and
20mg bd for 7 days agent abdominal pains vomiting.
orally
Buscopan 20mg tds for 5 days Antispasmodi It cause smooth smooth muscles in the Breathing difficulty, No these effect was
cs muscles in the digestive system were dry mouth . observe
digestive system to relaxed as they were no
relax to relief bowel complains of bowl
cramps cramps
Paracetamol 1g three times daily x 3 Analgesics, To relieve headache, Patient responded to Hypoglycemic coma, None of the side
days, orally antipyretic bodily pains and treatment liver damage, effects was observed
reduce high body drowsiness, jaundice,
temperature glossitis, urticaria and
erythematous skin
reaction, leucopoenia.
Nugel 0 15mls three times daily antacid Provides a protective Help to reduce acid Constipation, None of these was
for 7 days suspension coating on the content in the stomach diarrhea. observed
stomach lining and and relieved patient of
lowering acid level. pain
Ringers 1L for 24 hours Electrolyte To replace fluid and Patient regains adequate Allergic reaction,high None of these was
Lactate intravenously solution electrolyte blood pressure and was blood potassium, observed
rehydrated fluid volume
overload and high
blood calcium.

40
 Table 5.0: Pharmacology of Drugs given to Miss O.P

Drug Dosage/Route of Classification Desire effect/Action Actual effect Side effect Remarks
administration of Drug

Tramadol 200mg stat intravascular Analgesic, Binds to mu-opioid Client was relieved of Dizziness, None was observed
centrally receptors and inhibits pains somnolence, nausea,
the reuptake of nor constipation—but
acting
epinephrine and does not have the
serotonin; causes respiratory depressant
many effects similar effects.
to the opioid

Infusion 1.5 litre for 24 hours Isotonic To correct Patient fluid and Circulatory overload, None observed
solution dehydration and electrolyte balance was pulmonary oedema.
Dextrose Intravenously
maintain electrolyte maintained
Normal
balance
saline

Cefuroxime 1.5g stat, then 750mg tds Antibacterial Prevents infection by The patient was relieved Diarrhoea, nausea, None was observed
for 24 hours inhibiting bacterial from signs of infections vomiting, swelling of
cell wall synthesis such as fever face, lips, tongue and
intravenous
resulting in bacteria throat.
500md bd for 7 days death

Oral

41
Complication

None of the complications in the literature review were observed due to proper and effective

nursing care carried out on the client.

2.2 Patient / Family Strengths

According to Lewis (2012), Strength is the quality of being strong. It also involves those that

the family can also do to help in speedy recovery of the patient and those that the patient can

perform. This strength of the patient and family will help the nurse to be able to plan effective

nursing care for the patient.

1. Patient had good skin turgor and was not dehydrated

2. Patient was able to express the severity of pain on a scale of 0-10 and also could show

the exact location of the pain

3. Patient and family were able to verbalise their fears about the outcome of the disease

condition.

4. Patient could sleep for at least 3 hours in the night

5. Patient could eat at least small amount of food served.

6. Patient and family were willing to learn about disease condition

2.3 Patient/Family’s Health Problems

Health problem according to Hornby (2010), is an unmet health need to which the patient

responds in a variety of ways. To give effective nursing care, health problems must be

identified through observation and interactions. These problems include actual and potential

42
health problems. The following health problems were identified during interaction with Miss

O.P

1. Patient was vomiting (29/09/2018)

2. Patient complain of abdominal pain (29/09/2018)

3. Patient and family were anxious (29/09/2018)

4. Patient complain of sleeplessness (30/09/2018)

5. Patient had loss of appetite (30/09/2018)

6. Patient and family had inadequate knowledge about disease condition (1/10/2018)

2.4 Nursing Diagnosis

According to Smelter and Bare (2010), nursing diagnosis is the organization, analysis,

synthesis and summarization of data collected and determines the patient’s need for care.

Nursing diagnosis are developed based on data obtained during nursing assessment. This is a

component of nursing care which involves formulating of diagnosis from clients potential and

actual problems which were gathered during the assessment phase. The following nursing

diagnosis was made on client;

1. Risk for imbalanced fluid volume related to excessive fluid loss secondary to

vomiting (29/09/2018)

2. Acute pain related to irritated stomach mucosa (29/09/2018)

3. Anxiety related to unknown outcome of condition (29/09/2018)

4. Sleep pattern disturbance(insomnia) related to abdominal pain (30/09/2018)

5. Imbalanced nutrition, less than body requirements, related to inadequate intake of

nutrients (30/09/2018)

43
6. Knowledge deficit related to lack of inadequate information on causes, signs and

symptoms and prevention of disease condition (1/10/2018)

44
 CHAPTER THREE

PLANNING FOR CLIENT AND FAMILY CARE

3.0 Introduction

According to Murcko, (2013), planning is the process of setting goals, developing strategies

and outlining tasks and schedules to accomplish the goals.

Planning for the patient/family care is the third stage of the nursing process. It involves the

developing of plans designed to reduce, correct and prevent the health problems identified

during the phase of analysis. In order to achieve and implement an effective nursing care

plan, the nurse has to draw a care plan with the patient and his family on the various nursing

actions. This will serve as the tool for the nurse to keep record of the patient’s health needs

and provide the basis for the continuity of care for the patient and family in the hospital and

at home. In planning, objectives are set and prioritized in short and long term goals. Goals set

are developed upon and a plan of care drawn to resolve the nursing diagnosis within a

stipulated time frame.

3.1 Objective/Outcome Criteria for Patient/Family Care.

The following objectives were set for the patient and family care during the period of

hospitalization to help solve their health problems;

1. Patient will be relieved of vomiting within 48 hours

2. Patient will be relieved of abdominal pain within 72 hours

3. Patient and family will be relieved of anxiety within 24 hours

4. Patient will regain her normal sleeping pattern within 48 hours

45
 5. Patient will regain her normal appetite within 48 hours

6. Patient and family will gain adequate knowledge on her disease condition within 24

hours.

Table 6 below shows the nursing care plan for Miss O.P.

