CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

This chapter gives information about the patient, family and their relationship with the

community to identify their health problems. It involves the collection of data from the

patient and family. It includes; Patient’s particulars, Family medical and socio-economic

history, Patient’s lifestyle/hobbies, Past medical history, Present medical history,

admission of the patient patient’s concept of illness ,literature review on the condition and

validation of data.

Patient’s Particulars

Mr. E.N is a 17 year old student from Kroboodumase in the Eastern Region , born on the

22nd of September 1997 at Akosombo, to Opanyin A.U and Maame G.A. He is the second

born of three children . He is dark in complexion, 45kg of body weight, and has a height

of 152cm and speaks krobo and Fante .He started school at age 4 at Ebukrom D/A

Primary School and at age 15 moved to Oxford Prepartory school. Mr E.N stays at

Ebukrom where he currently schools. He is a Christian and worship with Ebukrom

Pentecost Congregation. Madam G.A is the next of kin.

Family’s Medical and Socio-economic History

Mr. E.N said, there is no history of hypertension, tuberculosis, diabetes, asthma and

mental disorder . Mr. E.N is very sociable and relates well with other members of the

family. He has not been admitted to any hospital before. His family members however,

experience fever, headache,

and bodily pains as minor illness which are usually treated at home and has his source of

Income from his parent.

1
 Patient’s Developmental History

Mr. E.N was delivered per vaginum at Volta River authority Hospital without any

abnormality. He was not exclusively breastfed and was introduced to complementary

feeds such as porridge and light soup at age two. He was immunized against the childhood

killer diseases and has evidence of scar on the right upper shoulder to indicate

immunization against Bacillus CalmetteGuerine (BCG). He went through the

developmental stages normally but could not remember when each happened,

He started school at age Four at Ebukrom D/A Primary School. He later moved to Oxford

Preparatory at age fifteen. where he is currently schooling

Patient’s Lifestyle/ Hobbies

Mr. E.N is very active and sociable. He wakes up at 4:30 am each day, prays to God, and

brushes his teeth, he then goes on to set fire to boil water to bath. He moves his bowel

twice daily thus morning and evening, maintains oral personal hygiene twice daily. He

normally uses tooth brush and close-up paste but sometimes prefers chewing sticks. He

takes his breakfast at 7:00 am which is normally porridge and bread after he has taken his

bath. After his breakfast he leaves for school until 3:00pm. He takes his lunch after school

which is normally kenkey and fish. Mr. E.N claims he is a very good footballer. He takes

his bath whilst the food is on fire and eats his super after bathing. He loves listening to

radio and enjoy chatting with his friends and other family members. On Saturday, he goes

to farm and on Sundays he goes to church at 9:00am and returns at 12:30pm after which

he relaxes for the rest of the day.

2
 Patient’s Past Medical History

According to Mr. E.N he has never been admitted into any hospital before neither has he

any allergy to any kind of food or drug

Patient’s present medical history

Mr. E.N was doing well until He started having chest pains, fever, productive cough and

then difficulty in breathing about a week ago. He then reported to the Cape Coast

Metropolitan Hospital on 14th January 2014, as the condition became unbearable. He was

seen by Dr. Arthur and was hence diagnosed with Right Lobar Pneumonia and was

admitted for further treatment.

Admission of patient

Mr. E.N was admitted into the male ward through the Out Patient Department (O.P.D) on

14th January 2014 at 10:30am with the diagnosis of Right Lobar Pneumonia by Dr.

Arthur. He came with the history of fever, difficulty in breathing, chest pains and anorexia

which started a week ago. He was warmly welcomed andreassured of quality nursing care.

The admission papers were collected and patient’s particulars entered into the Admission

and Discharge Books as well as the Daily Ward state. He was made comfortable in bed

and orientated later since He felt dizzy .I established rapport by introducing myself to him

and also informed him that I am one of the nurses who will help in his care.

His vital signs were checked and recorded as follows;

1. Temperature: 38.20C

2. Pulse: 96 beat per minutes

3. Respiration: 33 cycle per minute

4. Blood pressure: 90/50 mmHg

3
The following drugs were prescribed for him;

1. Tab Diclofenac 50mg tid ×7 days .

2. Intravenous Fluid Dextrose Saline 1 Liters × 48hrs

3. Intravenous Cefuroxime 750mg bd×3.

4. Syrup Brozedex 10mg tid ×7 days.

A trolley was set for tepid sponging due to His high body temperature (38.2 0C). After the

tepid sponging was done, the temperature had reduced to 37.20C. Another tray was set for

setting of an intravenous line to administer intravenous fluid Dextrose saline 2 Liters and

Intravenous cefuroxime 750mg bd×3. Since patient was experiencing difficulty in

breathing, He was put in semi fowler’s position to aid in breathing, good ventilation was

also provided by opening nearby windows .Patient was also taught and encouraged to do

deep breathing exercise .Continuous reassurance was given. since patient was complaining

of chest pain, he was also assisted to assume a comfortable position which may help to

relief pain. Patient was provided with a sputum mug, taught coughing exercise and

encouraged to bring out secretions since patient was having productive cough, was also

given vomitus bowl and was encouraged to vomit into the bowl anytime he has the urge,

water was given to rinse the mouth. nauseating items removed and was monitored for

signs of dehydration such as poor skin turgor.

The following investigations were requested and they were all done:

1. Chest x-ray

2. Haemoglobin level estimation

3. Blood film for malaria parasites

4. White Blood Cell Count and total differential Count

5. Urine examination

4
 Patient’s Concept of his Illness

Mr. E.N has no idea about the cause of his condition however, he believes diseases are

natural phenomena that occur in the life for every individual, so with time and treatment

he will be well and discharged home.

5
 Literature Review on Pneumonia

Definition:

Pneumonia is an inflammation of the parachymal or alveolar of the lungs with

consolidation and exudation. In order words, It can also be described as an inflammation

of the parachymal structure of the lung such as alveoli and bronchioles. This causes an

impairment of gaseous exchange in the alveoli which is the microscopic air filled sacs in

the lungs.

Classification of Pneumonia

Pneumonia can be classified into:

1. Anatomical changes or deviations in the lungs which are revealed by investigations

such as x-ray.

2. Microbiological organism

3. Combined clinical classification

According to Anatomical Changes in the Lungs

A. Lobar Pneumonia: It is an acute infection involving a large portion of the entire

lobe of the lungs. It involves consolidation of the entire lobe, it can occur in either

the left or the right lobe or both at the same time.

B. Bronchopneumonia: This inflammation is found scattered in the bronchioles of the

lungs. It is commonly seen in children. In this type patchy areas of consolidation

occur throughout the bronchioles.

