PATIENT / FAMILY CARE STUDY

(A NURSING PROCESS APPROACH)

ON

MRS. N.F

WITH

PEPTIC ULCER DISEASE

PRESENTED

BY:

ABDULLAH ABDUL AZIZ

(7220170004)

A FINAL YEAR STUDENT OF NURSING AND

MIDWIFERY TRAINING COLLEGE,

DUNKWA-ON-OFFIN

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA

IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF

REGISTERED GENERAL NURSING CERTIFICATE

SEPTEMBER, 2020

21
 TABLE OF CONTENT
CONTENT
PAGES
Table of content i
List of tables iv
Preface
v
Acknowledgement vi
Introduction vii

CHAPTER ONE
1.0 Assessment of patient and family 1
1.1 Patient’s particulars 1
1.2 Family’s medical history 2
1.3 Family socio-economic history 2
1.4 patient’s developmental history 3
1.5 Patient lifestyle and hobbies 3
1.6 Past medical history 4
1.7 Present medical history 4
1.8 Admission of patient 5
1.9 Patient’s concept of illness 6
1.10 Literature review of disease condition 7
1.11Validation of data 19

CHAPTER TWO
2.0 Analysis of data 20
2.1 Comparison of data with standards 20
2.2 Diagnostic Investigation 20
2.3 Causes of patients condition 26
2.4 Clinical features exhibited by patient 26
2.5 Treatment 27
2.6 Complication 36
2.7 Patient and family problems 36
2.8 Patient and family strength 36
22
2.9 Nursing diagnosis 37

CHAPTER THREE
3.0 Planning for patient and family care plan 38
3.1 Objective and outcome criteria 38
3.2 Nursing care plan 41

CHAPTER FOUR
4.0 Implementation patient and family care 57
4.1 Summary of actual nursing care rendered to patient and family 57
4.2 Preparation of patient and family towards discharge and rehabilitation 64
4.3 Follow up/home visit/ continuity of care 65

CHAPTER FIVE
5.0 Evaluation of care rendered to patient and family 68
5.1 Statement of evaluation 68
5.2 Amendment of nursing care plan partially met or unmet outcome criteria 70
5.3 Termination of care 70
5.4 Summary of care rendered to patient and family 71
5.5 Conclusion of patient/family care 72
Bibliography 73

23
 LIST OF TABLES
TABLE 1:
Diagnostic investigation 22
TABLE 2:
Comparison of patient’s clinical features with those in literature review 26
TABLE 3:
Pharmacology of drugs 28
TABLE 4:
Nursing care plan 41

APPENDICES
Bibliography 73
Signatories 74

24
 PREFACE

The patient/family care study is a complete and detailed written report of the nursing

care rendered to a patient and his/her family chosen by the student nurse and nursed

over a specified period of time.

The patient/family care study helps the final year student nurses to apply the

knowledge acquired in their study areas such as Psychiatry, medicine, surgery, public

health, obstetrics, and paediatrics nursing to give effective care to a patient/family.

The study also helps the student nurse to deliver holistic care to patients by nursing

each and every patient as an individual. It helps the student nurse to acquire more

knowledge into disease conditions, their presentations and how they are treated.

The study forms part of the final assessment of the student nurse at the end of the

three(3) years training programme before the Registered General Nurses Diploma

Certificate is awarded to him/her by the Nursing and Midwifery Council (NMC) of

Ghana.

The patient/family care study also serves as a means to establish effective

nurse/patient relationship and a way of collaborating with other health care team

members.

25
 ACKNOWLEDGEMENTS

I wish to express my sincere gratitude first and foremost to Almighty God for granting

me the grace, strength, wisdom and direction throughout the writing of this care study.

Without Him nothing could have been achieved.

My sincere thanks go to Mrs. N.F and her family for their co-operation and for

providing me with all the requisite information during the interactions with them

which contributed immensely to the success of this care study.

I am grateful to the Physician Assistance, Nurse-in-charge, nursing staff of the

Female’s Ward of Dunkwa-on-offin Municipal hospital, who in diverse ways assisted,

taught and corrected me in the writing of this script.

I also wish to express my profound gratitude to the principal Mr. David Benjamin

Sampson and the entire staff of the Nursing and Midwifery Training College, Dunkwa

for their advice especially to my supervisor Madam. Evelyn Amoakoaa Aidoo, whose

encouragement and guidance helped me throughout the writing of this study.

Finally, I acknowledge the authors and publishers of the literatures used as references

for the care study.

26
 INTRODUCTION

Patient care is part of a nurse’s role. Nurses use the nursing process to assess, plan,

implement and evaluate patient care. Patient care is founded in critical thinking and

caring in a holistic framework. Nursing care is increasingly framed in best practice,

which is the application of evidenced-based concepts to patient problems in a

particular setting.

For purpose of confidentiality, the patient of this care study will be known as Mrs.

N.F. Permission was sorted from Mrs, N.F and her family for them to be used as the

subject of this study.

This care study is about Mrs. N.F, a sixty year old woman and her family with a

diagnose of Peptic Ulcer Disease. The interaction with Mrs. N.F and her family

started on the 7th of October, 2019 during the admission process at Dunkwa Municipal

Hospital where she was admitted to the Female’s Ward.

During admission patient looked anxious and also had abdominal pain, general body

weakness, anorexia and heartburns. A care plan was drawn and appropriate nursing

orders implemented to ensure speedy recovery of patient. With the cooperation and

support from patient, her family and other health care givers at the Female’s Ward,

Mrs. N.F’s condition gradually improved. Subsequently, she was discharged on the

11th of October, 2019.

At the time of discharge Mrs. N.F looked cheerful. Patient and her family were very

happy that her condition had improved.

During the care of the patient, home visits were made during and after admission.

This study has been organized under five (5) chapters:

 Chapter one (1) is the Assessment of the patient/family which include patient’s

particulars, her family’s medical and socio-economic history, patient’s

27
 developmental history, etc. Literature review on the disease condition and

validation of data.

 Chapter two (2) deals with Analysis of data collected which covers

comparison of data with standards, patient/family strengths, patient’s health

problems, nursing diagnoses.

 Chapter three (3) deals with planning for patient/family care, Nursing

objectives/outcome criteria and Nursing care plan for patient/family.

 Chapter four (4) consists of Implementing of patient/family care plan which

include a summary of Actual Nursing Care, preparation of patient/family for

discharge and rehabilitation and follow-up / home visits / continuity of care.

 Chapter five (5) deals with Evaluation of care of the client/family, summary,

conclusion and Bibliography.

 There are also tables which show laboratory investigations and their results,

the pharmacology of drugs the client was managed on, and care plan used in

nursing the patient/family

28
 CHAPTER ONE

1.0 ASSESSMENT OF PATIENT AND FAMILY

This is the first phase of the nursing process and consists of the systematic and orderly

collection and analysis of the data pertaining to and about the health status of the

patient for the purpose of making a nursing diagnosis. Assessment, serves as a

foundation on which the other steps are built upon. It is vital to the nursing process

and is the basis for all the other stages in the process.

A holistic view during the assessment phase ensures that the biological,

psychological, social and spiritual spheres of the individual are considered. It focuses

on the patient’s developmental history, lifestyle, hobbies, past and present medical

history. The patient is the primary source of data but the families, health records

among others also serve as a means of data collection. Data collected may be

classified as subjective or objective.

1.1 Patient’s Particulars

Patient’s particulars include the collection of basic data about patient, these include

her name, age, occupation, marital status, and other basic essential information.

Mrs. N.F. a sixty (60) years old, born on 07th October, 1959, lives at Dunkwa -

Oponsu and comes from Mampong- Akuapim in the Eastern region of Ghana. She is

an Akuapim. Her next of Kin is her firstborn, Mrs. D.N. She is a Christian. Mrs. N.F

stopped schooling after form one (1) because of lack of financial support. Presently

she is a farmer at Dunkwa.

Mrs. N.F is the second child born out of eight children to her parents; she is dark in

complexion, weighs about 70kg and about 4 feet tall. She is physically healthy with

29
no deformity. She is not registered with National Health Insurance Scheme (NHIS).

She is a Ghanaian by birth and speaks Asante twi, akuapim twi and krobo language.

She is married to Mr. K.F and they are blessed with TEN (10) children; FIVE (5)

males and FIVE (5) female who are all alive and well.

1.2 Family Medical History

According to patient, there are no hereditary disease such as sickle cell disease,

hypertension and diabetes mellitus in the families of both parents. Also there is no

known history of communicable diseases like leprosy and tuberculosis as well as

chronic diseases such as asthma and epilepsy. They do not have any food or drug

allergy among the family members. The family member occasionally experience

minor illness such as headache, diarrhea and bodily pains which they usually resort to

over- the -counter drugs or medical care at any hospital for treatment.

