TABLE OF CONTENT

CHAPTER TOPIC PAGE

Table of Content I

List of Tables IV

Preface V

Acknowledgement VI

Introduction VII

ONE ASSESSMENT OF PATIENT/FAMILY 1

Patient’s particulars 1

Family’s Medical/Socio-economic history 2

Patient’s Developmental History 2

Patient’s Lifestyle/Hobbies 2

Past Medical History 3

Present Medical History 3

Admission of Patient 3

Patient’s concept about her illness 4

Literature Review on the disease condition 5

i
 TABLE OF CONTENT

CHAPTER TOPIC PAGE

Validation of data 16

TWO ANALYSIS OF DATA 18

Diagnostic Investigations and Tests 18

Cause of Patient’s Condition Compared with Literature 21

Comparison of Clinical Features Exhibited by Patient and 21

those in Textbooks

Treatment of Patient 22

Pharmacology of Drugs and their Effects 23

Patient/Family Strength 25

Health Problems 26

Nursing Diagnoses 26

THREE
PLANNING PATIENT/FAMILY CARE 27

Nursing Care Plan 28

ii
 TABLE OF CONTENT

CHAPTER TOPIC PAGE

FOUR IMPLEMENTATION OF NURSING CARE RENDERED TO 40

PATIENT/FAMILY

Summary of Actual Nursing Care 40

Preparation of Patient/Family for Discharge and Rehabilitation 50

Follow-up, Home visits and Continuity of Care 51

FIVE EVALUATION OF CARE RENDERED TO PATIENT/FAMILY 54

Statement of Evaluation 54

Termination of Care 55

Summary 55

Conclusion 56

Bibliography 57

Signatories 58

iii
 TABLE OF CONTENT

TABLE LIST OF TABLES PAGE

ONE Diagnostic Investigations and Tests 20

Comparison of Clinical Features exhibited by Patient and those in 21

TWO
Textbooks

THREE Pharmacology of Drugs and their Effects 23

FOUR Nursing Care Plan 28

FIVE
Observation Chart
45

iv
 PREFACE

A patient/family care study is a detailed written account of an individualized nursing care

rendered to a patient and his or her family at a given period of time. This care is continued until

follow-up care is done and then, the patient handed over to a Community Health Nurse in-charge

of her area of residence for continuity of care if need be.

In this care study, the student is required to choose a patient, identify and analyze his or

her problem and find solutions to the problems. This involves the patient, family members of

patient and significant others.

The care study helps the student nurse to become more familiar with the patient’s condition and

also to improve upon his or her typing skills. This also helps the nurse to render skillful and

effective nursing care to a patient with similar or the same condition in future.

A patient/family care study forms is an academic exercise in partial fulfillment for the award of

Diploma in Registered General Nurse by the Nurses and Midwives Council of Ghana.

Finally, the care study encourages the creation of a good interpersonal relationship

among the health team, patient and his family members. It also gives the opportunity to educate

the patient, his or her family members and the community as a whole on the prevention of

diseases and promotion of good health. For confidentiality, my patient will be known as Mrs.

R.A, her husband as Mr. K.K, Miss G.A.D her younger sister as her next of kin and Mr. K.A and

Mrs. A.B as her parent throughout the study.

S.O

v
 ACKNOWLEDGEMENT

I wish to thank the Almighty God for the strength, wisdom and success He granted me in writing

this care study.

My sincere appreciation also goes to my patient, Mrs. R.A and her family for their co-

operation and for providing me with the needed relevant information.

Special thanks go to the tutorial staff of Nurses and Midwives Training College, Cape Coast

especially my clinical supervisors for their encouragements and directives in preparing this care

study.

I wish to express my gratitude to the Medical officers, Nurses and Paramedical staff of

the Obstetric and Gynaecological unit of the Central Regional Hospital for the patience,

consistence and corrections they did in guiding me when choosing and nursing my patient to a

successful recovery.

My final thank goes to the Authors of the various Literature I used as my references, my family

and colleagues who helped me in diverse ways to make my care study a success.

vi
 INTRODUCTION

A patient and family care study is a detailed report on the nursing care rendered to a

particular patient, his or her family and the community as a whole at a given period of time.

This patient and family care study is on Mrs. R.A a 45yr old woman who was admitted to the

Obstetric and Gynaecology unit of the Central Regional Hospital through the Out Patient

Department by Dr. Ekenam at around 9:00a.m on the 21st of March, 2011.

She came into the ward with her husband Mr. K.K and daughter accompanied by a consulting

room nurse. She came with the history of frequent small vaginal spotting since four days, large

abdominal mass, dysmenorrhoea, and headache. She was diagnosed as having uterine fibroid. Her

condition on admission was fair.

My encounter with her began on the admission day around 9:10a.m. I established rapport with

her and made my intention known to her and her husband that I would like to take her as my

patient for my care study. I took my time to explain to her, what care study was about with which

she willingly agreed to my proposal and assured me of her cooperation.

My interaction with her lasted for six weeks. She received competent individualized nursing care

for six days on the ward and I paid her three home visits before termination of care.

Mrs. R.A was nursed using the nursing process which is a scientific framework used by a nurse

to organize the health care needs of a patient, family and the community as a whole and to

deliver a continuous, comprehensive and individualized nursing care. This helped in her early

recovery. On discharge, her condition had improved with all nursing objectives met.

vii
 The patient and family care study was organized and written in five chapters using the

nursing process steps.

Assessment: This involves systematic collection of subjective and objective data about the

patient, her family and environment.

Analysis: The data collected during interview and physical examination is sorted and analyzed.

Actual and potential problems are identified and ranked according to priority. Analysis of the

data may identify the need for more information from the patient, family and other sources.

Planning: It is the nursing care plan developed to meet the needs identified during the

assessment phase. Priorities are set for the identified problems and nursing objectives.

Implementation: This involves putting plan into action by performingvarious orders for the

identified problems to be able to meet set objectives.

Evaluation: This is the final step in the nursing process and it gives the nurse the opportunity to

assess the successful review and progress of patient condition and make adjustment where

necessary.

viii