HOLY FAMILY NURSING AND MIDWIFERY TRAININIG COLLEGE,

BEREKUM

A PATIENT CARE STUDY ON HYPERTENSION

RITA NAULESU

A PATIENT/FAMILY CARE STUDY SUBMITTED TO NURSING AND

MIDWIFERYCOUNCIL OF GHANA IN PARTIAL FULFILMENT FOR THE

AWARD OF LICENCE TO PRATICE AS A PROFESSIONAL REGISTERED

GENERAL NURSE

AUGUST, 2022
 PREFACE
Nursing is a profession that requires knowledge, skills and attitude. It owes much of

its body of knowledge to the influence of Florence Nightingale (1820 - 1910), a

woman who pioneered and brought much respect to the profession through her

visions. The ability to render comprehensive nursing care rests on the nurses’ ability

to assess the client’s condition, analysis, plan, implement and evaluate the effects of

management on patient health status. The patient and family care study is the account

of a nursing care given to a selected patient within a specific period to meet physical,

physiological, spiritual and socioeconomic needs and help to attain optimum health.

The patient/family care study is also a requirement as a partial fulfillment for an

award as a Registered General Nurse honored by the Nurses’ and Midwives’ Council

of Ghana to student pursuing Diploma in Nursing in the country. It also offers the

student nurse an opportunity to put into practice the knowledge acquired at school to

give an effective nursing care to client with reference to the patient’s condition.

In addition to the above, patient/family care study enables the student to acquire more

knowledge about the causes, signs and symptoms, diagnosis and treatment given to

patient with specific condition using the nursing process concept.

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 ACKNOWLEDGEMENT
My earnest gratitude goes to the Almighty God for his fortification and intelligence

given to me throughout the study. My special thanks go to Mrs. C.K and family for

the smooth interaction and co-operation given to me in conducting the study. My next

gratitude goes to Ms. Antoinette Effum for her time and energy spent in supervising

me throughout this study and the entire teaching staff of Holy Family Nursing and

Midwifery Training College, Berekum. My profound thanks also goes to the Nursing

Officer in charge of Female Medical Ward and her staff at Holy Family Hospital,

Berekum for their assistance and guidance during the care and management of the

patient. Also I will thank my colleagues at Holy Family Nursing and midwifery

Training College Berekum, especially my friend (Osei Vida) for being my source of

guidance and motivation during this study.

I am grateful to all the authors of books from which relevant information were picked

for this study. Finally, I would like to thank my entire family, especially my father,

Mr. Tuoro Sangna and my mother, Mrs. Aripuor Sagbo for all their support

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throughout my education. May the Almighty God bless you all and answer all your

heart desires abundantly.

INTRODUCTION
Patient/ family care study is a report of comprehensive nursing care rendered to

patient and their family from the day of admission, discharge and subsequent follow

ups visits in order to help them meet their health needs. For confidentiality purposes,

the name of patient and her family would be replaced by their initials. Mrs. C.K, a 67

year old was the subject in the study. She was admitted to the Female Medical ward at

Holy Family Hospital, Berekum on 30th November, 2021 with the complains of

elevated blood pressure, headache and dizziness. Patient spent five days at the Female

Medical ward but was detained at the Emergency Ward for 24 hours. Patient was

discharged on the 4th November, 2021 after which home visits were embarked.

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Patient was managed under the following medications: IV Labetalol 20mg stat, Tab

Nifedipine 40mg bd x 14days, tab Lisinopril 10mg daily x 30 days and tab

Paracetamol 1g tds for 5 days.

Good interpersonal communication and relationship was established with patient

throughout the study. Patient and relatives were reassured of confidentiality. I made it

known to them that, as a final year student, it is a requirement by the Nursing and

Midwifery Council to take a patient, to render individualized nursing care to him/her

until discharge and follow up visit after discharge until she recovers fully as a partial

fulfillment for the license to practice as a Registered General Nurse.

On the day of admission, patient presented the following problems; elevated blood

pressure of 170/102mmHg, headache, and dizziness but with good nursing and

medical intervention, her condition became well and satisfactory on discharge.

Table of Contents
PREFACE .............................................................................................................................................. i

ACKNOWLEDGEMENT ......................................................................................................................... ii

INTRODUCTION ................................................................................................................................. iii

CHAPTER ONE ..................................................................................................................................... 1

ASSESSMENT OF PATIENT AND FAMILY ............................................................................................... 1

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1.0 Introduction............................................................................................................................................ 1

1.1 Patient’s Particulars ................................................................................................................................ 1

1.2 Patient and Family Medical History ......................................................................................................... 2

1.3 Patient’s Socio-Economic History ............................................................................................................ 2

1.4 Patient’s Developmental History ............................................................................................................. 3

1.6 Patient’s Lifestyle and Hobbies ................................................................................................................ 5

1.7 Patient’s Past Medical History ................................................................................................................. 5

1.8 Patient’s Present Medical History ............................................................................................................ 6

1.9 Admission of Patient ............................................................................................................................... 6

1.10 Patient’s Concept of Illness ................................................................................................................... 8

1.11 Literature Review .................................................................................................................................. 9

1.12 Validation of Data ............................................................................................................................... 29

2.1 Comparison of Data with Standards .................................................................................................. 31

A. Diagnostic Investigation\Test ........................................................................................................... 31

B. Causes of the Patient’s Condition .................................................................................................... 38

C. Treatment of the Patient .................................................................................................................. 38

D. Complications ................................................................................................................................... 43

2.2 Patient and Family Strength ............................................................................................................... 43

2.3 Patient’s Health Problems .................................................................................................................. 43

2.4 Nursing Diagnoses............................................................................................................................... 44

CHAPTER THREE ........................................................................................................................ 45

PLANNING FOR PATIENT/FAMILY CARE.............................................................................. 45

3.0 Introduction ........................................................................................................................................ 45

3.1 Objectives/ Outcome Criteria ............................................................................................................. 45

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 CHAPTER FOUR ................................................................................................................................. 59

IMPLEMENTING PATENT / FAMILY CARE PLAN .................................................................................. 59

4.0 Introduction.......................................................................................................................................... 59

4.1 Summary of Actual Nursing Care ........................................................................................................... 59

4.2. Preparation of Patient/Family for Discharge and Rehabilitation. ........................................................... 69

4.3 Follow Up / Home Visit / Continuity of Care .......................................................................................... 69

CHAPTER FIVE ................................................................................................................................... 74

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY ............................................................. 74

5.0 Introduction.......................................................................................................................................... 74

5.1 Statement of Evaluation........................................................................................................................ 74

5.2 Amendment of the Nursing Care Plan ................................................................................................... 79

5.3 Termination of Care .............................................................................................................................. 79

CHAPTER SIX ..................................................................................................................................... 80

SUMMARY AND CONCLUSION........................................................................................................... 80

6.0 Introduction.......................................................................................................................................... 80

6.1 Summary .............................................................................................................................................. 80

6.2 Conclusion/Recommendation ............................................................................................................... 81

APPENDIX ......................................................................................................................................... 83

BIBLIOGRAPHY.................................................................................................................................. 84

SIGNATORIES ......................................................................................... Error! Bookmark not defined.

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 CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

1.0 Introduction
Assessment is the systematic collection of data to determine the patient's health status and

any actual or potential health problems (Hinkle & Cheever, 2014). It is the first step in the

nursing process. During this phase, the nurse gathers information through the interviews,

observations, laboratory investigations, consultations and home visits. Assessment of a

patient and family in this chapter covers; patient’s particulars, family medical history, and

socioeconomic history. Again, it focuses on patient’s developmental history, patient’s

obstetric history, hobbies, and lifestyle, past and present medical history, admission of

patient, literature review of the disease condition, validation of data.

1.1 Patient’s Particulars

Patient particulars refers to information about a patient’s history and behavioral patterns,

gathered by a therapist or medical professional primarily from the patient but sometimes from

others who know or are related to him or her (American Psychological Association, 2020).

Mrs. C.K, a 67years old woman was born on 4th September, 1956, at Nsapor of the Berekum

West District in the Bono Region to Mr. K.K and Mrs. A.F. She hails from Nsapor but

resides in Jinijini with house number 21 near Methodist Primary School and speaks Bono -

Twi. Mrs. C.K is married to Mr. Y.F and has eight (8) children five (5) girls and three (3)

boys. She is a Christian and worships at the church of Pentecost. She had her formal

education up to primary six. She is a farmer. Her next of kin is Mr. Y.F her husband, who

stays at Berekum-Jinjini. The patient’s folder number is 16496/11. She is dark in complexion,

with a height of 156cm and weighs 56kg. An observation made on patient revealed that she

has no disabilities.
 1.2 Patient and Family Medical History

As mentioned by Mrs. C.K, there is no family history of medical condition such as

Glaucoma, Epilepsy, Diabetes Mellitus and Mental illness. However, two relatives (her elder

brother and younger sister) have been diagnosed of hypertension and is being managed. She

revealed that she suffered measles during childhood. There is a history of hypertension in

both the paternal and maternal families. Aside that there is neither other hereditary disorder

like diabetes mellitus, asthma, sickle cell, epilepsy nor any mental disorders in the family.

Mrs. C.K. said that headache, chills and fever are the most common symptoms experienced

by members of the family which they usually managed with over- the counter medications.

Mrs. C.K. indicated that, she has been a known Hypertensive for the past three years (3years).

She indicated that she did not know the cause of death of her two children. There are no

known allergies in the family.

1.3 Patient’s Socio-Economic History

Mrs. C.K. comes from a nuclear family consisting of eleven (11) members that is herself,

husband and the last born (one boy). The other six (6) children are married. The family

depends on income generated from farming. Mrs. C. K. is insured with National Health

Insurance Scheme, which usually cares most of their bills whenever they seek medical

treatment. She also receives financial support from other immediate relations. Mrs. C.K

indicated that, she has a good relationship and full support from friends and family, because

whenever she asks of something they are able to help. Mrs. C.K. vividly pointed out the

taboos, norms and values in the family. According to her, it is a taboo to touch or eat a hawk

and they are not permitted to see a particular snake termed locally as the “Asonawo” which

when sighted, symbolizes a bad omen or ordeal. Mrs. C.K. shortlisted their values to kingship

titles and norms to be abstinence from narcotics and nicotine substances as well as

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contributing an amount of forty cedi’s monthly as family welfare to cater for sudden

emergencies. She is a Christian who worships at the church of Pentecost.

1.4 Patient’s Developmental History

According to McIntosh (2013), development is the process in which someone or something

grows or changes and becomes more advanced. Growth is the series of physical changes that

occur from conception through maturity. Maturation is the biological processes involved in

an organism’s becoming functional or fully developed (American Psychological Association,

2020).

Mrs. C.K was told by her mother that she was delivered with the assistance of a Traditional

Birth Attendant. Her mother did not experience any abnormalities during pregnancy, labor

and puerperium. Mrs. C.K. revealed that she was told by her mother that she was not

exclusively breastfed. She vaguely stated that she passed through the developmental stages

normally without any setback. She also verbalized that she never suffered from any serious

ailments or injuries during childhood that could affect her development. Mrs. C.K. said her

mother informed her that she was not immunized against the vaccine preventable diseases

(diphtheria, tetanus, whooping cough, measles, poliomyelitis and yellow fever) which was

confirmed by the absence of Bacilli Calmette Guarine (BCG) mark on the right upper part of

her arm on observation. Though she never developed any complications throughout her

development. She went through a normal developmental milestone. This includes sitting up at

the 7th month, crawling at the 10th month, walking, talking and running between the ages of

one and three years old. She started her primary education at the age of five years at the

Methodist Primary school at Jinjini. She had her formal education up to primary six, because

she was academically weak as a result she was not having the interest to continue her

education. Mrs. C.K. developed her secondary sexual characteristics such as growing of

pubic hairs and developing of breast at the age of thirteen. She got married at the age of

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twenty (20) to Mr. Y.F. In Erik Erikson’s psychological theory (1950), he suggested that

there are eight stages that one goes through from birth to death and failure to go through one

stage successfully can result in a reduced ability to complete further stages and therefore

unhealthier personality. Below are the stages one goes through from birth to death according

to Erickson

1. Trust versus mistrust (0-1year)

2. Autonomy versus shame and doubt (2-3years)

3. Initiative versus guilt (3˗5years)

4. Industry versus inferiority (6˗11years)

5. Identity versus role confusion (12˗18years)

6. Intimacy versus Isolation (19˗40years)

7. Generativity versus stagnation (40-65years)

8. Integrity versus despair (65years-death)

Mrs. C.K. falls within the eighth stage thus integrity versus despair (65years to death) of Erik

Erikson’s psychosocial theory. With reference to her age and psychosocial behavior, she has

developed a sense of integrity since she has been able to achieve most of her life goals

without regrets. She has been able to raise her children with determination and hard work.