1.3 Family Socio – Economic History

This is an essential data which can lead to an accurate diagnosis especially when it’s a

family disease. This history can also provide a clue to their standard of living, average

income, nutritional and other practices that can predispose her to her present

condition.

Mrs. N.F is a farmer and also gets financial support from her husband. She is not

insured with the National Health Insurance that caters for part or whole of her hospital

bills when she seeks medical care. Mrs. N.F lives at Dunkwa -Oponsu, her family can

be described to belong to the middle class in the society. Mrs. N.F does not belong to

any social group such as funeral groups but attend social gathering such as funerals,

weddings, naming ceremonies, birthday parties of friends and Church members.

30
1.4 Patient’s Developmental History

Patient’s mother told her that she was going about her normal duties when she

experienced labor and was rushed to a nearby house of a traditional birth attendant,

where she delivered spontaneously. She was born with no congenital defects such as

cleft palate or lip, hydrocephalus or jaundice etc. She was not immunized against any

of the childhood killer diseases such as poliomyelitis tuberculosis, measles, whooping

cough and others

According to patient’s mother, she was breastfed alongside complementary foods

provided by the family in the house. She went through the developmental milestones

successfully and, she was weaned at age two and started sitting without support by the

sixth month. She began to crawl at the eighth month and started walking at the

fifteenth month (one year and three months) with talking ability at year two of birth.

Mrs. N.F commenced her education at age six. She did not complete her basic

education but she left school at form one (1) due to financial problems. She joined her

parents in farming activities.

She indicated that she saw her menarche when she was 15years. At that time her

breast had already matured. She got marriage at the age of 25years.

According to Eric Erickson’s psychosocial stages of normal development, Mrs. N.F

falls under Generativity verse Stagnation.

1.5 Patient’s Lifestyle and Hobbies

Mrs. N.F is a very active woman, vibrant, full of energy, and ready to work hard to

support her family. Like all human beings she also experience life uncertainties. She

31
usually wakes up around 6am, and have a short prayer. She brushes her teeth once

daily with toothbrush and a tooth paste and sometimes chew chewing stick during the

day. She takes her bath twice daily and eliminates her bowel once a day.

She claimed that breakfast was not a regular meal but often combined with lunch. She

leaves for work around 7:00am or about 7:30am and usually comes back around

4:00pm. During weekends she normally attends funerals and weddings if any, and go

to church on Sundays. Her hobbies are cooking, keeping the house tidy and listening

to radio. Her favourite food is fufu with groundnut soup. She doesn’t drink alcohol or

smokes cigarrate / marijuana . She usually sleeps around 7:30pm.

1.6 Patient Past Medical History

According to her, she has not been admitted before and hardly does she hardly goes to

the hospital. When she gets sick she mostly goes to the pharmacy shop to get

medication for management. She mostly suffers from minor ailments such as

headache, fever, nausea, vomiting, common cold, and abdominal upset. According to

Mrs. N.F, she had no history of chronic and mental disorders such as diabetes,

hypertension.

1.7 Present Medical History

Patient was at her usual state of health until early October, 2019 when she started

having severe abdominal and dull epigastric pains, which she did not pay much

attention to until Monday morning, 07 th October, 2019, about 08:50am when it

became severe. She was also experiencing general body weakness and episodes of

vomiting. She was then rushed to the Dunkwa Municipal Hospital for treatment. At

32
the Out Patient Department, P.A. N. Aboagyewaa attended to her and assessed that

she had abdominal pain, which has no relieving factors and vomitus was creamy.

Patient also had anorexia. She was not coughing neither did she had dyspnoea and

dysuria. Patient complained of heartburns. P.A. Aboagyewaa finally diagnosed her

illness of peptic ulcer disease based on the signs and symptoms she presented and she

was admitted to the female’s ward, bed number 9. Patient was put on Intravenous

Metronidazole, Intravenous Ciprofloxacin, Intravenous Dextrose saline, Injection

Buscopan, Syrup Megacid and Tablet Paracetamol.

1.8 Admission of Patient

On 07th October, 2019 at 9:30am, patient was admitted to the females’ ward of the

Dunkwa Municipal Hospital from the Out Patient Department under the care of P. A.

N. Aboagyewaa. She came in the company of a member of the admission team and

her son. Patient was brought in ambulant and was conscious, alert and well oriented to

time, place and person despite the illness. Patient and her relative were welcomed to

the ward. Patient was given a bed immediately since she was in pain and could not

stand for long. Self-introduction was done to her and her son, and she was also

introduced to other nurses on the ward as well as patient on admission. Patient’s

folder was taken and her name was mentioned to confirm all the information to be

entered into the admission and discharge book.

Patient’s son was also orientated to the ward environment, the daily routine on the

ward and the time for visiting were made known to her. He was informed of the items

patient will need while on the ward. Patient’s relative was reassured and encouraged

to be supportive by showing care and love. Patient’s vital signs on admission were;

Temperature: ………………………………………… 37.0° degrees Celsius (ºC)

33
Pulse: …………………………………………………. 68 beat per minute (bpm)

Respiratory rate: ………………………………………. 18 Cycle per minute (cpm)

Blood pressure: …………………………… 130/80 millimetre of mercury (mmHg)

The relatives were then asked to bid her goodbye and come later in the day. The

prescribed drugs by the physician included:

• Intravenous metronidazole 500mg tds x 48 hours

• Intravenous ciprofloxacin 200mg bd x 48 hours

• Intravenous dextrose saline 2 liters x 48 hours

• Injection buscopan 40mg bd x 24 hours

• Syrup megacid 15ml tds x 5 days

• Tablet paracetamol 1g tds x 5 days

• Capsule Prilosec 20mg bd x 72 hours

The following diagnostic investigations were ordered and carried out on Mrs. N.F:

• Full blood count to rule out for infection

• Blood film to rule out the presence of malaria parasite

• Blood for fasting blood sugar

1.9 Patient’s Concept of Illness

Patient was not clear as to the exact cause of her illness but believes falling sick is

part of struggles of life and did not attribute her sickness to any spiritual forces. She

added that she has confidence in the health workers and hopes everything will be

alright and expressed her willingness to comply with the care that will be rendered to

her to aid recovery alongside with prayers.

34
1.10 Literature Review on Peptic Ulcer Disease (PUD)

Peptic ulcer disease involves a break in continuity of the esophageal, gastric or

duodenal mucosa. It may occur in any part of the gastrointestinal tract that comes into

contact with gastric juices. The ulcer may be found in the esophagus, stomach,

duodenum and jejunum.

Types

There are four (4) types of peptic ulcer disease. These are;

1. Gastric ulcer

2. Duodenal ulcer.

3. Esophageal ulcer.

4. Stress ulcer.

Gastric ulcers, which tend to heal within few weeks, form within 1 inch of the pylorus

of the stomach in an area of gastritis. Gastric ulcers are probably caused by a break in

the ‘mucosal barrier.’ Decreased blood flow to the gastric mucosa may also alter the

defensive barrier and may make the duodenum more susceptible to gastric acid and

pepsin trauma. The recurrence rate in gastric ulcer is lower than in duodenal ulcer.

Duodenal ulcers, which have a higher incidence than gastric ulcers, usually occur

within 1.5cm of the pylorus. They are usually characterized by high gastric acid

secretion. Patients with duodenal ulcers have more rapid gastric emptying. Combined

with hypersecretion of acid, rapid emptying of food from the stomach reduces the

buffering effect of food results in large acid load in the duodenum. Within the

duodenum, inhibitory mechanisms and pancreatic secretion may be insufficient to

control the acid load.

35
Esophageal ulcer occurs as a result of backward flow of HCL from the stomach into

the esophagus.

Stress ulcer is the term given to the acute ulceration of the duodenal or gastric area

after physiological or stressful event. There are six major assaults which can give rise

to gastroduodenal ulcerations, these are,

1. Severe trauma or major illness

2. Severe burns

3. Head injury or intracranial disease

4. Drug ingestion e.g. aspirin and alcohol that acts on the gastric mucosa

5. Shock

6. Sepsis

Incidence

It occurs frequently before ages of 40-60 years. It is common in males than females. It

occurs in approximately 10% of the population. Gastric ulcers are more likely to

occur during the fifth and sixth decades of life, duodenal ulcers more common during

the fourth and fifth decades for men.

36
Aetiology

No single cause has been found, however, it is clear that an ulcer is the end result of

imbalance between digestive fluid in the stomach and duodenum. Below are some of

the risk factors/ predisposing factors;

The bacteria Helicobacter pylori infection is the most cause.

1. Hypersecretion of gastric juice.

2. Inflammation of the mucosal lining of the stomach as in gastritis and trauma.

3. Hereditary.

4. Excessive intake of alcohol.

5. Prolonged use of certain drugs (NSAID’S) as aspirin, cortisone.

6. Aging.

7. Excessive secretion of histamine.

8. Individuals with blood group A and O.

9. Stress.

10. Bile reflux.

11. Anxiety.

12. Emotional tension.

13. Highly spicy diet.

14. Certain illness like pancreatitis, hepatic disease etc.

15. Trauma like extensive burns, shock or intracranial surgery.

37
Pathophysiology

Adrenocorticosteroids may increase the susceptibility of the mucosa, or they may

reduce the rate of renewal of mucosal cells and the formation of granulation tissue.