46
 Table 6: Nursing care plan for Miss O.P

Date/ Nursing Objectives/Outcome Nursing orders Nursing interventions Date/ Time Evaluation Sign
Time diagnosis criteria

29/09/18 Risk for Patient’s normal body 1. Reassure patient that 1. Patient was reassured that vomiting 1/10/2018 Goal fully met

4:35pm fluid volume will be vomiting will subside with will subside with treatment. 4:35pm as patient
imbalanced treatment.
maintained within 48 2. Monitor strict intake and verbalized
2. Intake and output of oral fluids
hours as evidenced output of oral fluids. were strictly monitored. relieve of
fluid volume
by; 3. Ensuring adequate intake of 3. Intake of adequate liberal fluids vomiting and no
liberal fluids such as water and such as water and soft drinks was
related to 1. Patient verbalizing sign of
soft drinks ensured.
4. Identify nauseating factors 4. Nauseating factors such as bedpans dehydration was
that vomiting has
excessive fluid and eliminate them when need were moved out of patient’s view. observed.
ceased. be
loss secondary 5. Monitor for signs of 5. Patient was monitored for signs of
2. Nurse observing dehydration by assessing skin turgor
dehydration like assessing skin
on admission and during discharge
to vomiting turgor
that patient has good
6. Patient was weighed daily and
skin turgor and show 6. Weigh patient daily and recorded to ascertain weight loss.
record
no sign of 7. Administer intravenous fluid 7.Intravenous infusion ringers lactate
as prescribed. and normal saline were administered
dehydration.
as prescribed.

47
 Table 6: Nursing care plan for Miss O.P continued

Date/ Nursing Objectives/Outcome Nursing orders Nursing interventions Date/ Evaluation Sign
Time diagnosis criteria Time

29/09/18 Acute pain Patient will be 1. Reassure patient and family of 1. Patient and family were reassured 2/10/2018 Goal fully met
effectiveness of medications to about effectiveness of medications 4:30pm as patient
4:30pm related to relieved of abdominal relieve pain.
verbalized
2. Assess patient’s pain on a scale 2. Pain was assessed on a scale of 0-10
irritated pain within 72 hours
of 0-10 and rated as moderate. relieve of
stomach mucosa as evidenced by; 3. Identify precipitating factors of 3.Precipitating factors such as abdominal pain
pain like caffeinated drinks and caffeinated drinks and spicy food was
spicy food. avoided. .
4. Encourage intake of bland diet 4. Patient was encouraged to take bland
1. Patient verbalizing and explain why it is necessary diet such as “too” and the need for such
food was explained to patient.
relieve of pain.
5. Monitor vital signs every four 5. Vital signs were monitored every four
2. Nurses observing hours hourly and charted.
6. Serve prescribed medication 6. Prescribed medication was served and
patient exhibiting and observes for therapeutic and therapeutic effects observed.
adverse effects
comfort and relieve of 7. Provide diversional therapy like 7. Television set was turned on for
watching television set when patient on request to watch her favorite
pain.
necessary television show

48
 Table 6: Nursing care plan for Miss O.P continued

Date/ Nursing Objectives/Outcome Nursing orders Nursing interventions Date/ Evaluation Sign
Time diagnosis criteria Time

29/09/2018 Anxiety related Patient will be relieved 1. Reassure patient about speedy
recovery.
4:35pm to unknown of anxiety within
twenty four hours (24
outcome of
2. Educate patient on the need for
condition hours) as evidenced hospitalization.
3. Explain all procedures that will
by;
be performed on the patient to her
1. The nurse observing
4. Encourage patient to ask
patient having a questions about condition.
5. Provide simple and straight
cheerful facial
forward answers to their questions
expression. promptly and tactfully.
6. Introduce to her other patients
2. Patient verbalizing who have suffered from the same
condition and are recovering
they are no more
7. Monitor physiological
anxious responses, such as tachypnea,
palpitations, dizziness, headache,
tingling sensations, and
behavioral cues, such as
restlessness
1.Patient was reassured that, with their 30/09/18 Goal was fully
cooperation and compliance to
4:35pm met as patient
treatment regimen, the condition can be
controlled
and immediate
2. Patient was educated on the need for
hospitalization family
3. Procedures that were performed on
verbalized
the patient were explained to her to gain
her cooperation
4. Patient was encouraged to ask relieve of
questions about condition.
anxiety and they
5. Simple and straight forward answers
were given to their questions promptly wore a relaxed
and tactfully.
6.Other patient’s recovering from the facial
same condition was introduced to her
expression
7.Physiological response such as
palpitations, headache, restlessness etc
was observed for the degree of fear and
anxiety patient was facing

49
 Table 6: Nursing care plan for Miss O.P continued

Date/ Nursing diagnosis Objectives/Outcome Nursing orders Nursing interventions Date/ Evaluation Sign
Time criteria Time

30/09/2018 Sleep pattern 1. Patient’s sleeping pattern was

Patient will regain her 1. Assess the sleeping pattern of 02/10/18 Goal fully met
patient. assessed.
7:30am disturbance normal sleeping 2. Ensure that the room is well 2. Ventilation of the room was 7:30am as evidenced by
ventilated ensured by turning on the fans and
(insomnia) related to pattern within 48 nurse observing
folding of the curtain
abdominal pain. hours as evidenced by 3. Carry all nursing activity at 3. All nursing activities such as vitals patient sleep for
ago and medication was carried out at ago
: 4. Lay a comfortable bed free 4. A bed free from creases and 6 hours at night
from creases and cramps cramps was made.
1.patient verbalizing 5. Restrict visitors 5. Visitors were restricted during the uninterrupted
period patient was sleeping or taking
she had a sound sleep
a nap.
2.Nursing observing 6. Serve warm beverage at bed 6.Warm milo drink was served
time and give warm bath before
that patient sleeps for bed time.
7. Ensure a quiet and serene 7. Noise free environment was
6 hours at night environment. ensured by lowering the television set
in the ward.
uninterrupted
8. Administer prescribed 8. Prescribed analgesics and antacids
analgesics and antacids. i.e tab paracetamol and Suspension
Nugel were administered.

50
 Table 6: Nursing care plan for Miss O.P continued

Date/ Nursing diagnosis Objectives/Outcome Nursing orders Nursing interventions Date/ Evaluation Sign
Time criteria Time

30/09/18 Imbalanced nutrition, Patient will be able to 1.Reassure patient that she will 1. Patient was reassured that she will 2/10/18 Goal fully met
regain her normal regain her normal eating pattern be able to regain her normal eating
10am less than body 10am as patient was
appetite and interest pattern and appetite.
requirements, related able to
in food within 48 2. Assess patient’s preferences 2.Meals were planned with patient
to inadequate intake of hours as evidenced with food and plan diet with considering her likes and dislikes consumed more
by: patient.
nutrients than half plate
1. The patient 3. Maintain adequate oral 3. Patient mouth was cared for early
of meal served
verbalizing that she hygiene to stimulate her in the morning and in the evening
can eat well. appetite after super. her.
2. The nurse 4. Provide companionship at 4. Patient’s husband was present at
observing that patient mealtime to encourage mealtime to encourage patient to eat.
can tolerate at least nutritional intake
half of 5. Remove unpleasant articles 5. Unpleasant articles like bedpan
meal served from patient’s sight. and vomits bowl were removed
6. Serve food attractively and at 6. Meals were served attractively at
regular intervals to the patient regular intervals to patient.

