Beruflich Dokumente
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ASSESSMENT OF PATIENT/FAMILY
1.0 Introduction
Assessment can be defined as critical analysis and evaluation or judgments of the status or
Assessment is the first phase of the nursing process. It includes collection of data from the
patient/family about their health status, hence enabling the nurse to render quality health care
patient’s lifestyle and hobbies and patient’s past and present medical/surgical history. This
begins from the day of admission and ends after termination of care.
According to Weller (2009), particulars of a patient are the facts or details about them which
Mrs. E.A., a 33year old woman and the fourth born among eleven siblings, born to Mr. K.A
and Mrs. A.B on the 06/05/1985. She is a Bono by tribe, hails from Tom, a town in Nkoranza
and currently lives at Nkoranza in a house with number NDA 304, in the Brong Ahafo.
According to the patient, she had her education up to junior high school and could not
continue due to financial constraint of her parents. Mrs. E.A is married to Mr. A.M.K. with
whom she has one child who is 6 year old boy. Mrs. E.A speaks Bono and little of English.
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Mrs. E.A. is 1.5m tall, dark in complexion and weighs 60kg. Mrs. E.A has no tribal mark on
her face and has no physical disability. Her next of kin is S.A who is her sister.
Patient is a known hypertensive and has being admitted before for treatment of hypertension.
According to Mrs. E.A, hypertension runs through her family. She affirmed that her
grandmother suffered from hypertension before she died of stroke and her mother is also a
hypertensive patient. Aside the hypertension that runs through her maternal side of her
family, there are no known hereditary diseases such as asthma, diabetes mellitus, sickle cell
disease and mental illness in the family. She also said that, there are no chronic and infectious
conditions like cancer, tuberculosis, epilepsy and leprosy in the family. Aside her
grandmother who is dead, all her relatives are alive, except one of her mother’s sister who
Furthermore, patient stated that they sometimes suffer from minor symptoms such as
headache, fever, diarrhoea and cough which they usually treat at home using over the counter
medications such as paracetamol, and other anti – malaria drugs. They sometimes used herbal
medications bought from local market or acquired from the farm. She stressed that when
home management fails, they report to the hospital for further treatment. They normally
receive treatment at the St. Theresah’s Hospital in Nkoranza, in Brong Ahafo Region.
According to Mrs. E.A, she has been hospitalized with hypertension before. Patient
Mrs. E.A is hair dresser by profession. She has her own hair dressing shop in Nkoranza and
has apprentices who are learning from her. She works from Monday to Friday and
occasionally on Saturdays if someone request her services. According to Mrs. E.A, she
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averagely has at least four to five customers daily. Mrs. E.A said the income from her work is
used to support that of her husband Mr. A.M.K, who is the main bread winner of the house.
Mr. A.M.K is a taxi driver. According to Mrs. E.A, she and the husband also has cashew farm
at Sampa. In difficult times, they are supported by her family financially but she said their
income is normally sufficient for the upkeep of her family and as such they don’t normally
require financial assistance. She said as the fifth born of her parents, she normally sends
money to her parents and also takes care of her younger siblings. According to Mrs. E.A, she
and the husband are middle class, since she and the husband are both working and they also
have a cashew farm that gives them money each year. Patient and her family are registered
Mrs. E.A is Christian and worship at the Methodist Church of Ghana in Nkoranza. She is a
member of the church choir. According to patient, she is also an active member of the women
fellowship in the church. Her church celebrates festivals such as Easter and Christmas.
Even though patient could not throw much light on taboo and other cultural practices, she
said in Sampa where they have the cashew farm, there are days that are regarded at a taboo to
go to farm. She also said she was raised her parents to respect all adults and to be
hardworking as well.
Also Weller (2009), describes growth as the progressive development of a living thing
especially the process by which the body reaches its point of complete physical development.
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According to patient, her mother experienced normal pregnancy for a period of nine months
and did not experience any disease during that period. She did not attend antenatal.
According to Mrs. E.A, said she was told by her mother that she was delivered per
spontaneous vaginal delivery by traditional birth attendant at home. Her mother had no
problem during the childbirth or peurperium. She said her mother started going for post natal
care in order to immunize her. She was immunized against the six childhood killer diseases
which is evidenced by a mark of her deltoid muscle and also indicated in her weighing card.
According to Mrs. E.A, growing up she did not suffer from any serious diseases that could
have impeded her development. According to Mrs. E.A., she was told by the mother that at
about seven months she was sitting, crawling at nine months and could walk at after one year.
She said her mother told her that she started didn’t do exclusive breast feeding as she started
feeding her food such as porridge at 3months and could eat all meals prepared at home and as
a result was from breast milk after one and half years. She also added that, she started her
primary education at the age of 7 at a Methodist school at Tom. She continued her education
till she completed junior high school. She could not continue her education because her
Weller (2009) defines puberty as the period during which adolescents reach sexual maturity
and become capable of reproduction. Even though Mrs. E.A. developed her secondary sexual
characteristics such as development of breast, growing of hair in the armpit and around the
pubic-areas as early as twelve years, she experienced her menarche at age eighteen. Since she
has regular menstrual cycle of 28 days and menstrual flow of 5 days. According to Mrs. E.A,
she never had a sexual relationship till she married her husband. According to Mrs. E.A, she
had an aspiration to be a banker by profession when she grew up but because she was not
able to continue he education, she then switched to hair making. She has no regret over her
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According to Erikson’s theory of psychosocial development (1959), there are eight distinct
stages with each possible results, thus either success or failure personality. These theory;
Mrs. E.A is within the sixth stage (intimacy versus isolation). This stage takes place during
the adulthood of people. During this stage, the major conflict centers on forming intimate,
loving relationships with other people. The individual learns to share and care without
loosing themselves. Isolation on the other hand occurs when the person fails to find a partner.
They feel alone and isolated. Mrs. E.A is married happily and has one child. She is also
According to Mrs. E.A., she experienced her menarche at age eighteen and had a regular
menstrual flow of 5 days and a normal 28 days cycle. She does not have history of menstrual
pains. Patient has had only one pregnancy and delivered per vagina spontaneously without
any complications. Currently, she has only one child, who is alive. Mrs. Y.A has practices
natural family planning method and the use of condom. She has no history of contraceptive
use.
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1.6 Patient’s lifestyles / hobbies
Mrs. E.A often wakes up early in the morning around 5:00am. She says a prayer performs her
first oral hygiene, empty’s her bowel and her bladder. She then sweep her compound and
prepares breakfast for her family. After that she takes her first bath, eats her breakfast and
bath her child and make him ready for school. She normally leaves for work, which is about
20 minute walk from her house after the school bus of her child has picked him to school.
She mostly cooks at her shop in the afternoon. She normally arrive at work at work between
8:00 and to 8:30am. She normally returns from work to home around 5pm in order to prepare
Mrs. E.A empties her bowels twice daily and performs oral hygiene twice as well, thus
morning and evening and she eats three times daily and sleeps at 10:00pm after watching her
angel television respectively. On Wednesdays, she normally attends church choir practices.
The above mentioned routines are done from Monday to Friday. Nevertheless, when Mrs.
E.A feels tired at work or on days that customers do not seek her services, she spreads a mat
During the weekends, Mrs. E.A said she wakes up at 6: 00am on Saturdays, she visits the
toilet, brush her teeth and performs her household chores, takes her breakfast and bath her
child. She normally wash their dirty clothing on Saturdays. She normally rest in the morning
or sometimes joins her church women group activities such as sports, cleaning exercises or
choir practices. In the afternoon, she mostly attends wedding ceremonies and funerals.
She also said on Sundays she wakes up at 6:30am prepares and leaves for church at 8:00am.
She closes at 12:00pm. She returns home for lunch and visit the houses of her friends who
stay nearby. She said because her husband does not normally go to work on Sundays, they
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make time for themselves, visit friends and family. She has no difficulties in grooming,
She further stated that, she mostly has good appetite when she is not ill. Her favorite meals
are fufu with light soup and jollof rice with fried chicken. Mrs. E.A. said she takes alcohol
occasionally, but since she was diagnosed of hypertension, she has stopped drinking it. She
added that she does not smoke. She likes to watch television programs especially telenovela
Mrs. E.A is an extrovert, kind, caring but sometimes when provoked by neighbors, she fights
them back. She also loves to express her emotions through talking she has good
communication skills as well. She also communicate with her son using nonverbal
After the interaction with my patient, I realized that, Mrs. E.A is a good woman, with a caring
heart and above all, she is friendly. She has no drug allergies.
Mrs. E.A never suffered any child hood disease such as measles, polio myelitis or whooping
cough but has suffered from chicken pox before. According to Mrs. E.A, she has been
hospitalized with the diagnosis of hypertension on three different occasions. She was first
diagnosed of hypertension at the age 25 years and has since being on antihypertensive.
Patient said she was supposed to go for week B.P check every week but due to her busy
schedule, she normally doesn’t go for the blood pressure checking unless she feels headache
or palpitation. Her previous medical history includes drugs such as Tab Nifedipine, Tab
Also, she has been treated on OPD bases on tonsillitis, bronchitis and nail prick when she
accidentally stepped on one. Occasionally, she experiences minor ailments such as fever or
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cold which she treats using drugs bought from a pharmaceutical shop. But when symptoms
persist or become worse, she seeks medical care at the St. Theresah’s’ Hospital. Patient has
never had any surgery in her life. She does not suffer from any disability due to complication
of any illness. She has no known allergy to any food, drug or animal or insect.
Patient said all she knows about hypertension is the increase in blood pressure and nothing
more. She also verbalized that, she hardly ever visit the hospital for checkups and mostly
refuses to take her medication because she is mostly busy and has the perception that the
hypertension is gone because she does not normally feel sick. She has easy access to health
care.
According to Mrs. E.A she was feeling well until about three days ago (25/09/2018), when
she started feeling headache and palpitation. She took paracetamol to curb the headache but it
still persisted. According to patient she then took her antihypertensive which was with her in
her house. She said the palpitation subsided till on the morning of 28/09/2018, around 9am,
when she felt dizzy and headache with palpitations. She then left her shop in the care of her
apprentices and went home for her health insurance and came to the out patient department of
the St. Theresa’s Hospital. Her vital signs at the OPD was
Temperature 36.9
Pulse 89bpm
Respiration 20cpm
Patient was then admitted to the females’ ward of the St. Theresah’s Hospital
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1.8 Admission of Patient.
Mrs. E.A was admitted to the females’ ward of the St. Theresah’s’ Hospital per ambulatory
on the 28/09/2018 at 10:30am from the outpatient department accompanied by an OPD nurse.