When patient undergo stress reactions, the sympathetic nervous system causes the

blood vessels in the duodenum to constrict, which makes the mucosa more vulnerable

to trauma from gastric acid and pepsin secretion. On activation of the adrenal cortex,

mucus production decreases, and gastric secretion increases. Together, these factors

result in an increased vulnerability of the patient to ulceration. Prolonged stress from

burns, severe trauma and so forth can produce ‘stress ulcers,’ or stress erosion

gastritis, within the gastrointestinal tract.

An infection with H. pylori may contribute to ulceration and may affect persons who

have history of chronic gastritis.

Certain medication may contribute to gastroduodenal ulceration by altering gastric

secretion, producing localized damage to mucosa, interfering with the reparative

process, delaying the healing process. Anti-inflammatory agents, aspirin, caffeine,

chemotherapeutic agent and alcohol are related to mucosal damage.

Zollinger- Ellison syndrome is a condition characterized by abnormal secretion of

gastrin by a rare islet cell tumor in the pancreas. Pathophysiologic changes associated

with this syndrome include hypergastrinemia and diarrhea secondary to fat

malabsorption from decreased duodenum- inactivation pancreatic lipase or from acid

induced injury of the villi. Besides gastric secretion, there is hyperplasia of the gastric

mucosa induced by the trophic effects of gastrin. Treatment of this disease is aimed at

suppression of acid secretion.

38
Clinical Features

1. Epigastric pain experienced after taken meals.

2. Loss of appetite.

3. Loss of weight.

4. Haematemesis.

5. Malena stools.

6. Bloating and abdominal fullness.

7. Heart burns.

8. Nausea and vomiting.

9. Weakness.

10. Insomnia.

39
 The Differences And Similarities Between Gastric And Duodenal Ulcers

Gastric Ulcer Duodenal Ulcer

• Burning or gaseous pressure • Burning , cramping pressure-

in high epigastrium and back like pain across mid

and upper abdomen epigastrium and upper

abdomen

• Pain occurs half to an hour • Pain occurs two to three hours

after meal after meal

• Food increases the pain • Food relieves the pain

• Pain do not often occur in • Pain awakes client from sleep

sleep usually in the middle of the

night 1-2am

• There is weight loss • There is increase in weight

• Vomiting is common • Vomiting is uncommon

• Malignancy occurs • Malignancy do not occur

occasionally

• There is haematemesis • There is melaena stool

• Less likely to perforate • More likely to perforate

• There is diarrhea or • There is diarrhea or

constipation and flatulence constipation and flatulence

• Heartburns • Heartburns

• Abdominal tenderness • Abdominal tenderness

Diagnostic Investigations

40
1. Physical examination may reveal pain or tenderness or abdominal distension.

2. Endoscopy may reveal the presence of ulcers.

3. Barium meal or swallowing may reveal the presence of ulcer.

4. Biopsy to rule out cancer of the stomach or duodenum.

5. Gastric secretion analysis or studies.

6. Lab analysis of stool may reveal occult blood in stool.

7. Stool antigen test and urea breath test is done to isolate the bacteria Helicobacter

pylori.

8. Stool for routine examination.

9. Plain x-ray of the abdomen reveals abnormalities in the mucosa.

10. Full blood count.

Medical Management

1. Nasogastric tube is passed to allow for lavage which controls bleeding by

constricting the blood vessels.

2. Antacids example sodium carbonate is given to neutralize hydrochloric acid.

3. Antibiotics example Metronidazole is given to prevent further infection.

4. Histamine receptor antagonist example cimetidine is given to reduce gastric

secretion.

5. Sedatives example diazepam may also be given to reduce stress.

41
6. Analgesics example paracetamol is given to relieve pain.

Surgical Management

Surgery is indicated for perforation suspected cancer and other complications,

depending on the site and extent of the disorder. Surgical procedures adopted include;

1. Bilateral vagotomy: This is the division or incision of the vagual nerve that

stimulate the acid secreting cell which supply the stomach and duodenum. It’s an

operation of choice for most duodenal ulcers.

2. Pyloroplasty.

3. Gastrectomy: It can be sub-total or partial. In this procedure a portion of the

stomach including the area of ulcer and part of the parietal cells are removed. Subtotal

gastrectomy involves partial removal of the stomach.

Total gastrectomy is the removal of the stomach, with anastomosis of the esophagus

to the jejunum.

4. Billroth I: In this procedure a part of a part the distal portion of the stomach is

removed including the antrum. The remainder of the stomach is anastomosed to the

duodenum. This combined procedure is more properly called gastroduodenostomy. It

decreases the incidence of dumping syndrome, which often occurs after Billroth II

procedure.

5. Billroth II: In this procedure resection involves reanastomosis of the proximal

jejunum. Pancreatic secretions and bile continue to be secreted into the duodenum

even after gastrectomy. Because these secretions are necessary for digestion, a route

42
to the intestine must preserved them. Recurrent ulceration develops less frequently

with this procedure.

Nursing Management

Reassurance

Patient with peptic ulcer disease become scared at their illness and diagnostic

procedures that are associated with the condition. Patient and relatives are assured that

necessary nursing care would be provided to allay his/her fear and anxiety.

Position

Patient is made to assume a comfortable position which is not contraindicated to

his/her health, example supine position. This helps the patient to relax and reduce pain

since muscle spasm is reduced and pressure and tension are redistributed on the other

body parts.

The patient is positioned with care to prevent neck and join stiffness.

Rest and Sleep

A calm and quiet environment is provided for patient to rest, conserve energy and aid

in his/her healing process. Beds are made free from creases. Warm bath is given in

order to relax the patient and to induce sleep.

Warm drinks may also be served. Good ventilation is also ensured and bright is also

put off to induce sleep.

43
Observation

Vital signs such as temperature, pulse, respiration and blood pressure are monitored

four (4) hourly to assess whether condition is improving or deteriorating. Mental

orientation is assessed to know whether patient is oriented to time, place, people and

space.

The desired effects and side effects of drugs served are also observed. Fluid intake

and output chart is maintained to know the patient’s fluid and electrolyte status. The

site of intravenous cannulas is also assessed, if it is dripping through the veins or

surrounding tissues.

Patient’s ability to perform her personal hygiene needs is also observed. All findings

are documented.

Personal Hygiene

Patient is given assisted bathroom bath twice daily to prevent offensive odour and to

remove dirt from the skin. The bed linens are changed when dirty or wet to prevent

bad odour and infections like decubitus ulcer. Mouth care is done once daily to

prevent harboring of microbes.

This is done to prevent oral infection. Patient’s hands and feet are cared for by

soaking them in water and trimming nails with nail clippers as well as washing and

brushing of the hand and feet to prevent harboring of microbes and causing injury to

patient.

44
Nutrition

Prescribed intravenous infusions are monitored to ensure that it is dripping at the

prescribed rate. This helps provide calories for the patient and also rehydrates her. As

condition improves light nourishing balanced diet is given to provide energy and

improve patient’s immunity.

Patient is involved in planning her meal. Meals are served attractively and in bits to

stimulate appetite. Irritating foods like alcohol, spices and pepper must be avoided

since they aggravate pain. Patient is also advised to eat slowly and chew food

thoroughly to reduce mucosal irritations. Patient is also given snacks between meals

to prevent total gastric emptying which causes pain.

Exercises

Patient is engaged in mild to moderate exercises example flexion and extension of

limbs to prevent joint stiffness, muscle wasting, thrombosis and contractures. It also

helps to improve circulating and peristalsis.

These exercises are carried out at least every 6 hours for 5 minute

Health Education

Patient and relatives are educated on the causes, signs and symptoms, prevention and

complication of patient’s condition, in order to gain an insight the condition and for

them to be involved in the care. The education includes the following;

• Patient is informed to seek medical treatment when having any form of re-

occurring epigastric pain.

• Patient and family are advised to adopt regular and good eating habits.

• Patient is advised on the need to follow drug regimen as directed by physician.

45
 • Patient is also educated on the need for review and medical check-ups.

• Patient is educated on the need to have a well-balanced diet containing

carbohydrate to provide energy, protein to repair worn out tissues and aid the

healing process, vitamins to improve immunity, adequate intake of fluids to

flush the system of toxins and roughage to prevent constipation.

Complications

1. Hemorrhage.

2. Pyloric obstruction.

3. Intractable ulcer.

4. Perforation.

5. Gastric outlet obstruction.

6. Shock.

7. Peritonitis.

8. Severe anemia.

1.11 Validation of Data

Information provided by patient on present condition presents with almost all of the

features indicated in the literature of the condition such as the signs and symptoms of

the condition. All examinations conducted confirm the condition of patient and are

also stated in literature and therefore makes data collected valid.

