CHAPTER FOUR

4.0 IMPLEMENTING PATIENT/FAMILY CARE PLAN

This constitutes the fourth stage of the nursing process. It involves the
actual and holistic care rendered to Miss M.T and the family during the
period of admission to the time of discharge. This chapter consists of the
following; Summary of the actual nursing care rendered to patient and
family. Preparation of patient/family for discharge and rehabilitation.
Follow up/home visits and continuity of care

4.1 SUMMARY OF ACTUAL NURSING CARE

The nursing care of Miss M .T started from the day of admission to the day
she was handed over to the community health nurse. She stayed in the
hospital from 19th of November , 2024 to 25th November, 2024. The
nursing management of Miss M.T was based on series of activities that
were scheduled to help her to regain optimum level of health that
included her physical needs. In all, Miss M.T spent seven days on
admission. The day to day nursing care of my patient was carried out as
follows;

FIRST DAY OF ADMISSION (19/11/2024)

Miss M.T was admitted to the female medical ward at Regional hospital
Bolgatanga on the 19/11/24 through the out patient department at
9:30am. Her sample was taken at the out patient department (OPD) level
for laboratory investigations (ie blood sample). To check out for;

 typhoid RDT
 Bf malaria
 full blood count

Her lab results shown Hb-12.5, no signs of malaria parasite were found
and typhoid img positive. I accompanied patients and her mother in to the
female medical ward with a diagnose of Typhoid fever. On arrival to the
ward, the mother and M.T were welcomed and given comfortable seat. I
then introduced myself to them and collected the hospital card and took a
quick glance through the computer to see and confirm her identity. A
comfortable bed was then made quickly for patient to rest. I immediately
carried out nursing procedures like checking vital signs which read as
follows; Temperature………….39.4degree Celsius Blood
pressure..........115/70 mmHg Pulse…………………110 beats per minute
Respiration…………. 21 cycles per minute Saturated Pressure of Oxygen
(SPO2)...99 percent Weight………………55kilograms. An intravenous line
was secured and particulars including name, age and address as well as
diagnosis were entered into the admission and discharge book as well as
the daily ward state.

Patient’s mother was then orientated to the ward surroundings such as

the bathroom, toilet, nurses bay and other patients in the ward. She was
also informed about other routines of the ward like visiting hours, ward
rounds time, meal schedule and other items to bring to the hospital to
assist in patient care. She was reassured of competent nursing care. The
health problems identified were as follows;

[Link] had pyrexia upon assessment. A nursing diagnosis was made

thus; Hyperthermia related to inflammation process as evidence by
patient body temperature assess and recorded as 39.4. An outcome
criteria was set to help patient attain and maintain normal body
temperature of 36.2oC-37.2oC within 3 hours. The following interventions
were made, patient was reassured that measures will be put in place to
reduce her temperature to normal range, patient was tepid sponged using
sweep stroke leaving damp water on patient body to dry up by
evaporation by reducing the temperature in every 15 minutes, prescribed
medications were administered IV ciprofloxacin 400mg and IV Paracetamol
500ml were administered, light clothing was used to cover the patient to
prevent her from generating heat, adequate ventilation was ensured by
opening nearby windows and her vital signs were checked and recorded.
[Link]’s had headache upon assessment. A nursing diagnosis was made

thus;Acute pain (headache) related to an increase in frontal arterial load as

evidenced by patient report of a 7 /10 throbbing headache, head being warm to

touch, and onset of symptoms 2 hours ago. An outcome criteria was set as

Patient’s pain level will reduce after 1 hour as evidenced by;

a) Nurse assess and patient pain scale record as 3/10

b) patient’s verbalizing relieve of headache and being cheerful.

Nursing interventions were made as follows; patient and mother were

reassured that patient is in the hands of competent personnel and that
everything possible will be done to reduce the pain, patient pain was
assessed, diclofenac 10mg IM and paracetamol 100mg were
administered, patient was made comfortable in bed, and her attention
was taken of the pain by engaging her in a conversation about her past
pleasant experiences and listening to music.
[Link] the process of rendering care for my patient, Patient’s and mother was

observed to be anxious and worried and their reasons were due to unknown

outcome of the condition and change of environment. An outcome criteria was

set as Patient’s and her relative will be relieved from anxiety within 24hr as evidenced by

patient and mother having cheerful facial expression and being cooperative.