51
 Table 6: Nursing care plan for Miss O.P continued

Date/ Nursing diagnosis Objectives/Outcome Nursing orders Nursing interventions Date/ Evaluation Sign
Time criteria Time

1/10/2018 Knowledge deficit Patient will gain 1. Reassure patient /family that 1. Patient /family were reassured that 2/10/18 Goal fully met
adequate knowledge with detailed information detailed information on gastritis as patient and
10am related to lack of they will have understanding will be given for better 10am family gave
on the disease
of gastritis understanding. correct answers
inadequate information
condition within 2. Schedule time with patient 2. Time was scheduled with patient to questions
on causes, signs and 24hours as evidenced and relatives to educate them and relatives to educate them on asked on
on gastritis. gastritis. gastritis and
by;
symptoms and 3. Make patient comfortable by 3. Patient was made comfortable by patient/ family
1. Patient / family lying in bed whiles relatives lying in bed whiles relatives and verbalizing
prevention of disease and the nurse sit by bedside. the nurse sit by bedside. understanding
being able to answer
4. Assess patient and family 4. Patient and family knowledge on on the
condition (gastritis). some questions on
knowledge level on gastritis gastritis was assessed. information
gastritis correctly and 5. Correct any misconception 5. Accurate information on the given them
2.Patient/family and provide accurate predisposing causes, signs and
verbalizing information on the symptoms, prevention, drug
predisposing causes, signs management and lifestyle
understanding on the and symptoms, prevention, modification were provided to
information given drug management and correct misconceptions
them. lifestyle modification 6. Questions were invited and
6. Invite questions and answer tactfully answered.
them tactfully.
7. Give patient pamphlets on 7. Pamphlets on gastritis were given
gastritis to read to patient

52
 CHAPTER FOUR

IMPLEMENTING PATIENT AND FAMILY CARE

4.0 Introduction

According to Mish (2016), Implementation is making something that has been officially

decided start to happen or be used.

Implementation is the fourth step of the nursing process. It refers to carrying out of proposed

plan of care. The nurse takes responsibility including the family and other health team

members. While implementing care, the nurse should assess the patient’s response to the

nursing care and make alteration when necessary.

This chapter entails the summary of nursing care rendered to Miss O.P and her family

from the day of her admission to the day of discharge based on the problems identified. It

also covers the preparation towards discharge, home visits and follow-up care made to

ensure continuity of nursing care.

4.1 Summary of Actual Nursing Care Rendered To Patient and Family

First Day of Admission (29/09/2018)

On the 29/09/2018, Miss O.P was admitted around 4:10pm into the female medical ward per

ambulatory from the outpatient department accompanied by a staff nurse and patient’s

mother. Miss O.P and her mother were welcomed and they were offered seat. Miss O.P was

in a conscious state and well orientated to time, place and persons. The accompanying nurse

handed over her folder with the number 09/4319 and the patient’s name and other particulars

were mentioned to confirm the right patient. On admission patient complained of headache,

abdominal pain and vomiting. Upon observation, Miss O.P was found to be anxious and in

pains. Miss O.P was diagnosed as gastritis by Dr. Adu. Patient was then made comfortable in

an already prepared simple unoccupied bed (11) and vital signs was checked and recorded as

53
 Blood pressure 130/70 mmHg

Pulse rate 85 bpm

Respiration 21 cpm

Temperature 36.5 degree Celsius (0C)

The following diagnostic investigations were requested for Miss O.P

Full blood count

Blood film for malaria parasites

Stool for routine examination.

Gastroscopy

Blood sample was taken, the bottles were well labeled and sent to laboratory for the requested

investigations to be done.

Medications ordered for Miss O.P on admission were;

Suspension Nugel 0 15mls tid for 7 days

Intravenous tramadol 200mg in ringers lactate 500mls

Infusion ringers lactate 1L for 24 hours

Infusion 5% dextrose 1.5L for 24 hours

Intravenous Cefuroxime 1.5 g stat and 750mg tid for 24 hours

All drugs were then procured from the pharmacy department, an intravenous cannula was

established and due medications were administered.

She and her relative were reassured of the readiness of the health team to do their best to

bring about recovery and the effectiveness of prescribed medications to aid in early recovery.

All information about Miss O.P was recorded in the admission and discharge book including

the ward state. All necessary documents such as vital signs sheet, medication sheet and

nurses’ continuation sheet were filled and kept in Miss O.P’s folder. All activities carried out

on the ward daily were explained to Miss O.P’ and her mother. They were then orientated to

54
the ward including the toilet, nurses station, the bathroom. Since there was no dining hall,

patient was encouraged to eat by the bed side. They were then introduced to the other

patients and staff on the ward. Items to be used at the ward during Miss O.P stay at the

hospital such as towel, bucket, spoon and bowl were also mentioned to the mother. She was

encouraged to bring those items from the house.

The hospital policy concerning payment of bills, routine visiting time and times for

medication were also explained to the patient and her mother.

After these interventions, permission was sought from the ward in-charge to use the patient

for my case study and she agreed. Introduction of myself to patient again as a third year

student in the Nurses’ Training College, Sampa who wants to care for her with the aid of

other staff and would like to take Miss O.P in writing of care study. Miss O.P and relative

were told that, the care study was recommended by the nursing and midwifery council of

Ghana in order for a nursing student to be awarded a license to practice as a nurse. Patient

and relative were reassured that all information taking from them will be kept confidential.

Fortunately, patient and family responded positively to the request as mother of patient said

she believed her daughter will be cured of her illness soon looking at how she is being cared

for. They were thanked for their acceptance. Patient and family ware made to understand

that, hospitalization is temporal and patient will be discharge home once her condition

resolves.

After the initial care had been rendered to patient, a care plan was drawn and all identified

health problems of Miss O.P was written on it.

At 4:25pm, upon interaction with Miss O.P, she complain of vomiting twice on the day. A

nursing diagnosis of risk for imbalanced fluid volume related to excessive fluid loss

secondary to vomiting formulated. An objective was set to be met in 48 hours, to ensure

patient does not vomit again. The following nursing orders were carried out to achieve the

55
goal set; Patient was reassured that vomiting will subside with treatment. Intake and output of

oral fluids were strictly monitored. Intake of adequate liberal fluids such as water and soft

drinks was ensured. Nauseating factors such as bedpans were moved out of patient’s view.