46
 CHAPTER TWO

2.0 ANALYSIS OF DATA

This is the second phase of the nursing process. It deals with breaking down of

information gathered through assessment into small components and putting the parts

together in order to plan for the patient/family care. It also involves the comparison of

the results of the investigation carried out with the normal values to identify any

abnormality, clinical features, treatment, and patient and family strength, problems

and corresponding nursing diagnoses. It enables the nurse to updates herself with

these problems and how best to help solve them.

2.1 Comparison of Data with Standards

Data collected from diagnostic investigations; causes of patient’s condition, clinical

features, treatment and complications are compared with standards from the literature

review.

2.2 Diagnostic Investigations/Tests

The following diagnostic investigations were ordered and carried out on Mrs. N.F

• Full blood count to rule out the presence of infection.

• Blood film to rule out the presence of malaria parasite.

• Blood for fasting blood sugar

47
 Table 1: Diagnostic Investigations Of Mrs. N.F

Date Specimen Investigations Result Normal Values Interpretations Remarks

07/10/19 Blood Full blood count:

Haemoglobin level 14.98g/l 14- 17g/l Normal indicating No treatment

estimation blood level is normal was given

White blood cell Normal indicating No treatment

5.7 x 109/L 5.0-10.0 x 103/L
absence of infection was given

Haematocrit 47.2% 40.2%- 57.0%

Results are with
No treatment
normal range
was

Given

22
Table 1: Diagnostic Investigations Of Mrs. N.F Cont’d

Differential

white blood

cells: 4.0 2.0- 7.5 Within normal No treatment

Neutrophils range was given

39.5% 24%-40% No treatment

Lymphocytes Normal was given

0.4 x 109L 0.2-0.8 x0.4 x No treatment

Monocytes 109L Within normal was given

0.28 x 109L range No treatment

Eosinophils 0.04-0.44 x109L was given

Within normal

range

23
24
Table 1: Diagnostic Investigations Of Mrs. N.F Cont’d

Basophils 0.08 x 109L 0.01 x 109L Within normal No treatment

range was given

Platelet count 288(103/uL) 150-400(103/uL) No treatment

Within normal was given

Red blood cells 4.8x106/L 4.5-5.5x106/L range No treatment

was given

Normal indicating

no development

MCV 80fL 78-98fL of anaemia No treatment

was given

Within normal

MCH 30pg 27-32pg range No treatment

was given

25
 Within normal

range

07/10/19 Blood Malaria Parasite No parasite seen Negative No malaria No treatment

(absence) of was given

malaria parasite

07/10/19 Blood Fasting Blood 6.8 mmol/l 4- 7mmol/l Normal glucose No treatment

Sugar level was given

26
2.3 Causes of Patient’s Condition

With references to the literature review on the causes of peptic ulcer disease and the

diagnostic investigations carried out on Mrs. N.F, the exact cause of her condition could

be poor dietary habit and stress.

2.4 Clinical Features Exhibited By Patient

Some of the signs and symptoms revealed in the literature review was exhibited

by patient. Below is a table that shows the comparison of the clinical features

exhibited by patient and those in the literature.

Table 2: Comparison of Clinical Features In Literature To Clinical Features

Exhibited By Patient

Clinical Features Outlined In The Clinical Features Exhibited By The Patient

Literature Review

1. Epigastric pain 1. Patient experienced epigastric pain.

2.Loss of appetite 2. Patient experience anorexia.

3. Loss of weight 3. Patient maintained weight.

4.Haematemesis 4. Patient did not experience Haematemesis.

5. Melena 5. Patient did not experience Melena.

6.Repeated episode of gastrointestinal 6. Gastrointestinal bleeding was not

bleeding experienced by patient.

7.Heartburns 7. Patient experienced heartburns.

8. Nausea and vomiting 8. Patient experienced nausea and vomiting.

9. Weakness 9. Patient experienced general body

27
 weakness.

10. Insomnia 10. Patient did not experience insomnia.

As indicated in the table above, Mrs. N.F exhibited about 50% of the clinical features

listed in the literature review.

2.5 Treatment

Peptic ulcer disease may be treated surgically or medically. Mrs. N.F was treated

medically with the aim of relieving pain and preventing the occurrence of the attacks.

The following drugs were used in the treatment of her condition:

• Intravenous Metronidazole 500mg tds x 48 hours

• Intravenous Ciprofloxacin 200mg bd x 48 hours

• Intravenous Dextrose Saline 2 liters x 48 hours

• Injection Buscopan40mg bd x 24 hours

• Syrup Magacid 15ml tds x 5 days

• Tablet Paracetamol1g tds x 5 days

• Capsule Omeprazole 20mg bd x 72 hours

28
 Table 3: Pharmacology Of Drugs Administered To Mrs. N.F.

Date Drug Dosage/Route Of Dosage Given Class Of Mechanism Of Actual Side Effect

Administration In To Patient Drug Action Action

Literature Observed

07/10/1 Intravenous Adult dose: 500mg tds x 48 Amoebicide It inhibit nucleic acid Patient did not Headache

9 Metronidazole 500mg tds x 48 hours hours synthesis by have any Nausea and

(flagyl) Child dose: intravenously interrupting the DNA infections vomiting

It depends on the weight of the microbial cells Dizziness,

Route: Abdominal,

Intravenous cramps

Polyuria,

None of these

was observed in

the patient.

29
 Pharmacology Of Drugs Administered To Mrs. N.F. Continues

Date Drug Dosage/Route Of Dosage Class Of Drug Mechanism Of Actual Side Effect

Administration In Given To Action Action

Literature Patient Observed

07/10/1 Intravenous Adult dose 400mg bd x 2 Ciprofloxacin is To inhibit the Infection More common

9 Ciprofloxacin IV 200mg-400mg (bd or tds x days a member of the enzymes required was Diarrhea.

7- 14 days) intravenously fluoroquinolone for bacterial DNA combated. Rare

Oral 250mg-500mg bd x 3 class of replication, Bloody or black

days- 14 days antibacterial transcription, tarry stool,

Paediatric dosage agents. repair and chills,

IV 6mg/kg-10mg/kg (tds x recombination Fever,

10-21 days). Maximum confusion

400mg per dose; not to exceed None was

even in patients weighing > observed with

51kg. patient.

Oral 10mg/kg-20mg/kg bd x

10-21 days

30
(Maximum 750mg per dose;

not to exceed even in patients

weighing > 51kg.

Route :Intravenous, oral

31
 Pharmacology Of Drugs Administered To Mrs. N.F. Continues

Date Drug Dosage/Route Of Dosage Given Class Of Drug Mechanism Of Actual Side Effect

Administration In To Patient Action Action

Literature Observed

07/10/1 Intravenous Adult dose: 2000 ml x 48 Isotonic infusion To improve glucose Fluid and Nausea,

9 Dextrose hours status and maintain Vomiting, Fluid

variable electrolyte
Saline fluid and electrolyte overload,
Intravenously balance were
Pediatric dose:
balance Osmotic diuresis,
improved and
Variable
maintained. Hyperglycaemia.

Route
None was

Intravenous observed

32
 Pharmacology Of Drugs Administered To Mrs. N.F. Continues

Date Drug Dosage/Route Of Administration Dosage Class Of Drug Mechanism Of Actual Side Effect

In Literature Given To Action Action

Patient Observed

07/09/19 Injection Adult dosage 40mg bd x 24 Antispasmodics To relieve Relieved Tachycardia,

Hyoscine 20mg IM, dilute required dose to hours smooth muscle patient’s skin reactions,

Butylbromide 10ml with normal saline or 5% intramuscular. spasms in the flank pain. dyspnoea, dry

(Buscopan) dextrose for IV, repeated after half stomach, mouth,

an hour if necessary. intestine, bladder urinary

Maximum daily dose 100mg. and urethra. retention.

Paediatric dosage None was

IV 0.5mg/kg observed with

Route patient.

Intramuscular, Intravenous, oral.

33
 Pharmacology Of Drugs Administered To Mrs. N.F. Continues

Date Drug Dosage/Route Of Dosage Class Of Drug Mechanism Of Actual Side Effect

Administration In Given To Action Action

Literature Patient Observed

07/10/1 Antacid Adult: 15ml tds × 5 Antacid It neutralizes acid Patient was Rebound

9 Syrup 15ml – 20ml three times days orally in the stomach and relieved of acidity.

(Magacid) daily for 7 days also help protect gastric Alkalosis.

Child dose: the mucosa of the discomfort. Constipation.

5ml – 10ml three times stomach and Diarrhea.

daily for 7 days duodenum from

Route: ulceration. Patient did not

Oral experience any

of the side

effects.