Nursing interventions were made as follows; patient’s and mother anxiety

level were assessed and they were reassured of competent nursing care,
prognosis of the condition was clearly explained to them to allay fears and
anxiety. They were again orientated to the ward environment and
routines. Treatment modalities were explained to them and they were
allowed to ask questions to clarify doubt and misconceptions. I then
introduced myself to them as a third year student nurse from the nursing
training college, Bolgatanga who will help them in their care and will also
want to take her daughter as a Patient for my care study and she
concerted. I then bid them goodbye and promising to visit them early the
next morning.

SECOND DAY ON ADMISSION (20/11/2024)

On the second day I was in the ward as early as possible to continue the
nursing care on my patient and to know the level of improvement. Report
from the night nurses showed she slept well the previous night. I then got
to Miss M.T and the mother to ask how they were feeling that morning. I
was told that she did not eat enough the previous evening. Upon my
inquiries, she did not have appetite to eat and she was poorly feed as
well. A nursing diagnosis was therefore formulated as; Risk for nutritional
and electrolytes imbalance related to inadequate oral intake (food and
water) .An outcome criteria was set as ;Patient’s will maintain normal nutritional
and electrolytes balance throughout hospitalization as evidence by;
a) Nurse ensuring patient oral hygiene and encourage patient to take balance diet.

b) patient’s taking adequate food and water every day.

They following nursing intervention were then made for a patient as follows; Patient’s and

her mother was reassured, Patient’s oral hygiene was ensured morning and evening,

Adequate water and balance diet was given to the patient, Admission bed was made for a

patient, and Vitamins B complex was administered to boost the patient appetite.
Her vital were checked and recorded as follows; Temperature 36.0, pulse
122, Blood pressure 109/75mmHg, Respiration 16 and Saturated partial
pressure 99.

THIRD DAY ON ADMISSION (21/11/24).

Upon continuous assessment, it was found out that patient complained of body

weakness and couldn’t perform her personal hygiene . A nursing diagnosis was

therefore formulated as; impaired ability to perform personal hygiene related to fatigue as

evidence by patient decrease ability to perform activities of daily living. An outcome criteria

was set as, After 48 hours patient will perform activities of daily living without being assist

as evidence by,

a) Nurse observing patient’s performing activities of daily living such as mouth care, bathing,

and washing of hands regularly after visiting the washroom.

b) patient performing activities of daily living without being assist. The following nursing

interventions were made for a patient’s ;

Patient’s was reassured that she will be able to care for herself and do normal activities as

soon as possible but at the moment, she needs temporal assistance in doing them.

On request, bed pan was served warm. After voiding, the amount, colour and consistency

was observed and documented. 1010mls of normal colour urine was emptied .

Patient’s was assisted to bath with warm water, soap and sponge twice daily to improve

blood circulation. Pressure areas such as elbow, heals, scapula and sacral region were

massage with mild soap and water. Vaseline was applied afterward to prevent formation of

bed sores.

Little assistance was given to patient’s to maintain her oral hygiene with toothpaste and

toothbrush twice daily to prevent mouth odour and improve freshness. Vaseline was applied

on the mouth to prevent crack lips.

5. Patient was given support to walk around her bed and in the ward till she was able to walk

alone.

Her vital were checked and recorded as follows; Temperature 36.5, pulse
79, Blood pressure 101/94mmHg, Respiration 19, and Saturated partial
pressure 98.

FOURTH DAY ON ADMISSION (22/11/24).

On the four day of admission, there was much improvement in Miss M.T

condition. She had a cheerful face on my arrival to the ward. Miss M.T condition

was better though she complained of sleepless night. A nursing diagnosis was

made as; Insomnia related to unfamiliar hospital environment as evidenced by

patient report of sleepless night. An outcome criteria was set as, Patient will

maintain normal sleeping pattern throughout the period of hospitalization as evidenced by patient

sleeping at least 3 hours during the day and 6-8 hours in the night. The following interventions were

made for a patient. . Patient’s was reassured that measures are in place to enable her have a

normal sleep pattern

Movement of visitors are regulated, volume of radio and television set turned down and

nursing procedures carried on patient were organized and performed at once to prevent

interruption and noise.