They were warmly welcome and seat was offered. Patient’s folder was collected from the
OPD nurse and her name was mentioned to ascertain and confirm the identity of the patient.
Mrs. E.A was immediately made comfortable in an already prepared admission bed in
female’s ward with bed number FW-2 because complained of dizziness. I introduced myself
and the staff around to the patient. Mrs. E.A’s particulars were documented into the
admission and discharge book and daily ward state. Upon assessment patient looked ill. She
also.
Temperature - 36.9oc
Pulse - 84bpm
Respiration - 21cbm
SPO2 - 97%
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Blood sample was taken, sample bottle labelled and sent to the laboratory for the
Drugs were immediately procured from the pharmacy department. An intravenous cannula
was established and due medication was administered as prescribed. Other medical orders
such as hourly blood pressure monitoring, complete bed rest and education of patient on
condition were all carried out. A care plan was drawn to help solve patient’s identified
Patient was then orientated to ward and its environs such as the toilet, bath room and the
nurses station. They were also introduced to the other patients on the ward. Since the ward
didn’t not have a dining hall, patient was encouraged to eat by the bed side. She was also
told of the visiting hours of the hospital. Patient was encouraged to call home for them to
bring patient’s personal items that she may need at the ward such as towel, sponge, tooth
brush, toothpaste and bucket from the house. She was asked to talk to any of the nurses
After these interventions, I told the ward in-charge of my intention of using the patient and
the family for a case study and I was given the permission. I introduced myself to the patient
again that, I am a student nurse of Nurses’ Training College, Sampa, who was conducting a
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care study at the hospital. I then made it known to Mrs. E.A of my desire to give her a
special nursing care for her speedy recovery. She was told that, as part of my training, final
year students are to take a patient each, nurse him or her from the time of admission till time
of discharge and home visits. Mrs. E.A accepted and promised her cooperation and readiness
to give me any information needed for my study. She was told that, she would be discharged
home once her condition was stable and that she were not going to be on the ward forever.
She was also informed that, as part of my care, I would visit their home whiles she was on
admission and after she has been discharged. I promised to keep the data that give out with
utmost confidentiality.
I choose to write my care study on hypertension because even it’s very common in most
people, there are a lot of misconception about it and because it may be asymptomatic, people
who are diagnosed with hypertension default with treatment and come to the hospital only
after complications. I wanted to know more about this condition and to holistically nurse a
Mrs. E.A said even though she was told of having hypertension some years back and was on
medications, she had been well and felt no pain and going about her day to day activities until
on the 25/09/2018, when she experienced unusual signs and symptoms. She however did not
attribute the present condition to any spiritual forces. She believed that it is just a disease and
had the belief that she would be cured to continue her normal daily activities. She was of the
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1.11 Literature Review on Hypertension
According to Areti (2012), a literature review is an essential tool for a study and it helps to
identify relevant information about the disease condition. It involves types, causes,
According to Waugh and grant (2010), humans and other vertebrates have a closed circulatory
system: This means that circulating blood is pumped through a system of vessels, this system
consists of the heart (pump), series of blood vessels and the blood that flows through them.
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The Heart
It is located near the center of your chest and a hollow structure, Composed almost entirely of
muscle and is about the size of your clenched fist. Enclosed in a protective sac called the
pericardium. In the walls of the heart, two layers of tissue form a sandwich around a thick layer
of muscle called the myocardium. Contractions of the myocardium pump blood through the
circulatory system. The right and left sides of the heart are separated by a septum, or wall. On
each side of the septum are two chambers. The upper chamber (receives blood) is the atrium.
The lower chamber (pumps blood out of heart) is the ventricle. The septum prevents the mixing
of oxygen rich and oxygen poor blood. The heart contracts about 72 times per minute and
Pumps about 70mL of blood with each contraction. Heart muscles are composed of individual
fibers, each atrium and ventricle contracts as a unit. Each contraction begins with a group of
cardiac muscle cells in the right atrium known as the sinoatrial node (SA node). Because the
SA node paces the heart it is known as the pacemaker. The impulse spreads from the pacemaker
to the rest of the atria. From the atria, a signal is sent to the atrioventricular node and then to a
bundle of fibers in the ventricle. When the ventricle contracts, blood flows out.
Cardiac output
The cardiac output is the amount of blood ejected from each ventricle every minute. The
amount expelled by each contraction of each ventricle is the stroke volume. Cardiac output is
expressed in liters per minute (L/min) and is calculated by multiplying the stroke volume by
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Stroke volume
The stroke volume is determined by the volume of blood in the ventricles immediately before
they contract, i.e. the ventricular end-diastolic volume (VEDV), sometimes called Preload. In
turn, preload depends on the amount of blood returning to the heart through the superior and
inferior venacave (the venous return). Increased preload leads to stronger myocardial
contraction, and more blood is expelled. In turn the stroke volume and cardiac output rise. In
this way, the heart, within physiological limits, always pumps out all the blood that it receives,
allowing it to adjust cardiac output to match body needs. This capacity to increase the stroke
volume with increasing preload is finite, and when the limit is reached, i.e. venous return to the
heart exceeds cardiac output (i.e. more blood is arriving in the atria than the ventricles can
pump out), cardiac output decreases and the heart begins to fail . Other factors that increase the
force and rate of myocardial contraction include increased sympathetic nerve activity and
thyroxin.
Circulation of Blood
Deoxygenated blood passes from the right atrium into the right ventricle and then goes to the
lungs. From the lungs, blood moves back toward the heart into the left atrium to the left
ventricle and then passes into the aorta to go to the rest of the body
Blood Vessels
As blood moves through the circulatory system it moves through 3 types of blood vessels:
Arteries
Capillaries
Veins
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Arteries: Large vessels that Carry blood from heart to tissues of body e.g., aorta, carotid artery
oxygen rich blood, with the exception of pulmonary arteries. It has thick walls-needed to
Capillaries: Smallest blood vessels .Walls are only one cell thick and very narrow. Important
for bringing nutrients and oxygen to tissues and absorbing CO 2 and other waste products.
Veins: Once blood has passed through the capillary systems it must be returned to the heart.
This is done by veins which walls contains connective tissue and smooth muscle. Largest veins
contain one way valves that keep blood flowing toward heart E.g. SVC, IVC, Jugular veins
.Many found near skeletal muscles. When muscles contract, blood is forced through veins.
Blood Pressure
The pressure of the arterial blood is regulated by the blood volume, total peripheral resistance,
and the cardiac rate. These variables are regulated by a variety of negative feedback control
mechanisms to maintain homeostasis. Arterial pressure rises and falls as the heart goes through
systole and diastole. The force of blood on the wall of the arteries is known as blood pressure.
Blood pressure decreases as the heart relaxes, but the rest of the circulatory system is still under
pressure.
Definition of hypertension
person can be described as hypertensive if there is a constant systolic blood pressure above
pressure greater than 140mmHg and a diastolic blood pressure greater than 90mmHg based on
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average of two or more blood pressure readings taken during two or more contacts with the
Hypertension means the heart is working harder than normal, putting both the heart and blood
Blood pressure is the pressure exerted by the blood against the walls of the blood vessel
It varies with the strength of the heartbeat, the elasticity of the arterial walls, the volume and
viscosity of the blood and the individual’s health, age and physical condition.
In the elderly, it is defined as the persistent elevation of blood pressure above160mmHg and
diastolic blood pressure above 90mmHg. It is usually called the silent killer because it is
asymptomatic and a major public health concern. Two factors determine blood pressure:
pressure
Aldosterone release
Incidence
Between 20% and 25% of the adult population in the United States has hypertension (Hinkle
and Cheever, 2010). According to Hinkle and Cheever (2010), hypertension is more severe
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and prevalent in blacks than in whites by a ratio of 2:1 approximately, 14% of the worlds’
urban areas than in rural areas, it tends to affect women over 55years of age. It is also common
in the second trimester of pregnancy. Recent studies have revealed that condition is increasing
among teenagers. In Ghana, a study by Professor Albert Amoah shows that, 1 out of 4
Ghanaians aged more than 35years have hypertension (Report on Hospital Community survey,
In Ghana the incidence on hypertension was rated at 4.28 percent per 1000 reported cases of
diseases in the She was under constant observation and two hourly B.P monitoring.
Preparation of patient and family for discharge commenced on the first day of admission as it
was communicated to them that, the hospital was just a temporary place to keep patient and
Table one below Hinkle and Cheever, (2010), classifies blood Pressure as
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Types Of Hypertension
According to Pimenta and Oparil (2010), there are three major types of hypertension
These are:
1. Primary Hypertension
2. Secondary Hypertension
3. Malignant Hypertension
1. Primary hypertension:
The primary is also called essential or idiopathic hypertension. The term is used
accelerated or malignant state. It is the most common type of hypertension and accounts for
90 - 95% of all cases of hypertension. Although the exact cause of the type of hypertension is
A. Diet
A diet high in sodium (Na+) and saturated fat increases the risk of developing hypertension. A
high intake of sodium such as salt increases blood pressure. Also, intake of high levels of
saturated fatty diet narrows the lumen of the blood vessels due to the formation of atheroma in
B. Alcohol
Excessive intake of alcohol increases both cardiac output and sympathetic activity which
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C. Smoking of Tobacco/Cigarette.
Nicotine in tobacco or cigarette have a vasoconstrictive property and this does cause acute
D. Obesity
Weight above desirable levels places extra burden on the heart as it (produces an increase in
the number of smooth muscle cells and a collection of lipids within the intima medium and
large –sized arteries) eventually narrows the Lumina thereby resulting in reduced blood flow
at the distal end of the Artery while pressure is an increased at the proximal end. This process
E. Sedentary lifestyle.
Physical in activity decreases high density lipoproteins, the collateral circulation and vessel
size and increases total cholesterol level, glucose intolerance and body weight. This increase
F. Aging
High blood pressure rises progressively with increasing age .This is because, the number of
collagen fibers in the artery and arterioles walls increases overtime making blood vessels
stiffer. With the reduced elasticity comes a cross - sectional area in systolic and so a raised
G. Family History.
Studies have shown that hypertension is familial thus; persons who are related to hypertensive
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H. Race
High blood pressure occurs two to three times more in blacks than in whites, especially at
I. Stress.
For instances ,emotional stress triggers the release of fatty acids, glucose and clots promoters
into the blood stream ,when they tend to such in those rips and stick ,helping to form a plaque
.This plaque causes vessels obstruction and structural alteration leading to increased blood
pressure. Also, there is vascular response to sympathetic activation during stress and it is
typically associated with cardiac output which causes an elevation in blood pressure.