34
 Pharmacology Of Drugs Administered To Mrs N.F. Continues

Date Drug Dosage/Route Of Dosage Class Of Drug Mechanism Of Actual Action Side Effect

Administration In Given To Action Observed

Literature Patient

07/10/1 Tablet Adult dose: 1g tds x 5 Non – narcotic It produces anti- Patient was Headache,

9 Acetaminophe 500mg – 1000mg/1g three days oral Antipyretics inflammatory, relieved of nausea,

n times daily for 5 days analgesic and pain and her dizziness,

(Paracetamol) Child dose: antipyretic effects temperature vomiting.

250mg – 500mg twice or by inhibiting was normal. None was

three times daily for 5 prostaglandin observed in

days. synthesis. patient.

Route:

Oral

35
 Pharmacology Of Drugs Administered To Mrs N.F. Continues

Date Drug Dosage/Route Of Dosage Class Of Drug Mechanism Of Actual Side Effect

Administration In Given To Action Action

Literature Patient Observed

08/10/1 Capsule Adult dose: 20mg bd x Antiulcer-proton Reduction of gastric Patient was Liver damage.

9 Prilosec 20mg – 40mg daily or 72 hours pump inhibitor acid production. It relieved of Skin rash.

(Omeprazole) twice daily for 4 – 8 orally (Antimuscarinic) inhibit gastric acid gastric Hypoglycemia.

weeks. by blocking the discomfort Jaundice.

Child dose: hydrogen potassium

Variable adenosine Patient did not

Route: triphospjhate experience any

Oral and intravenous enzyme of the of these.

gastric [parietal cell

36
2.6 Complications

With reference to the complications in the literature review, patient did not exhibit any

complications due to the effective nursing care given.

2.7 Patient and Family Health Problems

From the data collected on the patient and clinical manifestation presented by the following

health problems were identified.

1. Patient experienced pain in the epigastric region.

2. Patient experienced general body weakness.

3. Patient experienced nausea and vomiting.

4. Patient had loss of appetite.

5. Patient experienced heartburns.

6. Patient and family had inadequate knowledge on peptic ulcer disease.

7. Patient was anxious.

2.8 Patient and Family Strength

1. Patient could tolerate oral analgesics to relieve pain.

2. Patient could verbalize her weakness.

3. Patient could tolerate sips of water.

4. Patient could tolerate oral care to improve appetite.

5. Patient could tolerate antacid to relieve heartburns.

36
 6. Patient and family were willing to be educated.

7. Patient had the ability to communicate effectively on her fears and anxiety.

2.9 Nursing Diagnosis

 Alteration in body comfort (epigastric pain) related to erosion of the stomach mucosa.

 Activity intolerance related to body weakness.

 Risk for fluid volume deficit related to excessive loss of fluid associated with vomiting.

 Alteration in nutrition (less than body requirement) related to anorexia.

 Alteration in body comfort (pyrosis) related to gastric reflux

 Knowledge deficit related to inadequate information on the causes of Peptic Ulcer

Disease and its management.

 Anxiety related to hospitalization.

37
 CHAPTER THREE

3.0 PLANNING FOR PATIENT AND FAMILY CARE

Planning for patient and family care involves a care plan stating the objectives/outcome criteria

to provide adequate nursing care for patient and to help in the restoration of health. The

following are the components of a nursing care plan;

 Nursing Diagnosis

 Objective/Outcome Criteria

 Nursing Orders

 Nursing Interventions

 Evaluation of care

3.1 Objectives of Care

Objectives and outcome criteria are the expectations of patient’s condition after intervention of

patient’s problems.

The following objectives and outcome criteria were set for patient and her family:

1. Patient will state a reduction in the epigastric pain within 48 hours as evidenced by:

a. Nurse observes that patient feels calm and more relaxed in bed

b. Patient verbalizes that pain has subsided.

38
2. Patient will resume normal activities without complains of weakness within 3 days as

evidenced by;

a. The nurse observes that patient is going about her normal activities as expected of her without

complaints of weakness.

b. Patient verbalizes that she can perform her normal activities such as bathing, grooming and

caring for her mouth.

3. Patient will experience decrease in vomiting within 48 hours as evidenced by:

a. Nurse observes that patient has good skin turgor

b. Patient verbalizes that vomiting has subsided

4. Patient’s nutritional needs will be improved within 4days as evidenced by:

a. Nurse observes that patient eat food at regular intervals

b. Patient verbalizes that she can eat 2/3 of food served.

5. Patient will be relieved of pyrosis within 48 hours as evidenced by:

a. Nurse observes that patient is calm in bed with good facial expression.

b. Patient verbalizes that she has been relieved of pyrosis.

39
6. Patient will gain adequate knowledge onto the causes and management of peptic ulcer disease

within 24 hours as evidenced by:

a. Nurse observes that patient gives accurate feedback on the causes of peptic ulcer disease and

its management.

b. Patient verbalizes that she has accurate feedback on the causes of peptic ulcer disease and its

management.

7. Patient and her family’s level of anxiety and fear will be reduced in 24hours as evidenced by:

a. Nurse observes that patient is relaxed in bed with cheerful face.

b. Patient verbalizes that there is a reduction in level of fear and anxiety.

40
 3.2 Table 4: Nursing Care Plan For Mrs. N.F

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign

Time Diagnosis Outcome Time

Criteria

07/10/19 Alteration in Patient will a. Reassure patient. a. Patient was reassured that all 09/10/19 Goal fully met as

9:35am body state a reduction measures would be put in place to 7:30 am evidenced by;

comfort in the epigastric relieve her of the epigastric pain. This a. Nurse

(epigastric pain within 48 was done to gain her cooperation. observed that

pain) related hours as b. Assess the level b. Level and intensity of pain was patient felt more

to erosion of evidenced by: and intensity of the assessed using a pain rating scale of 1 relaxed and

the stomach a. Nurse pain -10 and was found to be 6. comfortable in

mucosa. observes that c. Put patient in a c. Patient was made comfortable in bed.

patient feels comfortable position. the supine position. This was done to b. Patient

calm and more reduce muscle spasms and tension verbalized that

relax in bed. and also to redistribute pressure on pain had

the body part to help reduce pain. subsided.

41
 Nursing Care Plan For Mrs. N.F

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ E

Time Diagnosis Outcome Time

Criteria

b. Patient d. Provide diversional d. The television was switched on for

verbalizes that therapy. her to watch to take her mind off the

pain has been pain.

subsided. e. Apply warm e. Warm compresses were put on

compresses on the patient abdomen to help dilate blood

abdomen vessels thereby reducing pain.

f. Serve prescribe f. Prescribed medication (inj.

analgesics and buscopan) severed to help reduce

antacids. pain.

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/

Time Diagnosis Outcome Criteria Time

07/10/19 Activity Patient will resume 1. Reassure Patient was reassured that she will 19/10/19

10:00am intolerance normal activities patient. be able to resume her normal daily 8:00am

related to without complains activities as measures would be put

body of weakness within in place to ensure early recovery.

weakness 3 days as evidenced

42
 by

a. Nurse observes 2. Ensure complete 2. A comfortable bed free from

that patient is going bed rest. creases and cramps was provided for

about her normal patient. Adequate bed rest was

activities as ensured to reduce energy demands

expected of her 3. Serve high 3. High caloric diet such as boiled

without complaints caloric diet yam and cabbage stew was served to

of weakness. patient to increase her energy level

Nursing Care Plan For Mrs. N.F

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ E

Time Diagnosis Outcome Criteria Time

b. Patient 4. Assist patient in 4. Patient was assisted in performing b

verbalizes that she performing daily daily activities such as bathing, v

can perform her activities. caring for the mouth and grooming. s

normal activities p

such as bathing, n

grooming and a

caring for her 5. Serve prescribe 5. Prescribed medication (tab. b

mouth. treatment. paracetamol) was served to relieve g

general body weakness. c

43
 Nursing Care Plan For Mrs. N.F

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/

Time Diagnosis Outcome Time

Criteria

07/10/ 19 Risk for fluid Patient will a. Reassure patient. a. Patient was reassured that all 09/10/19

11:30 am volume deficit experience measures would be put in place to 9:10am

related to decrease in decrease vomiting.

excessive loss vomiting within

b. Assess and report for b. Signs and symptoms of fluid
of fluid 48 hours as
signs and symptoms of volume deficit was assessed and
associated evidenced by:
fluid volume deficit. any deviations observed was also
with
a. Nurse reported.
vomiting.
observes that c. Implement measures c. Measures to prevent fluid

patient has good to prevent fluid volume volume deficit such as maintaining

skin turgor deficit fluid intake of at least 1000ml/day

was implemented to help prevent

dehydration.

