HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE,

BEREKUM

A PATIENT AND FAMILY CARE STUDY ON CELLULITIS

SUMAILA FATIMATA

(4120220050)

A PATIENT/FAMILY CARE STUDY SUBMITTED TO THE NURSING AND

MIDWIFERY COUNCIL OF GHANA IN PARTIAL FULFILMENT TOWARDS

AWARD OF A LICENCE TO PRACTICE AS A PROFESSIONAL REGISTERED

GENERAL NURSE

AUGUST,2024

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 PREFACE

Nursing in the olden days was ‘untaught’ and instinctive which was performed out of compassion

and desire to help others by just caring for the sick on the sick bed. The Crimean war was a

significant development in nursing history where a nurse (Florence Nightingale) laid the

foundation of professional nursing. The profession gradually moved from just caring for the sick

to include taking the medical history and conducting physical examination which was previously

the duty of medical officers.

According to Virginia Henderson, ‘’Nursing is the process of assisting the individual whether sick

or well in the performance of those activities which contributes to health or peaceful death that

he/she would perform unaided if he had the necessary strength, will or knowledge and to do this

in such a way as to help him/her gain independence as rapidly as possible’’

Nursing is a profession within the health care sector focused on the care of the individual, families,

and communities so they may attain, maintain, or recover optimal health and quality of life. This

involves the promotion of health, treatment, prevention of illness and care for the ill. The patient

and family care study is a detailed written account or report of the comprehensive individualized

nursing care rendered to a particular patient and family within a specific period of time. Patient

/family care study is carried out by student nurses to enable them to put into practice the knowledge

and skills which they have acquired throughout their training and to render an individualized

/family centered and comprehensive nursing care to patient from the day of admission till the

patient recover. This helps the student nurse to have encounter with the patient/family and gather

important information on a disease condition to provide a comprehensive nursing care to the

patient and family. This study serves as a requirement for the award of a professional license to

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practice as a nurse/midwife by Nurses and Midwives council of Ghana. Patient /Family initial have

been used instead of their full names to ensure privacy and confidentiality as part of the ethics of

the nurses and midwives council.

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 ACKNOWLEDGEMENT

My first and foremost thanks goes to the Almighty Allah for his direction, strength, and protection.

I express my gratitude to Mrs. K.M and her family for not hesitating in allowing me to use her for

the care study and for providing and helping me to get the necessary information to complete this

study. My appreciation also goes to my mother Mrs. Safura Yussif and my father Mr. Sumaila

Yussif and my siblings for supporting and helping me financially to be able to complete the study.

I also thank my supervisor Mr. Amos Owusu and Mr. Alhassan Ibrahim for the support and

encouragement. I would also express my gratitude to all nurses and doctors of Sunyani Municipal

hospital especially all the staff of the surgical ward and also express my sincere gratitude to all

friends most especially Addisson, Racheal, Mariam, Hawa and my colleagues of RGN 24 who

were always there for me during the difficult times. Finally, I extend my profound gratitude to the

authors and publishers of the books I used as reference in writing this study.

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 INTRODUCTION

Patient and family care study is a written report of the care rendered to the patient /family which

is required by the Nursing and Midwifery Council of Ghana in partial fulfillment for the award of

license to practice as a professional Registered General Nurse. It involves the interaction between

the patient, family, and the community on one hand and the health team. It also involves the

application of the nursing process to attain and maintain a high level of wellness for a patient. This

interaction occurs within a specific period. The nursing process approach provides a systematic

method for nurses to plan and implement care to achieve desired outcomes. It includes collecting

information, identifying problems, developing an outcome-based plan, carrying out the plan and

evaluating the results. This study was carried out on Mrs. K.M a 45-year-old woman who was

admitted at the Female Surgical ward at Sunyani Municipal Hospital in the Bono Region, with a

diagnosis of Cellulitis of the right lower limb and tinea pedis (In between the toes of the right

limb). Mrs. K.M was admitted on 23RD of August 2023 and was discharged on the 29TH of August

2023. Mrs. K.M spent seven days in the hospital. I introduced myself to her as a final year student

who would like to use her as my patient for my patient/family care study. I told her instead of her

full name, I will rather use her initials for the purpose of confidentiality which she agreed. On

admission, patient complained of pain of the leg, nausea, and insomnia. She was anxious too.

Patient vital signs were checked and recorded as follows, Temperature 38.1oc, Blood pressure

130/80mmHg, pulse 81 bpm, respiratory 21cpm, spo2 100%, RBS 5.4, patient was reassured of

competent nursing care and interventions were made. Patient was discharged with no

complications due to the effective medical and nursing care rendered to her. Home visits were

made during admission and after discharge to ensure continuity of care, assess the effectiveness of

treatment and educate patient and family on the disease condition (Cellulitis). I chose Mrs. K.M

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for my care study to learn more about Cellulitis. she was cooperative and was willing to partaker

in the care. The following medication was administered to the patient; IV metronidazole(500mg)

for seven days, tablet ibuprofen(400mg) for one day, IV paracetamol(500mg) for seven days,

Enoxaparin (120mg once a day). This script is presented in six (6) chapters that is in line with the

nursing process as follows;

Chapter 1: comprises of the assessment of patient and family with regards to Particulars, Lifestyle

and Hobbies, Past and Present Medical History, Admission of patient, Patient’s Concept of Illness,

Literature Review on disease condition as well as Validation of data.

Chapter 2: Analysis of data. Data collected from patient/family and literature was compared with

standard in terms of Diagnostic Investigations, Causes, Clinical Manifestations, Treatment and

Complications. It also involved Patient/Family Strengths, Actual and Potential Health Problems

and their corresponding Nursing Diagnoses.

Chapter 3: Planning of patient and family care. Considers the deliberate approach to solving patient

and family’s actual and potential health problems which was effective using the nursing care plan.

Chapter 4: Implementation of patient and family care plan. Designated to unveiling the

Implementation of Patient/Family care plan, Summary of actual nursing care given, Preparation

of patient towards discharge, Rehabilitation and Home visits

Chapter 5: Evaluation of care rendered to patient and family. Covers the evaluation of care

rendered to patient and family, Statement of evaluation, Amendment of the nursing care plan for

unmet and partially met goals, Termination of care, Summary and Conclusion of nursing care from

admission to discharge.