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 According to Microbiological Organism

Various laboratory investigations and tests are done and carried out to identify the

causative organism. It is also sub-grouped base on the organism responsible for the

infection.

Viral Pneumonia: Mainly caused by viruses when they reach the lungs when airborne

droplets are inhaled. Viruses responsible for this type include influenza virus,

cytomegalovirus and varicella zoster etc.

Bacterial Pneumonia: This is caused by bacteria, grouped into one of the two large

categories by laboratory procedure used to identify them under microscope. They are gram

positive or gram negative. Examples are; staphylococcus aureus, hemophilic influenza but

the commonest of all bacteria causes of pneumonia is streptococcus.

Parasitic Pneumonia: These are caused by parasites and they enter the body through the

skin or they can be swallowed.

Fungal Pneumonia: These are caused by fungi. It is uncommon but may occur in

individuals with low immune system due to Acquired Immune Deficiency Syndrome

(AIDS), Immunosuppressive.

According to Combined Clinical Classification

This is known to be the most commonly used classification scheme. The advantage it has

over the microbiological classification is the selection of treatment before the

microbiologic cause of pneumonia will be ready in several days. This categorizes

pneumonia into two based on where the individual contracted the organism responsible

for the cause of the pneumonia. They are:

1. Community – Acquired Pneumonia

 Hospital – Acquired Pneumonia

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 Community – Acquired Pneumonia (CAP)

This is an infectious pneumonia that a person acquires in the community. The common

cause varies with age but includes streptococcus pneumonia, viruses, atypical bacteria and

Haemophilus influenza. It can also be described as the type of pneumonia that occur

either in the community setting or within the first 48 hours after hospitalization.

Hospital - acquired pneumonia (HAP)

This can be also known as Nosocomial Pneumonia. This is acquired during

hospitalization. The onset is after 72 hours on admission. Patients who are at risk of

developing hospital –acquired pneumonia include; patients on mechanical ventilation,

prolonged malnutrition and immune compromised patients such as severe anemia patient,

sickle cell patient and HIV/AIDS patients etc. The organism that causes nosocomial

pneumonia includes resistance bacteria such as Pseudomonas Enterobacter andseratia.

Other types of pneumonia

Severe Acute Respiratory Syndrome (SARS): This is highly contagious and a deadly

type of pneumonia, which first occurred in 2002 after an initial outbreak in China. It is

caused by Severe Acute Respiratory Syndrome Corona Virus.

Aspiration Pneumonia: This is caused by aspirating foreign objects which are usually

oral or gastric contents either by eating or vomiting which results in bronchopneumonia.

Eosinophilic Pneumonia: This is caused by invasion of eosinophil of white blood cells

after exposure to certain types of environmental factors.

Chemical Pneumonia: This is caused by inhalation of toxicants or by contact with the

skin. An example of these chemicals is pesticide.

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Idiopathic Interstitial Pneumonia: this is caused by an unknown factor but may be

precipitated by excessive smoking

Lobar Pneumonia: It is an acute infection involving a large portion of the entire lobe of

the lungs with consolidation and exudation. This could affect the right lobe or the left lobe

or both at the same time. It is mostly caused by pneumococcus.

Incidence

The condition affects all age group. In children, majority of death occurs in new born

babies. The WHO estimates that, one third (1/3) of new born babies’ death are due to

pneumonia. Lobar pneumonia is commonly seen in adults but uncommon in infants and

elderly. The incidence of pneumonia is approximately 6 cases for every 100 people

between the ages of 18 -39 years and 75 cases of every 100 people worldwide in

developing countries.

Causes

Streptococcus pneumonia and staphylococcus are the most common organism responsible

for lobar pneumonia. Other organisms also include Haemophilus influenza and

Mycobacterium tuberculosis.

Inhalation of chemicals such as pesticides and aspiration of gastric content are also other

causes of lobar pneumonia.

Predisposing Factors

1. Physical injury to the lungs

2. Lung Cancer

3. Abdominal and thoracic surgeries

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 4. Chronic illness and debilitating diseases

5. Prolonged hospitalisation

6. Atelectasis

7. Immunosuppressive therapy

8. Viral infection

9. Prolonged malnutrition

10. Tracheotomy

11. alcoholism

Mode of Entry

a) Inhalation of infectious micro organisms from the atmosphere.

b) Inhalation of normal flora in the mouth or aspirating gastric content into the lungs.

c) Infections can spread through the blood stream from other organs of the body to

the lungs.

Pathophysiology

The upper airway is adapted to prevent potentially infectious particles from reaching the

lower respiratory tract. Inflammatory response as a result of invasion of micro-organisms

to the respiratory tract causes physiological changes which affect both ventilation and

diffusion. These organisms reaching the alveoli of the lungs through inhalation of

infectious organisms from the atmosphere, inhalation of normal flora in the mouth or

through circulation of infection from other body organs. The organisms multiply and cause

inflammatory response the immune system reacts to the invasion of the organism. The

inflammatory response that occurs can be grouped into four (4) stages:

1. Congestion: This is the initial response and it is characterized by vascular

engorgement of the alveoli and transudation of serous fluid into the alveoli. This

period lasts about 24 hour.

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 2. Red hepatization: There are extravasations of red blood cells and fibrin into the

alveoli. The lungs become firm and red with liver appearance.

3. Gray hepatization: This stage is characterized by accumulation of fibrin and

disintegration of inflammatory white and red blood cells begin.

4. Resolution: This stage, there is enzymatic digestion and removal of the

inflammatory exudates from the affected area of the lungs either by cough up or

removal by macrophages.

The occlusion of the airways by secretion, mucosal oedema and bronchospasm lead to

poor oxygenation. The mixing of poor oxygenated blood and oxygenated blood results in

arterial hypoxia.

Clinical Manifestations

1. The onset is sudden, characterized by fever

2. General malaise

3. Cough up greenish/ yellow/ blood sputum.

4. Sweating

5. Headache

6. Chest pain

7. Difficulty in breathing

8. There may be cyanosis

9. Increase in pulse rate

10. Low blood pressure

11. Nausea and vomiting

12. There may be joint pains

13. Loss of appetite

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 Diagnostic Investigation

1. White Blood Cell Count: This may show high white blood cell, indicating that

there is presence of infection but in people with immunosuppressive diseases. The

White Blood Cell may appear deceptively normal.

2. X- rays: Chest x- rays can reveal areas of opacity, which represents consolidation.

3. Physical Examination: This may show decrease in chest expansion of the affected

side. On auscultation with stethoscope, hash sounds are heard at the affected area

during inspiration. The affected area may be dull during percussion.