Nursing Care Plan For Mrs. N.F

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/

Time Diagnosis Outcome Time

Criteria

44
 b. Patient d. Check and record vital d. Vital signs was checked and

verbalizes that signs. recorded to monitor progress of

vomiting has the condition.

subsided
e. Remove all nauseating e. All nauseating articles were

articles away from patient taken away from patient site to

site. prevent nausea and vomiting.

f. Monitor and record f. Patient input and output was

input and output and recorded and balanced every 24

balance every 24 hours. hours.

Nursing Care Plan For Mrs. N.F

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ Ev

Time Diagnosis Outcome Time

Criteria

07/10/19 Alteration in Patient’s a. Reassure patient a. Patient and her family were 11/10/19 Go

nutrition nutritional needs and family. reassured that when she takes in evi
12:00pm 6:00am
(less than will be improved food the pain was going to
a.
body within 4days as decrease and help heal her ulcer.
obs
requirement) evidenced by: b. Weigh patient daily b. Patient was weighed daily to
pat
related to and record. check whether she was losing
a. Nurse reg
weight or gaining weight since
observes that

45
 anorexia. patient eat food her admission and it was

at regular documented

intervals

Nursing Care Plan For Mrs. N.F Continues

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/

Time Diagnosis Outcome Time

Criteria

b. Patient c. Plan patient’s diet with c. Patient’s diet was planned with

verbalizes that patient and dietician patient and dietician with the

she can eat 2/3 taking into consideration consideration of his likes and

of food served. his likes and dislikes. dislikes to increase his tolerance

level of meals served.

d. Serve a well-balanced d. A well balanced diet was served

diet. to patient and was well garnished

to boost the appetite of the client

and her immunity

e. Encourage family e. Family members were

members to reduce the encouraged to reduce the amount

amount of spice used to of spices to prevent irritation of

prepare food the stomach mucosa

46
Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/

Time Diagnosis Outcome Time

Criteria

f. Encourage patient to eat f. Patient was encouraged to eat in

in bits as she can tolerate bits as she can tolerate to ensure

adequate nutrition

g. Congratulate patient g. Patient was congratulated after

after eating and document eating and documented.

it.

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ E

Time Diagnosis Outcome Time

Criteria

07/10/19 Alteration Patient will be a. Reassure patient. a. Patient was reassured that 11/10/19 G

1:30 pm in body relieved of with effective medical and 7:40am e

comfort pyrosis within 48 nursing intervention heart

a
(pyrosis) hours as burns will subside.
th
related to evidenced by: b. Assess patient for b. Assessment of patient for
c
gastric signs and symptoms of signs and symptoms of pyrosis
a. Nurse observes g
reflux pyrosis. was done to determine the
that patient is

47
 calm in bed with intensity of pain. e

good facial c. The type of food or fluid that

b
expression. c. Determine the type of contribute to pyrosis
v
food or fluid that Was also determined to help
h
contributes to pyrosis. control the level of discomfort.
o

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/

Time Diagnosis Outcome Time

Criteria

b. Patient d. Implement d. Implementation of measures such as

verbalizes that measures to reduce encouraging patient to avoid food high

she has been pyrosis in fat, carbonated beverage, gas

relieved of producing food as well as avoiding

pyrosis smoking to control pyrosis.

e. Administer e. Prescribed medication such as

prescribed medication antacid was served to relieve

such as antacid. discomfort.

f. Monitor vital signs f. Vital signs were checked and record

to serve as baseline data.

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ E

Time Diagnosis Outcome

48
 Criteria Time

8/10/19 Knowledge Patient will gain a) Provide a conducive a). A conducive environment 9/10/19 G

8:30am deficit adequate environment for teaching was ensured to facilitate 6:10 am e

related to knowledge onto and learning. teaching and learning. a

inadequate the causes and b) Provide privacy and b) Privacy was provided and o

information management of assure her of confidentiality was p

on the causes peptic ulcer confidentiality guaranteed. a

of peptic disease within 24 c) Make patient c) Patient was encouraged to fe

ulcer disease hours as comfortable either by assume a comfortable in

and its evidenced by: sitting or lying down. position. th

management. a. Nurse d) Sit comfortably by d) Nurse sat comfortably on a p

observes that patient’s bedside and assess chair by patient’s bedside and d

patient gives patient’s level of assessed her general m

accurate understanding of the knowledge on the condition.

feedback to the disease condition.

Date/ Nursing Objective/Outcome Nursing Orders Nursing Intervention Date/

Time Diagnosis Criteria Time

information on the e) Build on what the e) Patient’s knowledge was

causes of peptic ulcer patient knows. built upon with scientific data

disease and its of condition in a language the

management patient understand. She was

b. Patient verbalizes that educated on the disease

she has accurate condition, signs and symptoms,

49
 feedback on the causes causes and treatment

of peptic ulcer and its f) The rational for treatment and

management. f) Explain to patient the possible outcome was explained

rational for treatment and to her.

possible outcome.

Date/ Nursing Objective/ Nursing Orders Nursing hIntervention Date/ Ev

Time Diagnosis Outcome Time

Criteria

g) Encourage patient to g) Patient was encouraged to

ask questions for ask questions pertaining to any

clarification. misunderstanding of the

disease condition

h) Provide answers to h) Answer was provided to

questions asked questions asked by patient.

i) Review patient i) Patient was encouraged to

understands. give feedback of what she had

learnt.

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ E

Time Diagnosis Outcome Time

50
 Criteria

8/10/19 Anxiety related Patient and her a. Reassure patient and a. Patient and her family were 9/10/19 G

9:00am to family’s level of her family reassured to allay fears and 5:00am e

hospitalization. anxiety and fear anxiety. a

will be reduced b. Establish rapport b. Patient and her family were t

within 24hours with patient and her introduced to staff and other r

as evidenced by: family. patients on the ward to make w

them feel at ease and to call f

a. Nurse
the attention of any staff when
observes that
necessary.
patient is relaxed
c. Orient them to the c. Patient and her family were
in bed with a
ward and its oriented to the ward and its
cheerful facial
environment environment.
expression.

Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/ Eva

Time Diagnosis Outcome Time

Criteria

b. Patient d. Allow patient and her d. Patient and her family were b. P

verbalize that family to verbalize their encouraged to verbalize their verb

there is a fears fears and misconceptions. that

reduction in was

level of fear and e. Explain every e. Consent and explanation of redu

51
 anxiety procedure to patient and every procedure done on leve

her family. patient were sorted from and

patient.

CHAPTER FOUR

4.0 IMPLEMENTATION OF PATIENT / FAMILY CARE PLAN

Implementation refers to putting into action, the nursing orders outlined in the nursing care plan

to relieve patient and family of their health related problem. It is the fourth stage of the nursing

process. It involves carrying out both medical and surgical nursing interventions. The patient and

relatives are encouraged to participate by playing their part for the patient’s speedy recovery.

4.1 Summary of the Actual Nursing Care Rendered

The actual nursing care rendered to Mrs. N.F., was aimed at meeting patient’s recovery. The

nursing care started on the day of detain which was 07 th October, 2019 to the time of discharge

on 11th October, 2019 till care was terminated.

Routine Nursing Care

Reassurance

Patient and her relatives were reassured of competent health team who will help restore the

patient to optimal health. This was done to allay all fears and anxiety

52
Vital signs

The temperature, pulse, respiration and blood pressure were observed four hourly from the time

of admission to the time of discharge. The findings were documented accordingly into the four

hourly monitoring charts.

Personal Hygiene

Patient was able to take her bath, groom herself, care for her mouth twice daily until discharge.

She was also educated on the need to maintain good personal hygiene.

Nutrition

The prescribed intravenous fluids were served accordingly to maintain the patient’s fluid and

electrolyte balance. Patient’s diet was planned with her taking into consideration her preferences.

Patient was given three square meals daily. A well balance diet rich in vitamins, protein,

carbohydrate, minerals and low fat and oil food were served to facilitate recovery process.

Elimination

Patient was encouraged to empty her bowel and bladder daily throughout the period of

hospitalization to prevent infections and complication such as distended abdomen and

constipation.

Medications

53
Drugs prescribed for patient were served accordingly and recorded in the drug administration

chart observing the ten rights of drug administration such right patient, right drug, right dose,

right route, right time, right to accept and refuse, right of assessment, right evaluation and right

documentation.

The above routine cares were rendered during admission.

Day of Admission (07th October, 2019)

Mrs. N.F was admitted to the female medical ward of Dunkwa Government Hospital through the

Out Patient Department on 07th October, 2019 with abdominal pain, anorexia, general body

weakness and heartburns. She was diagnosed of Peptic Ulcer Disease due to the signs and

symptoms she presented. Patient came to the ward with her son accompanied by the admission

team member. She and her family were introduced to the nursing staff on duty since patient was

conscious on admission. They were also orientated to the ward and the ward’s routines (meal

time, checking of vital signs, drug administration, etc). Patient was reassured and made

comfortable in bed. The ward’s protocols about visiting hours were spelt out to her relatives. Her

particulars were obtained from her relatives. Her vital signs were checked and recorded as

follows;

Temperature - 37.0 degree Celsius

Pulse - 68 beats per minute

Respiration - 18 cycle per minute

Blood Pressure - 130\80 milliliters of mercury

54
Patient was put on the following drugs:

• Intravenous metronidazole 500mg tds x 48 hours

• Intravenous ciprofloxacin 200mg bd x 48 hours

• Intravenous dextrose saline 2 liters x 48 hours

• Injection buscopan 40mg bd x 24 hours

• Syrup megacid 15ml tds x 5 days

• Tablet paracetamol 1g tds x 5 days

The following diagnostic investigations were ordered and carried out on Mrs. N.F:

• Full blood count to rule of infection.