J. Sex.
In young adults, hypertension is common among men than women but from age fifty five years
2. Secondary Hypertension.
a. Renal Disorders
rennin. Subsequently; retention of sodium and water, along with vasoconstriction results in
b. Cardiovascular Disorders.
For instance, coarctation of the aorta leads to increase pressure in the blood vessels and may
result in hypertension. This usually occurs when the posterior wall of the aorta is thickened
c. Endocrine Disorders.
Elevated level of adrenal cortical hormones can result in blood pressure. Glucorticoid result in
high blood pressure .Both glucocorticoid (cortisol) and these mineral corticoid (aldosterone)
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promote sodium and water retention by the kidney resulting in elevated blood pressure.
Examples of conditions that produce excess of these hormones are primary aldosterone and
d. Neurologic Disorders
Neurologic disorders such as brain tumors and head injuries put pressure on the posterior
Increase levels of catechol amines cause an increase in cardiac output which may result in
e. Pregnancy
In pregnancy there may also be pregnancy induced hypertension. This usually occurs when
f. Medication.
Medication such as nervous stimulant oral contraceptive, steroids pills and synthetics in high
3. Malignant Hypertension.
It is a severe form of hypertension which usually occurs as a result of poorly controlled blood
pressure. Malignant hypertension is defined as severe hypertension that occurs along with
internal bleeding of the retina in both eyes and swelling of optic nerves behind the retinas. It is
about four times more common in blacks than whites and occurring more in men than in
women. It is especially common in people under 40 years and those of a lower socio-economic
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class. Malignant hypertension is a medical emergency and if left untreated can lead to serious
organ damage or can become rapidly fatal, sometimes even death in three to six month.
Like high blood pressure in general, the exact cause of malignant hypertension is not
completely understood. The details of how malignant hypertension starts have been an essential
research topic for many years, and whiles the complete picture is emerging, we do know some
Younger patients are at higher risk than older patients, which is the opposite of the risk
Anyone with a history of kidney failure or a disease called renal artery stenosis
In conclusion, malignant hypertension and the serious nature of the disease, however, make it
an important problem.
Pathophysiology
the control of vascular tone and sodium and water balance. The overall control of blood
pressure is based on the sympathetic nervous system and the renal rennin-angiotensin system
with cardiac output and peripheral vascular resistance serving as the primary regulatory factor
may lead to an increase in blood pressure. Where there is a decreased blood supply to the
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kidney such as in renal artery stenosis or condition that alters renal function or failure of any
kind, there is resultant retention of sodium and water through the production of aldosterone
by the kidneys. Also the kidneys release rennin which stimulate angiotensinogen (it is
adrenalin is secreted by the tumor cells or other conditions that increase intracranial pressure
where pressure on the hypothalamus, medulla and nerve pathways resulting in the production
blood pressure hence hypertension. There is also decreased supply of blood to the brain due
to the constriction of the blood vessels which intend leads to mental confusion, headache and
Hypertension mostly occurs without symptoms, yet can be profoundly damaging to the blood
vessels of major organ systems including the brain, heart and kidneys.
In early phases, few pathologic changes can be found in the structure of the blood vessels
over time, however chronically elevated blood pressure causes widespread pathologic
changes that interfere with effective blood flow especially to the vital organs. Most important
shearing forces from the elevated blood pressure caused by the excess production of
catecholamine damage the intimal layer of the blood vessels, leading to increase fibrin
accumulation and vessels edema. Both the large and small arteries in the body may become
atherosclerotic, tortuous and weak. These changes also narrow the lumen of the blood vessels
thereby decreasing blood flow to the organ or tissue supplied. As the damage progresses, the
vessel can become occluded or even rupture, causing an abrupt cessation of blood flow to the
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area. Finally, the pathophysiologic changes decrease local auto-regulatory control of blood
flow, as the vessel are less able to control and dilate in response to tissue needs. These greatly
increase the risk for coronary artery disease, cerebrovascular disease, renal artery and
Clinical Manifestations
According to Hinkle and Cheever (2010), hypertension is usually referred to as the “silent
1. Visual disturbances
2. Epistaxis
3. Dizziness
4. Palpitation
5. Fatigue
6. Body weakness
7. Memory loss
8. Chest pain
9. Dyspnoea
11. Seizures
12. Restlessness
14. Vomiting
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15. Coma
16. Haematuria
18. Headache
Complications
According to Hinkle and Cheever (2010), hypertension is not identified early for prompt and
various organs and structures which are dependent to the heart. The organs commonly affected
are;
1. Heart
2. Brain
3. Kidneys
4. Eyes
1.Heart
The excessive workload put on the heart as a result of hypertension makes the heart grow bigger
in size. This is to compensate for the demand put on it. Upon reaching it threshold it results to
conditions such as lift and right heart failure, myocardial infarction, angina pectoris and heart
failure.
2.Brain
cerebral aneurysms.
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3.Kidneys
The elevation of blood pressure caused by hypertension leads to thickening of the arteries. This
affects the blood vessels of the kidneys reducing blood flow through it. This causes loss of
4.Eyes
Continuous high blood pressure puts strain on the structures of the eyes. This produces changes
in arteries of the eye with damage to the retina and may lead to visual impairment.
Hypertension also changes the nature of the endothelium of blood vessels causing fatty
Diagnostic Investigations
the presence of disease in an individual suspected of having the disease, usually following the
1. Urinalysis to detect protein, red blood cells and white blood cells suggesting renal disease.
2. Blood chemistry (i.e. analysis of sodium, potassium, fasting glucose and total and high-
3. Electrocardiography (ECG) which may reveal left ventricular hypertrophy and also the
4. Chest x-ray, this demonstrates cardiomegaly. It may also reveal aortic aneurysm.
5. Excretory urography may reveal renal atrophy indicating chronic renal disease.
6. Monitoring of blood urea nitrogen (BUN and creatinine levels, whether normal or elevated
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7. Urinary catecholamine levels are used to diagnose pheochromacytoma.
Diagnostic Measures
1. Presenting signs and symptoms e.g. Palpitations, fatigue, peripheral edema etc.
2. Physical examination
Medical Management
According to Smeltzer & Bare (2010), the main objective of any treatment program selected
for individuals is to keep blood pressure within normal range. With the essential hypertension,
there is no specific care rendered but drug therapy, lifestyle modifications and dietary
Pharmacological Management
According to Hinkle and Cheever (2010), the general goal of pharmacological treatment of
hypertension is to reduce and maintain diastolic blood pressure less than 90mmHg and to keep
They include;
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1. Diuretics
i. Loop diuretics
Bumetanide (Bumex) 1 – 5 mg
Torsenide (Demadex)
Example: Amiloride (Midamor) 5 – 10mg daily, Triamterene 150 -250mg daily , Spiro lactone
(Aldactone)
iii.Thiazides
They act by diminishing the sympathetic reflexes that increases blood pressure. Some of the
types include;
They block the beta – adrenergic receptors of sympathetic nervous system decreasing heart rate
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Examples: Doxazosin (Cardura), Prazosin (Minipress), Herazosin (Hylrin).
(Aldomet)
3 .Vasodilators
Inhibits converting of angiotensin I to angiotensin II, thus blocking release of aldosterone and
reducing sodium and water retention. Examples: benazepril (lotensin), Captopril (captoten),
Inhibit influx of calcium into muscle cells, act on vascular smooth muscles to reduce spasms
Blocks the action of angiotensin, thereby relaxing muscle cells and also dilating blood vessels.
29
7. Benzodiazepines:
Works by facilitating the action of Gama amino butyric acid (GABA), an inhibitory
neurotransmitter in the central nervous system. This calms the brain and nerves. Eg
Diazepam.
Nursing Management
According to Kaplan (2010), the nursing care of hypertensive patients begin with reassurance
and explanation of the condition to the patient about the causes, prevention, predisposing
factors and side effects of drugs. Knowledge of the disease condition allays anxiety, thereby
reducing the high blood pressure. Nursing management focuses on diet, rest, observation
Reassurance
The patient is reassured that with the good nursing interventions, the blood pressure will fall
within normal range so far as she remains in the hospital. This is done to relax patient, win her
cooperation and confidence and also to relieve and prepare her psychologically for what to
expect
Position
Put patient in an upright position to ensure breathing and to expand the chest supported with
back rest and pillows. The patient may also assume a comfortable and more suitable position.
30
Rest and sleep
Ensure enough rest and sleep to enhance relaxation. Patient should be given warm baths, proper
ventilation, ensure that he is neatly laid and made free from creases, ensure that patient gets
Observation
Vital signs such as temperature, pulse, respiration and blood pressure should be monitored two
and take appropriate interventions accordingly. Patient is also observed for therapeutic effect
and side effect of drugs as well as the mental orientation of patient to time and place.
Monitoring of patient’s intake and output chart is done and balanced at the end of 24 hours.
Patient can also be observed closely for any stressful events psychological, financial and social
problems.
Personal hygiene
Patient may be assisted to take his or her bath twice daily or given a bed bath in order to remove
dirt, microbes and sweat from the skin, improve circulation for comfort and relaxation
The choice either depends on the severity of the patient’s conditions. Patient’s is also assisted
to wash hair to prevent hair infestation. Hands and feet must also be cared for in order to
prevent them from harboring microbes or injuring patient. Patient’s clothing must be changed
Nutrition
Patient is assisted to meet his nutritional requirement by eating a well – balanced diet that is
low in sodium and fat. Patient should be encouraged to take in vitamin supplement or fruits
31
and vegetables to boost the body’s immune system. Patient should therefore be involved in
planning diet and assisted to adopt the DASH eating plan (Dietary Approaches to Stop
Hypertension). Meals served should be presented attractively and given in small quantities at
regular intervals because the cardiac output tends to increase with the intake of large heavy
meals.
Exercise
Patient is encouraged and assisted if there is the need undertake either passive or active exercise
to his or her tolerance levels, in order to improve circulation and to prevent complications such
Assist patient to sit up in bed, walk around the bed and gradual turning in bed.
Elimination
Serve bed pan or assist patient to visit the toilet at patient’s request and urinals served when
necessary. When patient is unable to micturate, nursing measures such as opening for it to run,
applying cold compresses on the abdomen and catheterization carried out as ordered by the
doctor in the extent that all other measures taken to get patient to micturate fails.
The diagnosis of hypertension is usually unexpected and asymptomatic. Yet, once the diagnosis
is made, the patient is asked to modify meal patterns and food choices, adopt daily exercise
routine and adhere to the use of new medication with a variety of side effects.