Mrs. C.K. is calm, humble, and respectful and treats all people equally.

1.5 Patient's Obstetric History

She stated that she experienced her menarche at age thirteen (13) and had a normal menstrual

flow, which usually lasted for five (5) days during her menstrual period without irregularities

from adolescence to adulthood until she had menopause at the age of fifty (55). Mrs. C.K.

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revealed that she had eight (8) pregnancies with no abortion. Patient has eight (8) children,

six (6) alive and healthy, and two are deceased. She explained that she did not use

contraceptives and other family planning methods. However, the birth spacing was achieved

solely through natural means. Furthermore, she has never experienced any pregnancy or birth

complication. All her deliveries were spontaneously per vagina.

1.6 Patient’s Lifestyle and Hobbies

As defined by Mayor (2010), a hobby is a regular activity, enthusiasm or past time that is

undertaken for pleasure or relaxation, typically done during one leisure time whilst lifestyle is

a composite of motivations, needs, wants and influenced by factors such as culture, family,

reference groups, and social class. Mrs. C.K. stated that, she normally wakes up at 5:00am

early in the morning, sweeps her compound, she attend to her personal hygiene. She empties

her bowel twice in a day. She normally takes her breakfast at home before she goes to work.

Mrs. C. K. sometimes eats thrice or four times daily with snacks in between. She then leaves

the house to the farm around 8:00am and returns home at 4:30pm to prepare her supper. Her

favorite food is fufu with groundnut soup. She normally takes heavy meals during the day.

After eating, she takes her bath and rest by watching television for a while. Mrs.

C.K .normally goes to bed at 9:00pm. She dislikes pork meat. On Saturdays she usually goes

to farm or takes pleasure to visit some friends at times depending on the quantum of work she

has to do at the farm. She takes the pleasure to visit friends and other members of her

extended family on Sundays. She engages herself in ludo with her children, during her leisure

time.

1.7 Patient’s Past Medical History

Mrs. C.K. has been a known Hypertensive for three years now. She hardly goes to the

hospital for checkup. She usually manages minor ailment like headache, stomach upset and

body pains with over- the- counter medications such as ibuprofen, magacid and aluminum

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hydroxide purchased from a nearby pharmacy shop. Mrs. C.K could valid information about

the last time she visited the hospital and went on further to say that she always see the

specialist on the special clinic session organized by the hospital. Mrs. C.K’s means of access

to the hospital was quite difficult when she travelled for a month to a different town. Per her

past medical history, the number of times she presented herself for checkups were recorded

and had various frequent investigations such as x-rays, electrocardiographs and angiographies

done, as well as appropriate treatments received documented. Patient has not undergone any

surgery before.

1.8 Patient’s Present Medical History

Mrs. C.K had been in the best of health until 30th November, 2021, in the morning when she

began to experience dizziness and felt weak on awakening. Patient kept complaining after

some minutes hence she was rushed to the Emergency unit of the Holy Family Hospital-

Berekum at exactly 8:30am by her daughter in a conscious state. Her vital signs were checked

and recorded and all parameters were within the normal range with the exception of blood

pressure which was 170/102mmHg. She was given Tablet Nifedipine 40mg and Tablet

Lisinopril 10mg. And was to be admitted at the Female Medical Ward with a diagnosis of

Hypertension.

1.9 Admission of Patient

On the 30th November, 2021 at 3:00pm, patient was brought to the female medical ward in a

wheelchair accompanied by a staff nurse, student nurse and a relative. On observation, patient

was mildly weak and anxious. Patient was received onto an already prepared simple

unoccupied bed.

On admission, patient’s vital signs were checked and recorded as follows;

1. Temperature 36.00C

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 2. Pulse 91bpm (beats per minute)

3. Respiration 24cpm (cycles per minute)

4. Blood pressure 170/105mmHg (millimeters of mercury)

Mrs. C.K. was to be managed on the following medications

1. IV labetalol 20mg stat

2. Tablet Nifedipine 40mg bd for 14 days

3. Tablet Lisinopril 10mg daily for 30 days

4. Tablet Paracetamol 1g tds for 5 days

Laboratory investigations requested for the patient were;

1. Full blood count

2. Random blood sugar

3. Blood urea electrolyte and creatinine

4. Blood film for malaria parasites

5. Lipid profile

A head-to-toe examination was carried out and no abnormalities were seen. She presented

with the history of elevated blood pressure; intervention was given by administering

Nifedipine 40mg as prescribed, Tablet Paracetamol 1g was administered to help relieve

patient from headache. Patient was nursed on a low bed with side rails elevated to prevent her

from falling because she complained of dizziness.

Patient’s treatment was commenced immediately due to availability of drugs at the hospital’s

pharmacy as well as wards stock and was administered during admission. As part of

monitoring, a four hourly blood pressure chart was drawn.

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Her information collected was confirmed again before entering them into the admission and

discharge book, daily ward state, nurse’s notes and report books. Additional information such

as home town and place of birth were also obtained from patient and documented.

Mrs. C.K’s. daughter was orientated to the ward and was made aware of visiting hours, ward

rounds and medication time. After these interventions, I informed the ward In-charge of my

intention of using the patient and the family for a care study and I was granted the permission

to do so.

I introduced myself to patient and relatives as a final year student nurse from the Holy Family

Nursing and Midwifery Training College-Berekum. I also explained the concept of the family

or patient care study to patient and emphasized that it is a requirement by nursing and

Midwifery Council in partial fulfillment and towards the award of a license to practice and

my intention to use her for my care study due to my interest in her condition. She was

assured of confidentiality of her identity and any particulars that will be collected and they

agreed. Mrs. C.K was made comfortable in bed and reassured of competent nursing care. A

brief health education was given to her and her relatives on condition, hygiene and type of

diet to eat. Her daughter was also told to bring the necessary items which will be needed

during her stay at the ward. Because of patient’s dizziness, the orientation procedure was not

carried orally. She was nursed on a low bed with side rails elevated to prevent her from

falling. Patient’s daughter was well oriented to the ward and it annexes.

1.10 Patient’s Concept of Illness

During my interaction with patient, she did not attribute her illness to any spiritual forces but

believed that diseases can attack anybody at any time. She gave a concern that the disease

could have been as a result of the stress she goes through on the farm. However, she strongly

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believed in the treatment she is receiving at the hospital and she is convinced that with the

help of God and the health professionals, she will be well in no time.

1.11 Literature Review

This section deals with documented information about the condition of Mrs. C.K. which was

Hypertension. Literature review of a condition gives a thorough understanding into the

condition.

Review of Anatomy and Physiology on the Cardiovascular System

The Blood Vessel

Figure 1: Diagram of the blood vessels

The three major types of blood vessels in the vascular system are the arteries, veins, and

Capillaries. Arteries, except for the pulmonary artery which carry oxygenated blood away

from the heart and Veins, except for the pulmonary veins which carry deoxygenated blood

toward the heart. Small branches of arteries and veins are arterioles and venules, respectively.

Blood circulates from the left side of the heart into arteries, arterioles, capillaries, venules and

veins, and then back to the right side of the heart. The arterial system differs from the venous

system by the amount and type of tissue that make up arterial walls. The large arteries have

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thick walls composed mainly of elastic tissue. This elastic property cushions the impact of the

pressure created by ventricular.

Contraction and provides recoil that propels blood forward into the circulation. Large arteries

also contain some smooth muscle. Examples of large arteries are the aorta and the pulmonary

artery. Arterioles have relatively little elastic tissue and more smooth muscle. Arterioles serve

as the major control of arterial BP and distribution of blood flow. They respond readily to

local conditions such as low oxygen (O2) and increasing levels of carbon dioxide (CO2) by

dilating or constricting. The innermost lining of the arteries is the endothelium. The

endothelium serves to maintain hemostasis, promote blood flow, and, under normal

conditions, inhibit blood coagulation. When the endothelial surface is disrupted (e.g., rupture

of an atherosclerotic plaque), the coagulation cascade is initiated and results in the formation

of a fibrin clot (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2017).

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The Heart

Figure 2: Structure of the heart

Source: (Hinkle & Cheever, 2014)

The heart is a roughly cone - shaped hollow muscular organ. It is about 10cm long and is

about the size of the owner’s fist. It weighs about 225grams in women and is heavier in men

(about 310grams) (Wagh & Grant, 2014).

Position: The heart lies in the thoracic cavity in the mediastinum between the lungs. It lies

obliquely, a little more to the left than the right, and presents a base above, and an apex

below. The apex is about 9cm to the left of the midline at the level of the 5 th intercostal space,

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that is, a little below the nipple and slightly nearer the midline. The base extends to the level

of the 2nd rib (Wagh & Grant, 2014).

Structure: The heart is composed of three layers of tissue. They include pericardium,

myocardium and endocardium (Wagh & Grant, 2014).

1. Pericardium: The pericardium is made up of two sacs. The outer sac consists of

fibrous tissue and the inner of a continuous double layer serous membrane. The outer

fibrous sac is continuous with the tunica adventitia of the great blood vessel and is

adherent to the diaphragm below. It’s inelastic, fibrous nature and prevents over

distention of the heart. The outer layer of the serous membrane, the parietal

pericardium, lines the fibrous sac. The inner layer, the visceral pericardium, which is

continuous with the parietal pericardium, is adherent to the heart muscle. The serous

membrane consists of flattened epithelial cells which secrete serous fluid into the

space between the visceral and parietal layers, allowing movement between them

when the heart beats (Wagh & Grant, 2014).

2. Myocardium: The myocardium is composed of specialized cardiac muscle found only

in the heart. It is not under voluntary control but, like skeletal muscle, cross-stripes

are seen on microscopic examination. Each cell has a nucleus and one or more

branches. The ends of the cells and their branches are in very close contact with the

ends and branches of adjacent cells. Because of the end- to -end continuity of the

cells, each one does not need to have separate nerve supply. When impulses are

initiated, it spreads from cell to cell by the branches and intercalated disc over the

whole sheet of the muscle, causing contraction (Wagh & Grant, 2014).

3. Endocardium: This forms the lining of the myocardium and the heart valves. It is thin,

smooth, glistening membrane which permits smooth flow of blood inside the heart. It

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 consists of flattened epithelial cells, continuous with the endocardium that lines the

blood vessel (Wagh & Grant, 2014).

Blood Flow to the Heart

There are two largest veins in the body, the superior and the inferior vena cava empties it

contents into the right atrium. This blood passes via the right atrioventricular valve into the

right ventricle, and from there it is pumped into the pulmonary artery. The opening of the

pulmonary artery is guarded by the pulmonary valve, formed by three semi lunar casps.

This valve prevents the back flow of blood into the right ventricle when the ventricular

muscle relaxes. After leaving the heart, the pulmonary artery divides into the left and right

pulmonary arteries, which carry the venous blood to the lungs where exchange of gases takes

place. Carbon dioxide is excreted and oxygen is absorbed. Two pulmonary veins from each

lung carry oxygenated blood back to the left atrium. Blood then passes through the left

atrioventricular valve into the left ventricle and from there it is pump into the aorta. The

opening of the aorta is guided by the aortic valve where blood is supplied to various parts of

the body (Wagh & Grant, 2014).