• Blood film to rule out malaria parasite.

• Blood for fasting blood sugar

Mrs. N.F had not registered the National Health Insurance Scheme (NHIS), photocopy of bill

was pasted in the folder. Her name and other important information collected were entered in the

admission and discharge book, the daily ward state. Visiting time was also discussed with the son

in order for Mrs. N.F and her relatives to understand the hospital’s protocol. Patient was made

comfortable in an already made bed and reassured of competent care.

Around 9:35am, patient complained of epigastric pain and the following nursing measures were

rendered, patient was reassured that all measures would be put in place to relieved her of the

epigastric pain. Level and intensity of pain was assessed using a pain rating scale of 1 -10 and

was found to be 6. Patient was made comfortable in the supine position. This was done to reduce

55
muscle spasms and tension and also to redistribute pressure on the body part to help reduce pain.

The television was switched on for her to watch to take her mind off the pain. Warm compresses

were put on patient abdomen to help dilate blood vessels thereby reducing pain. Inj. Buscopan

40mg bd x 24 hour was prescribed and was serve intramuscularly to help reduce pain.

On that same day, patient complained of general body weakness. Appropriate nursing measures

that were implemented are as follows:

Patient was reassured that he will be able to resume to his normal daily activities as measures

have be put in place to ensure early recovery to allay his fear and anxiety. A comfortable bed

free from creases and cramps was provided for patient. Adequate bed rest was ensured to reduce

energy demands. High caloric diet such as boiled yam and cabbage stew was served to patient to

increase his energy level. Patient was assisted in performing daily activities such as bathing,

caring for the mouth and grooming. Tab. Paracetamol 1g tds x 5 days was prescribed and added

to her drugs of which it was serve orally to help reduce pain.

And, she complained of nausea and vomiting, and the following nursing interventions were

rendered, patient was reassured that all measures would be put in place to decrease vomiting.

Signs and symptoms of fluid volume deficit was assessed and all deviations were also reported.

Measures to prevent fluid volume deficit such as maintaining fluid intake of at least 1000ml/day

was implemented to help prevent dehydration. Vital signs were checked and recorded to monitor

progress of the condition. All nauseating articles are taking away from the patient to prevent

nausea and control vomiting. Patient input and output was recorded balance every 24 hours.

On the same day, patient was given necessary nursing measures to improved her nutritional

status such, Patient and her family was reassured that when she takes in food the pain was going

to decrease and help heal her ulcer. Patient was weighed daily to check whether she was losing

56
weight or gaining weight since her admission and it was documented. Patient’s diet was planned

with patient and dietician with the consideration of his likes and dislikes to increase his tolerance

level of meals served. A well balanced diet was served to patient and was well garnished to boost

the appetite of the client and her immunity. Family members were encouraged to reduce the

amount of spices to prevent irritation of the stomach mucosa. Patient was encouraged to eat in

bits as she can tolerate to ensure adequate nutrition. Patient was congratulated after eating and

documented.

On the same day patient complained of heart burns and the following nursing interventions were

given, patient and family was reassured to allay fears and anxiety. Assessment of patient for

signs and symptoms of pyrosis was done to determine the intensity of pain. The type of food or

fluid that contribute to pyrosis was also determined to help control the level of discomfort.

Implementation of measures such as encouraging patient to avoid food high in fat, carbonated

beverage, gas producing food as well as avoiding smoking to control pyrosis. Prescribed

medication such as antacid (syrup megacid 15ml tds x 5 days) were served to relieve discomfort.

Vital signs were also checked and record to serve as baseline data.

First Day on Admission (08th October, 2019)

On this day, it was observed that she had knowledge deficit regarding the causes, signs and

symptoms and management of her condition. The following nursing measures were rendered; a

conducive environment was ensured to facilitate teaching and learning. Patient was encouraged

to assume a comfortable position. Nurse sat comfortably on a chair by patient’s bedside and

assessed her general knowledge on the condition. Patient’s knowledge was built upon with

scientific data of condition in a language the client understand. She was educated on the disease

condition, signs and symptoms, causes and treatment. The rational for treatment and possible

outcome was explained to her. Patient was encouraged to ask questions pertaining to any

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misunderstanding of the disease condition. Answer were provided to questions asked by patient.

Patient was encouraged to give feedback of what she had learnt

On the same day, Patient was observed as being anxious. Patient and her family were reassured

to allay fears and anxiety. Patient and her family were introduced to staff and other patients on

the ward to make them feel at ease and to call the attention of any staff when necessary. Patient

and her family were oriented to the ward and its environment. . Patient and her family were

encouraged to verbalize their fears and misconceptions.

Second Day on Admission (09th October, 2019)

On 09th October 2019, patient had no problem. It was noticed that patient’s rate of recovery had

increased remarkably and he looked well and cheerful. All routine cares such as checking of vital

signs, feeding and medication were carried out on patient.

On the same day, her relatives were informed of the intension to visit their home when her

relatives visited her during visiting hours.

Third Day on Admission (10th October, 2019)

On this day, it was notice that patient made no complain. Her vital signs such as pulse,

respiration, blood pressure, temperature as well as prescribed medication also served and

recorded in the nurse’s note. During ward rounds, the doctor told the patient and her son that they

will be discharged home tomorrow if God permit after seeing there has been an improvement in

patient’s condition.

Day of Discharge (11thOctober, 2019)

Patient’s condition had improved tremendously. She looked cheerful and had a sound sleep over

the night as verbalized by her. Routine personal hygiene was maintained. Her vital signs

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(temperature, pulse, respiration and blood pressure) were checked and recorded and prescribed

medications served and documented. She had no complains. Her bills were assessed and settled

before all the procedures were documented especially into the admission and discharge book and

the daily ward state.

She was reviewed and discharged on this day 11 th October, 2019 by P.A. Bannor. She was asked

to come for review on the Friday 18nd of October, 2019.

During the discharge procedure, the need to adhere to drug regimen, come for review, report any

identified problems even before date for review were made known to her. She and her family

were reminded of the cause, prevention and complications of the condition. The desired and

adverse effects of drugs were also emphasized. She and her family were assisted to pack her

belongings. They thanked the health care givers on the ward and left for home. Before departure,

she and her family were once again reminded to honor the date of review

4.2 Preparation of Patient / Family towards Discharge and Rehabilitation

This usually started from the day of admission to the day of actual discharge due to the important

role it plays in patient’s recovery. She and her family were prepared towards discharge through

effective education. They were informed that she will return home after a satisfactory recovery.

They were educated on the need to take in a well-balanced diet and to avoid spicy foods since it

is not good for her health. She was advised to take a lot of water with her medication. Her family

was also advised on the need to refrain from over the counter drugs. They were also advised on

the need for periodic checkups on their health at the nearest health center to detect any risk

factors of some conditions that may be a threat to their lives on late recovery. She was again

advised on the need to fulfill her follow up visit to the hospital. She and her family bade goodbye

to other patients on the ward and the nursing staff and went home. Her bed linens were removed
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and her bedside items were disinfected with parazone 1:10. Bed linens were taken to the sluice

room and the bed was later made ready for the next admission. All the procedures were

documented especially into the admission and discharge book and the daily ward state

4.3 Follow Ups / Home Visits / Continuity of Care

Friendly but purposeful visit to the home of patient with the aim of preventing diseases,

maintaining health and promoting life through health education, counseling and rehabilitation

were carried out before and after patient was discharge from the hospital.

First Home Visit (9th October, 2019)

The visit was scheduled with her relatives on the second day of her hospitalization and they

accompanied me to their house. The house is a compound house made up of 8 rooms, one big

space as their kitchen, one bathroom and a toilet. It is situated at Oponsu, Mampong – Dunkwa.

The whole appearance of the house is very clean except the kitchen area where things are placed

inappropriately. I therefore informed them to rearrange the kitchen and to observe proper

sanitation to prevent contamination of food. The house does not have its own pipe borne water.

Their solid waste disposal was also at the outskirt of their house. The family is living together in

a basic traditional extended family system. The aim of the visit was to access the actual home

situation and to impact on the patient current health status.

After establishing rapport, the reason for the visit was made known to her family members. After

staying with the family for a while, permission was sought to leave their house and promised

them of next home visit.