The family and patient is educated on the risk factors, signs and symptoms and management of
hypertension.
They are advised to go for regular checkups and their blood pressure taken since hypertension
is hereditary.
32
Non – Pharmacological Management
o Dietary changes
o Lifestyle modifications
Dietary Changes
Lifestyle Modification
2. Regular exercise. Regular aerobic exercise such as jogging, walking and swimming can
help control blood pressure. It can cause about 10mmHg decrease in systolic blood
pressure.
33
Prevention of Hypertension
According to Hinkle and Cheever (2010), hypertension is a life threatening condition and as
such best to prevent its occurrence. A positive outlook towards health is reflected in the
individual’s lifestyle and habits. Health promotion focuses on educating the entire public to
Primary Prevention
Health education is the most ideal action taken in primary prevention of hypertension. These
thwart the habit or lifestyle of the general public as the causes and effects of hypertension
likewise how the environment becomes a risk factor in the promotion of the disease are taught.
1. Early identification of the condition and providing prompt and appropriate treatment. This
is done through regular screening of individuals to detect any abnormality and if present
3. Weight reduction
Secondary Prevention
This has to do with, prevention of complications of the conditions by using drugs. It can also
34
Tertiary Prevention
Tertiary Prevention involves rehabilitation which focuses on assisting the patient to live
Surgical Management
Surgical interventions may become necessary in the case of tumours (pheochromacytoma) and
sclerotic changes of the renal arteries which may be the cause of secondary hypertension. This
Prognosis
Prognosis of hypertension is good if one seeks early medical attention but may worsen if left
According to Weller (2009), validation is the extent to which a measure, indicator or a method
This is to ensure that the data is devoid of errors, relating the signs and symptoms presented by
Mrs. E.A. and the information gathered from her family history and lifestyle and laboratory
investigations carried out corresponds to the literature from selected textbooks confirm that
35
CHAPTER TWO
2.0 Introduction
According to Weller (2010), analysis is the study of a whole in terms of its parts.
It is the second phase of the nursing process and it involves the act of deducing fact or
information from data that has been gathered on the patient and his condition in order to arrive
at the needs of the patient and the problems hindering attainment of health and intervening
2. Patient/Family strength
3. Health problems
4. Nursing diagnosis
The results from laboratory investigation, history or signs and symptoms manifested by the
patient are carefully analyzed, comparing them with standard measures to aid in diagnosing the
patient ’s condition.
disease in an individual suspected of having the disease usually following the report of
36
1. Full Blood Count
2. Malaria parasite
4. Urinalysis
Table 1 below shows the Comparism of diagnostic tests carried out on Mrs. E.A with those
Review Patient
Urinalysis to detect protein, red blood cells and Urinalysis was done for patient
white blood cells suggesting renal disease.
Urinary catecholamine levels are used to was not carried out on patient
diagnose pheochromacytoma
Monitoring of blood urea nitrogen (BUN and was not carried out on patient
creatinine levels, whether normal or elevated
above 1.5mg/dl which suggest renal disease.
Excretory urography may reveal renal atrophy was not carried out on patient
indicating chronic renal disease.
Chest x-ray, this demonstrates cardiomegaly. It was not carried out on patient
may also reveal aortic aneurysm.
Electrocardiography (ECG) which may reveal was not carried out on patient
left ventricular hypertrophy and also the
electrical activity of the heart.
Blood chemistry (i.e. analysis of sodium, Fasting blood glucose was not ordered for
potassium, fasting glucose and total and high-
density lipoprotein) may be high indicating patient.
renal dysfunction.
37
Only one diagnostic investigation in the literature review was conducted on Mrs. E.A which
was urinalysis to help confirm the diagnosis and to rule out any complications.
The following tests however, were not pointed out in the literature review but were carried
Blood for Hemoglobin level estimation was requested and done to know the hemoglobin
level in the system so that if it is low and out of normal, it can be corrected with blood
transfusion. Patient Hemoglobin level was within normal range and there was no need for
transfusion.
Blood film for malaria parasites was also done to know if there were presences of malaria
parasites in her blood, so that treatment can be given, but she tested negative which showed
Details of the test carried out on patient have been presented in table 3
38
Table 3: Diagnostic Investigations Carried Out On Mrs. E.A
39
Table 3: Diagnostic Investigations Carried Out On Mrs. E.A
Red blood 4.6 x 10/l 3.9 -6.5 x 10/l No treatment was given
cell count Normal
40
Table 3: Diagnostic Investigations Carried Out On Mrs. E.A
Date Specimen Investigation Result Normal Values Interpretation Remarks
28/09/2018 Blood Blood urea 4.75 2.9 -8.2 mmol/l Within normal range No treatment ordered
28/09/2018 Blood Creatinine 92 41-133 umol/l Within normal range No treatment ordered
41
b. Causes of Patient’s condition
Considering the factors that cause hypertension as indicated in the literature review Mrs.
E.A’s condition is due stress may be a contributive factor since it triggers the sympathetic
nervous system to activate vascular response which is typically associated with cardiac output
and causes an elevation in blood pressure. Her condition can also be said to have been
associated with genetics. This is because her mother and late grandmother had already being
Comparison of clinical features exhibited by Patient with those listed in the literature review.
Exhibited
Review
140/90mmHg or more.
42
Clinical Features In Literature Clinical Features Exhibited By Patient.
Review
From the comparison in table 4 above, there is clear indication that the patient exhibited some
of the signs and symptoms listed in the literature review, which include, elevated blood
Epistaxis, visual disturbances, memory loss, chest pains, dyspnoea, peripheral oedema,
seizures, vomiting, weak peripheral pulse, heamaturia and coma because she reported earlier
to the hospital.
D. Treatment
Mrs. E.A was managed on the following drugs throughout admission;
43
Hydralazine hydrochloride (intra venous) 10mg stat
Table 5 below shows the treatment given to Patient compared with those in literature review
Table 5: Comparison of treatment outlined in literature review with those ordered for
Mrs. E.A
Adrenergic inhibiting agent like Prazosin Tablet Methyldopa 1g bd for 30 days was
ordered.
Angiotensin converting enzyme inhibitor like She was not given lisinopril
lisinopril
Calcium channel blockers like nifedepine Tablet Amlodipine 10mg daily x 30 was
prescribed
44
From the table above, it can be said that patient received most of the treatment for managing
Table 6, below shows the details of the pharmacology of drugs administered to my patient
45
Table 6: Pharmacology of Drugs Given To Mrs. E.A
Date Drug Dosage/route of Classification Desired effect Actual action observed Side effects /Remedies
administration
28/9/18 Tablet 5mg daily x 30 Thiazide diuretics Inhibits sodium High blood pressure Postural hypotension,
Bendroflumethi Oral reabsorption at the distal controlled from
hypernatremia, hypercalcaemia,
azide convoluted tubules. 160/110mmHg to
gout, impaired glucose tolerance,
Increasing the amount of 120/80mmHg as
urine, passed from the evidenced by the hourly impotence, fatigue.
kidneys. blood pressure chart
None was observed on patient
And dilates the vessels as
well.
08/8/16 Tablet 10mg daily × Calcium channel Dilates coronary and Patient’s blood pressure Dizziness, fatigue headache,
Amlodipine 30days oral blocker peripheral arteries reduced from
190/100mmhg to nervousness, peripheral oedema.
120/70mmHg.
None was observed on Patient.
46
Table 6: Pharmacology of Drugs Given To Mrs. E.A continued
Date Drug Dosage/route of Classification Desired effect Actual action observed Side effects /Remedies
administration
28/9/18 Tablet diazepam 10mg Benzodiazepines It induces a calming effect Patient was able to sleep, Drowsiness, fatigue and ataxia. None
daily(nocturnal) × on the thalamus and throughout the night. was observed on patient.
5 days oral hypothalamus
28/9/18 tablet 1g tid for 5 days Analgesic It suppresses production of Headache subsided Jaundice, nausea, loss of appetite,
Paracetamol oral prostaglandins by abdominal upset. None was observed
inactivation cyclooxygenase
thereby reducing pain
29/9/20 Soluble aspirin 75mg daily x 30 Analgesics It suppresses production of Headache subsided Abdominal pain, constipation
18 Oral prostaglandins by diarrhea, fluid retention. None was
observed.
inactivation
cyclooxygenase thereby
reducing pain.
28/9/18 Injection 10mg stat Vasodilator It relaxes and dilates the Patient’s blood pressure Body pain, nausea, shortness of
Hydralazine Intravenous blood vessels in the body, reduced from breath, vision changes , itching,
allowing blood to flow 190/100mmhg to numbness.
120/70mmHg
through the vessels more None was observed on Patient.
easily and at a lower
pressure.
47
Table 6: Pharmacology of Drugs Given To Mrs. E.A continued
Date Drug Dosage/route of Classification Desired effect Actual action observed Side effects /Remedies
administration
28/9/18 Tablet Losartan 100mg daily for Angiotensin Blocks the action of Patient’s blood pressure Body pain, nausea, shortness of
30 days receptor blockers angiotensin, thereby reduced from
breath, vision changes , itching,
orally relaxing muscle cells and 190/100mmhg to
120/70mmHg numbness.
also dilating blood vessels
None was observed on Patient.
28/9/18 tablet 1g bd for 30 Peripheral–acting Deplete catecholamine in Patient’s blood pressure Body pain, nausea, shortness of
methyldopa days peripheral sympathetic reduced from
breath, vision changes , itching,
adrenergic postganglionic fibers. 190/100mmhg to
120/70mmHg numbness.
Block norepinephrine
antagonist
release from adrenergic None was observed on Patient.
nerve endings
48
Complications
With reference to the complications indicated in the literature review such as myocardial
infarction, cerebrovascular accidents, renal failure, Mrs. E.A did not experience any
complication due to effective medical and nursing care rendered during hospitalization.
A patient and family strengths refers to the factors or activities that can be identified on
a patient irrespective of his/her illness that can help the nurse to plan an individualized
care for the patient. This involves the activities that contribute to the well-being of
The following strengths were observed on patient and family during the period of
admission;
3. Patient was able to voice her fears about unknown outcome of disease.
6. Patient and family were ready and willing to learn about the disease condition.
Weller (2010) defines problems as, any health care condition that requires diagnostic,
therapeutic, or educational action. It also refers, in nursing, to any unmet or partially met
basic human need. The patient/family’s problem means, the difficulties they faced
because of the disease condition .The following were the actual and potential health
problems identified with the patient during the period of hospitalization. They include ;
49
1. Patient complained of headache (28/09/2018)
The following nursing diagnoses were formulated for patient and her family;
(hospitalization) (29/09/2018)
50
CHAPTER THREE
3.0 Introduction
Planning is the third stage of the nursing process in which the nurse and the patient
together consider the goals to achieve in meeting the patient’s identified or potential
problems in daily life and produce an individual care plan. (Weller, 2009).