Definition

Hypertension is defined as persistence increase in the blood pressure with the systolic

pressure greater than 140mmHg and a diastolic blood pressure greater than 90mmHg (Hinkle

& Cheever, 2014).

Incidence

Hypertension is more severe and prevalent in Blacks than white by a ratio of 2:1

approximately. Also 1/4th of the world’s population has hypertension (Lewis, Dirksen,

Heitkemper, Bucher, & Harding, 2017). In Africa, prevalence of hypertension is higher in

urban areas than in rural areas, it tends to affect women over 55years of age. It is also

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common in the second trimester of pregnancy. In Ghana, in about 10% of cases of

hypertension, there may be an underlying kidney disease, endocrine disorder, renal artery

stenosis or coarctation of the aorta (secondary hypertension) (Ministry of Health, 2017).

Table 1: Classification of Blood Pressure

Category Systolic (mm/Hg) Diastolic (mm/Hg)

Normal ˂120mmHg ˂80mmHg

Prehypertension 120-139mmHg 80-89mmHg

HPT stage 1 140-159mmHg 90-99mmHg

HPT stage 2 ≥160mmHg ≥100mmHg

Source: (Hinkle & Cheever, 2014)

Types of Hypertension

Hinkle and Cheever, (2014) also assert that basically there are two types of hypertension;

1. Primary Hypertension

2. Secondary Hypertension

According Ilidiades (2009), there are additional forms of hypertension which includes;

Isolated Systolic, Malignant, Resistant and Gestational hypertension.

Isolated systolic hypertension: Normal blood pressure is considered under 120/80. With

isolated systolic hypertension, the systolic pressure rises above 140, while the lower number

stays near the normal range, below 90. This type of hypertension is most common in people

over the age of 65 and is caused by the loss of elasticity in the arteries. The systolic pressure

is much more important than the diastolic pressure when it comes to the risk of

cardiovascular disease for an older person (Iliades, 2009).

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Malignant hypertension: This hypertension type occurs in only about 1 percent of people

with hypertension. It is more common in younger adults, African-American men, and women

who have pregnancy toxemia. Malignant hypertension occurs when the blood pressure rises

extremely quickly. If the diastolic pressure goes over 130, it may indicate malignant

hypertension. This is a medical emergency and should be treated in a hospital (Iliades, 2009).

Resistant hypertension: If a doctor has prescribed three different types of antihypertensive

medications and the blood pressure is still too high, it may signify resistant hypertension.

Resistant hypertension may occur in 20 to 30 percent of high blood pressure cases. Resistant

hypertension may have a genetic component and is more common in people who are older,

obese, female, African American, or have an underlying illness, such as diabetes or kidney

disease (Iliades, 2009).

Gestational Hypertension: High blood pressure can also occur with pregnancy; women who

experience high blood pressure during pregnancy are at increased risk of ischemic heart

disease, heart attacks, strokes, kidney disease, diabetes, and death from heart attack

(Männistö, Mendola, & Vääräsmäki, 2013).

Primary hypertension; the primary is also called Essential or Idiopathic hypertension. The

term is used interchangeably. It normally begins as a benign disease and slowly progresses to

an 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 unknown, there are predisposing factors,

These are;

a. Diet

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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 the vessels which results in increased blood pressure.

b. Alcohol

Excessive intake of alcohol increases both cardiac output and sympathetic activity which

eventually increases the blood pressure and the peripheral resistance.

c. Smoking of Tobacco/Cigarette

Nicotine in tobacco or cigarrete have a vaso-constrictive property and this does cause acute

elevations of blood pressure hence, hypertension.

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 collection of lipids within the lipids within the lumen

of 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 increased at the proximal

end. This process leads to increased blood pressure.

e. Sedentary lifestyle

Physical inactivity decreases high density lipoproteins, the collateral circulation and vessel

size and increases total cholesterol level, glucose intolerance and body weight. This increases

the risk of developing hypertension.

f. Aging

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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

mean blood pressure mostly common with older people(men) at the ages of 60-70years and

elderly older than 80years of age

g. Family History

Studies have shown that hypertension is familial thus; persons who are related to

hypertensive patients are at risk of developing hypertension.

h. Race

High blood pressure occurs two to three times more in blacks than in whites, especially at

diastolic levels above 105mmHg.

i. Stress

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 and above it is more common in women.

17
Secondary Hypertension: With secondary hypertension, the cause may be due to an

underlying disease condition and often occurs in 5％of patients with hypertension. These

include;

a. Renal Disorder

Stimulation and activation of the renin angiotensin aldosterone system results in increased

retention of sodium and water, vasoconstriction result in elevated blood pressure.

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 increased blood pressure. Both

glucocorticoid (cortisol) and mineralocorticoid (aldosterone) 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’s and Cushing syndrome. In

addition, hypertension in pregnancy is mainly due to hormonal disturbance during pregnancy.

d. Neurologic Disorders

Neurologic disorders such as brain tumors and head injuries put pressure on the posterior

hypothalamus, medulla or nerve pathways leading to excess catecholamine production.

Increase levels of catecholamine cause an increase in cardiac output which may result in

elevated blood pressure.

e. Pregnancy.

18
In pregnancy there may also be Pregnancy Induced Hypertension or gestational hypertension.

This usually occurs when there is abnormal placentation leading to placental perfusion. This

triggers a response in the circulatory system leading to vasospasms and subsequently

hypertension.

f. Medication.

Medication such as nervous stimulant, oral contraceptives, steroids pills and synthetics in

high blood pressure are part of their side effect.

Pathophysiology

Blood pressure is the product of cardiac output multiplied by peripheral resistance. Cardiac

output is the product of the heart rate multiplied by the stroke volume. In normal circulation,

pressure is transferred from the heart muscle to the blood each time the heart contracts and

then pressure is exerted by the blood as it flows through the blood vessels. Hypertension can

result from an increase in cardiac output, an increase in peripheral resistance (constriction of

the blood vessels), or both. Although no precise cause can be identified for most cases of

hypertension, it is understood that hypertension is a multifactorial condition. Because

hypertension is a sign, it is most likely to have many causes, just as fever has many causes.

For hypertension to occur there must be a change in one or more factors affecting peripheral

resistance or cardiac output. In addition, there must also be a problem with the body’s control

systems that monitor or regulate pressure. Single gene mutations associated with the

mechanisms used by the kidneys to reabsorb sodium ions have been identified for a few rare

types of hypertension, but most types of hypertension are thought to be polygenic (i.e.,

mutations in more than one gene) (Hinkle & Cheever, 2014).

Clinical Manifestation

19
Hypertension is usually referred to as the ‘’Silent killer’’ because it is frequently

asymptomatic and usually detected on a routine physical examination of blood pressure

(Hinkle & Cheever, 2014).

Ministry of Health, Ghana (2017) outlined the following as clinical manifestations of

hypertension;

1. Headaches

2. Palpitations

3. Dizziness

4. Easy fatiguability

5. Blood pressure ≥ 140/90 mmHg

6. Epistaxis

Diagnosis

Ministry of Health, Ghana (2017) outlined the following as diagnostic investigations of

hypertension;

1. Full blood count

2. Urinalysis

3. Blood urea, electrolytes and creatinine

4. Blood glucose

5. Serum lipids

6. Serum uric acid

7. Chest X-ray

8. 12-lead ECG

9. Ultrasound scan of kidneys and adrenals (in suspected secondary hypertension)

10. Echocardiogram

Hinkle and Cheever (2014) added the following;

20
 11. Health history and

12. Physical examination

Medical Management

The goal of hypertension treatment is to prevent complications and death by achieving and

maintaining the arterial blood pressure at 140/90 mm Hg or lower (Hinkle & Cheever, 2014).

Pharmacological therapy

The medications used for treating hypertension decrease peripheral resistance, blood volume,

or the strength and rate of myocardial contraction (Hinkle & Cheever, 2014). Medications

include;

Diuretic

Diuretic are not antihypertensive, but their combination with antihypertensive works

effectively in lowering blood pressure. According to Smeltzer et al, (2010), diuretic are

grouped under the following heading with examples:

1. Thiazide Diuretics: These groups inhibit reabsorption of sodium chloride in distal

convoluted tubule in the nephron Examples Bendrofluazide. This group

(bendrofluiade) was prescribed to the patient.

2. Loop Diuretics: These groups of diuretic inhibit reabsorption of sodium and chloride

in ascending loops of Henle. Examples include Furosemide (laxis), Torsemide etc.

3. Potassium Sparing Diuretic: these group of diuretics acts to block the effect of

aldosterone on the renal tubule leading to loss of sodium and water and the retention

of potassium. Example includes, Spironolactone, Amiloride etc

Antihypertensive

1. Central Alpha 2 Agonist: These groups of drugs displace norepinephrine from their

storage site. Examples include Methyldopa (Aldomet) and Clonidine

21
 2. Beta – Blockers: These groups of drugs block the effect of catecholamine from

receptor site to decrease cardiac output. Examples include Propranolol, Atenolol etc.

3. Alpha 1 Blocker: This drug work similar to vasodilators. They are peripheral

vasodilators by acting directly on blood vessel. Examples include Terazosin,

Prazosin etc.

4. Vasodilators: These drugs decrease peripheral resistance by dilating blood vessel.

Examples include Hydralazine, Sodium Nitroprusside etc

5. Angiotensin Converting Enzyme Inhibitors: These groups of drugs lower blood

pressure by blocking the conversion of angiotensin I to angiotensin II, a potent

vasoconstrictor. Examples include, Lisinopril and Captopril

6. Angiotensin II Receptor Blockers: These drugs also block the effect of angiotensin II

at the receptor site. Examples include Losartan, Candesartan etc

7. Calcium Channel Blockers: These groups of drugs work effectively to lower blood

pressure by inhibiting influx of calcium ion into the blood vessel. Examples;

Nifedipine, Amlodipine etc

8. Direct Renin Inhibitors: they block the activities of enzyme renin. Example Aliskiren

Non - Pharmacologic Management

1. Dietary changes

2. Lifestyle modifications

Dietary Changes

1. Sodium intake like salt should be restricted to reduce retention of water

2. Increase fiber intake to prevent constipation

3. Increase potassium intake such as banana as it increases extracellular potassium and

sodium level

4. Caloric and fat restriction

22
 5. Adequate intake of fruits and vegetables

Lifestyle Modifications

1. 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.

2. Avoidance of cigarette smoking

3. Moderation of alcohol intake

4. Stress management

Nursing Management

As discussed in Hinkle and Cheever (2014); the patient is nursed under the following

headings;

Psychological Management

1. The patient is reassured that with the good nursing interventions and medical team,

the blood pressure will fall within normal range so far as he remains in the hospital.

This is done to relax patient, win his cooperation and confidence and also to relieve

and prepare her psychologically for what to expect.

2. The patient was encouraged to ask questions about his condition and any other

misconceptions he has for clarification.

3. Patient was shown other recovering patient who suffered the same chronic disease

condition

4. Patient was made free to operate within his capacity thus, engaging a little chat with

bedmates to avoid excess thinking since it can mildly precipitate disease condition.

5. Positive aspect of the medical therapeutic treatment was centered on to patient.

23
 6. Patient was taken through series of counseling sessions and multiple diversional

therapies like, discussing the good olden days which he shared his experience,

television watching and newspaper reading.

7. Patient and family should be made to understand that with their maximum co-

operation, the condition can be managed.

Position

1. Put patient in an upright position to ensure breathing and to expand the chest

supported with back rest and pillows.

2. The patient may also assume a comfortable and more suitable position.

Rest and sleep

1. Ensure enough rest and sleep to enhance relaxation, this is done to conserve energy,

relax patient, promote healing, and reduce stress.