Patient was then monitored for signs of dehydration by assessing skin turgor, sunken eyes etc.

and patient was weighed daily and recorded to ascertain weight loss .Intravenous infusion

ringers lactate and normal saline were administered as prescribed.

Moreover at 4:30pm, Miss O.P complained of abdominal pain. A nursing diagnosis of acute

pain related to irritated stomach mucosa was framed. An objective was set to ensure patient

was relieved of abdominal pain within 72 hours. The orders carried to ensure goals were met

included; Patient and family were reassured about effectiveness of medications. Pain was

assessed on a scale of 0-10 and rated as moderate. Precipitating factors such as caffeinated

drinks and spicy food was avoided. Patient was encouraged to take bland diet such as “too”

and the need for such meal was explained to patient. Vital signs were monitored every four

hourly and charted. Prescribed medication was served and therapeutic effects observed.

Television set was turned on for patient on request to watch her favorite television show as a

form of diversionary therapy.

At 4:35pm, patient was observed to be anxious as she was verbalising fears about the

prognosis of the disease. An objective was set to help relieve patient and her family of

anxiety within 24 hours. In order to achieve the target set, Patient was reassured that, with

their cooperation and compliance to treatment regimen, the condition can be controlled.

Patient was educated on the need for hospitalization. Procedures that were performed on the

patient were explained to her to gain her cooperation .Patient was encouraged to ask

questions about condition. Simple and straight forward answers were given to their questions

promptly and tactfully. Other patient’s recovering from the same condition was introduced to

56
her. Physiological response such as palpitations, headache, restlessness etc was observed for

the degree of fear and anxiety patient was facing.

At 6pm, patient had banku and okro soup for her supper. She could not eat much of the food.

Vital signs were checked and charted at 8pm and due medications was served. Patient was

then encouraged to bath warm water and brush her teeth. Patient retired to bed around 10pm.

She was handed over to the nigh nurses for continuity of care.

Second day of admission (30/09/2018).

Miss O.P woke up from bed around 4:30am since she couldn’t sleep well and patient also

complain of intermittently waking up due to the abdominal pain. Patient was assisted by

her mother, Mrs. M.O to carry out her personal hygiene needs such as brushing of the

teeth, bathing and grooming. Her bed linen was also changed to make her comfortable.

She was served with breakfast (Tombrown and buffloaf). She was visited by her siblings

and her friends. Patient looked happy after the visit.

Morning vital signs were checked and recorded at 6:00am as:

Temperature 36.5 degree Celsius

Pulse 90 beat per minute

Respiration 22 cycle per minute.

Blood Pressure 100/60mmHg

Morning medications served charted at 7:00am were IV Cefuroxime 750mg, IV omeprazole

40mg, Suspension Nugel 0 15mls and IVF DNS 0.5l was set up. The therapeutic and side

effects of the drugs were monitored.

At 7:30am, due to patient’s complain of sleeplessness, a nursing diagnoses was formulated.

Sleep pattern disturbance (insomnia) related to abdominal pain and an objective was set to

ensure patient will regain her normal sleeping pattern within 48 hours. The nursing

57
interventions carried out on patient included; Patient’s sleeping pattern was assessed.

Ventilation of the room was ensured by turning on the fans and folding of the curtain. All

nursing activities such as vitals and medication was carried out at ago. A bed free from

creases and cramps was made and visitors were restricted during the period patient was

sleeping or taking a nap. Warm milo drink was served. Noise free environment was ensured

by lowering the television set in the ward. Prescribed analgesics and antacids i.e tab

paracetamol and Suspension Nugel were administered. All other orders to ensure patient was

relieved of vomiting, abdominal pain and anxiety were continued.

At 8am, ward rounds was conducted by Dr. Adu. Patient complain of abdominal pains. Tablet

Buscopan 20mg tds for 5 days and Tablet paracetamol was prescribed. Upon review of

patient’s laboratory investigations which was ordered on the day of admission, malaria

parasite was negative, haemoglobin estimation 13.1 g/dl, hematocrit was 42%, Neutrophils

was 46% and red blood cell count was 4.6 x 10/l. All of them were within the normal range

except white blood cell count which was 12.3 x109/L and was slightly high. Patient was to

continue her antibiotic treatment.

At 10am, patient complain that she had loss of appetite. A nursing diagnosis of Imbalanced

nutrition, less than body requirements, related to inadequate intake of nutrients was

formulated. An objective was set to ensure patient regained her normal appetite and interest

in food within 48 hours. The orders carried out included; Patient was reassured that she will

be able to regain her normal eating pattern and appetite. Meals were planned with patient

considering her likes and dislikes. Patient mouth was cared for early in the morning and in

the evening after super. Patient’s husband was present at mealtime to encourage patient to

eat. Unpleasant articles like bedpan and vomits bowl were removed. Meals were served

attractively at regular intervals to patient.

58
Vital signs were checked and charted at 2pm. Patient had yam with palaver sauce in the

afternoon. She then took banana afterwards. She was then encouraged to take a nap in the

afternoon.

At 4:35pm, goal set to ensure patient was relieved of anxiety was evaluated. Upon evaluation,

goal was fully met as evidenced by patient and immediate family verbalized relieve of

anxiety and they wore a relaxed facial expression.

Miss O.P had rice ball with groundnut soup for supper. She took snacks. Patient joined the

other patients in the ward to watch “gangaa”. She was encouraged to take her bath with warm

water to aid her to sleep well. Vital signs were checked and charted and due medications

were served. Patient retired to bed at 10pm.

Third day of admission (01/10/2018).

On the third day of admission, patient woke up around 5:30am.Patient emptied her bowel,

took her bath, brushed her teeth and dressed up nicely before 6:00am. Her bed linen was

changed. Her vital signs were checked and recorded as

Temperature 35.5 degree Celsius

Pulse 88 beats per minute

Respiration 22 cycle per minute

Blood Pressure 120/60mmHg

Breakfast was milo drink and bread. Her medications were served at 8:00am.

Routine ward rounds was conducted by Dr. Adu. Patient’s said her abdominal pain had

subsided. No new complain was lodged. No new drugs were added to patient’s treatment

regimen.