4. Blood Culture: This is done to determine the invasion of the micro organism.

5. Computed Tomography Scan: They are x- ray procedures that combine multiple

images with the aid of a computer to generate the cross section of the lungs to

reveal the presence of an infection.

6. Sputum Culture and Sensitivity Test: This test is done to determine the causative

organism and know the appropriate antibodies to treat the pneumonia.

7. Arterial Blood Gas.

Clinical Treatment

1. Antibiotics: The treatment of pneumonia is based on the causative organism known

as Antibiotics Sensitivity. Since treatment should not delay, empirical treatment is

given. The drug of choice includes;

a) Celphalosporins: The drug of choice is 3rd and 4th generations. Example is

ceftriaxone 1g × 3 days.

b) Microlides: Example is Tablet Erythromycin 500mg 8 hourly × 7 days.

c) Aminoglycosides: Example is Intravenous Gentamycin 2- 5mg per body

weight in divided doses.

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2. Analgesics: Example is Dichlofenac Tablet 50mg 8 hourly × 3 days.

3. Antipyretic: Example is Paracetamol Tablet 1g 8 hourly × 3 days

4. Oxygen Therapy: Oxygen is given to patients with difficulty in breathing.

5. Cough Mixture: Example is Syrup Brozedex 10mls 8 hourly × 5 days.

Nursing Managements

1. Put patient in an upright position to enhance breathing by opening the airways.

2. If patient cannot cough up secretion, suction the airways under sterile techniques.

3. Encourage patient to cough and use deep breathing exercise every 2 hours.

4. Turn and position the patient in bed to help open the airway and free aspiration of

secretions.

5. Encourage drinking of fluid 3 liters daily.

6. Sputum test ordered should be collected into a sterile container.

7. Serve patient with food that contains proteins and calories.

8. Encourage patient to eat in bits.

9. Check and record vital signs of patient; temperature, pulse, respiration and blood

pressure every 30 minutes.

10. Balance intake and output chart should be done every 24 hours.

11. Administer prescribed medication.

12. Reassure patient that quality health care would be rendered to promote recovery.

13. Plan diet with patient.

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 Patient Teaching

1) Teach patient importance of adequate bed rest to promote recovery.

2) Advice patient to adhere to drug regimen.

3) Teach patient deep breathing and coughing exercise.

4) Teach patient to take in 3- 4 liters of fluid daily to maintain hydration.

5) Urge the patient to avoid environmental irritants that stimulate secretions such as

cigarette smoking, dust and industrial pollution.

6) Teach patient proper hand washing to minimize the risk of spreading infection.

7) Teach patient to avoid environment irritants such as fumes.

8) Avoid prolonged use of immunosuppressive therapy

Prevention

a) Cessation of smoking.

b) The room of the person should be well ventilated.

c) Avoid prolonged use of immunosuppressive drug.

d) Patient should eat nutritious diet.

e) Treat all underlying conditions with appropriate antibiotics.

f) Suctioning of mouth and nose at infancy with meconium- stained amniotic fluid to

decrease the rate of aspiration pneumonia.

g) Vaccination against haemophilus influenza and streptococcus pneumonia, and

other micro organisms.

h) Avoid infections as much as possible.

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 Complications

1. Respiratory Failure: Pneumonia can cause respiratory failure by triggering acute

respiratory distress syndrome, which occurs as a result of infection and

inflammatory response. The lungs become filled with fluid and very stiff. This

impairs the gaseous exchange in the lungs.

2. Pleural Effusion: This is an inflammation and exudation of serous fluid in the

plural space. During the inflammatory response of pneumonia, inflammation

mediators such as histamine, prostaglandin dilates the blood vessel and increase

permeability of the vessel. There is increase in hydrostatic pressure as a result of

increased blood flow, thereby pushing fluid through the permeable vessel into the

plural space.

3. Emphysema: It is a collection of pus in the pleural space. This occurs when there is

presence of micro organisms that cause pneumonia, and fluid collection. The fluid

is collected using a procedure known as thoracenthesis.

4. Lung Abscess: this is necrotic tissue of the pneumonia cells. Pneumonia causes

lung abscess when an inflammation is unable to resolve. The injury to the lungs is

caused by an invading micro organism.

5. Sepsis: This occurs when the micro organisms that cause pneumonia have entered

the blood stream.

6. Septic Shock: This is common in bacteria pneumonia. The micro organism enters

the blood stream, releasing endotoxin into the blood. This produces other

biological mediators leading to development of the septic shock.

7. Hypoxia: this is diminised amount of oxygen in the tissue. This occurs when the

lungs are filled with fluid and become very stiff as a result of the infection and

15
 inflammatory response. This impairs gaseous exchange leading to low amount of

oxygen in the body.

Validation of data

This is the act of confirming or verifying data. In other words it involves the act of

measuring the extent to which the data collected possess the quality of being true and free

from errors and biases. The information taken from Mr. E.N were found to be the same in

the folder. All information collected where counter check with the patient and family to

remove any errors.

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 CHAPTER TWO

ANALYSIS OF DATA

It is the identification of the patient’s actual and potential problems with regards to the

data gathered from the patient family to arrive at a diagnosis. It compares the data with

normal standard which consist of clinical features and diagnostic investigations as well as

pharmacology of drugs.

Comparison of data with standards including; diagnostic investigations, causes, signs and

symptoms, pharmacology of drugs, treatments and complications.

Diagnostic investigations

The following were the investigations carried out on Mr. E.N;

1. Blood for total white blood count and differential.

2. Chest x- ray

3. Sputum analysis for Acid Fast Bacilli, culture and sensitivity.

4. Blood for blood film to detect the presence of malaria parasites.

5. Routine urine examination.

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 TABLE 1: DIAGNOSTIC INVESTIGATIONS TEST

DATE SPECIMEN INVESTIGATION RESULTS NORMAL VALUES INTERPRETATIONS REMARKS

14-01-2015 Chest Chest x- ray The right side of the There should be no This indicates there is presence The patient was

lung was seen to be opacity seen on the of inflammation with fluid diagnosed as right

white and opaque. lung lobar pneumonia

14- 01- 2015 Blood White blood cell White blood cell White blood cell count: Patient’s WBC, neutrophils and Prescribed antibiotics

count, total and count: 14.1 × 109/L 2.5- 8.5 × 109/L lymphocytes do not fall within were given to treat

differential count Neutrophils: 82% Neutrophils: 60- 75% normal range indicating the the infection.

Lymphocytes: 18% Lymphocytes: 30- 45% presence of infection.