2. Patient should be given warm baths, proper ventilation and ensure that his bed is

neatly laid and made free from creases.

3. Avoid unnecessary visitations during sleeping hours and carry all nursing activities at

once to avoid sleep pattern interruptions.

4. Patient is given a complete bed rest for the first two weeks because of dizziness

experienced by patient.

Observation

1. Vital signs such as Temperature, Pulse and Respiration should be monitored two

hourly or four hourly to know the state or condition of patient, as to whether it is

deteriorating or progressing and take appropriate interventions accordingly.

2. Patient is also observed for therapeutic effect and side effect of drugs as well as

mental orientation of patient to time and place.

24
 3. Monitoring of patient’s intake and output chart is done and balanced at the end of

24hours. Blood pressure monitoring is done every hourly until stable.

4. Observe for possible complication that can occur.

Personal hygiene

1. 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.

2. Patient’s is also assisted to shave beard. Hands and feet must also be cared for in

order to prevent them from harboring microbes or injuring patient.

3. Patient’s gown must be changed regularly including bed linens and soiled diapers.

4. Oral care was done and sometimes assisted to do it.

5. Hand and feet are cared for by soaking them in water to soften it after which it

trimmed to the likeness of patient.

6. Care of the mouth is done by use of toothbrush and paste, and in an unconscious state

swap and normal saline is used.

7. Ensure hand washing with soap and water before and after eating and also after

visiting the toilet to prevent infection.

Nutrition

1. Patient’s nutritional level is met by serving patient with a well- balanced diet that is

low in sodium; low carbohydrate to help reduce weight in obese patient, low protein,

low fat to prevent hyperlipidemia, enough potassium supplement such as banana and

enough roughage to help reduce constipation.

2. Patient should be encouraged to take in vitamin supplement or fruits and vegetables to

25
 boost the body’s immune system.

3. Patient should therefore be involved in planning diet.

4. Meals served should be presented attractively and given in bits or at regular intervals.

5. Patient must have input and output to record the amount of food taken in

Exercise

1. Patient is encouraged and assisted if there is the need to either undertake passive or

active exercises to his or her tolerance levels, in order to improve circulation and to

prevent complications such as joint stiffness, aid in peristalsis and to prevent

constipation.

2. Assist patient to sit up in bed, walk around the bed and gradual turning in bed.

Elimination

1. Serve bed pan or assist patient to visit the toilet at patient’s request and urinals served

when necessary.

2. Encourage more fluids and roughages to soften stools.

3. When patient is unable to micturate, nursing measures such as opening tap water for it

to run, applying warm compresses on the lower segment of the abdomen and

catheterization carried out as ordered by the doctor in the extent that all other

measures taken to get patient to micturates fails.

Patient and Family Teachings

1. 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 new medication with a variety of side

effects.

2. They are advised to go for checkup for blood pressure to be checked.

26
Health Education

1. Health education is given on hypertension, taking into consideration the definition,

the cause, treatment and most especially the dietary changes.

2. Patient should be educated on the drug regimen and importance of taking it

appropriately to prevent any complication.

3. The chronicity of the disease condition and specific instruction concerning prescribed

therapy should also be emphasized.

4. Patients who smoke must be educated on the effect of smoking on hypertension. A

balanced between activity and relaxation should be touched on.

5. Because the condition is hereditary, other members of the family should be educated

to go for regular checking of blood pressure.

Prevention of Hypertension

Hypertension is a life threatening condition and as 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 form a positive and more comprehensive attitude

towards health.

Primary prevention

Health education is the most ideal action taken in primary prevention of hypertension.

These are 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.

Primary prevention of hypertension includes;

27
 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, prompt doctor’s attention for adequate treatment to be given.

2. Stress management by avoiding unhealthy arguments.

3. Weight reduction.

4. Moderation of alcohol intake.

5. Avoid smoking cigarette.

6. Regular physical exercise.

7. Fat and sodium.

Secondary Prevention

This has to do with, prevention of complications of the conditions by using drugs. It can also

be achieved through lifestyle modification.

Tertiary prevention

Tertiary production involves rehabilitation which focuses on assisting the patient to live

independent life after the complication has occurred.

Surgical Management

Surgical management may become necessary in the case of tumors (pheochromocytoma) and

sclerotic changes of the renal arteries which may be the cause of secondary hypertension.

This surgical intervention is known as adrenalectomy.

Complications

As opined by Hinkle and Cheever, (2014) if hypertension is not identified early for prompt

and effective treatment, it results in complications. These complications usually relates to the

various organs and structures which are dependent to the heart. The organs commonly

affected are;

1. Left ventricular hypertrophy

28
 2. Myocardial infarction

3. Heart failure

4. Transient Ischemic Attack (TIAs)

5. Cerebrovascular accident (CVA, stroke, or brain attack)

6. Renal insufficiency and failure

7. Retinal hemorrhage

1.12 Validation of Data

Validation is defined as the process of establishing the truth or logical cogency of something

(American Psychological Association, 2020). It simply means the act of checking and

confirming the accuracy of an information received. Information given by my patient were

continuously assessed by asking same questions in different ways from Mrs. C.K. and

relatives and the answers given were same. The home visit I embarked on and the interaction

I had with other family members of the patient confirmed the information given to me by my

patient. There were no contradictory answers. Moreover, the information gathered from the

doctor's notes, nurse's records, investigations carried out and the results and literature review

of the condition strongly confirms the validity of the information gathered. This implies that,

the information/data collected was valid and accurate.

29
Diagnostic Test Outlined in Literature Review Test Carried Out On Patient

1. Full blood count 1. Full blood count was done

2. Urinalysis 2. Urinalysis was not done

3. Blood urea, electrolytes and creatinine 3. Blood urea, electrolytes and creatinine was done

4. Blood glucose 5. Random blood sugar was checked

6. Serum lipids 4. Lipid profile was done

7. Serum uric acid test 5. Serum uric acid test was not done

8. Chest X-ray 6. Chest X-ray was not done

9. 12-lead ECG 7. 12-lead ECG was not done

10. Ultrasound scan of kidneys and adrenals 8. Ultrasound scan was not done

11. Echocardiogram 9. Echocardiogram was not done

12. Health history 10. Health history was taken

13. Physical examination 11. Physical examination was carried out

14. Blood film for malaria parasites was not in 12. Blood film for malaria parasites was done
the literature review
With reference to the table, Urinalysis, Serum uric acid, Chest X-ray, Ultrasound scan of

kidneys and adrenals and Echocardiogram were not carried out because the diagnoses were

arrived at and confirmed by Full blood count, Blood urea, electrolytes and creatinine,

Random blood sugar, Lipid profile, Healt

30
 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction

Analysis is a statistic that measures differences among group means and uses a

statistical technique to equate the groups under study in relation to another given

variable (Weller, 2014). This chapter forms the second phase of the nursing process

and it involves comparing the information gathered from the patient with the standard

treatment in the textbooks. It helps to identify the patient’s problems for appropriate

diagnoses to be formulated and also set nursing objectives. Data analysis comprises of

the following: comparison of data with standards, patient/ family strength, patient’s

health problems, and Nursing diagnoses.

2.1 Comparison of Data with Standards

Diagnostic investigations, causes, treatment, clinical manifestation and complication

of the patient’s condition are compared with the standard from the literature review.

A. Diagnostic Investigation\Test

Diagnostic investigation refers to procedures performed to establish a diagnosis, to

monitor a person’s health, disease or the effectiveness of treatment (Weller, 2014).

Several laboratory investigations were requested and done on Mrs. C.K to confirm her

diagnosis and help in treatment. They include;

1. Full blood count

2. Random blood sugar

3. Blood urea electrolyte and creatinine

4. Blood film for malaria parasites

31
 5. Lipid profile

Table 1: Comparison of Test Done to Literature

Diagnostic Test Outlined in Literature Test Carried Out On Patient

Review

15. Full blood count 13. Full blood count was done

16. Urinalysis 14. Urinalysis was not done

17. Blood urea, electrolytes and creatinine 15. Blood urea, electrolytes and creatinine was done

18. Blood glucose 19. Random blood sugar was checked

20. Serum lipids 16. Lipid profile was done

21. Serum uric acid test 17. Serum uric acid test was not done

22. Chest X-ray 18. Chest X-ray was not done

23. 12-lead ECG 19. 12-lead ECG was not done

24. Ultrasound scan of kidneys and adrenals 20. Ultrasound scan was not done

25. Echocardiogram 21. Echocardiogram was not done

26. Health history 22. Health history was taken

27. Physical examination 23. Physical examination was carried out

28. Blood film for malaria parasites was not in 24. Blood film for malaria parasites was done

the literature review

32
With reference to the table, Urinalysis, Serum uric acid, Chest X-ray, Ultrasound scan

of kidneys and adrenals and Echocardiogram were not carried out because the

diagnoses were arrived at and confirmed by Full blood count, Blood urea, electrolytes

and creatinine, Random blood sugar, Lipid profile, Health history and Physical

examination. Blood film for malaria parasites to rule out malaria.

33
 Table 2: Results of Diagnostic investigations carried Out on Patient

Date Specimen Investigations Results Normal values Interpretation Remarks

30/11/21 Blood Full Blood Count

Haemoglobin 15.6g/dL Males: 13g/dL -18g/dL Haemoglobin level was Patient was educated on

normal balanced diet to maintain

Females:12g/dL -16g/dL
hemoglobin.

Red Blood Cell 5.13x1012/L Males: 4.5 x1012/L -5.5 RBC count was normal No treatment given

x1012/L

Females: 4.0 x1012/L-5.0

x1012/L

White Blood Cell 3.87x109/L 3.50 x109/L -10.0 x109/L WBC count was within No treatment given

normal range.

34
30/11/21 Blood Blood film for Negative Absence of plasmodium Patient did not have No treatment given

malaria parasites parasite in the blood malaria

Table 2: Results of Diagnostic investigations carried Out on Patient Cont’d…

35
Ordered Specimen Investigations Results Normal values Interpretation Remarks

30/11/21 Blood Random Blood Sugar 6.2mmol/L 5.6-7.2mmol/L The value is within Patient was then

(RBS) normal range, and hence educated on his

indicating no diabetes in nutritional status.

my patient.

31/11/21 Blood Lipid profile

Cholesterol 175mg/dl <200mg/dl-239mg/dl Normal range No treatment given

Triglyceride 89mg/dl <150mg/dl-199mg/dl Normal range No treatment given

High Density Lipoprotein 42mg/dl 40mg/dl-60mg/dl Normal range No treatment given

(HDL)

Low Density Lipoprotein 76mg/dl <100mg/dl-159mg/dl Normal range No treatment given

36
(LDL)
31/11/21 Blood Urea 3.2mmol/L 1.67 mmol/L - 8.2 Normal No treatment given

mmol/L

Creatinine 94.6umol/L 57.0umol/L - Normal No treatment given

97.0umol/L

37
 B. Causes of the Patient’s Condition

With regards to the data collected, the patient’s condition is primary hypertension.

The cause is unknown.

Table 3: Comparing Clinical Manifestations of the Patient with Standards

Signs and Symptoms Outlined in Literature Signs and Symptoms Exhibited by Patient

1. Headaches 1. Patient complained of headaches

2. Palpitations 2. Patient experienced palpitations

3. Dizziness 3. Patient complained of dizziness

4. Easy fatiguability 4. Patient was easily fatigued

5. Blood pressure ≥ 140/90 mmHg 5. BP on admission-170/105mmHg

6. Epistaxis 6. Patient did not experience nose bleeds

From the above table, it clear that patient was clearly having Hypertension since she

exhibited some key manifestations of Hypertension.

C. Treatment of the Patient

Treatment is defined as the mode of dealing with a patient or disease (Weller, 2014).

The following medications were prescribed for the management of the patient’s

condition.