In planning, objectives are set and prioritized into short and long term goals. Goals set
are developed upon and a plan of care drawn to resolve the nursing diagnosis within the
The following objectives and outcome criteria was set for the patient;
5. Patient will be able to sleep uninterrupted for 6 hours in the night and at least 1
6. Patient will gain adequate knowledge on the disease condition within 24 hours
Table seven below shows the nursing care plan for Mrs. .E.A and family
51
Table 7: Nursing Care Plan for Mrs. E.A
Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
28/09/18 Acute pain Patient’s will be 1. Reassure patient her headache will 1. Patient reassured that all nursing01/10/18 Goal fully
subside with good care. procedures will be done to ease
11am (Headache) relieved of headache headache 11am met as
2. Assess patient’s level of pain 2. Patient’s level of pain was assess
related to within 72 hours as patient
using a pain rating scale from 0-10
distension of evidenced by; 3. Assist the patient to assume a 3. Patient assisted to lie in a semi – verbalized
comfortable position of her choice and prone position and encouraged to
the cerebral 1. Patient verbalizing encourage her to have enough rest. have enough rest to conserve energy. that she is
4. Apply cold compress on patient’s 4. Cold compresses applied to head
blood vessels that the headache has forehead. to relieve headache and patient relieved of
encouraged to rest.
associated been relieved. headache
5. Ensure quiet environment and dim 5. Quiet environment ensured by
with increased 2. Nurse observing environment. switching lowering the volume of
the television set in the ward and
vascular that the patient has a switching of the light .
6. Prepare a blood pressure chart for 5. Blood pressure chart prepared and
pressure. cheerful facial patient and blood pressure every 4hours blood pressure checked and recorded
and record. every 4hours.
expression
7. Serve prescribed analgesic and 7. Prescribed drugs served e.g.
antihypertensive drugs. Tablet Paracetamol 1g, tab.
Amlodipine 10mg.
52
Table 7: Nursing Care Plan for Mrs. E.A continued
Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
28/09/18 High risk for Patient will 1. Reassure patient that she will be 1. Patient reassured that she will be 03/10/18 Goal fully
demonstrate absence relieved of the dizziness with good relieved of the dizziness with good met as
11am injury related 8am
of injury throughout health care. health care. evidenced
to dizziness
hospitalization as 2. Elevate side rails 2. Side rails were elevated to prevent by patient
evidenced by fall. verbalizing
1.Patient verbalizing 3. Remove all source of injury from 3. All source of injury was removed absence of
absence of dizziness patient eg. needle i.e. sharps e.g. free needles dizziness
2.Nurse observing that 4. Ensure complete bed rest 4. Complete bed rest was ensured and nurse
patient demonstrates 5. Assist patient in self-care activities 5. Patient was assisted in self-care assessing
absence of injury. activities ie.bathing, mouth care that, patient
6. Serve prescribed antihypertensive 6. prescribed antihypertensive and demonstrate
and sedative and monitor patient for sedatives were served e.g. tablet s absence of
side effects of drugs on patient. diazepam 10mg and tablet injury
Nifedipine 20mg
And side effects of drugs was
monitored.
53
Table 7: Nursing Care Plan for Mrs. E.A continued
Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
28/09/18 Anxiety Patient will be relieved 1. Reassure patient about speedy 1.Patient was reassured that, with 29/09/18 Goals fully
recovery. their cooperation and compliance to
11:15am related to of anxiety within treatment regimen, the condition 11:15am met as
54
Table 7: Nursing Care Plan for Mrs. E.A continued
Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
28/09/18 Alteration Patient and will be 1. Reassure patient and relative that 1. Patient was reassured that 03/09/18 Goal fully
relieved of palpitation palpitations will stop with good nursing palpitations will stop with good met as
11:15am in body 8am
throughout care. nursing care. evidenced
comfort
hospitalization as 2.Ensure calm restful environment 2.Calm restful environment was by Patient
related to evidenced by ensured verbalizing
1.Patient verbalizing 3. Limit the number of visitors and 3. Number and length of visitors absence of
palpitations
absence of palpitations length of visit. was limited. palpitations
and 4.Maintain activity restriction during 4.Activity was restricted during and nursing
2.Nurse assessing that, crisis crises that the
Patient’s radial pulse 5.Ensure enough bed rest 5.Enough bed rest ensured radial pulse
reads within normal 6.Teach patient relaxing techniques 6. Patient was taught relaxation reads within
range(60-80bpm) techniques. the normal
7.Serve prescribed medications and 7. Prescribed antihypertensive, range (60-
monitor side effects of medications. sedatives etc. served and side 80bpm)
effects monitored.
55
Table 7: Nursing Care Plan for Mrs. E.A continued
Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
29/09/18 Sleep pattern Patient will be able to 1. Reassure patient that with good 1. Patient reassured that with good 01/10/18 Goal fully
sleep uninterrupted nursing care she will be able to sleep. nursing care she will be able to sleep. met as nurse
8am disturbance 8am
for 6 hours in the 2. Lay bed devoid of creases and 2. Bed laid devoid of creases and observing
(Insomnia)
night and at least 1 make patient comfortable in bed. patient made comfortable in bed. that patient
related to hour in the day within 3. Provide a noise free environment 3. Noise free environment provided has been
48 hours as by switching off nearby televisions able to sleep
change of
evidenced by; and restricting visitors. 6hours at
environment
1. Patient verbalizing 4. Provide proper ventilation. 4. Proper ventilation provided by night and
(hospitalization) that she can sleep opening nearby windows and 1hour in the
uninterrupted for 6 switching on fans. day and
hours at night and 1 5. Give warm bath and serve warm 5. Warm bath given and warm drinks patient
hour in the day. drinks served eg. Warm milo drink. verbalizing
2. Nurse observing 6. Serve prescribed drug E.g. tablet 6. Prescribed drugs or medication that she was
that patient can sleep paracetamol 1g, tablet diazepam, served e.g. tablet paracetamol 1g, able to
uninterrupted for 6 tablet amlodipine tablet diazepam, tablet amlodipine sleep.
hours in the night and
1 hour in the day.
56
Table 7: Nursing Care Plan for Mrs. E.A continued
Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
30/09/18 Knowledge Patient will gain 1. Reassure patient /family that with 1. Patient /family was reassured that 01/09/18 Goal fully
deficit related to detailed information they will have detailed information on met as
adequate knowledge
9am lack of understanding of hypertension hypertension will be given for 9am patient and
inadequate on the disease family give
better understanding.
information on correct
condition within 24 2. Schedule time with patient and 2. Time was scheduled with patient
causes, signs answers to
and symptoms hours as evidenced relatives to educate them on and relatives to educate them on questions
and prevention hypertension. hypertension. asked on
by;
of disease 3. Make patient comfortable by lying 3. Patient was made comfortable by hypertension
condition 1. Patient / family in bed whiles relatives and the lying in bed whiles relatives and correctly and
(hypertension) nurse sit by bedside. the nurse sit by bedside. .patient/
being able to answer
family
4. Assess patient and family 4. Patient and family knowledge on
some questions on verbalizing
knowledge level on hypertension hypertension was assessed. understandin
hypertension 5. Correct any misconception and 5. Accurate information on the g on the
correctly and provide accurate information on the predisposing causes, signs and information
predisposing causes, signs and symptoms, prevention, drug given them
2.Patient/family
symptoms, prevention, drug management and lifestyle
verbalizing management and lifestyle modification were provided to
understanding on the modification correct misconceptions
information given 6. Invite questions and answer them 6. Questions were invited and
tactfully. tactfully answered.
them.
7. Give patient pamphlets on 7. Pamphlets on hypertension were
hypertension to read given to patient
57
CHAPTER FOUR
4.0 Introduction
Implementing is the fourth stage in the nursing process. It gives a vivid account of the actual
nursing care given to the patient / family from the day of admission till his discharge based
on the health problems identified. It also deals with the home visits and follow-ups to ensure
continuity of care.
The actual nursing care rendered to patient and his family commence on the day of
admission, 28/09/2019 to the time care was terminated. The management of patient and her
family was planned to meet their physiological, psychological, emotional and spiritual needs.
Mrs. E.A was admitted to the females’ ward of the St. Theresah’s’ Hospital per ambulatory
nurse. They were warmly welcome and seat was offered. Patient’s folder was collected from
the OPD nurse and her name was mentioned to ascertain and confirm the identity of the
patient. Mrs. E.A was immediately made comfortable in an already prepared admission bed
in female’s ward with bed number FW-2 because she complained of dizziness. I introduced
myself and the staff around to the patient. Mrs. E.A’s particulars were documented into the
admission and discharge book and daily ward state. Upon assessment patient looked ill. She
also.
58
Her vital signs were checked and recorded as follows
Temperature - 36.9oc
Pulse - 84bpm
Respiration - 21cbm
SPO2 - 97%
Blood sample was taken, sample bottle labelled and sent to the laboratory for the
59
Drugs were immediately procured from the pharmacy department. An intravenous cannula
was established and due medication was administered as prescribed. Other medical orders
such as hourly blood pressure monitoring, complete bed rest and education of patient on
Patient was then orientated to ward and its environs such as the toilet, bath room and the
nurses station. They were also introduced to the other patients on the ward. Since the ward
didn’t not have a dining hall, patient was encouraged to eat by the bed side. She was also
told of the visiting hours of the hospital. Patient was encouraged to call home for them to
bring patient’s personal items that she may need at the ward such as towel, sponge, tooth
brush, toothpaste and bucket from the house. She was asked to talk to any of the nurses
After these interventions, I told the ward in-charge of my intention of using the patient and
the family for a case study and I was given the permission. I introduced myself to the patient
again that, I am a student nurse of Nurses’ Training College, Sampa, who was conducting a
care study at the hospital. I then made it known to Mrs. E.A of my desire to give her a
special nursing care for her speedy recovery. She was told that, as part of my training, final
year students are to take a patient each, nurse him or her from the time of admission till time
of discharge and home visits. Mrs. E.A accepted and promised her cooperation and readiness
to give me any information needed for my study. She was told that, she would be discharged
home once her condition was stable and that she were not going to be on the ward forever.