At 10am, upon interaction with Miss O.P and her family, it was realized they had limited

knowledge on the disease condition. A nursing diagnosis of Knowledge deficit (patient and

59
relatives) related to inadequate information on causes, predisposing factors, signs and

symptoms and prevention of the condition was then formulated. An objective was set to

ensure patient and family had adequate knowledge on the causes, signs and symptoms and

prevention of gastritis. To achieve this, patient /family were reassured that detailed

information on gastritis will be given for better understanding. Time was scheduled with

patient and relatives to educate them on gastritis. Patient was made comfortable by lying in

bed whiles relatives and the nurse sit by bedside. Patient and family knowledge on gastritis

was assessed. Accurate information on the predisposing causes, signs and symptoms,

prevention, drug management and lifestyle modification were provided to correct

misconceptions Questions were invited and tactfully answered. Pamphlets on gastritis were

given to patient and relatives to ensure they even read when they have being discharged.

Patient was then informed of my intention to visit her home the following day. Miss O.P was

happy and gave me directions to her house. She also gave me the telephone number of her

elder sibling Mr. A.Y.

Vital signs were checked and recorded at 2pm. Due medications were checked and charted.

The therapeutic and side effects of the administered drugs were monitored.

At 4:25pm, goal set to ensure patient maintained normal body fluid was evaluated. Goal was

fully met as Miss O.P verbalised that she was no more vomiting.

Patient was served with fufu and beef. Evening vital signs were checked and charted. Due

medications were also served. All nursing interventions to solve patient’s health problems

were continued. Miss O.P retired to bed at 10pm after taking her bath.

Fourth day of admission (02/10/2018)

Miss O.P woke up at around 6:00am, she looked cheerful and conscious than she did on

admission. She performed all her personal care activities that is brushing her teeth, emptying

60
her bowel and bathing as well grooming herself. Her bed linen and clothes were changed to

make her comfortable. Patient lodged no complain during the night. According to the night

nurses, she was able to sleep well. Patient verbalised that she was feeling better.

Her vital signs were checked and recorded as

Temperature 36.6 degree Celsius

Pulse 96beats per minute

Respiration 20 cycle per minute

Blood Pressure 110/80mmHg

Patient had porridge and koose for her breakfast. Morning medication were served and

charted. At 7:30am, goal set to ensure patient regained her normal sleeping pattern was

evaluated. Goal was fully met as patient slept for 6 hours at night uninterrupted.

During ward rounds, patient made no complain. No new medication was ordered. Dr. Adu

ordered for patient to be observed for the next 24 hours. And that if patient’s condition

remained stable as it was, she was going to be discharged the following fay. The decision

was conveyed to the patient and her mother.

At 10am, goals set to ensure patient regained her normal appetite and also to ensure patient

and family had adequate knowledge on her condition were evaluated. Goals were fully met

as patient was able to consume more than half plate of meal served her and as patient and

family gave correct answers to questions asked on gastritis.

At 11am, patient was informed and I left for the first home visit.

I returned from the home visit at 12:30pm. Upon arrival, patient was informed of my

findings and also advised accordingly. She was served with fried ripe plantain and beans.

Vital signs were checked and charted and due medications were administered. At 4:25pm,

goal set to ensure patient was relived of abdominal pain was evaluated. Goal set on the

first day of admission was fully met as Miss O.P verbalized relieve of abdominal pain.

61
Patient had rice and stew for supper. She was encouraged to avoid spicy food and

caffeinated drinks. Patient’s vital signs and medications were served and charted. She slept

at 10pm.

Fifth day of admission (Day of discharge). (03/10/2018).

On the fifth day of her admission in the ward, Miss O.P woke up at around 5:55am looked

strong and very cheerful. She maintained her personal hygiene and groomed herself. She was

visited by her friends during the visiting hours. Client had no complains. Her bed linen was

laid nicely. Her vital signs checked at 6:00am were recorded in the nurse’s notes as follows:

Temperature 36.1 degree Celsius

Pulse 84 beat per minute

Respiration 20cycle per minute

Blood pressure 120/80mmHg

Patient was served with white porridge and milk with bread as breakfast of which patient

was able to eat very well. Patient was anticipating to be discharged home today.

During ward rounds, patient lodged no complain. She was duly discharged on new

medications which were Capsule Omeprazole 20mg bd for 7 days, Tablet Cefuroxime

500mg bd for 7 days and Suspension Nugel 0 15mls tds for 7 days. Patient was to come

for review in weeks time. Patient was informed that she has being discharged. The drugs

ordered were collected from the pharmacy department and patient was taught how to take

the medications at home.

Patient and family were reminded of the causes and prevention of her condition, the need

to observe personal hygiene and to report signs of complications such as reoccurrence of

the condition and otitis media. And the need to adhere strictly to all her treatment regimen.

62
She was advised to avoid taking unprescribed analgesics and to avoid spicy and

caffeinated food and drinks.

Since patient is a registered member of the National Health Insurance scheme, patient was

asked to pay an amount of six Ghana cedis as her hospital user fee as per the hospital’s

policy since her bills had been catered for. Patient’s folder was then sent to the Nurses’

station and patient was dully discharged in the admission and discharge book including the

ward’s state..

Patient and family were educated on the medications they are sending home with emphasis

on the dosage, time and the need to follow strictly the orders giving by the doctor and the

need to complete treatment as prescribed. Around 11:40am patient and mother were ready

to go home after packing their belongings and patient had finished dressing up. Miss O.P

was again advised on the need to return for review on the said date. Mrs. M.O was advised

on the need to ensure all his family members report to the hospital early whenever they are

not feeling well. They expressed their gratitude to all staff and bid farewell to the

remaining patients on the ward. They were escorted to the station where they took a taxi

home at 12:25pm. They were bade goodbye

Bed accessories that needed to be decontaminated were removed and sent to the sluice

room for decontamination. The bed was also cleaned, decontaminated and laid nicely

awaiting new admission immediately after patient and family had left.

4.2 Preparation of Patient and Family for Discharge.

Preparation towards discharge started on the day of admission until the day of discharge.

Client and family were reassured that client will be discharged home once her condition

has resolved. The primary aim was to enable her to take active role in her care for speedy

recovery and also to give her insight of her condition. Emphasis was made on the need to

63
visit hospital immediately with any illness that may occur, so as to promote early detection

and treatment in order to avoid complication. They were educated on the following:

Dietary Management
Dietary instructions take into account the patient’s daily caloric needs, food preferences, and

pattern of eating. Foods and other substances that are to be avoided (eg, spicy, irritating, or

highly seasoned foods; caffeine; nicotine; alcohol) were reviewed with patient and family.