Nearby windows were opened, ceiling fan switched on to promote ventilation and induce

sleep.

Patient’s was assisted to have a warm bath to relax her muscles. She was assisted to groom

and put on a comfortable bed (admission bed) free from creases and crumps to induce sleep.

Prescribed injection diclofenac (I.M) 10mg was administered to relieve pain and promote
sleep.
Her vital were checked and recorded as follows; Temperature 37.1, pulse
100, Blood pressure 101/94mmhHg, Respiration 20, and Saturated partial
pressure 99.
FIFTH DAY OF ADMISSION (23/11/24).

On the fifth day of admission, continuous care were given to patient’s and
from my own observation patient was feeling better and she presented no
complains.

It was also observed that patient had less knowledge on condition and a
nursing diagnosis was formulated as; Deficit knowledge related to lack of
information about condition as evidence by patient not being able to
answer questions asked about her condition. The following interventions
were carried out; her knowledge on typhoid fever was assessed and she
was then educated on the condition, its causes, signs and symptoms, how
to prevent it from occurring. She was also provided with magazines and
pamphlets on the condition for further understanding. All misconceptions
about the condition was cleared off and more emphasis was then laid on
the causes and preventions. Patient’s vital signs were then checked and
recorded as follows; Temperature- 36.5degree Celsius, Blood pressure
105/94mmHg, Pulse- 90beats/minute Respiration – 21, Saturated partial
pressure of Oxygen (SPO2) – 99

SIXTH DAY ON ADMISSION (24/11/2024)

I got to the ward on 6th day of admission around 7:38 am. Interaction with
the night nurses and upon reading their report showed that patient had a
sound sleep the previous night. I proceeded to the patient and the
relatives to find out how they were faring. I was happy with the response
as they could go home if given the chance. Patient had already bathed
and was been served her breakfast (porridge). Her bed linen was then
changed after eating and a comfortable bed was made for her. There was
also much improvement in her appetite evidenced by the manner in which
she ate her breakfast. I smiled and reassured her that she will soon be
discharged to go home to continue treatment. At about 9:20am, doctor,
came on rounds and added that Miss M.T. would be discharged if there
was no new development the following day( 25 th November, 2024). It was
a welcoming news to Miss M.T.’s mother, as she was very excited to hear
that, patient ’s vital signs read as follows; Temperature: 36.1degree
Celsius Pulse: 90beats/minute Respiration: 20cycle/minute Saturated
Pressure of Oxygen (SPO2) - 98 percent Weight- 55kilograms Patient
medications were served and recorded in the treatment sheet.

ADMISSION DAY 7 (25/11/2025)On this day, which was the seventh day of
admission, Miss M.T’s mother had much anticipation to be discharged. I
got to the ward at 8:10am and then enquired from the nurses how my
patient faired during the night and they said they had no complain, ate
well and had a sound sleep. At exactly 8:30am, her breakfast was served.
On review at about 9:00am by Doctor, she was assessed and found fit to
go home. The following drugs were prescribed; Syrup multivate 20mls
8hourly x 10days.. Paracetamol 1 gram TDS for 7 days . Drugs were
given to her to continue taking at home, I duly educated her on the
dosage and time to take the drugs and the preventive measures in order
to avoid relapse of the disease. She was asked to come for review in a
week time. Patient’s vital signs were taken and recorded as; Temperature
37.1 degree Celsius Pulse 78 beats/minute
Respiration 19 cycle/minute Saturated Pressure
of Oxygen (SPO2)- 99 percent Weight
80 kilograms. Miss M.T had no problems with regards to the settling of her
hospital bills. She was duly discharged from the admission and discharge
book officially. The review date was documented to her mother and the
essence explained in simple terms to her understanding. I also ceased the
opportunity to find out whether the health education given her was well
understood. Miss M.T mother confidently told me all that she had learnt
about typhoid fever. She vividly remembered the causes as well as
preventions of the disease. I again emphasized the need to observe
proper personal and environmental hygiene and wash foods thoroughly
before eating. Also, I advised her on the need to feed Miss M.T well
balanced diet rich in iron at home. Since her belongings were already
packed the previous day awaiting discharge, a tricycle (Cando) cab was
arranged to take her and the mother home. Both patient and mother
were extremely excited and thanked the staffs of the ward for the valuable
services rendered. I in turn thanked them for their co-operation and told
the mother to give my client the best of support at home. I accompanied
them outside to the cab and goodbye them. I returned to the ward to
remove the bed linen and to decontaminate the bed and lastly
documented in the admission and discharge book as well as the daily
ward state indicating the remarks of her condition and discharge.