1. IV labetalol 20mg stat

2. Tablet Nifedipine 40mg bd for 14 days

3. Tablet Lisinopril 10mg daily for 30 days

4. Tablet Paracetamol 1g tds for 5 days

38
 Table 4: Treatment Given to Patient as Compare to Literature Review

Treatment in the Literature Review Treatment Given to Patient

1. Diuretic Example: Furosemide 1. Diuretic was not prescribed

2. Central Alpha 2 Agonist Example: Methyldopa 2. Central Alpha 2 Agonist was not prescribed

3. Beta-Blocker Example: Propranolol 3. Intravenous Labetalol was administered

4. Alpha 1 Blocker Example: Terazosin 4. Alpha 1 Blocker was not prescribed

5. Vasodilator Example: Hydralazine HCL 5. Vasodilator was not prescribed

6. ACE Inhibitors Example: Captopril 6. Tablet Lisinopril was administered

7. Angiotensin II Receptor Blocker Example: Losartan 7. Angiotensin II Receptor Blockers was not prescribed

8. Calcium Channel Blockers Example: Nifedipine 8. Tablet Nifedipine was administered

9. Direct Renin Inhibitor Example: Aliskiren 9. Direct Renin Inhibitor was not prescribed

10. Analgesic/Antipyretic not in literature review 10. Tablet Paracetamol was administered

39
 Table 5: Pharmacology of Drugs Administered to Patient

Date Drug Dosage/route of Date/route of Classification Action desired Action Side effect
administration in administration given observed
literature review to my patient

30/11/21 Labetalol Dosage: IV: 50 mg Dosage: 20mg stat Beta-adrenoceptor Beta-adrenoceptor Patients’ blood Drug fever, ejaculation

hydrochloride stat, then 50 mg every blocker blocking drugs (beta- pressure was failure,

5 minute blockers) block the reduced hypersensitivity,

Route: Intravenously
beta-adrenoceptors in urinary disorders. None
Mouth: 100 mg twice
the heart, peripheral was observed.
daily
vasculature, bronchi,
Route: Intravenous,
pancreas, and liver.
Oral

30/11/21 Nifedipine Dosage: 20–30 mg Dosage: 40mg stat, Calcium Channel Inhibit calcium ion Patient blood Constipation, malaise,

once daily then 30mg bd x 30 Blocker influx, Vasodilating pressure was oedema vasodilation.

effects on coronary and reduced. None was observed

peripheral arteriole

40
 Route: Oral Route: Orally

Table 5: Pharmacology of Drugs Administered to Patient Cont’d…

Date Drug Dosage/route of Date/route of Classification of Action desired Action Side effect
administration in administration drugs observed
literature review given to my
patient

30/11/21 Lisinopril Dosage: 10 mg once daily Dosage: 10mg daily Angiotensin- Block the conversion Patient blood Postural disorders,

for 14 days converting enzyme of angiotensin I to pressure was Hallucination, mood

inhibitor angiotensin II, a poten reduced. altered. None was

tvasoconstrictor. observed
Route: Oral
Route: Oral

41
30/11/21 Paracetamol Dosage: 0.5-1 g every 4– Dosage1g tds x 5 Antipyretic/Analgesic To reduce pain and Patient had a Malaise, skin reactions,

6 hours fever by preventing reduction in allergic reactions and

the releases of pain and did not liver damage. None was
Route: Oral, Rectal,
Route: Orally
prostaglandins that experience any observed
Intravenous.
increase pain and increase in

body temperature. temperature.

42
 D. Complications

As specified by Weller (2014), Complication refers to an unfavorable health result of

a disease condition. Patient did not experience any complication of hypertension due

to effective medical and nursing care rendered to him during the period of

hospitalization.

2.2 Patient and Family Strength

Strength refers to the quality or state of being strong (Merriam-Wester, 2020). The

following strengths were observed on patient during the time of nursing care.

1. Patient was able to specify the severity of the headache

2. Patient was restricted when it came to movement due to dizziness but could walk

when given some form of assistance.

3. Patient was able to perform passive form of exercise in bed.

4. Patient was able to verbalize her state of anxiousness.

5. Patient was able to eat one-third of 500ml of porridge served.

6. Patient expressed interest in gaining knowledge on the causes, prevention, signs

and symptoms and management of hypertension.

2.3 Patient’s Health Problems

Problem is defined as a question raised for inquiry, consideration, or solution

(Merriam-Wester, 2020). During assessment, Mrs. C.K. presented with the following

health problems:

1. (30/11/21) Patient complained headache.

2. (30/11/21) Patient grumbled about feeling dizzy.

3. ( 30/11/21) Patient was easily fatigued.

4. ( 30/11/21) Patient was anxious about the outcome of disease condition.

5. (01/12/21) Patient complained of loss of appetite.

43
6. (02/12/21) Patient had inadequate knowledge on the management of hypertension.

2.4 Nursing Diagnoses

According to Hinkle and Cheever (2014), nursing diagnosis is the organization,

analysis, synthesis and summarization of data collected and determines the patient’s

need for care.

1. (30/11/21) Impaired comfort related to hypertensive urgency related symptoms as

evidenced by self-report of headache.

2. (30/11/21) Risk for falls related to dizziness as evidenced by self-report of feeling

dizzy.

3. (30/11/21) Activity intolerance related to imbalance between oxygen supply as

evidenced by fatigue.

4. (30/11/21) Anxiety related to exposure to unfamiliar hospital environment as

evidenced by absent eye contact and self-report of anxiety.

5. (01/12/21)Imbalanced nutrition (less than body requirement) related to inadequate

dietary intake as evidenced by insufficient interest in food.

6. (02/12/21) Deficient Knowledge related to inadequate information as evidenced by

unfamiliarity with the need for frequent blood pressure checks, adherence to

antihypertensive therapy, and lifestyle changes.

44
 CHAPTER THREE

PLANNING FOR PATIENT/FAMILY CARE

3.0 Introduction

Planning is the process in which the nurse and patient together consider the goals to

achieve in meeting the patient’s potential problems in everyday life and draw an

individual care plan (Weller, 2014). Planning for patient/family care is the third stage

of the nursing process. A nursing care plan commences with the nursing diagnosis,

the goals and objectives. Once these goals are identified, unique nursing actions are

outlined to achieve the goals and objectives. It is based on the potential and actual

problems identified. The nurse further goes on to evaluate the care given to find out

whether set goals and objectives are fully met, partially met or unmet.

3.1 Objectives/ Outcome Criteria

1. Patient will be relieved from headache within 24 hours as evidenced by;

a. Patient verbalizing that she is relieved of headache

b. Nurse witnessing a jolly facial expression

2. Patient will not fall and sustain any injury throughout her period of hospitalization as

evidenced by;

a. Patient verbalizing she no longer feels dizzy

b. Nurse observing that patient is free of any trauma

3. Patient will partake in activities of daily living within 48 hours as evidenced by;

a. Patient verbalizing that she no longer has any feeling of fatigue

b. Nurse observing that patient perform activities of daily living independently

4. Patient will be relieved of anxiety within 24 hours as evidenced by;

45
 a. Patient verbalizing that she has been relieved of anxiety

b. Nurse observing patient interacting with other patient and cooperating with

care

5. Patient will achieve and continue adequate nutrition within 48 hours as evidenced by;

a. Patient verbalizing that she has gained appetite for food

b. Nurse observing that patient takes at least two thirds of 500ml of porridge served

6. Patient will gain adequate knowledge on hypertension within 24 hours of

hospitalization as evidenced by;

a. Patient verbalizing the importance of frequent BP checks

b. Nurse observing that patient adhering to antihypertensive therapy and lifestyle

changes.

46
47
 Table 6: Nursing care plan for Patient

Date/ Nursing Objectives/ Nursing Orders Nursing intervention Date/ Evaluation Sign

Time Diagnosis Outcome criteria Time

30/11/21 Impaired Patient will be 1. Reassure patient. 1. Patient was reassured that her condition 01/11/21 Goal fully N.R

comfort relieved from will improve met as

03:00pm 03:00pm
related to headache within 24 patient
2. Pain was assessed using the pain rating
2. Assess patient level of pain
hypertensive hours as evidenced verbalized
scale (0-10) which patient indicated 5.
urgency by; that she is
3. Head was elevated to help decrease
related relieved of
1.Patientverbalizing 3. Raise the head of the bed to 30
tension.
symptoms as headache
that she is relieved degrees
evidenced by 4. Patient was supported and complete bed and nurse
of headache
self-report of 4. Support client and ensure a witnessed a
rest was ensured in a calm environment and
2. Nurse witnessing complete bed rest.
headache bed was also free from creases and cramps. jolly facial
a jolly facial
5. Monitor blood pressure frequently. expression
5. Blood pressure was monitored every 30
expression
minutes.
6. Serve prescribed analgesics and

48
 antihypertensives 6. Tablet paracetamol 1g and Tablet

Nifedipine 40mg were served.

Table 6: Nursing care plan for Patient Continued

49
Date/ Nursing Objectives/ Outcome Nursing Orders Nursing intervention Date/ Evaluation Sign

Time Diagnosis criteria Time

30/11/21 Risk for Patient will not fall 1. Assess patient need to use the 1. Patients’ need to use the bathroom every two 04/12/21 Goal fully N.R

falls and sustain any injury bathroom every two hours. hours was assessed to aid her. met as
03:30pm 11:30am
related to throughout her period patient
2. Maintain an orderly environment 2. An orderly environment was maintained by
dizziness of hospitalization as verbalized,
with unobstructed walkways making sure walkways were unobstructed
as evidenced by; she no
3. Orient the patient to new 3. Patient was oriented to her new environment
evidenced longer
1.Patient verbalizing
surroundings.
by self- feels dizzy
she no longer feels
report of 4. Keep necessary items within easy and nurse
dizzy 4. Necessary items (including water, snacks,
feeling reach. observed
phone) were kept within easy reach.
2. Nurse observing
dizzy that patient
that patient is free of
was free of
any trauma 5. Ensure adequate lighting at night
5. Adequate lighting at night was ensured any trauma

50
 6. Keep bed in its lowest position with 6. Patient’s bed was kept in the lowest position

bed brakes on. with bed brakes on at all times to prevent falls

Table 6: Nursing care plan for Patient Continued

Date/ Nursing Objectives/ Nursing Orders Nursing intervention Date/ Evaluation Sign

Time Diagnosis Outcome criteria Time

51
30/11/21 Activity Patient will partake 1. Reassure patient of regaining 1. Patient was reassured that she will regain 02/12/21 Goal fully met R.N

intolerance in activities of daily strength for daily activities. strength for her daily activities. as patient
03:50pm 03:50pm
related to living within 48 verbalized that
2. Assess the patient level of 2. Level of physical activity and mobility was
imbalance hours as evidenced that she no
physical activity and mobility. assessed by engaging patient in activities such as
between by;living longer has any
walking.
3. Monitor the patient’s
oxygen independently feeling of
respiratory response to activity 3. Patients respiratory response to activity was
supply as fatigue and
1. Patient verbalizes
monitored
evidenced 4. Allow at least 90 min nurse observed
that she no longer has
by fatigue between activities for 4. At least 90mins between activities for that patient
any feeling of fatigue
undisturbed rest. undisturbed rest was allowed to enable performed
2. Nurse observing
physiologic recovery activities of
5. Provide emotional support
that patient perform
daily living
while increasing activity. 5. Emotional support was provided so as to enable
activities of daily
patient perform activities.
living 6. Place items of daily use close

to patient. 6. Items such as water were kept close to patient.