She was also informed that, as part of my care, I would visit their home whiles she was on
admission and after she has been discharged. I promised to keep the data that give out with
utmost confidentiality.
60
After the initial care rendered, patient was assessed intensely to identify her health problems in
At 11am, Mrs. E.A complain of headache. A nursing diagnosis of acute pain (Headache)
related to distension of the cerebral blood vessels associated with increased vascular pressure
was formulated. An objective was set to be met in 72 hours to ensure patient was relieved of
headache. The interventions carried out to achieve the goal set were; Patient was reassured
that all nursing procedures will be done to ease headache. Patient’s level of pain was assess
using a pain rating scale from 0-10. Patient was then assisted to lie in a semi –prone position
and encouraged to have enough rest to conserve energy. Also, cold compresses were applied
to her head to relieve headache and quiet environment ensured by switching lowering the
volume of the television set in the ward and switching off the light to provide a dim
environment. Blood pressure chart was prepared and blood pressure checked and recorded
every 4hours. Prescribed drugs served e.g. Tablet Paracetamol 1g, tab. Amlodipine 10mg, IV
hydralazine 10mg stat were administered and it’s therapeutic effects observed.
Also at 11am, patient complain of dizziness. A nursing diagnosis of high risk for injury
related to dizziness was formulated. An objective was set to ensure patient was free from
injury till she was discharged. Nursing orders carried out were; Patient was reassured that she
will be relieved of the dizziness with good health care been rendered. Side rails were elevated
to prevent fall and all source of injury was removed i.e. sharps e.g. free needles. Complete
bed rest was ensure and patient was assisted in self-care activities ie. Bathing, mouth care.
Prescribed antihypertensive and sedatives were served e.g. tablet diazepam 10mg and tablet
objective was set to help relieve patient of anxiety within 24hours. In order to achieve the
61
goal 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
and nursing procedures that were performed on the patient were explained to her to gain her
cooperation .Patient was then encouraged to ask questions about hypertension. Simple and
straight forward answers were provided to her questions promptly and tactfully. Other
patients recovering from the same condition were introduced to her. Physiological response
such as palpitations, headache, restlessness etc. was observed for the degree of fear and
Moreover, on the day on admission at 11:15am, Mrs. E.A complain of palpitations. Alteration
was set to ensure patient was relived of palpitations throughout the period of admission.
Nursing interventions carried out were; patient was reassured that palpitations will stop with
good nursing care. Calm restful environment was ensured. Number and length of visitors was
limited. Activity was restricted during crises as patient was encouraged to rest and relax. And
also enough bed rest ensured. Patient was taught relaxation techniques. Vital signs were
checked and recorded especially the value of pulse was noted and charted appropriately.
Temperature 35.7oc
Pulse 120
Respiration 28
B.P 180/90mmHg
SPO2 96%
62
Patient had yam and garden eggs stew for lunch.
During the visiting hours, patient was visited by her apprentices, who had brought her the
personal items she was going to need at home. Patient’s mother too came around to take care
of her. Her husband Mr. A.M.K also came to visit and brought along their son who had
closed from school. Mr. A.M.K brought her drinks and other items such as milo, bread and
milk. I introduced myself to patient’s mother and her husband. The husband and their son left
for home after the visiting hours, with her mother remaining behind to take care of her.
At 6pm, Mrs. E.A had banku with groundnut soup as supper. Vital signs was checked and
charted at 6pm. Due medications were served at 8pm. Patient was encouraged to have warm
Patient retired to bed at 10pm and she was duly handed over to night staff.
According to the night nurses patient had interrupted sleep pattern. This was confirmed by
patient herself, who said she could not sleep very well. Patient finally woke up at 5:30am. Her
personal hygiene activities such as brushing of her teeth, bathing, toileting and grooming were
all done in the morning without assistance. During the morning visiting time, patient was
visited by Mr. A.M.K (patient’s husband). Patient had bread and milo beverage as breakfast.
SPO2 99%
63
Morning medications included Tablet Losartan 100mg, Tablet Methyldopa 1g, Tablet
Bendroflumethiazide 5mg and Tablet Amlodipine 10mg were all served and the therapeutic
At 8am during interaction with patient, it was identified that patient had insomnia. A nursing
(hospitalization). An objective was set to help patient sleep well within 48 hours.
Interventions carried out were; Patient was reassured that with good nursing care she will be
able to sleep and bed was laid devoid of creases, cramps and patient was made comfortable in
bed. Noise free environment provided by switching off nearby televisions and restricting
visitors. Proper ventilation provided by opening nearby windows and switching on fans.
Warm bath given and warm drinks served eg. Warm milo drink. Prescribed drugs or
medication served e.g. tablet paracetamol 1g, tablet diazepam, tablet amlodipine and the side
At 9am, ward rounds was conducted by Dr. Adu Brobbey. Patient’s laboratory investigations
such as urinalysis, full blood count, BUE, creatinine and malaria parasite were all reviewed.
The results from the laboratory investigations were all normal. Patient still continue of
headache and dizziness. Patient was to continue her medications since patient’s blood
pressure had dwindled from 190/100mmHg to 130/90mmHg. Patient’s blood pressure was to
be monitored every four hourly. Vital signs was checked and recorded at 10am and recorded
accordingly.
Patient was encouraged to rest. At 11:15am, the objective set to ensure patient was relieved
of anxiety was evaluated. Goal was fully met as patient verbalised that she was no more
anxious about the prognosis of the disease. All other nursing interventions to ensure
64
Mrs. E.A’s headache subsided, free from dizziness, palpitations and was able to sleep well
Patient was fed with banku and okro soup in the afternoon. Patient was able to eat well. Vital
signs was checked and recorded at 2pm. Patient was encouraged to take a nap in the
afternoon.
Patient was fed with rice and tomato stew and egg. Patient took her bath and joined the other
patients at the ward who were watching “Kuch rang” on adom television. Vital signs were
checked and charted and medications were served at 10pm. She retired to bed afterwards.
On this day, patient woke up about 5:30am, brushed her teeth and took her bath and emptied
her bowel. Her bed was laid and the locker cleaned. Patient and the night nurse affirmed that
patient had a good night sleep with no complaints. Patient was visited by members of her
church during the morning visiting hours. They prayed for her. Mrs. E.A was happy they
visited her. Her vital signs were checked and recorded in the vital sign chart at 6:30am as;
Temperature 36.70c
Respiration 24cpm
After the vital signs, patient was served with breakfast which was corn porridge and bread.
Due medications such as Tablet Losartan 100mg, Tablet Methyldopa 1g, Tablet
Bendroflumethiazide 5mg and Tablet Amlodipine 10mg were all served and the therapeutic
65
Ward rounds was conducted by Dr. Adu. Tablet Diazepam 10mg nocte daily for 5 days,
Tablet Soluble Aspirin 75mg daily for 14 days were added to patient’s treatment plan. The
At 9am, during interaction with patient, it was realised patient had limited knowledge on her
information on causes, signs and symptoms and prevention of disease condition. An objective
was set to ensure patient had adequate knowledge on the disease condition within 24 hours.
Nursing orders carried out included Patient and family were reassured that detailed information
on hypertension will be given for better understanding. Time was scheduled with patient and
relatives to educate them on hypertension. Patient was then made comfortable by lying in bed
whiles relatives and the nurse sat by bedside. Patient and family knowledge on hypertension
was assessed. Accurate information on the predisposing causes, signs and symptoms,
hypertension were given to patient to ensure she is able to refer from it even when she is
discharged.
All other nursing interventions to ensure Mrs. E.A’s headache subsided, free from dizziness,
Vital signs was checked and recorded at 2pm. Tablet paracetamol 1g was also served at 2pm.
Patient had fufu with beef for lunch. Patient was able to eat well.
At 6pm, patient had rice and kontomire stew for supper. She was able to eat half of the food
served to her. Evening medications were then served and patient was encouraged to take her
evening bath. After that, vital signs were checked and recorded and tablet diazepam 10mg
66
Fourth day of admission (01/10/2018)
On the fourth day of admission, Mrs. A.O woke up at 5:20 am, performed oral hygiene and
took her bath. Patient looked very cheerful and relaxed. Patient did not lodged any complain.
Patient’s condition was good since the problems which were identified were all being worked
on so as to relieve her of all of them and possibly prevent complications from setting in.
SPO2 98%
Due medications served were Tablet Losartan 100mg, Tablet Methyldopa 1g, Tablet
Bendroflumethiazide 5mg, Tablet Soluble Aspirin 75mg and Tablet Amlodipine 10mg.
At 8am, goal set to ensure patient was able to sleep well was evaluated. Goal was fully met as
Mrs. E.A verbalised that she slept uninterrupted in the night and could now sleep at least 1
Also, patient assessed to evaluate the goal set to ensure patient had adequate knowledge on
disease condition. Goal was also fully met as Mrs. E.A was able to answer questions on the
Routine ward rounds was conducted by Dr. Adu. No new complains were lodged by patient.
67
After the ward rounds, patient was informed of my intention to visit her house the next day.
She readily accepted and gave me directions to her house. Patient claimed her house was very
At 11am, patient was assessed to evaluate the objective set to ensure patient was relieved of
headache. Goal was fully met as patient verbalised absence of headache. Vital signs was
monitored at 2pm and 10pm with no abnormalities and they were duly recorded. Patient took
fufu and groundnut soup as her supper. Evening medications were served and patient retired to
Mrs. E.A looked cheerful and relaxed than she did on admission. She maintained her personal
hygiene that is brushing her teeth and taking her bath. Patient groomed herself and changed
into a nice straight dress. Her bed linen were changed to make her comfortable.
Her vital signs checked at 6:00am were recorded in the nurse’s notes as follows:
Temperature -36.3oC
Her morning medications were charted and recorded on the medication sheet and its therapeutic
effects observed. Patient lodged no complain and had weanimix and bread for breakfast.
Ward rounds was conducted by Dr. Adu and patient was informed that if everything went well,
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At 11am, Mrs. E.A was informed that I was going to visit her house. She gave me the directions
to her house again and also gave me the phone number of her husband, Mr. A.M.K who she
said was at home. I left the hospital premises to visit the house at 11am.
At 12:30pm, I returned from the home visit. At 2pm her vital signs were checked and the
At 6pm, B.P checked and recorded was 120/80 mmHg. She was served with yam and fish
stew for supper. She was able to eat almost all the slices of yam served. She was encouraged
to watch television. Tablet Diazepam was served at 10pm and vital signs was checked na d
On the fourth day of her admission in the ward, Mrs. E.A woke up at around 5:50am looked
strong and very cheerful. She maintained her personal hygiene and took her breakfast. Mrs.