Patient was also encouraged to take in a bland diet and take small meals at frequent intervals

when possible. Eating antioxidant foods, including fruits( such as blueberries, cherries and

tomatoes), and vegetables (such as garden eggs and cucumber), avoiding refined foods such

as white breads, pastas, and sugar, use of healthy oils, such as olive oil, reducing or

eliminating trans-fatty acids, found in commercially-baked goods, such as cookies, crackers,

cakes, onion rings, donuts and margarine and drinking 6 to 8 glasses of filtered water daily

was encouraged. Patient was encouraged to chew food served very well before swallowing

and to eat in bits.

Medications

Information was provided about prescribed antibiotics, bismuth salts, medications to decrease

gastric secretion, and medications to protect mucosal cells from gastric secretions can help

the patient recover and prevent recurrence. Patient was taught to avoid over the counter pain

killers such as Diclofenac, EFPAC and other analgesics which are NSAIDS. She was taught

that taking those drugs may aggravate her ailment. Finally, emphasis was made on the

importance of keeping follow-up appointments with health care providers.

64
Personal hygiene.
The client and family were educated to maintain good personal and environmental

hygiene, she was advised to wash clothes frequently, proper disposal of refuse, weeding

around the environment; she should ensure good drainage systems because chocked and

stagnant water can result in breeding of mosquitoes. Patient was encouraged to bath and

brushed her teeth twice daily and to keep finger nails short, in order not to harbor micro-

organisms. Patient and family were encouraged to adhere to the various education in order

to maintain and promote a good environment and health in the house respectively.

4.3 Follow Up, Home Visit And Continuity Of Care.

Follow –up is an important aspect of continuity of care and help ton observe the health and

environmental conditions of the client. It also helps the client and family in knowing the

predisposing factors and other hazards which could be dangerous to the patient and family.

First Home visit (2/10/2018).

On the 1/10/2018, Miss O.P was informed of my intention to visit her home the following

day. Directions to her house was given by Miss O.P. On the 2/10/2018 11am, while patient

was still on admission the first home visit was made to miss O.P’s house. The aim of the

visit was to verify any information given and also assess her environment and identify

health problems to may have contributed to patient’s disease condition.

Patient’s house is about 10 minutes’ walk from the hospital. It is adjacent the Baptist

Church in Nkoranza. Upon arrival, I knocked on the main gate of the house and was met

patient’s elder brother Mr. A.Y at home. I was received, water and seat was offered. The

reason for the visit was explained to him. Permission was asked to inspect the environment

of the house. Miss O.P leave in a compound house with her family. There were 12 rooms,

65
2 kitchens, 2 bathrooms and a store room. They live in the house with other tenants. Upon

inspection, it was realized that Miss O.P and her family occupy three rooms in the house

and they used one of the two kitchens of the house. Patient and her family share the toilet

facility in the house with the other tenants. Upon inspection of the toilet facility, it was

KVIP toilet. They had a dustbin to keep the used toilet roll and burn it every morning. The

house has water and electricity supply. At their bathhouse, it was realised that the water

from the bath was connected to a large gutter about 20 meters outside the house but the

pipe was busted so much of the water got stagnated at the back of the house. Miss O.P’s

family temporarily store their water in a barrel at the kitchen. The barrel was well covered.

They use gas to cook in the kitchen. The kitchen was well ventilated and all utensils were

well washed.

I proceeded to inspect Miss O.P’s room. The room had two windows and a fan for proper

ventilation. Her items and clothes were well arranged except that Miss O.P didn’t sleep in

a mosquito net.

After the inspection of Miss O.P’s house, her elder brother Mr. A.Y was advised to

encourage the other tenants in the house to repair the bust pipe and to drain the stagnated

water since it may lead to mosquito breeding. He was advised to find a mosquito net for

Miss O.P before she was discharged home. He was congratulated for keeping their home

clean. Permission was sought to leave. He accompanied me to the road side and thanked

me for the visit. He promised to deal with the health problems identified before Miss O.P

was discharged. I left for the hospital to continue the caring for Miss O.P.

Second Home Visit (06/10/2018)

On the third day after patient had been discharged, the second home visit was made. The

aim of the visit was to find out how client and family were coping with the treatment

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regimen and the education given after discharge as well as to remind them of the review

date.

I arrived at the house about 3:30pm. This time Miss O.P was home. Patient looked very

cheerful, happy and relaxed. I greeted her and was offered a seat. After making myself

comfortable, assessment of the general health status of Ms. B.G was done and she was

found to be in good health. She made no complain and said her abdominal pain had

ceased. Patient was made to bring out her medications. Upon inspection, it was found out

that patient was taking her medications as prescribed. She verbalised that she had not had

any side effect. Her room now had a mosquito net hanging on her bed. Miss O.P was

congratulated for taking her drugs as prescribed. Patient also said she was no more taking

unprescribed pain killers for pain. She was also not taking alcohol or spicy food.

The back of their house was inspected to see if they had fixed the bust pipe. It was realized

they had fixed it and there was no stagnated water at the back of the house.

Before leaving, Miss O.P was reminded of the review date which was 10/10/2018. She

was encouraged to come for the review and to continue her medications as prescribed. She

was also told that I will be paying her a last visit to hand her over to a community health

nurse for continuity of care. Miss O.P thanked me and accompanied me to road side. She

promised to come for the review, adhere to the advice given to her on diet and also on her

medication.

Review day (10/10/2018).

On the said date of review, client and her mother were met at the outpatient department of

the St. Theresah’s Hospital, Nkoranza. Miss O.P looked very cheerful and happy. After

exchanging pleasantries, client and mother were helped to collect their folders which was

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handed over to the nurse in charge and their vital signs were checked and recorded in their

respective folders with patient’s values being

Temperature-36.5degree Celsius

Pulse-80bpm

Respiration-19cpm

Blood pressure-110/70mmHg

Weight 58kg

Patient was seen by doctor on duty at the OPD. Patient had no complains. After thorough

examination, the doctor expressed satisfaction and advised the client to take good care of

herself. No new treatment was prescribed for Miss O.P. Patient was encouraged to

complete her medications at home and to adhere to the dietary advice given to her.

They were informed that the care will be terminated during the next visit and that they will

be handed over to a community health nurse who will ensure continuity of care. They were

accompanied to the outside of the hospital and bid good bye.