Chapter 6: Summary and conclusion

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 TABLE OF CONTENT

PREFACE ........................................................................................................................... ii

ACKNOWLEDGEMENT ................................................................................................. iv

INTRODUCTION .............................................................................................................. v

TABLE OF CONTENT .................................................................................................... vii

LIST OF TABLES .............................................................................................................. x

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

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

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

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

1.2 Family’s Medical/Surgical History .......................................................................... 2

1.3 Family’s Socio – Economic History ......................................................................... 3

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

1.5 Patient’s Lifestyle/Hobbies....................................................................................... 5

1.6 Past Medical History ................................................................................................ 6

1.7 Present Medical History ........................................................................................... 6

1.8 Admission of patient ................................................................................................. 7

1.9 Patient’s Concept of Illness ...................................................................................... 9

1.10 Literature Review on Cellulitis............................................................................... 9

1.11 Validation of Data ................................................................................................ 17

CHAPTER TWO ............................................................................................................ 19

ANALYSIS OF DATA.................................................................................................... 19

2.0 Introduction ............................................................................................................ 19

2.1 Diagnostic Investigation ......................................................................................... 19

2.2 Patient/ Family Strength ......................................................................................... 32

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 2.3 Patient’s Health Problems ...................................................................................... 32

2.4 Nursing Diagnosis .................................................................................................. 33

CHAPTER THREE ........................................................................................................ 34

PLANNING FOR PATIENT AND FAMILY CARE .................................................. 34

3.0 Introduction ............................................................................................................ 34

3.1Objectives ................................................................................................................ 34

CHAPTER FOUR ........................................................................................................... 48

IMPLEMENTING PATIENT / FAMILY CARE PLAN ............................................ 48

4.0 Introduction ............................................................................................................ 48

4.1 Summary of Actual Nursing Care .......................................................................... 48

4.2 Preparation of Patient/Family for Discharge .......................................................... 57

4.3 Home visit /follow up/ continuity of care. .............................................................. 58

4.3.1 First home visit (24th August 2023) ..................................................................... 58

4.3.2 Second home visit (2nd September 2023) .......................................................... 59

4.3.3 Day of review (5TH September 2023) .................................................................. 59

4.3.4 Third home visit (8th September 2023) ................................................................ 60

CHAPTER FIVE............................................................................................................. 62

EVALUATION OF CARE RENDERED TO CLIENT AND FAMILY ................... 62

5.0 Introduction ............................................................................................................ 62

5.1 Statement of Evaluation.......................................................................................... 62

5.2 Amendment for Partial Met or Unmet Goals ....................................................... 65

5.3 Termination of care ................................................................................................ 65

CHAPTER SIX ................................................................................................................. 67

SUMMARY AND CONCLUSION.................................................................................. 67

6.0 Introduction ............................................................................................................ 67

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 6.1 Summary................................................................................................................. 67

6.2 Conclusion/Recommendation ................................................................................. 68

APPENDIX ....................................................................................................................... 70

BIBLIOGRAPHY ............................................................................................................. 72

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

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 LIST OF TABLES

Table 1: Diagnostic Investigation Conducted For Mrs. K.M As Compared With Literature

Review. ......................................................................................................................................... 21

Table 2: Diagnostic Investigation Carried Out On Mrs.K.M. ...................................................... 22

Table 3: Clinical Features ............................................................................................................. 25

Table 4: A Comparison Of Specific Medical Treatment Prescribed To Patient Compared With

Literature Review.......................................................................................................................... 27

Table 5: Table Showing Pharmacology Of Drug Given To Mrs. K.M ........................................ 28

Table 6: Nursing Care Nursing Care Plan For Mrs. K.M. ............................................................ 36

Table 7: Vital Signs Of Mrs. K.M ............................................................................................... 70

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 CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

1.0 Introduction
Assessment is a systematic and continuous collection of data, sorting, analyzing and organizing

that data, documenting, and communicating of the data collected. Critical thinking skills applied

during the nursing process provide a decision-making framework to develop and guide a plan of

care for the patient/family incorporating evidence-based practice concepts. The concept precision

helps to tailor care based on the individual’s unique cultural, spiritual, and physical needs rather

than a trial and error (Abdul-Kareem et al.,2019). It involves the systematic collection of data to

determine the patient’s health status and any actual or potential health problems and an interactive

process of gathering information to identify strength of the patient, her potential and actual health

problems, as well as to evaluate the effectiveness of the care rendered. It is the first step in the

nursing process. Assessment is considered critical because it is the only step that helps in obtaining

subjective and objective data that will lead to effective planning of care for the patient. It consists

of patient biographic data, family socio-economic history, patient’s developmental history,

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

history of the patient, literature review and validation of data. Assessment can be done through

observations, physical examination, interviewing and investigations such as laboratory results, x-

ray reports of the patient. Data was collected through interview and observation of both patient

and family which helps to identify patient problems. Laboratory investigations were also done.

1.1 Patient’s Particulars

Particulars are defined as an officially recorded detailed information about a person or an

individual. Patient’s particulars are the biographical state of individual within a geographical area

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at a particular time (Nurses Dictionary,2016). Mrs. K.M is a 45-year-old woman born on the 25th

of May 1978 to Mr. M.I and Madam M.A at Wenchi in the Bono Region of Ghana. She is dark in

complexion with round face, pointed noise, weighs 86 kilograms and she is 152(cm) tall. She is

the first child among two children. She is married to Mr. A. S, and they have since delivered six

children (1males and 5 female). The family resides at Abetifi Zongo in Sunyani the capital of Bono

Region. Mrs. K.M is a Muslim, and she observes all the five obligatory prayers in Islam daily. She

is a Wangara who speaks a bit of French and also Twi. Mrs. K.M is a trader who sells at Sunyani

market. Her next of kin is her husband Mr. A.S. Mrs. K.M is a National Health Insurance

beneficiary. She has no physical impairment or disabilities.

1.2 Family’s Medical/Surgical History

Health history is a holistic assessment of all factors affecting a patient’s health status, it is designed

to assess the effects of health care deviations on the patient and family, to evaluate teaching needs,

and to serve as the basis of an individualized plan for addressing wellness (Nurses Dictionary,

2016). According to patient, her father and mother is deceased. They died of a disease not known

to patient. Some of her uncles and aunties and her sibling are alive and healthy. There is no

identified hereditary of chronic illness, such as asthma, diabetes and hypertension, communicable

diseases such as tuberculosis and mental illness such as psychosis. However, she said her family

occasionally suffers minor ailments such as malaria, headache, diarrhea, cold and cough. They

rely on over-the- counter drugs and herbal medicines for treatment when herself or any of her

family member suffers from any of the ailment mentioned above. She said, she has been admitted

in the hospital on different occasions with the diagnosis of malaria due to where she was first

staying (there was a big drainage behind their house which bleeds mosquitos) but have not had

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malaria since she relocated. There are no known allergies in the family. And no one has undergone

surgery in the family.

1.3 Family’s Socio – Economic History

According to Mrs. K.M, she together with her family forms a family size of eight. Her eldest child

to the youngest child is all of school going age and therefore do not engage in any income

generating activity. Their source of income is from the things she sells and the income from her

husband’s work. According to patient, the income generated by the family is not enough to cater

for herself and the family. Patient source of funding to her medical care is from the National Health

Insurance (NHIS). She also said she has good interpersonal relationship with her neighbors same

as her extended family and participates in almost all kind of community and religious activities.

There are no taboos governing the family.

1.4 Patient’s Developmental History

Development refers to the process of growth differentiation which involves cognitive,

psychosexual, and psychosocial processes (Weller,2014). According to patient, she was born in

the house at Wenchi, and she did not know whether her birth was supervised by a trained person

(nurse, midwife) or not. She had no congenital deformities such as cleft lip or palate. She went

through a normal development milestone. These includes sitting up at the 7th month, crawling at

the 10th month, walking, talking, and running between the ages of one and three. Around the age

of thirteen she begun to experience secondary sexual characteristics such as developing of the

breast, broaden of hips, growing of pubic hair, etc.