4.2 PREPARATION OF PATIENT/FAMILY FOR DISCHARGE AND

REHABILITATION

The preparation of patient and family towards discharge is an important

process that began immediately after Miss M.T was admitted to the ward.
As part of the reassurance, Miss M.T mother was made to understand that
the hospital was a temporal place and as her daughter’s condition
improves, she will be discharge home to continue her normal activities.
Patient’s relatives were also educated on the causes, clinical signs and
symptoms, and steps to prevent it. On the 20th of November, 2024, I
visited the home to assess the readiness of the family to receive her. I was
warmly welcomed and after exchanging greetings, I introduced myself and
made known to them the reason for the visit. These included the
following:

FOLLOW UP/ HOME VISIT/ CONTINUITY OF CARE

This visit is aimed at ensuring continuity of care after hospitalization. It

also helps the nurse to identify potential problems patient may face after
discharge and also to evaluate the health education given to her during
hospitalization.

FIRST HOME VISIT (20/11/24)On the 20th of November, 2024, while Miss
M.T was still on admission, I made my first home visit to Miss M. T house
in Bolgatanga estate at around 10:00am. On arrival, I met her father who
warmly welcomed me and served me with a cup of water. I then
introduced myself and told him the purpose of my visit which was to
assist them prepare the home prior to Miss M.T’s arrival. My observations
in and around the house revealed that the place was clean and everything
properly arranged. Food and water was properly covered and there was an
area behind the house where they dispose of their refuse and burn it
regularly. I therefore educated him on his daughter’s condition which
included; the causes, and the preventive measures to avoid relapses in
the family. I also encouraged him to keep up the good work and to expect
his daughter (Miss M.T) back home soon. I then bid him goodbye and left
for school.

SECOND HOME 28th November , 2024)On the 27th of November 2024, I

again visited Miss M.T and family to honour the promise I made to them.
This was to help me know whether she was taking the treatment given. I
was friendly welcomed by the mother who offered me a sit and a glass of
water. Both mother and daughter were over joyed seeing me. We
exchanged warmed greetings and I observed how united and lovely they
both are at home. I then went ahead to ask whether there have being any
complains after discharged and the answer was ‘no complains’. I
continued to educate them on the importance of maintaining personal and
environment hygiene, eating iron rich food and feeding Miss M.T with
same to prevent relapse of the condition. They were also encouraged to
store water in clean containers and making sure foods are covered to
prevent contamination and to avoid buying foods from unhygienic
vendors. I finally educated her on the need to support Miss M.T with her
remaining treatment as the effectiveness of the drugs depend on taking
the full course accordingly. I then informed them about introducing them
to a community health nurse who will continue with the nursing care. I
reminded her about the importance of review and encouraged her to
come on the said date and goodbye them and promised to visit again.
THIRD HOME VISIT (01/12/2024)On 1ST of December, 2024, I went back to
visit Miss M.T and family the third and last time. This time, she had fully
recovered and the relatives had no complains. They had honoured the
review and nothing abnormal was detected. I however emphasized on her
diet and the need to feed client with ion rich, protein rich and sufficient
fluid intake and also improve on personal hygiene as this could cause a
relapse of her condition. I also stressed on proper hand washing after
visiting the toilet to prevent other communicable diseases. She was then
introduced to the community health nurse at the Estate CHPS compound
and was urged to channel all her health problems to the nurses for
assistance. I also advised her to report immediately to the hospital if she
notices any of the signs and symptoms for proper management and
treatment. Miss M.T and family expressed their sincere gratitude for the
care rendered. I then goodbye them and wished them well.