Third Home Visit (14/10/2018)

On the 14/10/2018, the last home visit was made to patient’s house. I made my third home

visit on 14/10/2018 around 1:30pm with a Community Health Nurse to patient’s house some

few days after her review. They welcomed us by offering us seat after we had exchanged

greetings. I asked about her condition and she happily responded she was well and healthy.

Emphasis was made on the education given to her already. I introduced the Community

Health Nurse who works at St. Theresah’s Hospital, Nkoranza to her. The community health

nurse informed them that she will be taking over which was being rendered. Miss O.P and her

family were happy to have someone who was going to help her and her family in their health

matters when am not around and assurance was given to them that the nurse is competent to

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provide a holistic continuity of care for them. Since it was my last day of therapeutic

relationship, I terminated my care and wished them well. They escorted us and thanked me

for the care and support they have received from me and the health team as a whole.

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 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT/FAMILY

5.0 Introduction

According to Smelter and Bare (2010), evaluation is the determination of the patient

responses to the nursing intervention and the extent to which the outcome have been

achieved.

This is the final phase of the nursing process. It is directed towards determining the Patient’s

nursing intervention and the extent to which the goal set have been achieved. This chapter

involves the following;

 Statement of evaluation

 Amendment of nursing care plan for partially met and unmet outcome criteria.

 Termination of care rendered to my patient and family

5.1 Statement of Evaluation

Miss O.P was relieved of vomiting within 48 hours

On the day of admission(29/09/2018) at 4:25pm, upon interaction with Miss O.P, she

complain of vomiting twice on the day. A nursing diagnosis of risk for imbalanced fluid

volume related to excessive fluid loss secondary to vomiting formulated. An objective was

set to be met in 48 hours, to ensure patient does not vomit again. The following nursing

orders were carried out to achieve the goal set; Patient was reassured that vomiting will

subside with treatment. Intake and output of oral fluids were strictly monitored. Intake of

adequate liberal fluids such as water and soft drinks was ensured. Nauseating factors such as

bedpans were moved out of patient’s view. Patient was then monitored for signs of

dehydration by assessing skin turgor, sunken eyes etc. and patient was weighed daily and

recorded to ascertain weight loss .Intravenous infusion ringers lactate and normal saline were

administered as prescribed.
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On 01/10/2018 at 4:25pm, goal set to ensure patient maintained normal body fluid was

evaluated. Goal was fully met as Miss O.P verbalised that she was no more vomiting.

Miss O.P was relieved of abdominal pain within 72 hours

On the day of admission (29/09/2018) at 4:30pm, Miss O.P complained of abdominal pain. A

nursing diagnosis of acute pain related to irritated stomach mucosa was framed. An objective

was set to ensure patient was relieved of abdominal pain within 72 hours. The orders carried

to ensure goals were met included; Patient and family were reassured about effectiveness of

medications. Pain was assessed on a scale of 0-10 and rated as moderate. Precipitating factors

such as caffeinated drinks and spicy food was avoided. Patient was encouraged to take bland

diet such as “too” and the need for such meal was explained to patient. Vital signs were

monitored every four hourly and charted. Prescribed medication was served and therapeutic

effects observed. Television set was turned on for patient on request to watch her favorite

television show as a form of diversionary therapy.

Miss O.P and family were relieved of anxiety within 24 hours

On the 29/09/2018 at 4:35pm, patient was observed to be anxious as she was verbalising fears

about the prognosis of the disease. An objective was set to help relieve patient and her family

of anxiety within 24 hours. In order to achieve the target set, Patient was reassured that, with

their cooperation and compliance to treatment regimen, the condition can be controlled.

Patient was educated on the need for hospitalization. Procedures that were performed on the

patient were explained to her to gain her cooperation .Patient was encouraged to ask

questions about condition. Simple and straight forward answers were given to their questions

promptly and tactfully. Other patient’s recovering from the same condition was introduced to

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her. Physiological response such as palpitations, headache, restlessness etc was observed for

the degree of fear and anxiety patient was facing.

On the 30/09/2018 at 4:35pm goal set to ensure patient was relieved of anxiety was

evaluated. Upon evaluation, goal was fully met as evidenced by patient and immediate family

verbalized relieve of anxiety and they wore a relaxed facial expression.

Miss O.P regained her normal sleeping pattern within 48 hours

During interaction with patient on the 30/09/2018 at 7:30am, Miss O.P complain of

sleeplessness due to the abdominal pain. a nursing diagnoses of Sleep pattern disturbance

(insomnia) related to abdominal pain and an objective was set to ensure patient will regain

her normal sleeping pattern within 48 hours. The nursing interventions carried out on patient

included; Patient’s sleeping pattern was assessed. Ventilation of the room was ensured by

turning on the fans and folding of the curtain. All nursing activities such as vitals and

medication was carried out at ago. A bed free from creases and cramps was made and visitors

were restricted during the period patient was sleeping or taking a nap. Warm milo drink was

served. Noise free environment was ensured by lowering the television set in the ward.

Prescribed analgesics and antacids i.e tab paracetamol and Suspension Nugel were

administered. All other orders to ensure patient was relieved of vomiting, abdominal pain and

anxiety were continued.

On the 02/10/2018 at 7:30am, goal set to ensure patient regained her normal sleeping

pattern was evaluated. Goal was fully met as patient slept for 6 hours at night

uninterrupted.

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Miss O.P regained her normal appetite for food within 48 hours

On the 30/09/2018 at 10am, Miss O.P complain of loss of appetite. A nursing diagnosis of

Imbalanced nutrition, less than body requirements, related to inadequate intake of nutrients

was formulated. An objective was set to ensure patient regained her normal appetite and

interest in food within 48 hours. The orders carried out included; Patient was reassured that

she will be able to regain her normal eating pattern and appetite. Meals were planned with

patient considering her likes and dislikes. Patient mouth was cared for early in the morning

and in the evening after super. Patient’s husband was present at mealtime to encourage

patient to eat. Unpleasant articles like bedpan and vomits bowl were removed. Meals were

served attractively at regular intervals to patient.

On the 02/10/2018 at 10am, goals set to ensure patient regained her normal appetite was

evaluated. Goals were fully met as patient was able to consume more than half plate of meal

served.