E.A groomed herself. Her bed was laid. Client lodged no complains during the night.
According to the night nurses, patient was able to sleep very well.
Her vital signs checked at 6:00am were recorded in the nurse’s notes as follows:
Temperature -36.3oC
She was served with white porridge and milk with bread as breakfast of which she was able
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At 8: 00am, the following medication were also served and recorded on the treatment sheet:
Tablet Losartan 100mg, Tablet Aspirin 75mg, Tablet Methyldopa 1g, Tablet
Bendroflumethiazide 5mg and Tablet Amlodipine 10mg. Patient verbalising her readiness to
be discharged.
At 8am Mrs. E.A was assessed to evaluate goals set to ensure patient was free from injury
due to dizziness and also palpitations. Goal was fully met as patient was free from injury and
At 9am, ward rounds was conducted by Dr. Adu and patient lodged no complain. Upon
review of patient’s blood pressure pattern by the medical doctor, patient was duly discharged.
Patient was to come for review after one week. She was discharged on the drugs that she was
already on at the hospital. Patient called his husband, Mr. A.M.K and informed him that she
had being discharged. Mr. A.M.K came to the ward after 5 minutes.
Mrs. A.O. was scheduled to come back for review on 10/10/ 2018 and was encouraged on the
need for the review. Patient was encouraged to report to the hospital earlier than the scheduled
review date if she feels the condition was relapsing. Arrangements were made with patient and
her family about my second home visit on the 07/10/ 2018.The doctor prepared and signed the
discharge summary. Patient’s date of discharge, diagnosis and state of his condition were
entered into the Admission and Discharge book and daily census sheet. I helped them to pack
their belongings. Mrs. E.A’s folder was sent to the accounts and billing office for clearance.
Since patient is holder of the national health insurance scheme, patient only had to pay 7ghc as
per the hospital’s policy. Patient and family thanked the staff and the student nurses on duty
for her quick recovery. They were then accompanied to the road side. They took a taxi and I
bade them goodbye. The bed linen was removed and discarded into a receptacle to be taken to
70
the laundry and the bed was disinfected as well as the side locker with a 0.5% bleach solution
Preparation of Mrs. E.A and her family for discharge and rehabilitation started on the first
day of admission. The primary aim was to enable him to take active role in her care for
speedy recovery and also to give him an insight into her condition. Emphasis was placed on
the need to visit the hospital immediately when illness occurs, so as to promote early
detection and treatment, to avoid complications. The patient and family were educated on the
following;
1. Diet
They were educated on the importance of a well-balanced diet. She was encouraged to continue
with low salt diet, fruits and adequate fluid intake to prevent constipation, and finally limit the
Patient and her family were educated to maintain good personal and environmental
cleanliness. He was advised on twice daily bath, washing of clothes frequently, proper
disposal of refuse, weeding around the compound, and also avoids stagnant waters around
their house.
Patient was educated on the need to continue with the low salt diets, avoid high intake of fatty
food, and avoid strenuous exercise. She was encouraged to continue with the active exercise at
home and also adapt the habit of taking more fruits. I also encouraged her not to take alcohol
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4. Stress Tolerance / Management.
Mrs. E.A was educated on the management of stress to reduce hypertension. She was advised
to prevent stressful situations and share problems with her husband. She was also made to
understand that, she could also contact someone she trusts for advice when she encounters any
Patient was advised to continue with the medication or treatment regimen as prescribed to
prevent relapse of the disease condition. The side effects of the drugs were explained to them.
She was told to visit the nearest clinic or report to hospital when symptoms reoccur and come
This is a visit to the patient’s home before and after discharge to find out the actual and
potential problems that contributed to the patient’s illness and also to find ways of solving
them. Assessment is also done to know his response to treatment after leaving the hospital.
Patient was pre informed of the decision to visit her house on the 01/09/2018. She gave me the
directions to her house. On 02/09/2018, the first home visit was made to patient’s house while
she was still on admission. The visit was to find out the actual and potential problems that
contributed to the patient’s illness and find ways of solving them before the patient was
discharged as well as factors that contribute to good health and also to validate data obtained
72
from patient and family. I set off from the hospital at 11am after informing patient. She gave
me the number of her husband, Mr. A.M.K who did not go to work that day.
I took a car to the point four junction, around the “masalachi” area. The house is about 5
minutes walk from the road. Patient’s house was easily located as she vividly described it. Mrs.
E.A’ house number is NDA-304. The house is a four room self-contain house with fence wall
around it. It has ornamental flowers grown around the house. The house is built of blocked and
roofed with iron sheets. There is fence around the around and the house is painted only in the
The house share boundaries with about three houses and none of them has a fence. I knocked
on the gate of the house and I was welcome by a voice which was that of Mr. A.M.K. He
warmly welcomed me and offered a seat. The reason for the visit was explained to him. He
said the wife had told him I will be visiting their house and as such he didn’t go to work to be
in the house to receive me. The house has four bed rooms, a hall, toilet, bathroom and a
kitchen. The house is occupied by two other people who are tenants. Even though the house
has access to pipe born water, Mrs. .EA. has a large barrel in which they temporarily store
water. The barrel had a well fitted lid. They also have a plastic rubber with well fitted lid in
which they keep their refuse. The method of refuse disposal is dumping which is used by the
entire community and it’s about 500metres away from their house. I educated him on water,
food and environmental hygiene to help them improve their health. I asked permission to enter
the room and it was given. It was realised that their room didn’t have mosquito net but was
well ventilated because it had enough windows. Mr. A.M.K was educated on the importance of
the usage of mosquito nets. Inquiry was made from Mr. A.M.K as to who always sweep the
house and it environ. Mr. A.M.K said because the other rooms are occupied by male tenants,
Mrs. E.A always sweep the whole compound. He was educated to take part of the cleaning of
the house and it’s environ when Mrs. E.A is discharged to ensure she has enough rest and is
73
able to recover well. After the interaction, I sought permission to leave and he saw me off. I
walked to the road side and boarded a taxi back to the hospital to continue care of patient.
On the 07/10/ 2018, the second home visit was made to Mrs. E.A’s home. The objective of the
visit was to assess the health status of the patient after discharge, to remind patient and family
of review date/day, to find out whether what I said during the first home visit had been put into
I got to the house at 3:30 pm and met Mrs. E.A alone in the house. I was welcomed and she
offered me a seat and I thanked her. She asked of my mission, and I said I was there to check
on her and assess her condition at home and to make sure she was taken her medications as
prescribed. When I inquired about Mr. A.M.K, Mrs. E. A. said her husband had gone to work
and will be home soon. I assessed her to find out if she was still experiencing dizziness,
headache or palpitations. Patient said she was not feeling any pain or dizziness. Because I
carried along an electronic blood pressure apparatus with me, her blood pressure was checked.
Blood pressure was 130/80mmHg. Her general condition was assessed. Mrs. E.A.’s condition
was fair and stable. Her medications were inspected and it was found that she had being taking
her drugs as prescribed. Patient was then congratulated and she was encouraged to take the
remaining medications as prescribed. She was advised to take rest adequately and also dietary
advice was given to her. Patient encouraged to limit the amount of salt she takes. I reminded
her again on also the review date as scheduled on 10/10/2018. Mrs. E.A. promised to come for
review as scheduled. Mrs. E.A., she will be handed over to a community health nurse during
the next visit for continuity of care. After chatting for about thirty minutes, I sought permission
74
Review day(10/10/2018)
On day of review, 10/10/2018, patient came to the hospital alone. She reported around 9:15am.
She looked cheerful and had relaxed facial expression. Patient said she went to her shop to
Mrs. E.A was assisted to collect her folder and her vital signs were checked and recorded as
Pulse-76bpm
Respiration-20cpm
B.P.-130/70mmHg
Patient was then accompanied to see medical officer for review. On examination and
interaction with the doctor, the patient made no complains. She was encouraged to finish her
medications as prescribed. Tablet Amlodipine 10mg for 30 days, Tablet Losartan 100mg for
30 days, Tablet Methyldopa 1g for 30 days and Tablet Bendroflumethiazide 2.5mg daily for
30 days were all prescribed for patient. Patient was to check her blood pressure every two
weeks and to adhere to dietary management. She was encouraged to avoid stressful
situations, eating fatty diet, taking alcoholic beverages and too much salt, and also avoid
After the review, patient was escorted to the road side to pick a car home. She was reminded
of the next home visit. She was told that she will be handed over to a community health nurse
and care with her and the family will be duly terminated.
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Third home visit (14/10/2018)
Mrs. E.A was visited for the last time on the 14/10/2018. The aim if the visit was to terminate
care with my patient and family and also to handover to a community health nurse for the
At 11am, I went to the public health unit of the Ghana health service. I informed their
incharge of my aim. She allocated to me a community health nurse, Mrs. Falilatu, who is the
community health nurse who oversee the area where patient lives. We left for the home of
Mrs. E.A. At 11:30am, we arrived at the home of Mrs. E.A. This time Mr. A.M.K was home.
We were welcomed and seats were offered. The mission for the visit was asked. They were
told then aim for the visit was to handover Mrs. E.A to community health nurse for continuity
of care and to terminate care. Patient’s drug were inspected to identify if she was duly taking
them as prescribed. Mrs. E.A had no complains upon assessment. Her blood pressure read
130/80mmHg. Since it was the last visit, highlight on the various health education given
already was stressed. They were grateful and promised to adhere to the education. Mr. A.M.K
thanked me profusely for the care rendered to his wife from the period of admission to this
day. I therefore introduce the community health nurse to patient and family. She told them
that she will be paying them home visit and she will be continuing the health care which was
been rendered. I used this opportunity to thank them for giving me the chance to use them for
the patient and family care study. After the interaction, we bade them goodbye and they
76
CHAPTER FIVE
5.0 Introduction
effectiveness of patient care activities in bringing about a change in the patient’s position. .
(Weller, 2009).
This chapter gives information about the statement of evaluation, amendment of nursing
goals and the termination of care rendered to the patient and family. It is the final stage of
nursing process.
During the admission and hospitalization of Mrs. E.A, six (6) problems were identified and
objectives were set for them. The outcomes of the objectives set for the problems identified
are below:
On the day of admission at 11am, Mrs. E.A complain of headache. A nursing diagnosis of
acute pain (Headache) related to distension of the cerebral blood vessels associated with
increased vascular pressure was formulated. An objective was set to be met in 72 hours to
ensure patient was relieved of headache. The interventions carried out to achieve the goal set
were; Patient was reassured that all nursing procedures will be done to ease headache.