Patient was not immunized against the six-childhood killer disease (diphtheria, tetanus, whooping

cough, measles, poliomyelitis, and yellow fever) because it had not been introduced at that time.

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She also revealed that she was breastfed for 4 months and was introduced to complementary food.

According to patient, she did not have the opportunity to attend school because of the early death

of her parent which led her to stay with her grandmother. Her grandmother could not afford for

her to go to school. She had her first menstrual period at age 14 and she grew up as a normal child

and was ushered into adolescence and adulthood as every normal female. She was left to be

completely independent at the age of 25 years. Patient said she got married at age 28 and had her

first child at age 29. According to Eric Erikson’s theory of psychosocial development in 1959, he

describes the human life cycle as a series of eight developmental stages from birth to death. The

theory focuses on psychological task that are accomplished throughout the life cycle. According

to Erikson’s theory of psychosocial development, there are eight distinct stages with each possible

result could be success or failure. These stages are,

Trust versus Mistrust (birth to 18months)

Autonomy versus Shame and Doubt (18m to 3 years)

Initiative versus guilt (3 to 6 years)

Industry versus Inferiority (6 to12 years)

Identity versus Role confusion (12 to20)

Intimacy versus Isolation (20 to35)

Generativity versus Stagnation (35 to 65 years)

Integrity versus Despair (65 to death)

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Each stage is characterized by a distinct conflict, or crisis, relating to the person’s physiologic

maturation and to what society expects of a person at that age. Mrs. K.M falls under Generativity

versus stagnation (35 to 65) since she is 45 years of age; This stage is characterized by fulfilling

life goals that involves family, career, and the society. Generativity is the concern of helping in

guiding the future generation. Social –valued work and disciplines are expressions of this stage. A

person contributes during this period by raising a family or working towards the betterment of

society, this result in a sense of generativity, a sense of productivity and accomplishment results.

In contrast, a person who is self-centered and unable or unwilling to help society move forward or

help the younger generation develops a feeling of stagnation, dissatisfaction with relatives and lack

of productivity. Mrs. K.M falls under generativity because she is raising a family and working

hard towards the betterment of her children in future. Also, she contributes and attends to any

social gathering that is held in the community which brings about development and that will benefit

the people in the community.

1.5 Patient’s Lifestyle/Hobbies

Lifestyle is the pattern of daily living that an individual develops (Nurses Dictionary,2016).

Hobbies are activities one does for pleasure when he or she is not working or to release stress.

(Nurses Dictionary,2016). According to Mrs. K.M, she goes to bed around 9:00pm when all her

children have gone to bed, and she has finished with her house chores and wakes up at 4:30am

every day except on weekends which she wakes up at 6:00am. She brushes and baths twice daily.

When she wakes up at 4:30 am, she brushes her teeth, goes to the mosque, and pray after which

clean up the house and also wakes her children up and assist them in preparing for school. She

normally takes porridge with koose as breakfast around 8:00am then goes to the market and takes

her lunch at 12:30pm. She comes back from the market at 4:30pm to prepare food for the family.

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The food she likes best is Tuozafi and also fufu with light soup but eats other kinds of food. On

weekends she does the laundry of the family. She attends to events if any after which she comes

back home and rest. She eliminates her bowel and bladder when she feels the urge to do so. She

spends much time with her children but watches television when she is idle.

1.6 Past Medical History

Patient’s past medical history gives information on patient’s state of health before the present

complaints (Nurses Dictionary,2016). According to patient, she has been admitted on several

occasion to the hospital to be treated of Malaria. She indicated that she has ever suffered rhinitis,

diarrhea, and headaches but not to a point that warranted admission. The source of medical

treatment for Mrs. K.M. and family are both orthodox and herbal medicine which they buy from

over-the counter. There are no known allergies in the family. And no one has undergone surgery

in the family.

1.7 Present Medical History

Patient was well until the 15th of August 2023 she sustained a deep cut by falling into a gutter. She

went to the pharmacy shop and bought pain medication (paracetamol) and dressing solution to

dress the wound in the house. According to her, she felt better after taking the pain medication

[Paracetamol]. However, on the 19th of August, she experienced swelling of the right leg,

difficulty in walking accompanied by fever and chills. She failed to report until on the 23rd of

August 2023 when the condition became unbearable. She then reported to the Sunyani Municipal

Hospital, she went to the out-patient department (OPD) and upon being assessed and examined by

the doctor she was diagnosed with Cellulitis of the right lower limb and tinea pedis (Athletes foot,

which is in-between the toes of the right lower limb) and was admitted to the female surgical ward

for treatment.
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1.8 Admission of patient
Admission of patient means allowing and facilitating a patient to stay in the hospital unit or ward

for observation, investigation, and treatment of the disease the person is suffering from (Nurses

Dictionary, 2016). Mrs. K.M was brought to surgical ward on the 23rd of August 2023 through the

Outpatient Department (OPD) in a wheel chair and accompanied by a relative(husband). On

reaching the ward, I welcomed and introduced myself to them, the necessary documents were

collected, and her particulars were crosschecked. Her identity was verified. I introduced her to

other staffs in the ward. Patient name was entered into the admission and discharge book and the

daily ward state. Patient was given a bed and her belongings were collected and kept in a locker at

the bedside. On observation, she was alert and conscious. Vital signs were checked and recorded

as;

Temperature – 38.1 °c

Pulse – 86 b/m

Respiration – 21 c/m

Blood pressure - 130/80 mmHg

Patient was made comfortable in an admission. Patient relative was taken through ward orientation

which involved showing her the nurse’s station, where to find the bathroom etc. She was

introduced to other patients in the ward, and she was told to call for help when needed. She was

also made aware of the items she could keep in the ward as well as those she needed during

admission and also visiting hours. The cash and carry system as well as the National Health

Insurance Scheme was explained to her. She was reassured that she was in the hands of competent

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staff and everything possible would be done to return her health to normal. She revealed that she

was insured thus, it was explained to her that certain drugs and treatment were not covered by the

national health insurance scheme. The following drugs had already been prescribed for the patient.

1. IV Paracetamol 500mg tid × 3

2. Tablet ibuprofen 500mg tid × 3

3. IV Metronidazole 500mg tid × 7

The diagnostic investigations to be done were,

1. Full blood count

2. liver function test

3. Doppler ultrasound scan

4. Serum electrolyte

Her condition was explained to her and relative. I then informed the ward in- charged about my

intention of using the patient for my care study and she approved. I introduced myself to the patient

and relative as a final year student at Holy Family Training College, Berekum conducting a care

study and I would be glad if she would allow me to use her as my patient for the care study. I told

them that it is a requirement of the Nursing and Midwifery Council of Ghana to all final year

student nurses to take a patient each and nurse them from day of admission till discharge. I also

informed her that all information about her will be kept confidential. They agreed and assured me

of their cooperation. I decided to choose the patient for care study because I wanted to put into

practice the theoretical knowledge I have acquired.