14- 01- 2015 Urine Routine urine No abnormality seen There should be no The urine falls within the normal No treatment was

examination or detected abnormal constituents constituents of urine showing no given

such as; pus, mucus, urinary tract infection.

tissue necrosis seen in

urine.

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 CONTINUATION OF TABLE 1: DIAGNOSTIC INVESTIGATIONS TEST

DATE SPECIMEN INVESTIGATION RESULTS NORMAL VALUES INTERPRETATIONS REMARKS

14- 01- 2015 Blood Blood film for No malaria parasites Malaria parasites This indicates that the patient No treatment was

malaria parasite seen should not be seen in does not have malaria given

the blood

14- 01- 2015 Sputum Culture and Negative. No Acid There should be no This is an indication of patient To continue

sensitivity Fast Bacilli, acid fast bacilli, not have TB infection. treatmentof

streptococci were streptococci and pneumonia.

seen. pneumococcal

19
Table 2: Comparison of Patient’s Clinical Features With The Literature Review

Text Book Clinical Features Clinical Features Presented By

Mr. E.N

i. Onset is sudden, i. Onset was sudden and temperature was

characterized by fever (38.20C)

ii. General malaise ii. Patient complained of general body pains

iii. Coughing out iii. Patient had frothy productive cough.

greenish/yellow/bloody

sputum

iv. Difficulty in breathing iv. Patient had difficulty in breathing

v. Increased pulse rate v. Patient had an increased pulse rate (96

beats per minute)

vi. Loss of appetite vi. Patient had no desire to eat any food

vii. Chest pains vii. Patient complained of pains at the right side

of the chest

viii. Sweating viii. Patient had normal sweating

ix. Cyanosis ix. Patient had no cyanosis

x. Low blood pressure x. Patient’s blood pressure had reduced

(90/50mmHg)

xi. Nausea and vomiting xi. Patient vomited twice on day of admission

Patient showed most of the signs and symptoms listed in the literature review proving that

the diagnosis is right lobar pneumonia.

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 Causes of patient’s illness

In relation to the literature review, Mr E.N’s may have gotten the infection from

inhalation of chemicals that he uses to spray their cocoa farm.

Treatment

With respect to the literature review, Mr. E.N was managed medically on these drugs;

1. Intravenous Dextrose Saline 2 liters × 2 days

2. Syrup brozedex 10mls 8 hourly × 7days

3. Intravenous Cefuroxime 750mg bd ×3

4. Tablet Diclofenac 50mg tid x 7 day

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 TABLE 3: PHARMACOLOGY OF DRUGS

DATE DRUGS DOSAGE AND CLASSIFICATION DESIRED EFFECTS ACTUAL SIDE EFFECTS
ROUTE OF OF DRUGS EFFECTS
ADMINISTRATION OBSERVED
14-01-2015 Dextrose 2 liters x2 days Isotonic Solution For fluid replacement Mr.E.N’s fluid and Confusion, fever, circulatory
Saline Intravenously and caloric electrolyte balance overload, pulmonary oedema,
supplement. was maintained. sloughing and tissue necrosis.
Patient experienced no such
effects.
14-01-2015 Intravenous 750mg bd× 7 days Antibiotic To inhibit bacteria Patient infection Constipation, Nausea,
Cefuroxime intravenously cell synthesis was treated vomiting. Patient experienced
no side effect of the drug.
14-01-2015 Syrup 10mls 8 hourly x 7 days Expectorant It dries up mucus and Patient was relieved Headache, blood pressure
Brozedex Orally suppresses cough of cough and changes, nausea and vomiting.
congestion. Patient had no such effects.
14-01-2015 Tablet 50mg 8 hourly x 7 days Non steroidal Anti- Inhibits synthesis of Patient was relieved Abdominal cramping,
Diclofenac Orally inflammatory Drug. prostaglandin and of severe pain. constipation, nausea and
reduces intensity of dyspepsia. Patient had no such
the pain stimulus. effects.

22
 Complications

With reference to complications outlined in the literature review, Mr. E.N. developed no

complications due to effective medical and nursing care given to him.

Patient and family strengths

This involves patient and family contributions to promote speedy recovery. Mr. E.N and

His family were very cooperative. They provided all the necessary information needed as

the staff communicated with them in their own language (Fante). He was visited by His

family every day and was provided with all the support they could give as a family.

Mr. .E.N was able to walk about after 24 hours of staying in bed. He was very cooperative

since He was always willing to take His medications. Mr. E.N was also registered with the

National Health Insurance Scheme.

Patient’s health problem

With reference to the data collected the following health problems were identified while

Mr. E.N was on admission;

14/01/2015

1. Patient had difficulty in breathing

2. Patient had vomited 2 times on day admission

3. Patient has high body temperature (38.20C)

4. .Patient has productive cough

5. Patient complained of pain at the right side of the chest.

15/01/2015

1. Patient had general body pains.

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16/01/2015

1. Patient has little knowledge on disease condition.

Nursing Diagnosis

14/01/2015

1. Ineffective breathing pattern related to congestion in the lungs

2. Risk for fluid volume deficit related to vomiting

3. Hyperthermia (38.2˚C) related to infection of the lungs.

4. Ineffective airways clearance related to thick mucus secretions.

5. Acute pain (chest pain) related to persistent cough and inflammation in the chest.

15/01/2015

1. Activity intolerance related to general body pain

16/01/2015

1. Knowledge deficit on condition and treatment protocols.

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 CHAPTER THREE

PLANNING FOR PATIENT/ FAMILY CARE

The nursing care plan is part of the nursing process and it is the systematic approach in

carrying out individualized care to a patient. It is also the third phase of the nursing

process and the third chapter of the patient/ family care study.

In planning, the nurse discusses with the patient His problems and draws an individualized

care plan from the problems identified. The patient and the family are involved in the

planning for effective recovery.

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 TABLE 4: NURSING CARE PLAN FOR MR. E.N
Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/Time Evaluation Sign.
Time Diagnosis Outcome Criteria
14/01/15 Ineffective Patient will have 1. Reassure patient 1. Patient reassured that pain will be 15/01/15 Goal met
breathing improved breathing relieved 10:30am as patient’s
2. Put patient in a semi- 2. Patient put in a semi- fowler’s
10:30 am pattern patterns within 48 Breath rate
fowler’s position. position and hand supported by
related to hours as evidence cardiac table with a pillow on it came
congestion by for comfort and to facilitate within
breathing.
in the nurse observing: normal
3. Observe vital signs, 3. Respiration was observed every 4
lungs. especially respiration every hourly. (18-20
1. A respiratory rate 15 minutes for an hour, every c/m)
within normal range 30minutes within an hour,
every 1 hour for 2 hours then
(18-20 c/m) every 4 hourly when
condition stabilize.
4. Ensure enough rest 4. Enough rest ensured by restricting
visitors and providing condusive
environment.
5. Nurse patient in a well 5. Nearby windows were opened to
ventilated room. allow fresh air.
6. Ensure enough rest 6. Visitors were restricted to enable
patient have enough rest.