52
 Table 6: Nursing care plan for Patient Continued

Date/ Nursing Objectives/ Nursing Orders Nursing intervention Date/ Evaluation Sign

Time Diagnosis Outcome criteria Time

53
30/11/21 Anxiety Patient will be 1. Reassure patient 1. Patient and family were reassured that 01/12/21 Goal fully met R.N

related to relieved of anxiety they are in a new but safe environment. as patient
04:00pm 04:00pm
exposure to within 24 hours as verbalized that
2. Patient’s level of anxiety was assessed.
2. Assess patient’s level of anxiety
unfamiliar evidenced by; she has been
3. A calm manner was maintained while
hospital 3. Maintain a calm manner while relieved of
1.Patient verbalizing
interacting with the patient.
environment interacting with the patient. anxiety and
that she has been
as evidenced 4. Patient were oriented to the ward nurse
relieved of anxiety 4. Orientate the patient to the ward
by absent environment and new experiences observed
environment, new experiences
2.Nurse observing
eye contact patient interact
5. Patient was encouraged to talk about
patient interact with 5. Encourage patient to talk about
and self- with other
anxious feelings and they were addressed
other patient and anxious feelings
report of patient and
appropriately
cooperate with care
anxiety cooperated
6. Patient was assisted in developing new- with care
6. Assist the patient in developing
anxiety- reducing skills eg. Relaxation, deep
new- anxiety- reducing skills
breathing, etc.

Table 6: Nursing care plan for Patient Continued

54
Date/ Nursing Outcome Criteria Nursing Orders Nursing Intervention Date Evaluation S

Time Diagnosis /Time i

01/12/21 Imbalanced Patient will achieve and 1. Discuss with patient and family 1. Patient and family were 03/12/21 Goal fully met
about the importance of food for the educated about the importance of
8:20am nutrition continue adequate nutrition 8:20am as patient
body. food for the body.
(less than within 48 hours as verbalized that
2. Monitor the amount of food intake. 2. The amount of food intake was
body evidenced by; 3. Plan diet with dietician and make monitored. she has gained
sure patient preferences are 3. Diets were planned with
requirement 1. Patient verbalizing that appetite for
considered dietician and patients preferences
) related to she has gained appetite for food and nurse
were taken into consideration
inadequate food 4. Provide a varied diet to stimulate 4. A varied diet was provided observed that
patient’s appetite. according to patient’s diet to
dietary 2. Nurse observing that patient takes at
stimulate her appetite.

55
intake as patient takes at least two 5. Provide food in small portions but 5. Food was provided in small least two thirds
frequently. portions but frequently.
evidenced thirds of 500ml of porridge of 500ml of
6. Educate client on the need to take 6. Client was educated on the
by served porridge
in nutritionally rich diets. need to take in nutritionally rich
insufficient diets. served

interest in

food

56
 Table 6: Nursing care plan for Patient Continued

Date/ Nursing Objectives/ Nursing Orders Nursing intervention Date/ Evaluation Sign
Time Diagnosis Outcome criteria
Time

02/12/21 Deficient Patient will gain 1. Assess the patient’s health 1. Assessment of patient health care 03/12/21 Goal fully met R.N

knowledge adequate knowledge care literacy (language, literacy was carried out. as patient
8:00am 8:00am
related to on hypertension reading, comprehension). verbalized the
2. Information was selected and
inadequate within 24 hours of importance of
2. Assess culture and culturally presented in a manner that is
information as hospitalization as frequent BP
specific information needs. culturally after the assessment
evidenced by evidenced by; checks and

unfamiliarity 3. Educate patient on the 3. Patient was educated on the nurse observed
1. Patient verbalizing
with the need for importance of exercise and importance of exercise and taking that patient
the importance of
frequent blood taking less than 2 g/day sodium less than 2 g/day sodium diet. adhered to
frequent BP checks
pressure checks, diet. antihypertensive
4. Patient was educated on drug
adherence to 4. Teach patient drug administration times, side effects therapy and

antihypertensive 2.Nurs observing that lifestyle

administration times, side and adverse effects.
therapy, and patient adhering to effects and adverse effects. changes
antihypertensive 5. Misconceptions regarding drug

57
lifestyle changes therapy and lifestyle 5. Address misconceptions was addressed by telling patient to

changes such as drugs should only be always take the drug even when
taken when signs and signs and symptom are not showing
symptoms begin show

58
 CHAPTER FOUR

IMPLEMENTING PATENT / FAMILY CARE PLAN

4.0 Introduction
Implementation of client and family care is the first step in the nursing process. The

implementation of nursing orders in the care plan ensures that the nurse performs

established activities on the patient. The nurse assumes responsibility for the

implementation and coordinates the activities of all those involved in implementation,

including the patient and family, other members of the nursing team, and other

members of the health care team, so that the schedule of activities facilitates the

patient’s recovery (Cheever & Hinkle, 2014). This chapter gives a vivid account of

the nursing care that was rendered to the patient/family from the day of admission

until discharge based on the health problems identified. It also deals with follow up

visits/home visits to ensure continuity of care.

4.1 Summary of Actual Nursing Care

This involves the summary of the total nursing care rendered to Miss E.K from the

day of admission till the day of her discharge. The care given to the patient such as

grooming, feeding, medication administration is summarized on daily basis as

follows:

First Day of Admission (30th November, 2021)

On the 30th November, 2021 at 3:00pm, patient was brought to the female medical

ward in a wheelchair accompanied by a staff nurse, student nurse and a relative. On

observation, patient was mildly weak and anxious. Patient was received onto an

already prepared simple unoccupied bed.

59
 On admission, patient’s vital signs were checked and recorded as follows;

5. Temperature 36.00C

6. Pulse 91bpm (beats per minute)

7. Respiration 24cpm (cycles per minute)

8. Blood pressure 170/105mmHg (millimeters of mercury)

Mrs. C.K. was to be managed on the following medications

5. IV labetalol 20mg stat

6. Tablet Nifedipine 40mg bd for 14 days

7. Tablet Lisinopril 10mg daily for 30 days

8. Tablet Paracetamol 1g tds for 5 days

Laboratory investigations requested for the patient were;

6. Full blood count

7. Random blood sugar

8. Blood urea electrolyte and creatinine

9. Blood film for malaria parasites

10. Lipid profile

A head-to-toe examination was carried out and no abnormalities were seen. She

presented with the history of elevated blood pressure; intervention was given by

administering Nifedipine 40mg as prescribed, Tablet Paracetamol 1g was

administered to help relieve patient from headache. Patient was nursed on a low bed

with side rails elevated to prevent her from falling because she complained of

dizziness.

60
Patient’s treatment was commenced immediately due to availability of drugs at the

hospital’s pharmacy as well as ward stock and was administered during admission. As

part of monitoring, a four hourly blood pressure chart was drawn.

The information collected was confirmed again before entering them into the

admission and discharge book, daily ward state, nurse’s notes and report books.

Additional information such as home town and place of birth were also obtained from

patient and documented.

Mrs. C.K’s. daughter was orientated to the ward and was made aware of visiting

hours, ward rounds and medication time. After these interventions, I informed the

ward In-charge of my intention of using the patient and the family for a care study and

I was granted the permission.

I introduced myself to patient and relatives as a final year student nurse from the Holy

Family Nursing and Midwifery Training College-Berekum. I also explained the

concept of the family / patient care study to patient and emphasized that it is a

requirement by nursing and Midwifery Council in partial fulfillment towards the

award of a license to practice and my intension to use her for my care study due to my

interest in her condition. She was assured of confidentiality of her identity and any

particulars that will be collected and they agreed. Mrs. C.K was made comfortable in

bed and reassured of competent nursing care. A brief health education was given to

her and her relatives on condition, hygiene and type of diet to eat. Her daughter was

also informed to bring the necessary items which will be needed during her stay at the

ward, because of patient’s dizziness, Patient’s daughter was well oriented to the ward

and it annexes.

61
On admission at 3:00pm, patient complained of headache hence the nursing diagnosis

of impaired comfort related to hypertensive urgency related symptoms as evidenced

by self-report of headache was formulated. An objective criteria was set and the

following measures were implemented to aid her headache subside within 24 hours:

Patient was reassured that her condition will improve, Pain was assessed using the

pain rating scale (0-10) which patient indicated, Head was elevated to help decrease

tension, Patient was supported and complete bed rest was ensured in a calm

environment and bed was also free from creases and cramps, Blood pressure was

monitored every 30 minutes, Tablet paracetamol 1g and Tablet Nifedipine 40mg were

served.

At 3:30pm, patient complained of feeling dizzy hence the nursing diagnosis of risk for

falls related to dizziness as evidenced by self-report of feeling dizzy was formulated.

An objective criteria was set and the following measures were implemented to help

her from having any falls throughout her period of hospitalization: Patients’ need to

use the bathroom every two hours was assessed to aid her, An orderly environment

was maintained by making sure walkways were unobstructed, Patient was oriented to

her new environment, Necessary items (including water, snacks, phone) were kept

within easy reach, Adequate lighting at night was ensured, Patient’s bed was kept in

the lowest position with bed brakes on at all times to prevent falls.

Upon interacting with patient at 3:50pm, patient complained of body weakness and

further observation on patient in relation to how she carried out her activities, it was

observed that patient has lost strength as she could not fully tolerate activities.

Nursing diagnoses of activity intolerance related to imbalance between oxygen supply

as evidenced by fatigue was made. An objective criteria was set to restore patients’

strength in order to perform her daily activities on her own within 48hours. The

62
following interventions were carried out: Patient was reassured that she will regain

strength for her daily activities, Level of physical activity and mobility was assessed

by engaging patient in activities such as walking, Patients respiratory response to

activity was monitored, At least 90mins between activities for undisturbed rest was

allowed to enable physiologic recovery, Emotional support was provided so as to

enable patient perform activities, Items such as water were kept close to patient.

Upon interacting with patient 4:00pm, patient manifested a feeling of apprehension as

she was not cooperating. So, I asked patient to verbalize her fears with regards to her

stay in the ward. She then revealed to me that she was anxious because she was in a

new environment and does not know the outcome of the disease condition. Nursing

diagnosis was made as Anxiety related to new environment and unknown outcome of

disease condition. An objective criteria was therefore set to relieve patient and family

of anxiety within 24 hours. Nursing interventions carried out were as follows: Patient

and family were reassured that they are in a new but safe environment, Patient’s level

of anxiety was assessed, A calm manner was maintained while interacting with the

patient, Patient were oriented to the ward environment and new experiences, Patient

was encouraged to talk about anxious feelings and they were addressed appropriately,

Patient was assisted in developing new- anxiety- reducing skills eg. Relaxation, deep

breathing, etc.

At 10:00am, patients’ vital signs were checked and recorded as indicated in the

appendix.

At 2pm, afternoon vital signs were checked and recorded as indicated in the appendix.

Assessment of headache was carried out and goal was not fully met as patient was

still complaining of headache.

63
She ate rice and stew around 5:50pm as her supper. Due to the hospital protocols,

patient’s vital signs were checked and recorded at 6:00pm as indicated in the

appendix. At 10:00pm her vital signs were checked and recorded and due medications

were administered. Patient was recessed to bed at 10:20pm.

Second Day of Admission (1st December, 2021)

On the second day of admission, at 7:00am I went to the ward to continue with my

nursing care for patient. Her morning vital signs were checked at 6am and recorded as

indicated in the appendix.

At 8:20am, Patient had her breakfast which was Hausa porridge with milk and bread,

she was able to consume just one-third of the porridge and she did not even take a

piece of the bread. Based on my observation, I conducted a nursing assessment on

patient and it was realized that patient had a poor nutritional status. This was evident

as patient and her relative tested to the fact that patient is able to consume only one-

third of food she is been served with. A nursing diagnosis was formulated as

imbalanced nutrition (less than body requirement) related to inadequate dietary intake

as evidenced by insufficient interest in food. As such, an objective criteria was to help

her attain and maintain adequate nutrition within 48 hours was set. The following

nursing actions were implemented: Patient and family were educated about the

importance of food for the body, the amount of food intake was monitored, Diets were

planned with dietician and patients preferences were taken into consideration, A

varied diet was provided according to patient’s diet to stimulate her appetite, Food

was provided in small portions but frequently, Client was educated on the need to take

in nutritionally rich diets.