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1.9 Patient’s Concept of Illness
According to patient, she had no knowledge about her condition. she also believed that it was not

a punishment from God, but it is the work of enemies and witches from her house that made her

fall into the gutter and strongly believed that her health will be restored by the end of her admission.

1.10 Literature Review on Cellulitis

Definition of Cellulitis

Cellulitis is an inflammation of the cellular or connective tissue. It can also be described as the

direct spread of infection in the extra cellular space. It begins as a localized infection and spreads

affecting deeper tissues. It may be primary or secondary to a condition. If left untreated the

infection can spread to the lymph nodes and bloodstream rapidly and can become life

threatening. Cellulitis can affect the upper and lower limbs as well as the eye (Raff &

Kroshinsky,2016).

Incidence/Epidemiology

Cellulitis occurs in persons of all age but happens mostly in adult. The incidence of cellulitis is

about 200 cases per 100,000 and in nontropical religion, has a seasonal predilection for warmer

month. It can be life threatening when not treated early (McNamara & Martinez,2017).

Causes

According to Raff & Kroshinsky (2016), cellulitis is caused by streptococcus aureus,

staphylococcus pneumonia and Group A and B – Hemolytic Streptococcus.

Mode of Transmission

The bacteria get into the body through openings in skin like an injury or surgical wound. In general

cellulitis is not spread from person to person, it is not contagious (Raff & Kroshinsky, 2016).

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Risk Factors

According to Quirke & Ayoub (2017), several factors increase the risk of cellulitis, and they

include;

1.People with cracks or peeling between the toes.

2.History of peripheral vascular disease.

3.Injury or trauma with a break in skin

4.Insect bites and stings, animal, and human bite

5.Ulcers from diabetes.

6.Blockage in blood supply to a site (ischemia).

7.Use of corticosteroids or drugs that suppress the immune system.

8.Wound from recent surgery.

9.People with immunosuppression.

10.Malnutrition.

Pathophysiology of cellulitis

When streptococcus enters the body through an opening, they attack the hair follicles. They then

accumulate and multiply causing the local infection which results in swelling, redness, pain, and

warmth of the affected area. The organisms then produce an enzyme called hyaluronidase which

causes the spread of the infection by breaking down the fibrin network and other barriers that help

10
in keeping inflammation localized. The spread of the inflammation may eventually become

systemic if not treated (Raff & Kroshinsky, 2016).

Signs and Symptoms

According to Raff & Kroshinsky (2016), signs and symptoms of cellulitis include;

1.Swelling of the site

2.Tenderness

3.Warmth over the site

4.Sore skin or rashes

5.Tight, glossy, and stretched appearance of skin

6.Itching

7.Fever

8.Chills

9.Malaise

10.Headache

11.Blisters(occasionally)

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Diagnostic Investigation

According to Raff & Kroshinsky (2016) the following diagnostic investigations can be carried out

to diagnose an individual with Cellulitis;

1.Physical examination reveals warmth redness and swelling.

2.Full blood count.

3.Liver function test to rule out any involvement of the liver

4. Serum electrolyte sedimentation.

Medical Management

According to Hinkle & Cheever (2014) Cellulitis when acute must be treated as a medical

emergency for the following reasons,

1. To avoid the spread of disease to other parts of the body.

2. To avoid the complications of the disease.

3. Hospitalization may be needed as the patient requires as support treatment consisting of

bed rest, nutritional support and increase fluid which needs monitoring

4. Analgesic such as ibuprofen may be prescribed to reliefs pain.

5. Intravenous fluid and electrolyte replacement can be given.

6. The intravenous fluids which are normally given are normal saline, dextrose, and ringer

lactate.

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Nursing Management

According to Cranendonk & Lavrijsen (2017), the nursing management is grouped under the

following;

Psychological Care

Psychological care attends to the psychological and social aspects of a person’s life. Psychological

characteristics includes emotions, thought, attitudes, motivation, and behavior (Cranendonk &

Lavrijsen 2017). Reassure patient and family that the patient is in the hands of competent staffs

and that proper medical care is available for complete recovery. Allow client as well as her family

members to voice out their worries and ask questions, their worries should be addressed, and

questions answered as honestly as possible.

Engage patient in friendly interactions to aid cooperation and rapport. This also promote comfort

and relaxation at the hospital. Engage the patient in diversional therapy such as watching of

television and explain any procedure before carrying it out. This helps reduce anxiety.

Drug Administration

According to Cranendonk & Lavrijsen (2017), drug administration is the process of giving out

medication to a patient to treat or prevent disease or complication All prescribed drugs should be

administered ensuring that it is the right drug, given through the right route, to the right person at

the right time. Wound dressing should be done aseptically Observe for any side effects of the drug

and ask patient to voice out any abnormality noticed after taking the drug.

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Position.

Rest is a reduced level of physical and mental exertion. On the other hand, sleep is a natural

occurring state of unconsciousness and inactivity characterized mostly by diminished receptivity

to environmental stimuli. Position is the way one sleeps (Nurses Dictionary,2014). Ensure bed rest

in a peaceful environment. Patient should be made comfortable always to reduce the impact of

pain. Patient is best nursed in a supine position with the affected limb slightly elevated with a

pillow to help reduce oedema, Measures should also be taken to ensure that patient sleeps well.

Personal Hygiene

Personal Hygiene refer to behavior that can improve cleanliness and lead to good health such as

frequent handwashing, skin and facial cleanliness, and bathing with soap and water (Nurses

Dictionary,2015). Patient must have proper hygiene methods such as bathing at least twice daily

and brushing of the teeth or cleaning the mouth daily. Dirty clothing and linen should be changed.

The hands and feet should be well cared for, ensuring that nails are clean and tidy by washing and

trimming them. Care should be taken when bathing or cleaning the affected area to avoid inflicting

pain or introducing bacteria into the wound.

Nutrition

Nutrition is the biochemical and physiological process by which a person uses food to support its

life (Nurses Dictionary,2015).

A well-balanced meal should be provided containing carbohydrates, protein, vitamins, fats and oil,

roughages, and minerals. Food should be extra rich in vitamins especially vitamin C and protein

to help boost the immune system and facilitate healing. Roughages as well as proper intake of
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fluids should be ensured to help prevent constipation due to limitation in activities and movement

of patient. Patient should be involved in planning of her diet.

Observation

Patient’s vital signs should be checked and recorded accurately (temperature, pulse, respiration,

blood pressure). This aids to assess the progress or deviation from the normal. Patient’s level of

pain is also assessed so that measures may be taken to reduce it. Physical examination should be

done daily to assess signs and symptoms at the site. The patient’s level of activity is also assessed

so that the necessary help may be rendered. Therapeutic and side effects of drugs are also observed

to response to treatment. Observe possible complication of the condition(Cellulitis) so that

preventive measures can be done. The intravenous site must be observed for patency of line and

the flow of infusion. (Cranendonk & Lavrijsen,2017).