26
 TABLE 4: NURSING CARE PLAN FOR MR. E.N
Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/Time Evaluation Sign.
Time Diagnosis Outcome Criteria
14/01/15 Risk for Patient will 1. Provide vomiting bowl with 1. Vomiting bowl was provided. 16/01/15 Goal met
9:00 pm fluid maintain his fluid tight fitting lid. 9:00 pm as evidence
volume volume throughout 2. Remove nauseating items 2. Nauseating items were removed by nurse
deficit his hospitalization from the environment. from the environment like observing;
related to as evidence by urinals and bedpan.
vomiting nurse observing; 3. Give water to rinse mouth 3. Water was given to rinse mouth 1. Patient
after vomiting and discard and discarded after vomiting. having a
1. Patient having a 4. Give oral care 4. Patient was assisted to brush the good skin
good skin turgor. teeth. turgor.
5. Monitor strict intake and 5. Patient intake was chart with
2. Patient output chart. output 2. Patient
verbalizing 6. Encourage oral sips as 6. Patient was served with fluid of verbalizing
cessation of vomiting ceases. dextrose saline vomit
vomiting. 7. Serve patient with easily 7. Easily digestible well balanced stopped.

digestible well balanced diet. diet served.

8. Administer prescribed IV 8. Prescribed IV fluid administered
fluid (IV Dextrose).

27
 TABLE 4: NURSING CARE PLAN FOR MR. E.N
Date/Time Nursing Objective/ Nursing Orders Nursing Intervention Date/Time Evaluation Sign.
Diagnosis Outcome Criteria
14/01/15 Hyperthermia Patient will 1. Tepid sponge patient 1. Patient was sponged with tap water 14-01-2015 Goal met as
12:15 pm
(38.2˚C) maintain a normal under the armpit, the groin and on the evidence by

related to body temperature head. 12:15pm nurse

infection of (36.20C – 37.20C) 2. Recheck 2. Temperature was rechecked and observing;

the lungs. within 6 hours as temperature and recorded after 20 minutes of being Temperatur

evidence by nurse record. tepid sponged. e read as

observing; 3. Ensure good 3. Nearby windows were opened and 37.2˚C

Temperature ventilation. fans were put on to ensure good

readings is within ventilation.

normal 4. Administer 4. Prescribed anti-pyretic and antibiotics

range(36.2˚C- prescribed administered e.g. cefuroxime 750mg

37.2˚C) antipyretics and and Tab diclofenac 50mg was

antibiotics. administered.

28
 TABLE 4: NURSING CARE PLAN FOR MR. E.N
Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/Time Evaluation Sign.
Time Diagnosis Outcome Criteria
14/01/15 Acute pain Patient will be 1. Apply warm compress on 1. Warm compress applied 17/01/2015 Goal fully

10:30am (chest) relieved of pain the patient’s chest for every every 15 minutes. 10:30am met as

related to with 72hours as 15 minutes. patient

persistence evidenced by 2. Assist patient to assume 2. Patient assisted to assume verbalizing

cough and observing comfortable position. comfortable position(semi- that pain has

inflammation 1. Patient verbalize fowlers position). been

in that pain has 3. Engage patient in 3. Patient was engage in relieved.

the chest. been relieved. diversional therapy. diversional therapy such as

2. Patient watching T.V, Reading health

interacting magazines.

happily with 4. Administer prescribed 4. Tab diclofenac 50mg was

other patient’s analgesics. administered.

on the ward.

29
 TABLE 4: NURSING CARE PLAN FOR MR. E.N
Date/ Nursing Objective/Outcome Nursing Orders Nursing Intervention Date/Time Evaluation Sign.

Time Diagnosis Criteria

15-01- Activity Patient will be able 1. Reassure patient that he will 1. Patient reassured that He will be 15/01/2015 Goal met

2015 intolerance to perform self care be to maintain daily living able to maintain his daily living 4:45pm as patient

related to activities such as activities. activities. was able to

general bathing within 24 2. Assist patient to change 2. Patient was assisted to change bath

body hours as evidenced position position frequently. Himself

pains. by the nurse 3. Patient was encouraged and once daily.

observing that 3. Encourage and assist patient assisted to perform daily living

patient is able to to do daily living activities. activities.

take his bath once 4. Encourage patient to rest 4. Patient was encouraged to rest

daily. within activities. within activities.

30
 TABLE 4: NURSING CARE PLAN FOR MR. E.N
Date/ Nursing Objective/ Nursing Orders Nursing Intervention Date/Time Evaluation Sign.
Time Diagnosis Outcome Criteria
16-01- Knowledge Patient will have 1. Explain procedure to the 1. Procedure explained to the 16-01-2015
2015 deficit on adequate knowledge Goal met as
patient. patient.
disease about the disease 11:30 am patient
11:00 am 2. Assess what patient already 2. Patient was asked questions to demonstrated
condition. condition within 30
(right lobar minutes daily for 3 knows about the condition. assess his knowledge on the understanding
pneumonia) days as evidenced of what was
3. condition.
by: taught by
4. Educate patient about the 3. Patient was educated about the stating
Patient stating:
The cause of the cause, signs and symptoms, cause, signs and symptoms, The cause of
condition. the condition.
complication and complications and prevention of
The signs and The signs and
prevention of right lobar right lobar pneumonia. symptoms of
symptoms of the
condition. pneumonia. 4. the condition
Complication Complications
5. Assess patient’s 5. Patient’s understanding of right
The preventions of The
understanding by asking
lobar pneumonia was assessed prevention of
right lobar
questions on right lobar
pneumonia. through questioning. right lobar
pneumonia.
pneumonia

31
 CHAPTER FOUR

IMPLEMENTATION OF PATIENT/ FAMILY CARE PLAN

This chapter involves details of actual nursing care rendered during the course of

admission as described in the nursing care plan.

This comprises of the summary of actual nursing care rendered to the patient and family

on daily basis in the ward, preparation of patient and family for discharge as well as follow

up home visits and continuity of care.

Summary Of Actual Nursing Care Rendered To Patient And Family.

Day of admission 14/01/2015

Mr. E.N. was admitted into the male ward through Out Patient Department (O.P.D) on the

14th of January, 2015 at 10:30 am with the diagnosis of Right Lobar Pneumonia by Dr.