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Second Home Visit (15th October, 2019)

The second home visit took place on 15 th October, 2019 at 10:30am to enable me assess patient’s

state of health after discharge. The visit was aimed at finding out how Mrs, N.F was coping after

discharge and also to ascertain whether she was adhering to her education and discharge

education. On arrival, patient and her son and other members of the family were glad to see me

again. Mrs. N.F looked healthy and cheerful. After a warm welcome, patient told me that her

health status had improved and that she had no complains or discomfort. Patient’s sister said they

have adhered to the numerous pieces of advice particularly on nutrition, personal and

environmental hygiene. Patient’s drugs were inspected and it was realised she was taking them as

prescribed .Patient was reminded to come early for the review as scheduled with the P.A. Bannor.

This opportunity was used to informed patient and her family of the intention to hand over them

to the Public Health Nurse of the community on the third home visit for the continuity of care.

Review (Friday, 18th October, 2019)

Patient reported for review on Friday the 18 th of October, 2019 as scheduled. She was met at the

O. P. D at 7:00am. Her card was given to the staff at the O. P.D and her folder was retrieved for

her. She was sent to consulting room 2. The physician examined thoroughly and she was doing

well and responding to treatment. Her condition had improved and made no complains of pain or

what so ever. She was congratulated for taking her medications and taking good care of herself.

She was told to rest for a period of two weeks before resuming normal activities but was advised

to avoid starving herself. She made no complains and was asked to report in case she was ill.

Patient was seen off to board a car home after promising her another home visit.

Third Home Visit (25thoctober, 2019)

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Mrs N.F and her family were visited as promised on this day. She appeared healthy. Patient and

her family were happy on seeing me in company of the public health nurse. Her family was

congratulated for sticking to their medical advice given them and other education they had whilst

in the hospital. The patient was examined physically and was declared fit. Patient and her family

were thanked for their support and co-operation during the care. They were still encouraged to

keep up and promote good health practices such as good personal and environmental hygiene.

Patient and her family were handed over to the Public Health Nurse (Mrs. B.B) in charge of the

community for the continuity of care. They took charge to reasoned with us and showed their

great appreciation for the kindness and work done. Patient and her family dressed and escorted

us to the road side where vehicle was boarded.

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 CHAPTER FIVE

5.0 EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

Evaluation means judgment of action and the outcome of orders as against previously

determined goals. In nursing process, it is the stage at which the patient’s goals for nursing care

have been met. Thus to initiate the evaluation phase, the nurse must review and reflect on the

goals set by the original care plan. In evaluation, the nurse assesses the outcome criteria and

identifies if goals were partially or fully met. Evaluation is important because conclusion reached

determines the next nursing intervention

5.1 Statement of Evaluation

When patient was admitted a lot of objectives were set to relieve her of her condition. These

objective were fully met as a result of proper nursing and medical care rendered.

On 07th of October, 2019, patient complained of epigastric pain. With good nursing care rendered

to patient goal was fully met as evidenced by;

a) Nurse observed that patient felt more relax and comfortable in bed.

b) Patient verbalized that pain had subsided

On that same day patient complained of weakness. Nursing care approach rendered includes;

reassurance, serving a well balance diet, serving patient food attractively, and teaching patient to

perform passive exercises. Patient was able to resumed normal activity without assistance.

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a. The nurse observes that patient is going about her normal activities as expected of her without

complaints of weakness.

b. Patient verbalizes that she can perform her normal activities such as bathing, grooming and

caring for her mouth.

On the same day,patient was vomiting. With good nursing care rendered to patient goal was fully

met as evidenced by;

a. Nurse observed that patient had good skin turgor

b. Patient verbalized that vomiting had subsided

On the same day, patient complained of anorexia. With good nursing care rendered to patient

goals were fully met as evidenced by;

a. Nurse observed that patient ate food at reglaur intervals

b. Patient verbalized that she could eat 2/3 of food served.

On the same day, patient complained of heart burns. With good nursing care rendered to patient

goals were fully met as evidenced by;

a. Nurse observed that patient is calm in bed with good facial expression.

b. Patient verbalized that she had been relieved of pyrosis

With effective nursing measures, on the 08 th October, 2019, it was observed that patient had

knowledge deficit regarding the causes, signs and symptoms and management of her condition.

With good nursing care rendered to patient goal was fully met as evidenced by;

a. Nurse observed that patient and family gave accurate feedback on the causes of peptic ulcer

disease and its management.

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b. Patient and family verbalized that they had accurate feedback on the causes of peptic ulcer

and its management

On the same day, patient was anxious due to hospitalization. With good nursing care rendered to

patient goal was fully met as evidenced by;

a. Nurse observed that patient was relaxed in bed with a cheerful face.

b. Patient verbalized that there was a reduction in level of fear and anxiety

5.2 Amendment of Nursing Care Plan for Partially Met or Unmet Goals

With effective nursing care rendered to Mrs. N.F coupled with the cooperation and assistance

from patient and her family, goals set were fully met and there was no need for amendment of

the care plan.

5.3 Termination of Care

Termination is the last phase of nurse / patient relationship. It is a very difficult step to take after

a good interpersonal relationship has been established between the nurse and the patient, for this

reason the reality of separation has to be explained on the first day of admission.

Interaction with patient and her family began on the day of admission which is 07 th October,

2019. Home visits were made on different occasion to patient’s house to see how far she was

progressing. Series of health education were given during the visits.

On the day of the last visit, which was made on the 25 th of October, 2019, patient was very well

and had no complains.

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Patient and her family were grateful and thankful. They were informed to report any

complications to nearest hospital. Termination of care was successful and patient was handed

over to the public health in-charge (Mrs. B. B) of the community for continuity of care.

5.4 Summary of Care Rendered to Patient/Family

Mrs. N.F was admitted on the 07th of October, 2019 to the female’s ward of Dunkwa Government

Hospital. She came with abdominal pains, anorexia, general body weakness and heartburns of

which she was diagnosed of Peptic Ulcer Disease (PUD). Patient was in conscious state during

admission. She came with her son and a member of the admission team from the out patients

department and was warmly welcomed and her particulars and vital signs (temperature, pulse,

respiration and blood pressure) were checked and recorded. Her name was entered into the

admission and discharge book as well as the daily wards state. Patient and her family were

reassured that she would be well taken care off. They were orientated to the ward environment

and a comfortable bed was made for her. Throughout her period of hospitalization, an effective

nursing care was given to patient. All goals set to resolve identified problems were fully met due

to effective nursing care rendered to patient.

The following drugs were used in the treatment of her condition: Intravenous Metronidazole

500mg tds x 48 hours, Intravenous Ciprofloxacin 200mg bd x 48 hours, Tablet Paracetamol 1g

tds x 5 days, Intravenous Dextrose Saline 2 liters x 48 hours, Injection Buscopan 40mg bd x 24

hours, Syrup Magacid 15ml tds x 5 days, Capsule Omeprazole 20mg bd x 72 hours.

She was given appropriate nursing care which facilitated her speedy recovery and was fully fit

during the day of discharge. She was discharged on the 11 th of October, 2019. She spent four (4)

days on the ward. She was visited at home and care was finally terminated after she had honored

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her review visit to the hospital and the third home visit to patient’s home where she was handed

over to the public health nurse in-charge of the community.

5.5 Conclusion

The patient / family care study has helped me to gain good insight about the disease condition

Peptic Ulcer Disease. It has helped me to understand comprehensive nursing care that has to be

rendered to individual patient.

This study has equally helped me to put the knowledge I have acquired from the nursing course

into practice. I have also been able to establish a good interpersonal relationship with my patient

and her family. Patient / family care study has helped me to understand the nursing process well.

The experience would enable me to care for patients not only with Peptic Ulcer Disease but other

conditions in the future.

I therefore support the idea of patient/family case study as part of the programme to pursue and

enhance quality assurance of patient care.

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 REFRENCES

Carpenter D.O., Smith, J. Holmes H. N and Tscheschlog, B.A. (2001). Professional

Guide to Diseases. 7th Edition, Springhouse Corporation, Pennsylvania.

Linda S. R. (2005). Mosby’s Drug Guide for Nurses. 6th Edition Elvesier Mosby-U. S. A.

Lewis, Heitkemper, Dirksen (2000) Medical-Surgical Nursing. 5th Edition. Mosby, Inc. A

Harcourt Sciences Company- United State of America.

Suzanne C. Smsltzer and Brenda G. Bare (2004). Brunner and Suddarth’s Textbook of

Medical- Surgical Nursing. 10th Edition, J.P. Lippincott Company. Philadelphia

Sandra M. Nettina (2001). The Lippincott Manual of Nursing Practice. 7th Edition,

Lippincott Company, Williams and Wilkins. Philadelphia.

Weller B.F. (2005) Baillier’s Nurses Dictionary. 24th Edition, Tindall and Royal

College of Nursing. London.

Unpublished Article: Patient’s Folder

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