Rest and Sleep

Rest is a reduced level of physical and mental exertion. On the other hand, sleep is a natural

occurring state of unconsciousness and inactivity characterized mostly by diminished receptivity

to environmental stimuli. Rest and sleep are ensured to enhance the comfort of the patient and to

prevent further complications. A quiet and restful environment is to be ensured to enable patient

to have a maximum rest and sleep he/she needs. A comfortable bed is made and noise on the ward

should be minimized.

Elimination

Due to reduced activity and bed rest, patient may experience constipation thus intake of roughages,

fruits and fluids should be encouraged to aid free bowel movement. In case of vomiting, a vomitus
15
bowl should be made available to the patient. Vomitus should be observed for its characteristics

and abnormalities and record. Bowel elimination should be encouraged by serving bed pan on

request. Patient should be encouraged to have regular bladder elimination. Urinals should be

served when necessary. Aseptic techniques should be done to prevent infection (Cranendonk &

Lavrijsen,2017).

Exercise

Patient is encouraged to undergo mild to moderate exercise as his or her condition allows. This

helps to improve circulation, prevent joint stiffness, etc. patient is assisted to sit up in bed, walk

around in bed and gradually walk around the ward.

Medication

Antibiotics and analgesic needs to be given/served regularly to prevent infections and pain.

Complication

According to Raff & Kroshinsky (2016), if early treatment is not sought for, the following

complications may develop;

1.Bacteremia (blood Infection) The bacteria can spread to the blood, bones, lymph system, heart,

or nervous system. These infections can lead to amputation, shock or even death.

2.Cellulitis can cause an extensive tissue damage and tissue death. (gangrene)

3.It can cause Suppurative Arthritis. (bacterial infection)

4.Osteomyelitis. (bone infection)

16
Inflammation of the lymph vessels. (Lymphangitis)

Meningitis. (if its peri -orbital).

Patient and Family Education

Patient is educated on the causes, signs, and symptoms as well as complications of the condition.

Patient is educated on the need to conform to drug regiment and periodic checkups. Patient is also

educated on the measures to put in place to prevent the occurrence of the disease (Cellulitis) and

the need to report to the health facility when it happens. Advice patient and family to ensure

personal and environmental hygiene (bathing and brushing the teeth daily, keeping the

surroundings clean, wearing of clean clothing and proper well-fitting shoes. Educate on protective

measures for the skin such as application of lotions and skin cream to prevent cracking of the skin,

wearing of comfortable shoes to prevent athletes’ foot, wearing appropriate protective equipment

during work and sports. In case of a break in skin, it should be cleaned carefully and covered with

a clean material. It should be reported to the hospital if it bleeds severely or does not heal. They

should also be educated to take good care of bites from insects and avoid scratching them as it may

result in a wound. Dog bites and bites from other animals should be reported to the hospital for the

necessary treatment. Meals should also be well balanced with a lot of vitamins to boost immunity

and facilitate healing. Educate patient on the need for proper intake of drugs and the importance

of review (Raff & Kroshinsky ,2016).

1.11 Validation of Data

Validation is defined as the extent to which a data measures, indicator or method of data collection

possesses the quality of being sound or true, as far as can be judged (Weller,2014). In other words,

validation refers to the process by which data retrieve is being confirmed. Data collected from
17
patient were the same to that of what the relatives said, also Data presented by patient and his

diagnostic investigations carried out were like those in the literature review. When the patient’s

condition became stable and all the relatives had calm down, I again asked them the same questions

which were asked previously, and the same response was given. Upon this I therefore believe the

information gathered was authentic and valid for studies. Data from laboratory results and

manifestations compare well with literature that confirms that the patient was suffering from

cellulitis. The above indicate that the data collected was free from bias.

18
 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction
Analysis of data is a systematic examination and evaluation of data or information, by breaking it

into its component parts to uncover their interrelationship, thus providing basis for decision

making and problem solving (Weller, 2014). This chapter forms the second phase of the

patient/family care study. It entails comparing the results of the investigation carried out with

standards in the literature review. It also involves comparing the causes, clinical manifestations,

treatments, and complications of the patient’s condition (Cellulitis) with those stated in textbooks.

It gives the pharmacology of drugs prescribed by the medical officer for patient. This chapter also

captures the patient/family strengths, the health problems identified, and nursing diagnoses

formulated for given care to patient. Analysis of data comprises.

1.Comparison of data with standards

2. Patient and family strength

3. Patient health problems

4. Nursing diagnosis

2.1 Diagnostic Investigation

Diagnostic Investigation refers to an examination or analysis of the composition of a substance by

the use of chemical reagents, to determine the presence or absence of a substance (Weller 2014).

From the literature review, blood test to confirm whether the Cellulitis has spread to the blood,

wound culture/skin sample to confirm the diagnosis and the type of bacteria that is present and

19
imaging studies are done. Wound culture was done on patient. The following are list of

investigations which were carried out on Mrs. K.M during period of hospitalization;

1.Serum Electrolyte Estimation

2.Full blood count

3. Liver function test

4. Doppler ultrasound scan

2.1.1 Comparison of Data with Standards

This comprises.

1.Diagnostic investigations

2.Causes

3.Clinical features

4.Treatment

5.complications

20
 TABLE 1: Diagnostic Investigation Conducted for Mrs. K.M as compared with literature
Review.
Diagnostic investigation in Literature Review Diagnostic Investigation Conducted for

Patient

1.Physical examination 1.Physical examination was conducted which

revealed swollen lower extremity

2.Serum Electrolyte Estimation 2.Serum electrolyte estimation was done for

patient

3.Full blood count 3.Full blood count was done for patient to check

for infection

4.Liver function test 4.Liver function test was done for patient

5.Doppler ultrasound scan 5.Doppler ultrasound scan was done for patient

6.blood culture 6.Blood culture was not done for patient.

7.Wound culture 7.Wound culture was not done for patient.

With reference to table 1.0, Serum Electrolyte Estimation, Doppler ultrasound scan, full blood

count and liver function test were ordered. Right investigation was done on patient. From the

literature review, full blood count was done to determine if the infect has spread to the blood,

serum electrolyte sedimentation is done to measure the levels of essential electrolyte in the body,

Doppler ultrasound to detect blood clot. Wound culture was not done for patient.