Arthur. He came with the history of fever, difficulty in breathing, chest pains and anorexia

which started a week before. I got interested in his condition due to the fact that he was

sick, restless and was not able to do anything for himself so I decided to use him for my

care study.

Later I made my intentions clear to him, concerning the patient/family care study. We

conversed for awhile before a detailed explanation about the patient and family care study

was made known to him and he agreed to co-operate with me. He was made to understand

that this is a therapeutic relationship and therefore there will be termination of my nursing

care which will be done after my third home visit.

He was warmly welcomed and reassured of quality nursing care. The admission papers

were collected and patient’s particulars entered into the Admission and Discharge Books

as well as the daily ward state. He was made comfortable in bed and orientated since He

felt dizzy.

32
His vital signs were checked and recorded as follows;

Temperature: 38.20C,

Pulse: 96 beats per minutes,

Respiration: 33 cycle per minutes and

Blood pressure: 90/50mmHg.

The following treatments were prescribed for him;

1. Tab. Diclofenac 50mg 8 hourly x 7 days

2. Intravenous Fluid Dextrose Saline 2L × 48hrs

3. Intravenous Cefuroxime 750mg bd × 7 days

4. Syrup Brozedex 10mls 8 hourly x 7 days.

The following investigations were requested and they were all done:

1. Chest x-ray

2. Haemoglobin level estimation

3. Blood film for malaria parasites

4. White Blood Cell Count and total differentials

5. Urine examination

Mr. E.N was positioned in a semi-fowler’s position, tight clothing around neck were

removed, good ventilation was ensured by opening nearby windows to facilitate

breathing since patient was having difficulty in breathing. Patient was continuously

reassured and assisted to assume a comfortable position which helped to relief pain,

Cold compress was applied every 15minutes within a period of 2 hours. Patient was

encouraged to take in more fluid. Sputum mug was provided and patient was

encouraged to spit out the secretions.

33
A trolley was set for tepid sponging around 11:15 pm due to His high body temperature

(38.20C). After 15 minutes of tepid sponging; the temperature was rechecked and had

reduced to 37.20C. His bed cover was removed and nearby window was opened. Patient

was provided with vomit bowl and was encouraged to vomit into the bowl after which

water was also given to rinse his mouth. Another tray was set for IV line to administer

intravenous Dextrose saline 2 L and intravenous Cefuroxime 750mg was given .He was

reassured and the following treatment administered; Tab Diclofenac 50mg and Syrup

Brozedex 10mls and their therapeutic effects were also monitored.

Patient’s lunch was served around 1:45pm it was Agidi and Light soup with fish. Mr. E.N

ate only a small amount of the Agidi and drunk about 70mls of the soup. I sat by the

patient and gave continuous reassurance. He was severed with rice and stew with fish for

supper around 4:30pm, He ate slowly and patiently. Patient ate more than half of the food

and drank a glass of water. Both of which were served on demand and attractively. His

vital signs were checked at 6:00 pm with the following readings;

Temperature – 37.20C,

Pulse – 84 beats per minute,

Respiration – 28 cycles per minute.

Blood pressure 100/ 70mmHg

Patient was engaged in diversional therapy like chatting on issues of his interest. Mr.E.N

was encouraged to have enough rest by providing a calm environment and also provided

bed free from cramps. At 10:00 pm, patient was served with Tab. Diclofenac 50mg,

Cefuroxime 750mg and Syrup Brozedex 10mls. His bed linen was straightened and the

place kept quiet to aid in His sleep. Patient was assisted to bath and slept at around 10:50

pm after struggling the whole day to sleep due to His chest pains.

34
 Second day on admission 15/01/2015

Mr.E.N. complained of general body pains and due to that He was able to sleep well last

night. He was reassured and made comfortable in bed. Patient was assisted to take His

bath in the morning and His oral hygiene was also done. His vital signs were checked and

recorded at 6:00 am as the following;

Temperature – 36.60C,

Pulse – 81 beats per minute,

Respiration – 22 cycles per minute,

Blood pressure 100/ 60mmHg.

He took milo drink as breakfast, since patient complained of loss of appetite, He was

encouraged to eat, meals were also served on demand and attractively. Mr.E.N ate only

about half of the bread served and drunk about 100mls of the milo. He was served His

medications thus Tab Diclofenac 50mg and Syrup Brondex 10mls. At 8:45 am, patient

was reviewed by the medical team. His sputum was requested for cultural and sensitivity

test and to continue previous treatment.

At 10:00 am patient’s vital signs were checked and recorded as the following;

Temperature – 36.80C

Pulse – 80 beats per minute

Respiration – 24 cycles per minute

Blood pressure 100/ 60mmHg.

He took rice and stew for lunch. Patient was still complaining of loss of appetite so He

was continuously reassured and encouraged to eat. Nauseating items such as urinals and

sputum mugs removed to stimulate patient’s appetite. Meals were also served in bits and

on demand to help patient get enough time to chew and swallow. He was able to eat more

35
than half of the plate full of rice and was congratulated for that. Patient was also served

with fruits such as apples and oranges, Mr.E.N ate one orange.

At 2:00 pm His vital signs were checked and recorded and the readings were;

Temperature – 37.20C,

Pulse – 74 beats per minute

Respiration – 22 cycles per minute

Blood pressure 110/ 60mmHg

His medications were served thus Tab Diclofenac 50mg, intravenous Cefuroxime

750mg and Syrup Brozedex10mls . Patient was visited by the family members at 4:30 pm.

His family members were reassured and encouraged to visit whenever possible. Patient

was engaged in conversation which helped to divert patient’s mind from pain. He

struggled on the bed trying to sleep which He could not. Mr.E.N was given continuous

reassurance and was monitored and observed for therapeutic effect of drugs served.

He had His super at 6:00 pm. He ate banku and groundnut soup with fish which was

brought from the house, the food was inspected before He ate it. His vital signs were

checked and recorded with the following readings;

Temperature – 36.80C

Pulse – 74 beats per minute

Respiration – 26 cycles per minute

Blood pressure 100/ 70mmHg

His medication; Tab. Diclofenac 50mg, intravenous Cefuroxime 750mg and Syrup

Brozedex 10mls were administered and recorded at 10:00pm.

36
 Third day on admission 16/01/2015

Patient slept well over the night and made no complaints. His dirty bed linens were

changed and replaced with clean ones. He took his bath and performedhis oral hygiene

before taking His breakfast. He took Milo drink with bread for breakfast. His vital signs

were checked and recorded as follow;

Temperature – 36.80C

Pulse – 78 beats per minute

Respiration – 22 cycles per minute

Blood pressure 110/ 70mmHg

His medication, Tab. Diclofenac 50mg intravenous Cefuroxime 750mg and Syrup

Brozedex 10mls were administered as prescribed and recorded.