64
At 2:00pm, Afternoon vital signs were checked and recorded and due medications

were administered.

I embarked on my first home visit after work, I went with patient’s daughter. The

purpose was to know patient’s residence and the environment in which she lives,

verify the information given to me as well as to identify the risk factors such as

familial tendency and stresses that can lead to her condition.

At 3:00pm, objective that was set on 30th November, 2021 in order for patient’s

headache to subside within 24 hours was evaluated and goal was fully met as patient

verbalized that she is relieved of headache and nurse witnessed a jolly facial

expression.

At 4:00pm, objective that was set on 30th November, 2021 to help relieve patient of

fear and anxiety within 24hours was evaluated and goal was fully met as patient

verbalized that she has been relieved of anxiety and nurse observed patient interact

with other patient and cooperated with care.

At 10:00pm, her vital signs were checked and recorded as indicated in the appendix

and her due medications were served. Patient was made comfortable in bed and she

slept around 10:20pm.

Third Day of Admission (2nd December, 2021)

On the third day of admission, patient looked cheerful that morning, was assisted in

brushing her teeth, had her bath and emptied her bowel. Report from the night nurses

read that she was able to sleep well upon the measures put in place. I was told by the

nurse who handed over that she had taken her breakfast which was porridge and

Koose but she took only two of her five koose bought and little of the koko. She was

65
fine when I saw her in the morning. Doctor came for rounds and requested that patient

should continue with treatment.

At 8:00am, patient was engaged in an interaction and it was realized that patient had

less knowledge on condition (Hypertension). The nursing diagnosis formulated was

deficient knowledge related to inadequate information as evidenced by unfamiliarity

with the need for frequent blood pressure checks, adherence to antihypertensive

therapy, and lifestyle changes. An objective criteria was set for to help patient and

family gain adequate knowledge on hypertension within 24 hours of hospitalization.

Interventions carried out were: Assessment of patient health care literacy was carried

out, Information was selected and presented in a manner that is culturally after the

assessment, Patient was educated on the importance of exercise and taking less than 2

g/day sodium diet, Patient was educated on drug administration times, side effects and

adverse effects, Misconceptions regarding drug was addressed by telling patient to

always take the drug even when signs and symptom are not showing.

His four hourly vital signs thus 10:00am were checked and recorded as shown in the

appendix. She was served with fufu and garden eggs soup as her lunch brought by her

daughter. She ate a little bit and was served with energy drinks afterwards. At 2:00pm

her vital signs were checked and recorded as in the appendix.

At 3:50pm, objective that was on 30th November, 2021 set to help patient regain her

strength for her daily activities within 48 hours was evaluated and goal was fully met

as patient patient verbalized that that she no longer has any feeling of fatigue and

nurse observed that patient performed activities of daily living.

In the evening, she took rice and stew around 5:30pm as her supper. Patient was able

to consume a small portion of the food but with little improvement on previous meals

66
she took. She watched television with other patient in the ward and due medications

were served and vital signs were checked at 6:00pm and recorded as shown in the

appendix. She slept around 10:30pm

Fourth Day of Admission (3rd December, 2021)

On the fourth day of admission, patient looked cheerful that morning, was assisted in

brushing her teeth, had her bath and emptied her bowel. Report from the night nurses

read that she was able to sleep well upon the measures put in place. Vital signs

checked and recorded as indicated in the appendix. Due medications were served.

Patient was served with porridge and koose for breakfast.

At 8:00am, objective that was set on 2nd December, 2021 to help patient gain adequate

knowledge on hypertension within 24 hours of hospitalization was evaluated and goal

was fully met as patient verbalized the importance of frequent BP checks and nurse

observed that patient adhered to antihypertensive therapy and lifestyle changes.

At 8:20am, objective that was set on 1st December, 2021 to enable patient achieve and

continue adequate nutrition within 48 hours was evaluated and goal was fully met as

patient verbalized that she has gained appetite for food and nurse observed that patient

takes at least two thirds of 500ml of porridge served.

At 9:30am patient was reviewed and plan was to continue all medications.

At 2:00pm patient vital signs were checked and recorded as in the appendix and due

medications were administered. Patient took banku and okro stew as her supper

around 5:00pm after which she watched television with her ward mates. Her vital

signs at 10:00pm were checked and recorded as in the appendix. Patient went to bed

around 10:30pm.

67
Day of Discharge/Fifth Day of Admission (4th December, 2021)

I went to continue the nursing care rendered to patient at 7:35pm. Patient woke up

feeling strong and better. Report from night nurses indicated that patient was able to

sleep well. I greeted patient and her daughter, they responded with a cheerful facial

expression. I was inquisitive enough to ask patient why she has put up a smiley face.

Upon asking, patient said that she feels grateful to have special nursing care rendered

to her over the past few days since she was admitted. Her 6:00am vital signs had

already been checked and recorded as shown in the appendix.

At 11:30am, objective that was set on 30th November, 2021 so as to prevent patient

from falls throughout her period of hospitalization was evaluated and goal was fully

met as patient verbalized that she no longer feels dizzy and nurse observed that patient

was free of any trauma.

During routine ward rounds at 9:20am, patient was discharged by the Doctor since her

condition was stable and she had no complains. Patient was informed that she has

been discharged.

I enquired whether she left any valuable items with any nurse and the response was

no. Necessary documents were recorded into the admission and discharge book as

well as the ward state. Assessment of patient bills were made with the help of

National health insurance scheme. No amount of money was paid for medications

since all was covered by National Health Insurance Scheme. Patient was educated on

the need to eat food containing high fiber like whole grains, the entire essential food

nutrients, for example protein, vitamins and irons, as well as maintaining good

personal hygiene. Patients used linen was removed and placed in the laundry basket.

Bleach solution was used to disinfect the bed as well as the bed side locker.

68
4.2. Preparation of Patient/Family for Discharge and Rehabilitation.
Preparation for discharge commenced from the time of admission at the hospital till

the last day of visit. The patient and family were informed that staying in the hospital

was for a temporal period of time.

Education of patient / family on hypertension were reemphasized, some of the key

points were: limiting the intake of salt and all sodium containing foods, increasing the

intake of vegetables, fruits and low-fat dairy foods and moderate amounts of whole

grains, fish, poultry and nuts, avoiding the intake of alcohol, exercising, adhering to

medication regimen and follow up visits to the health facility. This was aimed at

helping the patient and relatives in the provision of adequate care. Patient / family

were also educated on the need to maintain personal and environmental hygiene to

help improve immunity. They were advised to adhere to treatment given and also to

report to the hospital immediately she experiences any abnormalities in her health so

the early measure will be taken. Sleeping under insecticide treated mosquito net was

also communicated to patient and her family. Patient was asked to come for review on

13th December, 2021. The importance and necessity of the review was explained to

the patient.

I entered her name, date of discharge and receipt number into the Admission and

Discharge book and daily ward state. They express their gratitude to the staff on the

ward and bid the other patient’s good bye. Patient belongings were packed and I

accompanied them to the hospital entrance and bid them goodbye.

4.3 Follow Up / Home Visit / Continuity of Care

To ensure a high standard of nursing care, the patient’s home was visited. The aim

was to assess the actual home situation in relation to the health of the patient and

69
family. It was also done to recommend solutions to problems which may pose as

health hazard.

First Home Visit (1st December, 2021)

My first home visit was made on the 1st December, 2021 while patient was on

admission. A planned visit was made from Holy Family Hospital, Berekum to an area

in town called Jinijin where patient resides. The purpose of this visit was to know

patient’s residence and the environment in which she lives, verify the information

given to me as well as to identify the risk factors such as familial tendency and

stresses that can lead to his condition. To enable me know patients nearest health

facility for possible referral and validation of patient data. I left the Hospital around

11:00am and boarded a tricycle at the entrance. Since I had been given direction to the

house by patients daughter locating it was never a problem. I alighted at Jinijin. It was

about 30 minutes ride. On arrival I was welcomed and offered a seat by those I met. I

informed them of my mission. They had already met me at the hospital so no

introduction was needed. They live in a 2-bedroom house built with blocks, not

painted and roofed with aluminum sheets and is wired correctly with electricity

power, had windows. The kitchen was located in the front view of the house. They

had a neat bathroom and toilet facilities at the back of the house. Their source of

water is from the pipe bone water. However, they have some big containers which are

well covered which is used for water storage. The patient is the landlady. The general

surrounding of the house was tidy, I congratulated them for that, I educated her on the

need to open the windows to promote proper ventilation. They have a dustbin with a

well-fitting lid in which they dump their waste materials and it is emptied every

morning into Zoomlion waste-truck. Observations made in patients’ room revealed

well-furnished hall with television set, sound system, a ceiling fan, bed, couch and a

70
wooden center table, it was very neat and well organized and they were applauded for

that. Patient’s daughter was educated on the need to practice good environmental and

personal health and also encouraged them to continue to keep their home and

surroundings clean. They were congratulated for keeping a neat compound. They

were advised to keep the bushy area at their backyard cleared since it could breed

mosquitoes and harbor snakes. No identifiable factor to patient’s condition was made

during the visit. I advised the children in the house to ensure good personal hygiene

since they are the most vulnerable group in the house. I left the house at 1:10pm and

got to the hospital at 1:40pm. Comments made on the condition of the house,

education and recommendations were repeated to Mrs. C.K. and she also promised to

do everything in her power to ensure that all the recommendations are initiated. I

identified on the first home visit that patient’s house was not close to any health

facility.

Second Home Visit (11th December, 2021)

This visit was made on 11th December, 2021. I made this visit to find out how patient

was doing and to see if she was following her treatment regimen and also to remind

the patient of the review date which was 13th December, 2021. On assessment patient

windows were opened as they were educated to do. The environment was neat and

they were congratulated for that. The importance of taking drugs as ordered was

reinforced to patient and family. Education on good nutrition was stressed on to help

protect patient / family from any diseases. I also stressed on the education we have

had on hypertension during her stay at the ward most especially the diet aspect where

she was told to limit the intake of sodium containing foods and salt, taking in more

vegetables and fruits.

71
Patient / family were thanked for their cooperation and permission was sought to

leave. I promised them of another visit which will be my last. Patient’s daughter

escorted me to the road side where I bordered a tricycle to my house.

Review (13th December, 2021)

On 13th December 2021 patient and daughter were met at the Out-Patient Department

of Holy Family Hospital, Berekum at 9:00am looking cheerful and lovely as noted

from facial expression. I accompanied them to go for patient’s folder.

At the Out-Patient Department, upon assessment patient was in good health. Patient

did not have complains. She was told not to hesitate to report to the hospital if she

encounters any health problem. She was advised to adhere to the medications

prescribed. She was told to report for another review in a month’s time. Patient was

assured of a third home visit. I then accompanied them to the hospital entrance where

they boarded a tricycle to their home.

Third Home Visit (20th December, 2021)

The main reason for conducting the third home visit was to: Assess the general

condition of patient and family, reinforce the need to comply with treatment regimen

and finally terminate care.

On the said date, I and the community health nurse set off early around 9:00am with a

tricycle. On arrival, I was welcomed and offered seat. The purpose of this visit was to

terminate care since patient was in good health and also was adhering to the treatment

regimen. Patient / family were doing well as they looked cheerful and had no

complains. We were welcomed and offered seats, I introduced the community health

nurse to the patient and family. After series of conversation, Patient was handed over

72
to a community health nurse to continue with care. Patients husband commended me

for good work done and accepted to continue the care of Mrs. C.K. at home. The

environment was tidy as there was neither rubbish nor stagnant water around. I

however stressed on the importance of regular check-ups and to seek prompt medical

attention whenever they fall sick, rather than relying on self-medication.