21
TABLE 2: DIAGNOSTIC INVESTIGATION CARRIED OUT ON MRS.K.M.

DATE SPECIMEN INVESTIGATIONS RESULTS NORMAL INTERPRETATION REMEDY

RANGE
23rd /08/23 Blood Serum electrolyte level: No treatment

Sodium (Na +) 138 mmol/Lˉ¹ 135-145mmol/Lˉ¹ Serum electrolyte level was was given

Potassium (K+) 4.3 mmol/Lˉ¹ 3.5-5.5 mmol/Lˉ¹ normal indicating that there

was no electrolyte
Chloride (Clˉ) 104mmol/Lˉ¹ 90-110 mmol/Lˉ¹
imbalance

23rd /08/23 Blood Liver function test Liver function was abnormal No treatment

Total proteins 40.57 g/L 39.70-49.50g/L as Total bilirubin was was given

increased indicating
Albumin 34.6 g/L 25.0-35.0g/L
increased hemolysis.
Globulin 16.7µmol/L 0.0-17.0

Total bilirubin 10.00 µmol/L 0.00-10.00

Direct bilirubin 15.2 µmol/L 1.5-17.5

22
 ALT 24.5 µ/L 10.0-41.0

AST 18.5 µ/L 5.0-40.0

GGT 33.3µ/L 10.0-71.0

23rd /08/23 Blood Full blood count; white blood cells level was Intravenous(IV)

above normal indicating Metronidazole

White blood cell 9.72k/µL 2.60-8.50k/µL
infection and decreased red was given.

Red blood cell 3.26k/µL 4.50-5.50k/µL blood cells.

Hemoglobin 13.3g/dL 14.5-18.0g/dL

Hematocrit 40.6 33.3-51.0%

23
23rd /08/23 Blood Blood urea/electrolyte Blood urea electrolyte and No treatment

and creatinine; creatinine level were was given

normal indicating that there

Blood urea and 19.1µmol/L 8.0-36.0µmol/L
is no kidney involvement
creatinine
140 mmol/Lˉ¹ 134-149 mmol/Lˉ¹

Sodium
3.5 mmol/Lˉ¹ 3.6-5.5mmol/Lˉ¹

Potassium

24th /08/23 Doppler ultrasound scan No deep vein Absence of An absence of thrombus in No treatment

thrombosis thrombus the blood vessel indicated was given

that there was no clotting

disorder.

24
Causes of Patient’s Illness

With reference to the various diagnostic investigations, there was increased white blood cells

indicating the presences of an infective process. And there was a decreased red blood cell

content and an increase in total bilirubin. This indicates increased hemolysis which can be

caused by allergic reaction to foreign substance, one of the many causes of cellulitis.

Table 3: Clinical Features

According To Literature As Exhibited By Client

1.Swelling at the site. 1. Patients right leg was swollen.

2.Tenderness. 2. Patient right leg was tender.

3.Warmth over the site. 3. Patient’s right leg was warm to touch.

4.Sore skin or rashes 4. Patient did not develop sores or rashes.

5.Tight, glossy, and stretched appearance 5. Patent’s right leg appeared tight,

of skin. glossy, and stretched.

6.Itching. 6. Client did not complain of itching.

7.Fever and chills. 7. Patient experienced fever.

8.Malaise. 8. Patient did not complain of malaise.

9.Headache. 9. Patient did not complain of headache.

10.Blisters. 10. Patient did not develop blisters.

25
 11.Redness. 11. Patient’s right leg appeared reddened.

The above comparison indicates that patient’s condition is Cellulitis since she exhibited most

of the signs and symptoms.

Treatment of Patient

With reference to the literature review, the following specific drugs were prescribed for the

patient;

1.Tablet ibuprofen 400mg tid ×1 to relieve pain.

2.Paracetamol 500mg b.i.d ×3 was prescribed due to the presence of fever.

3.Intravenous Metronidazole 500mg tid × 7 was prescribed due to the presence of infection.

4.Subcutaneous enoxaparin was prescribed as prophylaxis for deep vein thrombosis.

Pharmacology of Drugs

The medical treatment that was given to Mrs. K.M is outlined in the Table below. It consists

of date of the order, the drug name, the dosage, and route of administration for the patient,

classification, desired effect, actual effect observed and remarks.

26
Table 4: A Comparison of Specific Medical Treatment Prescribed to Patient Compared

with Literature Review

Medical Treatments in The Literature Medical Treatments Prescribed for Patient

Review

1. Histamine – Receptor Antagonist 1. Histamine- Receptor Antagonist was not

(Cimetidine) given to patient.

2. Antacids (Magnesium Oxide) 2. Antacids were not given to patient.

3. Analgesics – ibuprofen and IV 3. Analgesics (Tab. Ibuprofen and IV

Paracetamol Paracetamol) were given to patient to relief

pain.

4. Intravenous fluids and electrolyte 4. Intravenous fluids and electrolyte (Ringers

replacement Lactate) were not given to patient

5. (Ringers Lactate)

6. Antimicrobial agents (Ciprofloxacin, 5. Antimicrobial agents (Metronidazole) were

7. Metronidazole) prescribed for the patient

The medications ordered for the patient was in line with literature which aided in effective

management of patient condition and aided his speedy recovery without complication.

27
 Table 5: Table Showing Pharmacology of Drug Given to Mrs. K.M

DATE NAME OF DOSAGE AND ROUTE OF CLASSIFICATION ACTION OF ACTUAL SIDE EFFECT
DRUG ADMINISTRATION DRUG ACTION OF DRUG AND
OBSERVED ITS REMEDY
IN THE AS
LITERATURE PRESCRIBE
D FOR
PATIENT

23/08/23 Tablet Route; Oral 400mg tid × 3 Analgesic It inhibits Patient was Stomach ache,
Ibuprofen oral prostaglandin relieved of pain drowsiness,
synthesis by tinnitus, diarrhea.

Dosage: 50mg – inhibiting

None of these was
75mg - tid P.O. cyclooxygenase-
evident in the
1(COX-1) and
patient.
cyclooxygenase-2
(COX-2) to cause
antipyretic and
anti-inflammatory
effect

28
24/08/23 Metronidazole Route: intravenous 500mg tid × 7 Antibiotic It acts to inhibit Patient’s Headache, nausea,
intravenous DNA synthesis in condition vomiting,
Dosage: Adult- 1g
(IV) anaerobes to improved
b.d in severe diarrhea, metallic
cause death
infections and 625mg taste.
b.d in mild infections
Patient
for 5-14 days.
experienced
Children: mild to nausea.
moderate
1.. Meals were
infection;20 to
planned according
30mg/kg every 8
to the desires of
hours orally.
patient

2.Patient was
encouraged to
brush her teeth
twice daily and
rinse mouth before
and after meals.

29
23/08/23 Acetaminophen Route: Intravenous. 1g tds × 3 analgesic It decreases fever Patient’s fever Hepatic toxicity,
Dosage: Adults:1g intravenous(IV) by acting directly was decreased dyspnea, red skin,
for 6 hours on the hoarseness hives
hypothalamic heat and rash. None of
Children:10-15mg/kg
regulating center these were evident
4 to 6 hours for 12
to cause in the patient.
years and below
vasodilation and
sweating which
helps to control
Neonates:10-15mg temperature and
/kg 6-8 hours per day also block
prostaglandin
synthesis by
inhibiting COX-1
AND 2.

26/08/23 Enoxaparin Route: subcutaneous 80mg bd × 7 Enoxaparin It inactivates Patient had no Bleeding gum,
Adult:30-40mg every subcutaneous factor thus clotting dizziness, nose
12 hours ×10-14 days inhibiting abnormality bleeding, coughing
or 1mg/kg every 12 thrombus (deep vein out blood,
formation by thrombosis) difficulty breathing

30
hours for 10 to 14 blocking the and increased
days. conversion of menstrual flow or
prothrombin to vaginal bleeding.
thrombin and None of these were

Children: 1mg/kg per fibrinogen to evident in patient.