At 9:00 am, patient was reviewed by the medical team and was to continue treatment.

I informed Mr. E.N of visiting his house the following day to know more about his

environment so I may identify if there is any health problem. He accepted and gave me

directions to the house. Patient’s hands and feet were cared for, He was also educated on

the need to keep hands and feet clean.He was engaged in conversation which He was

cooperative.

At 2:00 pm He took plantain and palaver sauce with fish for lunch and He ate everything.

He was served with His prescribed medication, Tab. Diclofenac 50mg, intravenous

Cefuroxime 750mg and Syrup Brozedex 10mls. His vital signs were checked and recorded

as follow; Temperature – 36.90C

Pulse – 74 beats per minute

Respiration – 22 cycles per minute

Blood pressure -110/ 60mmHg.

His family paid him a visit at 4:30 pm.

37
At 6:00 pm patient was served with rice and fish stew. He ate well and was congratulated

for eating everything. His vital signs were checked and recorded as follow;

Temperature – 36.90C

Pulse – 74 beats per minute

Respiration – 22 cycles per minute

Blood pressure 100/ 60mmHg.

He was served with his prescribed medication; Tab. Diclofenac 50mg Intravenous

Cefuroxime 750mg and Syrup Brozedex 10mls around 9:45pm and His vital signs were

checked and recorded as follows

Temperature – 36.80C

Pulse – 74 beats per minute

Respiration – 22 cycles per minute

Blood pressure 100/70mm/Hg

He took His bath and went to bed around 10: 45 pm.

Fourth day on admission 17/01/2015

Mr. E.N. slept well throughout the night without complains. He had His bath and His oral

hygiene. He took porridge and bread for breakfast. His vital signs were checked and the

following readings recorded;

Temperature – 36.70C

Pulse – 72 beats per minute,

Respiration – 24 cycles per minute

Blood pressure 110/ 70mmHg.

At 8:30am He was reviewed by the medical team. He was anxious and wanted to be

discharged but the medical team placed His on observation and to continue

38
treatment.Mr.E.N was educated on the need for observation, he was encouraged to ask

questions and voice out His fears and anxiety and they were answered appropriately and

tactfully. His vital signs were checked at 10:00 am with the following readings;

Temperature – 37.10C

Pulse – 74 beats per minute

Respiration – 24 cycles per minute

Blood pressure 100/ 70mmHg.

He took rice and stew with fish for lunch and ate everything.

His relatives came around during the visiting time, a conducive environment was provided

and relatives were encouraged to reassure and interact with Him to relieve anxiety.

At 6:00 pm, patient took banku and okro soup. He was congratulated for eating

everything. His vital signs were checked and recorded as following;

Temperature – 36.70C,

Pulse – 72 beats per minute

Respiration – 24 cycles per minute

Blood pressure 100/ 60mmHg.

He took His bath and retired to bed at 10:00 pm.

Day of discharge 19/01/2015

Mr. E.N. slept well without any complaints. He woke up in the morning with smiles on

His face knowing that day was going to be His day of discharge. His condition was

actually fair. He took care of His personal hygiene after which His vital signs were

checked and recorded the following readings;

Temperature – 36.60C

Pulse – 70 beats per minute

39
Respiration – 22 cycles per minute

Blood pressure 110/ 70mmHg.

He took His breakfast with such joy. He took His breakfast with such joy and at 8:40am

He was reviewed by the medical team on ward rounds.

He was discharged due to his stable condition and was asked to come for review the

following week on 26th of January, 2015 but could come before the said date if He

experiences any problems. Patient was to continue treatment on discharge. Emphasis was

made on the treatment protocols and preventive measures. He did well by repeating almost

everything He was educated on. He was encouraged to have enough rest and sleep in order

to promote His full recovery.The discharge papers were signed by the doctor and entered

into the Admission and Discharge Books as well as the Ward States. His bills were

processed at the billing station. I called Mr. E.N family and informed them about the good

news. They came for him around 9:16am. He was helped to pack His belongings. They all

thanked the staff and left. His bed linen was removed and sent to the sluice room. All

items used for Him were decontaminated.

40
 Preparation of patient/ family for discharge and rehabilitation

The preparation of the patient and family towards discharge was started on the day of

admission throughout the period of hospitalization, when our interaction started with the

aim of promoting and maintaining health and prevention of complications. Mr.E.N was

admitted into the male ward through the Out Patient Department (O P D) on the 14 th of

January, 2015 at 10:30 am with the diagnosis of Right Lobar Pneumonia by Dr. Arthur.

Patient came with the history of fever, difficulty in breathing, chest pains and anorexia. He

received quality nursing care for 5 days and condition improved which led to His

discharge. Mr. E.N. and His family were advised to maintain good personal hygiene and

also to maintain good environmental hygiene Mr. E.N. was educated on His

treatmentprotocols and preventive measures. They were educated on eating good

nutritious diets such as green leafy vegetables, example; kontomire, fruits such as bananas,

oranges, apples, and pawpaw to build their immune systems and hemoglobin levels to

prevent them from getting infections. They were educated on the need for adequate rest

and sleep. He was discharged on that 19th of January, 2015 His discharge papers were

entered into the Admission and Discharge Books as well as Ward States. His bills were

processed at the billing section and settling of bills was not a problem since He was

registered with the National Health Insurance Scheme. The need for continuity of care was

emphasized and I informed them of my next home visits.

41
 Follow Up/ Home Visit And Continuity Of Care

First Home Visit

My first home visit was made on the 16th January, 2015 when patient was still on

admission. The main purpose was to familiarize myself with patient’s home environment

and assess the health related factors and ways of solving them. The environment of the

house was not all that tidy, the house has one single room with a roofing sheet on top. The

house has a single window located at the back of the room and a single door in front.

There were a few plantains in front of the house .The rooms were not that spacious and

properly ventilated. They had no toilet facility and therefore use the community’s public

toilet. I encouraged them to give Mr. E.N. all the support he would require when

discharged, his nutritional status, personal hygiene and his sleep pattern. I reassured them

of Mr. E.N’s improvement in condition and assured them of seeing him very soon. I told

them of my next visit, which was going to be after Mr. E.N.’s discharge. I thanked them

for their hospitality and asked permission to leave.

Second Home Visit 21-01-2015

My second home visit was made on the 21 st of January 2015, that was two days after Mr.