Miss O.P and family attained adequate knowledge on the disease condition (gastritis)

On the 01/10/2018 at 10am, upon interaction with Miss O.P and her family, it was realized

they had limited knowledge on the disease condition. A nursing diagnosis of Knowledge

deficit (patient and relatives) related to inadequate information on causes, predisposing

factors, signs and symptoms and prevention of the condition was then formulated. An

objective was set to ensure patient and family had adequate knowledge on the causes, signs

and symptoms and prevention of gastritis. To achieve this, patient /family were reassured that

detailed information on gastritis will be given for better understanding. Time was scheduled

with patient and relatives to educate them on gastritis. Patient was made comfortable by lying

in bed whiles relatives and the nurse sit by bedside. Patient and family knowledge on gastritis

was assessed. Accurate information on the predisposing causes, signs and symptoms,

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prevention, drug management and lifestyle modification were provided to correct

misconceptions Questions were invited and tactfully answered. Pamphlets on gastritis were

given to patient and relatives to ensure they even read when they have being discharged.

On the 02/10/2018 at 10am, goals set to ensure patient and family had adequate

knowledge on her condition were evaluated. Goals were fully met and as patient and

family gave correct answers to questions asked on gastritis.

5.2 Amendments Of Nursing Care For Partially Met Or Outcome Criteria

Due to the holistic care rendered by the health care team, all goals and objective set to ensure

patient was relieved of her health problems were all met fully within the stipulated time when

they were evaluated. There was no need for amendment of care plan.

No care plan was therefore amended.

5.3 Termination of Care

Termination of care is the official ending of care and the relationship between the patient,

relatives and the nurse. Since separation can sometimes bring about separation anxiety and

depression due to its accompanied psychological pain, the patient and family members were

given a gradual psychological preparation from the day of admission to the day of discharge

I under took three home visits.

The first home visit was 02/10/2018 to identify any health problem and remove any stressful

situation that will hinder her progress before she is discharged home.

The second home visit was on 6/10/2018. The purpose of the visit was to ascertain whether

the education given to her during the period of hospitalization and first home visit had been

adhered to and also remind them the review date.

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My last home visit to Miss O.P and family was made on 14/10/2018. The essence of this visit

was to terminate care and to hand over patient to a community health nurse for continuity of

care. Patient and family was encourage to adhere to educations given to them on proper eaten

habit such as limiting the intake of spicy foods and also avoidance of NSAIDS. Nurse Akutu

Tawiah Abigail was officially introduced to patient and family as the registered community

health nurse who would continue with Miss O.P’s care at home.

Patient and family showed appreciation for my service and asked me to keep the relationship

established. I thanked them for their co-operation and assistance. Care was finally terminated

on the 14/10/2018 at 2:00pm.

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 CHAPTER SIX

SUMMARY AND CONCLUSION

6.0 Introduction

This is the last chapter for the patient and family care study and it entails the summation and

conclusion of all care rendered to patient and family throughout the period of hospitalization

and after discharge.

6.1 Summary

According to Mish (2016), summary is a brief statement that gives the most important

information about something.

Miss O.P, a 20 year old woman, was admitted per ambulatory to the females’ ward of the

St. Theresah’s Hospital, Nkoranza on the 29/09/2018 at 4:10pm accompanied by an OPD

nurse and her mother. On admission, patient complained of vomiting, abdominal pain and

headache. On observation patient was conscious and orientated but was very anxious.

Vital signs were checked and charted. Throughout patient’s stay at the hospital, Miss O.P

was assessed thoroughly to identify her health problems. In all, six(6) health problems

were identified. These included vomiting, abdominal pain, anxiety, sleeplessness, loss of

appetite and lack of knowledge on disease on condition. A nursing care plan was drawn to

address the health problems. Specific objectives with stated timelines and interventions

were carried out to ensure patient’s health problems were solved. Due to the holistic and

systematic care rendered to Miss O.P and her family, all objectives set were duly met.

On admission till discharge, routine nursing care such as checking and charting of vital

signs, administration of medication, laying of patient’s bed, education of patient on disease

condition, reassurance etc. were rendered on daily basis to ensure patient’s was cared for

completely. Patient was managed on the following medications

Suspension Nugel 0 15mls tid for 7 days

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Intravenous tramadol 200mg in ringers lactate 500mls

Infusion ringers lactate 1L for 24 hours

Infusion 5% dextrose 1.5L for 24 hours

Intravenous Cefuroxime 1.5 g stat and 750mg tid for 24 hours

Tablet paracetamol 1g tid for 5 days

Tablet cefuroxime 500mg bd for 7 days

Capsule Omeprazole 20 bd for 7 days

The following laboratory investigations were ordered, done and reviewed by the attending

medical officer

Blood for full blood count (FBC).

Blood film for malaria parasites

Stool routine examination for occult blood

Gastroscopy.

All requested investigations were done except gastro spy because Miss O.P could not

afford it.

Patient was prepared towards discharge from the first day of admission. Miss O.P. recovered

within five days of admission without any complication and was scheduled for review on the

10/10/2018. In all patient was visited on three different occasions. The first home visit was paid

while patient was till on admission to assess patient’s home environment and to validate data

given to me. The second home visit was to ensure patient was adhering to treatment regimen

and to remind her of the review date. The third home visit was to terminate care and to hand

over patient to a community health nurse to ensure continuity of care. During the home visits,

education on patient’s condition and its management, personal and environmental hygiene were

given to Miss O.P and her family.

Care was finally terminated on the 14/10/2018.

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6.2 Conclusion

According to Weller (2009), conclusion is a final decision reached by reasoning.

The care rendered to Miss O.P has made me gain more Knowledge on the condition

(gastritis) with regards to the predisposing factors, cause, clinical features, medical

management, nursing management and prevention. The study has equipped me with skills on

how to render total individual care. It has also helped me improve on my interpersonal

relationship with other members of the health team, the patient and family.

Through this study, I have been able to put into practice actual and holistic nursing care as I

have learnt theoretically.

Finally I will recommend that, the idea and principle behind the adoption of the nursing

process which is the core approach to the writing of patient and family care study should be

embraced by all nurses to ensure total patient care.

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Table 7 ; Appendix Vital signs of Ms B.G throughout period of hospitalization

Date Time Temperature Pulse Respiration Blood pressure

(0c) (bpm) (cpm) (mmHg)
29/09/18 4:10pm 36.5 85 21 130/70

10pm 36.4 81 20 120/80

30/09/2018 6:00am 36.5 90 22 100/60

2pm 36.3 85 22 110/80

10pm 36.0 80 20 120/90

01/10/2018 6:00am 35.5 88 22 120/60

2pm 36.1 84 21 110/70

10pm 36.6 89 23 110/70

2/10/2018 6am 36.6 96 20 110/80

2pm 36.7 88 19 120/80

10pm 36 87 23 110/80

03/10/18 6am 36.1 84 20 120/80

10/10/2018 9am 36.5 80 19 110/70

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