12 hours in a day. fibrin which are

the final steps of
the clotting
process.

31
Complications

With reference to the literature review in chapter one, Mrs. K.M did not experience any

complications.

2.2 Patient/ Family Strength

The strength of the patient and the family involves what can be done on their part to facilitate

the work of health care providers in providing holistic care to promote recovery. Through the

interaction with the patient, her strength was observed as follows;

6. 1.Patient can tolerate tepid sponging. (23/08/23).

7. 2.Patient can walk with assistance. (23/08/23).

8. 3.Patient can indicate the location of pain and the intensity of pain as 7 on pain rating

scale. (23/08/23).

9. 4.Patient can eat one - fourth (1/4) of full bowl of rice. (24/08/23)

10. 5.Patient can verbalize her fear and concern about the condition. (24/08/23).

11. 6.Patient can sleep for few hours in the night when lights are switched off (25/08/23).

12. 7.Patient can tolerate passive exercise (26/08/230).

2.3 Patient’s Health Problems

Problem is defined as a situation that needs attention and needs to be deal with or solved from

data collected during assessment. It includes any condition, disease, disorder that affects

individual physical, mental or emotional well-being (Weller,2014). The following health

problems were noticed on patient:

1. 1.Patient had elevated body temperature (fever, 38.1 OC). (23/08/23)

2. 2.Patient right leg is swollen. (23/08/23)

3. 3.Patient complain of pain of the affected leg (right leg). (23/08/23)

32
 4. 4.Patient complained of nausea. (25/08/23)

5. 5.Patient was Anxious. (24/08/23)

6. 6.Patient says she cannot sleep (insomnia). (25/08/23)

7. 7.Patient is bed ridden. (26/08/23)

2.4 Nursing Diagnosis

According to Weller (2014), nursing diagnosis is defined as a clear and a definite statement of

a health problem or of a potential health problem in the patient’s health status that a nurse is

professionally competent to treatment. These nursing diagnoses were formulated based on the

health problems that were identified;

1. Alteration in body temperature (37.8C) related to inflammatory process of

disease(Cellulitis). (23/08/23).

2. Impaired skin integrity related to inflammation (right leg). (23/08/23).

3. Pain related to inflammatory process of disease (Cellulitis). (23/08/23).

4. Altered nutrition (less than body requirement) related to nausea. (24/08/23).

5. Anxiety related to unknown outcome of disease (24/08/23).

6. Disturbed sleeping pattern (Insomnia) related to change of environment

(hospitalization). (25/08/23).

7. High risk for clotting disorders (deep vein thrombosis) as evidence by patient being

bed ridden. (26/08/23).

33
 CHAPTER THREE

PLANNING FOR PATIENT AND 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 actual or potential problems in daily life and produce an individual

care plan (Weller, 2014). This is the third phase in the nursing process which deals with setting

of goals and objective/outcome criteria to meet the health needs of the patient. These

objectives/outcome criteria are set in order of priority which can be long or short term. This is

made possible based on the actual and potential problems identified. Before being made

effective, nursing care must go through assessment, analysis, diagnosis, implementation, and

evaluation. Planning in nursing process is the process whereby the nurse formulates strategies

required to eliminate or decrease patient’s health problems. Relatives of the patient are also

included in the planning of patient care.

3.1Objectives
1. (23/08/23) Patient would be relieved of fever within 2 hours as evidence by;

a Patient temperature falling within the normal range (36.2 °C-37.2 °C).

b Patient feeling comfortable and relaxed in bed.

2. (23/08/23). Patient would be relieved of swelling during the time of hospitalization as

evidence by;

a. Patient’s right leg returning to normal size.

b. Skin on patient’s right leg not appearing tight and glossy.

3. (23/08/23) Patient would be relieved of pain of the affected leg within 2 hours as

evidence by;

34
 a. Patient verbalizing that she is no more having pain on the leg.

b. Nurse observing patient being relaxed and calm in bed.

4. (25/08/23) Patient would be able to eat well and maintain her nutritional status within

72 hours as evidence by;

a. Patient being able to eat most of the food served at a time.

b. Nurse observing patient eat all the food served at a time.

5. (24/04/23) Patient would be relieved of anxiety within 48 hours as evidence by;

a. Patient verbalizing that she is no more anxious.

b. Patient looking relaxed and comfortable in bed.

6. Patient would restore her normal sleeping pattern within 24 hours as evidence by;

a. Nurse observing patient sleep soundly in the night.

b. Patient verbalizing that she is able to sleep in the night.

7.Patient would not develop any clotting disorder (deep vein thrombosis) within the time

of hospitalization as evidence by;

a. Diagnostic investigation indicating that there is no clotting disorder.

b. Absences of swellings or bumps on the veins closer to the surface of the skin.

35
 Table 6: Nursing Care Nursing Care Plan for Mrs. K.M.

DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION SIGN
DIAGNOSES
TIME /OUTCOME TIME

CRITERIA

23/08/23 Alteration in Patient would be 1.Reassure patient of 1.Patient was reassured that measures 23/08/23 Goal was fully S.F

body relieved of fever available measures to will be put in place to bring the situation met as evidence
At 2:00 pm
temperature within 2 hours as help return temperature under control by;

12:00 pm (fever) related evidence by; to normal.

1.Patient’s
to
1.Patient 2.Provide light clothing temperature fell
inflammatory 2.Heavy bed clothes were removed, and
temperature and bed clothes. within the
process. light clothing provided.
falling within normal range
3.Provide adequate
the normal range 3.Nearby windows were opened for
ventilation. (36.2°C37.2°C).
(36.2 adequate ventilation.

4.Serve cold drinks.

°C-37.2 °C). 4.Cold drinks were served.

36
2.Patient feeling 5.Administer prescribed 5.Intravenous(IV) Paracetamol 500mg 2.Patient feeling

comfortable and analgesic to patient. was administered comfortable and

relaxed in bed. relaxed in bed.

6. Re-check temperature 6.Temperature was checked 30 minutes

30 minutes after drug after drug administration to determine

administration. the improvement in condition and

recorded as 37.0°C.

37
DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION SIGN
TIME DIAGNOSES /OUTCOME TIME
CRITERIA
23/08/23 Impaired skin Patient would 1.Reassure patient and 1.Patient and family was 29/08/23 Goals fully met S.F
integrity be relieved of her family that the reassured that swelling was as evidence by;
At At
related to swelling within swelling was temporal, temporal and measures will be
1. Patient’s right
12:30pm inflammation. the time of and measure will be put put in place to relieve her of it 12:30pm
leg returning to
hospitalization in place to relieve her of
normal size.
as evidence by; it.
[

1.Patient’s 2.Dress patient’s wound 2.Patient’s right leg was dressed

right leg with normal saline aseptically with normal saline 2.Skin on
returning to patient’s right
3. Apply ice packs on the 3.Ice packs were applied to the
normal size. leg not
affected leg to reduce affected leg to reduce pain.
appearing tight
inflammation.
and glossy.
2.Skin on 4. Elevate patient right 4.Patient’s right leg was
patient’s right leg. elevated with a pillow.
leg not
5.Encourage patient 5. patient was encouraged to
appearing tight
avoidance of strenuous avoid strenuous activity.
and glossy.
activities.