Patient’s level of pain was assess using a pain rating scale from 0-10. Patient was then
assisted to lie in a semi –prone position and encouraged to have enough rest to conserve
energy. Also, cold compresses were applied to her head to relieve headache and quiet
environment ensured by switching lowering the volume of the television set in the ward and
77
switching off the light to provide a dim environment. Blood pressure chart was prepared and
blood pressure checked and recorded every 4hours. Prescribed drugs served e.g. Tablet
Paracetamol 1g, tab. Amlodipine 10mg, IV hydralazine 10mg stat were administered and it’s
On the 01/10/2018, at 11am, patient was assessed to evaluate the objective set to ensure
patient was relieved of headache. Goal was fully met as patient verbalised absence of
headache.
Patient was relieved of dizziness and was injury free throughout period of
hospitalization.
Again on the 28/09/2018 at 11am, patient complain of dizziness. A nursing diagnosis of high
risk for injury related to dizziness was formulated. An objective was set to ensure patient was
free from injury till she was discharged. Nursing orders carried out were; Patient was
reassured that she will be relieved of the dizziness with good health care been rendered. Side
rails were elevated to prevent fall and all source of injury was removed i.e. sharps e.g. free
needles. Complete bed rest was ensure and patient was assisted in self-care activities i.e.
bathing, mouth care. Prescribed antihypertensive and sedatives were served e.g. tablet
diazepam 10mg and tablet Nifedipine 20mg and side effects of drugs was monitored.
On the day of (03/10/2018), at 8am Mrs. E.A was assessed to evaluate goals set to ensure
patient was free from injury due to dizziness. Goal was fully met as patient was free from
injury.
objective was set to help relieve patient of anxiety within 24hours. In order to achieve the
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goal 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
and nursing procedures that were performed on the patient were explained to her to gain her
cooperation .Patient was then encouraged to ask questions about hypertension. Simple and
straight forward answers were provided to her questions promptly and tactfully. Other
patients recovering from the same condition were introduced to her. Physiological response
such as palpitations, headache, restlessness etc. was observed for the degree of fear and
On the 29/09/2018, at 11:15am, the objective set to ensure patient was relieved of anxiety
was evaluated. Goal was fully met as patient verbalised that she was no more anxious about
Moreover, on the day on admission at 11:15am, Mrs. E.A complain of palpitations. Alteration
was set to ensure patient was relived of palpitations throughout the period of admission.
Nursing interventions carried out were; patient was reassured that palpitations will stop with
good nursing care. Calm restful environment was ensured. Number and length of visitors was
limited. Activity was restricted during crises as patient was encouraged to rest and relax. And
also enough bed rest ensured. Patient was taught relaxation techniques. Vital signs were
checked and recorded especially the value of pulse was noted and charted appropriately.
On the day of discharge, (03/10/2018) at 8am, Mrs. E.A was assessed to evaluate goals set to
ensure patient was free from palpitations. Goal was fully met as patient verbalised absence of
palpitations.
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Mrs. E.A regained her normal sleep pattern within 48 hours
On the 29/09/2018, at 8am during interaction with patient, it was identified that patient had
environment (hospitalization). An objective was set to help patient sleep well within 48
hours. Interventions carried out were; Patient was reassured that with good nursing care she
will be able to sleep and bed was laid devoid of creases, cramps and patient was made
comfortable in bed. Noise free environment provided by switching off nearby televisions and
restricting visitors. Proper ventilation provided by opening nearby windows and switching on
fans. Warm bath given and warm drinks served eg. Warm milo drink. Prescribed drugs or
medication served e.g. tablet paracetamol 1g, tablet diazepam, tablet amlodipine and the side
On the 01/10/2018, at 8am, goal set to ensure patient was able to sleep well was evaluated.
Goal was fully met as Mrs. E.A verbalised that she slept uninterrupted in the night and could
On the 30/09/2018, at 9am during interaction with patient, it was realised patient had limited
knowledge on her disease condition. Nursing diagnosis of knowledge deficit related to lack of
inadequate information on causes, signs and symptoms and prevention of disease condition. An
objective was set to ensure patient had adequate knowledge on the disease condition within 24
hours. Nursing orders carried out included Patient and family were reassured that detailed
information on hypertension will be given for better understanding. Time was scheduled with
patient and relatives to educate them on hypertension. Patient was then made comfortable by
lying in bed whiles relatives and the nurse sat by bedside. Patient and family knowledge on
hypertension was assessed. Accurate information on the predisposing causes, signs and
80
symptoms, prevention, drug management and lifestyle modification were provided to correct
hypertension were given to patient to ensure she is able to refer from it even when she is
discharged. On the 01/10/2018 at 8am, Also, patient assessed to evaluate the goal set to ensure
patient had adequate knowledge on disease condition. Goal was also fully met as Mrs. E.A was
able to answer questions on the causes, signs, symptoms and treatment plan for hypertension.
All the objectives set to help Mrs. E.A out of her health problems were met within the
stipulated times therefore there was no amendment to be done to the care plan originally
drawn. Due to the maximum cooperation by Mrs. E.A and her family, all objectives set
very difficult step to take after a good rapport has been established. Because of this, the
reality of termination of care has to be made known to both patient and family from the day
of admission.
The termination of Mrs. E.A care started on the first day of interaction with her and her
family on 28/09/2018. To avoid separation anxiety, they were told that, our relationship was a
therapeutic one and would last for a reasonable period. They were also told that I would not
be able to stay on the ward for 24 hours with them, hence the need for their co-operation with
other nurses and paramedical staff on the ward. They were therefore not surprised when they
were finally told about the termination of the care and my relationship with them on the
14/10/2018. On this day, I visited my patient and family in her house with a public health
81
nurse from the public health unit of the Ghana Health service for continuity of care. I
promised to visit them anytime I had the opportunity. I thanked them sincerely for their co-
operation. They in turn thanked me for the care rendered. Mrs. E.A was successfully handed
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CHAPTER SIX
6.0 Introduction
This is the last step of the patient/family care study which entails the student’s personal
appreciation of the therapeutic relationship with the patient as well as the use of the nursing
process.
6.1 Summary
Mrs. E.A, a 33 year old a hair dresser from Tom in Nkoranza was admitted to the female's
ward of the St. Theresa’s Hospital (Nkoranza) on 28/09/2018. Patient was diagnosed of
Hypertension and the various laboratory investigations and clinical features helped to confirm
the diagnosis. On observation and examination, she was conscious but complained of
headache, palpitations and dizziness. The following investigation/test were ordered and
carried out on Mrs. E.A.; blood for malaria parasites, blood for full blood count, urine for
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Throughout admission, six problems were identified and care plan drawn to solve it. They
Patient and family were educated on the causes of the disease as through increased vascular
resistance and increased cardiac output. The predisposing factors were also unfolded to him
The signs and symptoms as exhibited by patient were mentioned to him as well the
prevention of the disease (hypertension) through nutritious diet of low sodium, fats and
cholesterol.
Patient was also assisted in maintaining his personal hygiene (care of the mouth, hair, toe and
fingers nails and skin). Rest and sleep, elimination, nutrition, clothing and exercises were also
ensured and patient’s husband was encouraged to continue care at home after discharge. He
was encouraged to assist with the home chores to prevent excessive stress when patient was
discharged.
She responded to the treatment quickly and condition improved. Mrs. E.A. was nursed for a
On the 10/10/2018, patient reported for review as scheduled and Mrs. E.A.’s condition had
improved.
Follow up visits were made to assess the home situation, to find out the actual and potential
problems that contributed to the patient’s illness and also to find ways of solving them, find
out if patient was able to observe the drug regimen and to know her response to treatment
Moreover, to find out if patient and family is carrying out the advice and all education given
Patient care was terminated during the third home visit when it was realized that patient was
fully covered and was managing well with her condition. Mrs. E.A and her family were
84
handed over to the community health nurse for continuity of care. Care was terminated on the
14/10/2018.
6.2 Conclusion
The care rendered to Mrs. E.A. and her family has really helped me to gain a great
knowledge on hypertension after nursing him. It has also offered me a great opportunity to
know how to nurse individuals with hypertension. It has also helped me to practice my skills
To the patient and family, this care study has enabled me to render an individualized care to
them and has also help them to know the need to report to the hospital immediately they have
any changes in the normal functioning of any part of their body. It has deepened my
relationship with patients, families and the people in that community as a whole.
To the hospital, I recommend that all patients admitted to the hospital are to be nursed using
And to my institution, a copy of this care study will be kept in the college library to be used
It is my recommendation that all students are given the opportunity to embark on the
patient/family care study to implement the nursing process in order to render individualized
comprehensive care to patients and families. In brief, I really enjoyed every bit of writing this
As this care study is kept in the college library, it will be used for research purposes and
85
APPENDIX
Table 8: Vital signs chart for Mrs. E.A
Date Time Blood pressure Pulse Temperature Respiration
mmHg bpm oc cpm
28/09/18 11am 190/110 84 36.9 21
2pm 180/90 120 35.7 28
6pm 170/90 90 36.3 25
10pm 160/90 95 36.5 23
29/09/2018 6am 130/90 88 36.7 20
10am 140/90 85 35.9 21
2pm 150/100 90 36.0 22
6pm 140/90 85 36.1 24
10pm 150/80 82 35.9 22
30/09/2018 6am 150/90 87 36.7 24
10pm 140/80 80 36.1 21
2pm 160/100 82 35.9 22
6pm 140/80 79 36.0 18
10pm 130/80 90 35.9 23
01/10/2018 6am 150/90 78 35.7 20
10pm 130/80 78 36.7 22
2pm 120/90 85 36 21
6pm 130/80 79 35.9 22
10pm 140/70 84 36.9 24
02/10/18 6am 120/90 80 36.3 20
10am 130/70 79 36.8 23
2pm 110/70 82 36.0 21
6pm 120/80 78 35.9 24
10pm 130/75 82 35.7 22
03/10/18 6am 120/90 80 36.3 20
10/10/18 9:15am 130/70 76 36.7 76
86
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Kumar, P. J., and Clark, M. L., (2011).Kumar and Clark clinical medicine, Edinburgh;
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Marilyn E., Mary F.M., & Alice C.M., (2012), Nursing care plans guidelines for
individualizing patient care across the life span, 8th edition, F.A Davis
Company. Philadelphia
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Waugh, A. and Grant, A. (2010).Ross and Wilson Anatomy and Physiology in Health and
Weller, F.B. (2009).Bailliere’s Nurses’ Dictionary for Nurses and Health Workers.
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