I asked about patient’s drugs and it was found that she had been taking her

medications and the recommended foods had also been adhered to. After interacting

with patient and family for a while, I reemphasized on health educations that had been

given to them already. Since it happened to be my last day of therapeutic relationship

with patient and family, I terminated my care and thanked them for their cooperation

which made my study a success. Again, patient and her family expressed their

gratitude by showing how grateful they were to me for the support and care given to

them. I eventually sought permission to leave and bid them the final farewell.

73
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

5.0 Introduction
Evaluation in simple terms is the outcome of nursing actions against the anticipation

goals and it is the final step in the nursing process (Hinkle & Cheever,2014). The

chapter gives information about the statement of evaluation, amendment of nursing

goals and the termination of the care rendered to my patient and family.

5.1 Statement of Evaluation

Throughout the period of admission, six health problems were recorded and

objectives were set to solve them. Below is the summary of the intervention carried

out and to what extent the goals were met

1. Patients headache was relieved

On admission at 3:00pm, patient complained of headache hence the nursing diagnosis

of impaired comfort related to hypertensive urgency related symptoms as evidenced

by self-report of headache was formulated. An objective criteria was set and the

following measures were implemented to help her headache subside within 24 hours:

Patient was reassured that her condition will improve, Pain was assessed using the

pain rating scale (0-10) which patient indicated, Head was elevated to help decrease

tension, Patient was supported and complete bed rest was ensured in a calm

environment and bed was also free from creases and cramps, Blood pressure was

monitored every 30 minutes, Tablet paracetamol 1g and Tablet Nifedipine 40mg were

served.

On 1st December, 2021 at 3:00pm, objective that was set on 30 th November, 2021 in

order for patient’s headache to subside within 24 hours was evaluated and goal was

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fully met as patient verbalized that she is relieved of headache and nurse witnessed a

jolly facial expression.

2. Patient was prevented from falls

On 30th December, 2021 at 3:30pm, patient complained of feeling dizzy hence the

nursing diagnosis of risk for falls related to dizziness as evidenced by self-report of

feeling dizzy was formulated. An objective criteria was set and the following

measures were implemented to help her from having any falls throughout her period

of hospitalization: Patients’ need to use the bathroom every two hours was assessed to

aid her, An orderly environment was maintained by making sure walkways were

unobstructed, Patient was oriented to her new environment, necessary items

(including water, snacks, phone) were kept within easy reach, adequate lighting at

night was ensured, Patient’s bed was kept in the lowest position with bed brakes on at

all times to prevent falls.

On 4th December, 2021 at 11:30am, objective that was set on 30th November, 2021 so

as to prevent patient from falls throughout her period of hospitalization was evaluated

and goal was fully met as patient verbalized that she no longer feels dizzy and nurse

observed that patient was free of any trauma.

3. Patient regained strength for daily activities

On 30th November, 2021, at 3:50pm, patient complained of body weakness and

further observation on patient in relation to how she carried out her activities, it was

observed that patient has lost strength as she could not fully tolerate activities.

Nursing diagnoses of activity intolerance related to imbalance between oxygen supply

as evidenced by fatigue was made. An objective criteria was set to restore patients

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strength in order to perform her daily activities on her own within 48hours. The

following interventions were carried out: Patient was reassured that she will regain

strength for her daily activities, Level of physical activity and mobility was assessed

by engaging patient in activities such as walking, Patients respiratory response to

activity was monitored, at least 90mins between activities for undisturbed rest was

allowed to enable physiologic recovery, Emotional support was provided so as to

enable patient perform activities, Items such as water were kept close to patient.

On 2nd December, 2021 at 3:50pm, objective that was on 30th November, 2021 set to

help patient regain her strength for her daily activities within 48 hours was evaluated

and goal was fully met as patient patient verbalized that that she no longer has any

feeling of fatigue and nurse observed that patient performed activities of daily living.

4. Patient was relieved from anxiety

On 30th December, 2021 at 4:00pm, patient manifested a feeling of apprehension as

she was not cooperating. So, I asked patient to verbalize her fears with regards to her

stay in the ward. She then revealed to me that she was anxious because she was in a

new environment and does not know the outcome of the disease condition. Nursing

diagnosis was made as Anxiety related to new environment and unknown outcome of

disease condition. An objective criteria was therefore set to relieve patient and family

of anxiety within 24 hours. Nursing interventions carried out were as follows: Patient

/ family were reassured that they are in a new but safe environment, Patient’s level of

anxiety was assessed, A calm manner was maintained while interacting with the

patient, Patient were oriented to the ward environment and new experiences, Patient

was encouraged to talk about anxious feelings and they were addressed appropriately,

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Patient was assisted in developing new- anxiety- reducing skills example Relaxation,

deep breathing, etc.

On 1st December, 2021 at 4:00pm, objective that was set on 30 th November, 2021 to

help relieve patient of fear and anxiety within 24hours was evaluated and goal was

fully met as patient verbalized that she has been relieved of anxiety and nurse

observed patient interact with other patient and cooperated with care.

5. Patient attained and maintained adequate nutrition

On 1st December, 2021 at 8:20am, Patient had her breakfast which was Hausa

porridge with milk and bread, she was able to consume just one-third of the porridge

and she did not even take a piece of the bread. Based on my observation, I conducted

a nursing assessment on patient and it was realized that patient had a poor nutritional

status. This was evident as patient and her relatives attested to the fact that patient is

able to consume only one-third of food she is been served with. a nursing diagnosis

was formulated as imbalanced nutrition (less than body requirement) related to

inadequate dietary intake as evidenced by insufficient interest in food. As such, an

objective criteria was to help her attain and maintain adequate nutrition within 48

hours was set. The following nursing actions were implemented: Patient and family

were educated about the importance of food for the body, the amount of food intake

was monitored, Diets were planned with dietician and patients preferences were taken

into consideration, A varied diet was provided according to patient’s diet to stimulate

her appetite, Food was provided in small portions but frequently, Client was educated

on the need to take in nutritionally rich diets.

On 3rd December, 2021 at 8:20am, objective that was set on 1 st December, 2021 to

enable patient achieve and continue adequate nutrition within 48 hours was evaluated

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and goal was fully met as patient verbalized that she has gained appetite for food and

nurse observed that patient takes at least two thirds of 500ml of porridge served.

6. Patient gained knowledge on hypertension

On 2nd December, 2021 at 8:20am, At 8:00am, patient was engaged in an interaction

and it was realized that patient had less knowledge on condition (Hypertension). The

nursing diagnosis formulated was deficient knowledge related to inadequate

information as evidenced by unfamiliarity with the need for frequent blood pressure

checks, adherence to antihypertensive therapy, and lifestyle changes. An objective

criteria was set for to help patient and family gain adequate knowledge on

hypertension within 24 hours of hospitalization. Interventions carried out were:

Assessment of patient health care literacy was carried out, Information was selected

and presented in a manner that is culturally after the assessment, Patient was educated

on the importance of exercise and taking less than 2 g/day sodium diet, Patient was

educated on drug administration times, side effects and adverse effects,

Misconceptions regarding drug was addressed by telling patient to always take the

drug even when signs and symptom are not showing.

On 3rd December, 2021 at 8:00am, objective that was set on 2 nd December, 2021 to

help patient gain adequate knowledge on hypertension within 24 hours of

hospitalization was evaluated and goal was fully met as patient verbalized the

importance of frequent BP checks and nurse observed that patient adhered to

antihypertensive therapy and lifestyle changes.

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5.2 Amendment of the Nursing Care Plan
Despite the numerous problem identified, with the individual comprehensive nursing

care and support from other members of the health team and cooperative of Mrs. C.K.

and family, all of the goals set were fully met. The care plan was therefore not

amended

5.3 Termination of Care

Care of patient / family ended on the 20th December, 2021 which was my last home

visit. This ended the interaction between the health team and Mrs. C.K and her family.

The preparation for termination started on day of admission through discharge, review

to the third home visit. During these periods, patient / family were educated on

various topics. I congratulated the family for the care they had rendered to Mrs. C.K.

They were thanked for their co – operation and patient was handed over to a

community health nurse. They were told that now that Mrs. C.K. health had been

restored, the care for her has officially ended. I informed them of my desired to visit

them unofficially whenever I had the opportunity. They were happy and noted that

they would miss my care and would strictly adhere to all instructions given to them. It

was a moment to remember when I told them of my intention to leave. There was no

separation anxiety as patient and the relatives had enough psychological preparation

from the day of admission till discharge but it was still difficulty bidding them

farewell.

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 CHAPTER SIX

SUMMARY AND CONCLUSION

6.0 Introduction
Summary is a comprehensive and usually brief abstract, recapitulation, or

compendium of previously stated facts or statement. Conclusion is some that you

decide when you have thought about all the information connected with the situation

(Weller, 2014). 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. C.K, a 67years old woman was admitted to the Female Medical ward through

the Accident and Emergency unit of the Holy Family Hospital, Berekum on the 30 th

November, 2021 at 3:00pm with the diagnosis of Hypertension. On admission, she

presented with headache, dizziness and anxiety. Patient was educated on hypertension

and its management. Patient was also assisted in maintaining her personal hygiene,

rest, and sleep, nutrition and exercise were also ensured.

Mrs. C.K. was to be managed on the following medications

9. IV labetalol 20mg stat

10. Tablet Nifedipine 40mg bd for 14 days

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11. Tablet Lisinopril 10mg daily for 30 days

12. Tablet Paracetamol 1g tds for 5 days

Laboratory investigations requested for the patient were;

11. Full blood count

12. Random blood sugar

13. Blood urea electrolyte and creatinine

14. Blood film for malaria parasites

15. Lipid profile

Mrs. C.K. presented with the following health problems:

7. Patient complained headache

8. Patient grumbled about feeling dizzy

9. Patient was anxious about the outcome of disease condition

10. Patient was easily fatigued

11. Patient complained of loss of appetite

12. Patient had inadequate knowledge on the management of hypertension

On the 13th December, 2021 patient reported for review as scheduled. Three home

visits were embarked on. The first home visit was done while patient was still on

admission on the 1 st December, 2021, second home visit was on the 11th December,

2021 and third home visit was on the 20th December, 2021. The care of Mrs. C.K. and

her family care were terminated on the 20th December, 2021, during the third home

visit when patient had fully recovered.

6.2 Conclusion/Recommendation
The study has equipped me with knowledge on how to care for a patient as an

individual. Through this study, I have been able to put into practice actual and holistic

81
nursing care as has been learnt theoretically. The study provided a therapeutic

environment for nursing patient as an individual and has promoted a good nurse-

patient (family) relationship as well as broadened my knowledge on hypertension, its

prevention, management and treatment. It has also helped me to practice my skills

acquired in the classroom theoretically. It has deepened my relationship with patients,

families and the people a given community as a whole. The study also provided the

platform for the patient /family to receive individualized care. Based on the

testimonies given by patient who receive individualized nursing at hospitals, it

prompts most of the community members to seek medical help at the various

hospitals. This helps to redeem the image of the hospital and the staff nurses as a

whole. Also this patient/family care study also helps to change the community’s

wrong perceptions about staff nurses and also improve the people’s attendance to the

hospital.

Therefore, 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/families. In brief, I really

enjoyed every bit of writing this script despite the challenges encountered.

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 APPENDIX
Table 7: Vital Signs of Mrs. C.K.

Date Time Temperature Pulse Respiration

(oC) (Bpm) (Cpm)

30/11/21 2:00pm 36.0 91 24

6:00pm 36.0 85 22

10:00pm 36.1 87 20

01/12/2021 06:00am 36.4 76 22

10:00am 36.1 79 23

02:00pm 35.8 82 21

10:00pm 36.1 84 24

02/12/2021 06:00am 36.6 100 24

10:00am 35.5 98 19

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 02:00pm 35.7 70 16

06:00pm 35.9 67 26

10:00pm 36.1 84 24

03/12/2021 6:00am 36.0 80 20

2:00pm 36.6 72 22

6:00pm 36.2 69 21

04/12/2021 10:00am 36.3 78 20

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