E.N.’s discharge. Everyone was happy to see me, they warmly welcome me and offered

me a seat. The main aim was to remind the patient of his review date and also to know

how He was responding to the education and treatment after discharge. I congratulated

them for the good decision they have taken. We talked for a while and I finally had to

leave. I thanked them for their company and they thanked me for keeping to my promise

by coming. I went and arranged with a Community Health Nurse at Kissi Health Center

about continuity of care for Mr. E. N.

42
 Third Home Visit

I made my third home visit which was the final home visit on 28 th January, 2015 The

main reason for this visit was to hand over the patient to the Community Health Nurse. I

got to kissi at 9:15am and remind them of the appointment. I was given one nurse whom I

went with to Mr. E. N. house and he was happy to meet the Community Health Nurse in

my presence. I asked about how he was doing and inquired if he was able to go for the

review visit. I told them the Community Health Nurse was going to continue the care I had

already started. Mr. E. N.told me everything went on successfully and the doctor had

assured him that everything was fine with him. The Community Health Nurse also

interacted with them to boost their confidence in him and assured them of his support

during his stay with them I thanked Mr. E.N. and His family members for their

cooperation I and thanked the Community Health Nurse for the support and understanding

and asked themwhether they desired any further assistance from me and they said no. I

then wished them all the best and said goodbye with a promise of visiting him whenever I

could get the opportunity.

43
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO THE PATIENT AND FAMILY

This is the final stage of the nursing process. The chapter talks about whether the desired

goals set have been met or not. However, the plan of care is amended if the set goals are

not met or they are partially met.

The chapter involves the following;

1. Statement of evaluation

2. Amendment of care.

3. Termination of care.

Statement Of Evaluation

Mr. E.N was admitted into the male ward through the Out Patient Department (O.P.D) on

the 14th of January, 2015 at 10:30am with the diagnosis of Right Lobar Pneumonia by Dr

Arthur. Patient came with the history of fever, difficulty in breathing, chest pains and loss

of appetite which started a week ago. Health problems were identified and objectives set.

He was given quality nursing care using a care plan as a tool for nursing His .All

objectives set were met.

Patient was able to breath effectively, His airway was cleared, His fluid volume was

maintained throughout hospitalization, His temperature was reduced from 38.2 0C to

37.20C, and nutritional status was maintained. He had no infection and acquired

knowledge on His treatment protocols and preventive methods. He was discharged on the

19th of January, 2015.

44
 Amendment Of Nursing Care Plan

The objectives set during the hospitalization of Mr.E.N. was fully met.

Termination Of Care

This is the aspect of care study, where the nurse- patient / family relationship comes to an

end. Preparation towards the termination of care began from the first day I came into

contact with Mr. E. N. and her family. It was made known to them that my interaction

with them would last for a short period. However, he was reassured that she will be

handed over to a Community Health Nurse who will continue the care. On admission,

there was a good interpersonal relationship between the nurse and the patient and patient’s

family but was temporal. I made them understood that, I was not going to be present at the

ward everyday due to my academic work and so the need to cooperate with the other

staffs. I assured them of the competency of the other staffs. During my second home visit,

I informed the patient about the community health nurse who would take over from me for

continuity of care and on my third home visit which was my last home visit. Patient was

handed over to Community Health Nurse. They were therefore not surprised when I

finally told them that my interaction with them has come to an end and I handed over to

the community health nurse. I expressed my greatest gratitude for their cooperation

throughout our interaction and encouraged Mr E.N. to visit the health center anytime she

has a health problem. They also showed appreciation for my assistance, visits and care

rendered to them.

45
 Summary

This study is about Mr. E.N, who is 17 years of age, was admitted to the male medical

ward of Metropolitan Hospital Cape Coast on the 14th of January, 2015 by Dr. Arthur. He

was diagnosed with Right Lobar Pneumonia. On admission, the nursing process was used

to give the necessary care to the patient. Patient and His family were reassured and

educated on the disease condition. Laboratory investigations requested were done and

prescribed medications were administered. Mr. E.N. and family were cooperative and this

allowed him to be nursed without complications. He was on admission for five days and

was discharged on 19th January, 2015 and came back for review on the 26 thof January,

2015. Three home visits were made to the patient’s house for the continuity of care.

46
 Conclusion

Mr. E.N and his family gave me the needed and maximum cooperation which helped in

the realization and achievement of the nursing goals.

The case study has given me the opportunity to render an individualized and holistic care

to Mr. E.N

My interactions with the patient and his family have given me a lot of experience..

My communication skill has improved very much. It has also given me a better

understanding of the nursing interventions as well as predisposing factors,

pathophysiology, signs and symptoms, complications and treatments of Right Lobar

Pneumonia.

47
 BIBLIOGRAPHY

1. Loeb,S. (1993), Disease Springhouse. Co-operation, Springhouse Pennsylvania.

2. Monahan, D.F (2004),Medical Surgical Nursing Foundation for Clinical Practice

(2nd Edition) U.S.A.Wb Saunders Company.

3. Phipps ,W.J. (1987), Medical SurgicalNursing Concept and Clinical Practice (3rd

Edition). St. Louis . The Cv Mosby Company.

4. Spark,S.(1999), Nursing Diagnosis Reference Manual (3rd Edition), Springhouse

Pennslyvania, Springhouse Co-operation.

5. Suzanne C. S.,Brenda,G.B.,Janice, L.H.,and Kerry ,H.L (2008), Brunner and

Sadarth Textbook of Medical Surgical Nursing (11 th Edition)Philadelphia,

Lippincott Williams and Wilkins

6. Welfer, B.F. and Pratt, R.J. (2005), Baillers Nursing Dictionary, 24 th edition,

United Kingdom, Harcourt PubliHiss Limited.

7. Wolff.L. Weitzel M.H etal (1983), Fundamentals of nursing (7th edition) USA j.b

Lippincott

8. Patient’s Folder number: 000688 /15

48
 SIGNATORIES

NAME OF DOCTOR: ……………………………………………………………………

SIGNATURE: …………………………………………………………………………….

DATE: ……………………………………………………………………………………..

NAME OF CLINICAL SUPERVISOR: …………………………………………………..

SIGNATURE: ……………………………………………………………………………..

DATE: …………………………………………………………………………………….

NAME OF SUPERVISING TUTOR: …………………………………………………….

SIGNATURE: ……………………………………………………………………………..

DATE: ……………………………………………………………………………………..

SIGNATURE OF CANDIDATE:…………………………………………………………

DATE: ……………………………………………………………………………………

SIGNATURE OF PRINCIPAL………………………………..………………………….

DATE: ………...……………………………………………………………………………

49