38
DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION SIGN
DIAGNOSES
TIME /OUTCOME TIME
CRITERIA
23/08/23 Pain related to Patient would gain 1.Reassure patient that 1.Patient was reassured that 23/08/2023 Goal fully met as S.F

At inflammatory mobility within 2 condition is only condition could be resolved with At evidence by;

2:30 pm process of hours as evidenced temporal and that she is in adequate measures put in place
4:30 pm 1. Nurse
disease(Cellulitis) by; the hands of competent
observing
staff.
1.Nursing patient being

observing patient 2.Dress patient’s leg 2.Patient’s right leg was dressed relaxed and calm

being relaxed and aseptically with normal aseptically with normal saline in bed.

calm in bed. saline.

2.Patient

2.Patient 3.Apply warm 3.Warm compresses were applied verbalizing that

verbalizing that compresses to reduce to the site to decrease pain and she is no more

she is no more pain and swelling swelling. having pain on

having pain on the the affected leg.

affected leg.

39
4.Elevate patient right leg 4.Patient’s right leg was elevated

with pillow. with a pillow.

5.Administer prescribed 5.Ibuprofen 400mg was given to

analgesic to patient. patient.

40
DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING DATE/ EVALUATION SIGN
DIAGNOSES INTERVENTION
TIME /OUTCOME TIME
CRITERIA

24/08/23 Anxiety related Patients would 1.Reassure patient that 1.Patient was reassured that 26/08/23 Goal was fully S.F
to unknown be relieved of she is in the hands of she was in the hands of met as evidence
At At
outcome of anxiety within competent staff and competent staff and that her by;

10:30am disease. 48 hours as condition would be condition was temporal and 6:00am
1. Patient
evident by; brought under control can be controlled.
verbalizing that
1.Patient
2.Assess patient 2.Patient’s knowledge on she is no more
verbalizing that
knowledge on condition was assessed by anxious.
she is no more
condition. asking her questions on
anxious 2.patient looking
condition which she was able
relaxed and
patient looking to answer most.
comfortable in
relaxed and
3.Educate patient on 3.Patient was educated on the bed
comfortable in
condition to clear causes, sign and symptoms,
bed.
fears and prevention and treatment

misconceptions. modalities on the condition to

clear her fears and
misconceptions.

41
4.Allow patient to ask 4.Patient was allowed to ask
questions and express questions and expressed her
fears fears and it was well
explained to her.

5.Engage patient in 5.Patient was engaged in

diversional therapy to conversation and watching of
divert her attention television to divert her
from pain attention from pain.

42
DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING DATE/ EVALUATION SIGN
DIAGNOSES INTERVENTION
TIME /OUTCOME TIME
CRITERIA

25/8/23 Altered Patient would 1.Reassure patient and 1.Patient and the family 28/08/2023 Goal was fully S.F
nutrition (less maintain her her family that patient members were reassured that met as evidence
At At
than body normal nutritional would be able to eat patient would be able to eat by;
8:30pm
requirement) status within 72 normally with the normally with the appropriate 8:30 am
1. Patient being
related to hours as evidence appropriate measures. interventions
able to eat most
nausea by;
2.Plan diet taking into 2.Patient diet were plan of the food
1. Patient being consideration patients considering patient’s likes served at a time.
able to eat most of likes and dislikes as and dislikes as well as
2.Nurse
the food served at well as culture. culture.
observing
a time.
3.Ensure proper 3.Prpoer mouth care was patient eat one -
2.Nurse observing mouth care. fourth of the
ensured.
patient eat one - food served at A
fourth of the food 4.Patient was engage in the time.
served at A time 4.Engage patient in
planning of her diet.
planning of her diet.

43
5.Serve meals in bits 5.Meals were served
and attractively. attractively and in bits.

6.Remove all 6.All nauseating factors were

nauseating factors removed from away from
away from patient patient.

44
DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING DATE/ EVALUATION SIGN
DIAGNOSES INTERVENTION
TIME /OUTCOME TIME
CRITERIA

25/08/23 Disturbed Patient would 1.Reassure patient that 1.Patient was reassured that 26/08/23 Goal fully met S.F
sleeping pattern restore her the condition would condition could be resolved as evidence by;
At At
(insomnia) normal be brought under with the proper measures put
1. Nurse
6:00am related to change sleeping control. in place 6:00am
observing
of environment. pattern within
patient sleep
24 hours as 2.Lower volumes of
(hospitalization) 2.Volume of television set soundly in the
evidence by; television set and
were lowered, and noise were night.
minimize noise at the
1.Nurse minimized at the ward.
ward. 2.Patient
observing
verbalizing that
patient sleep
she is able to
soundly in the
3.Encourage patient to 3.Patient was encouraged to sleep at night.
night.
have warm bath in the have a warm bath in the

2.Patient evening to help induce evening to help induce sleep.

verbalizing that sleep.

she is able to
sleep in the
night.

45
 4.Patient bed were made
4.Make patient’s bed properly and free from
properly and free from creases.
creases.

5.Ward fans and nearby

5.Put on ward fans windows were opened to
and open nearby ensure proper ventilation.
windows to ensure
proper ventilation.

46
DATE/ NURSING OBJECTIVE NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION SIGN
DIAGNOSES /OUTCOME
TIME TIME
CRITERIA

26/08/23 High risk for Patient would 1.Reassure patient and her 1.Patient and her family were 28/08/23 Goal was fully S.F
clotting not develop family that measures are reassured that measures were met as evidence
At At
disorders any clotting available to prevent available to prevent complication by;

9:00am (deep vein disorders complications. 9:00 am

1.diagnostic
thrombosis) as within time of
2.Patient was educated on the investigation
evidence by hospitalization
2.Educate patient on the need to cooperate with measures revealed no
patient being as evidenced
need to avoid clotting put in place to avoid the clotting disorder
bed ridden. by
disorders complication

1.Diagnostic
investigation 3.Patient was taken through mild
3.Take patient through mild
indicating that to moderate exercises.
to moderate exercises
there is no
clotting 4.Patient was encouraged and
disorder 4.Encourage and assist assist to ambulate early.
early ambulation.
5.Enoxaparin 12mg was
5.Administer Enoxaparin as administered as prescribed
prescribed

47
 CHAPTER FOUR

IMPLEMENTING PATIENT / FAMILY CARE PLAN

4.0 Introduction
Implementation is the fourth stage of the nursing process. It refers to carrying out of proposed

plan of care (Nurses Dictionary,2015). The nurse takes responsibility including the family and

other health team members. While implementing care, the nurse should assess the patient’s

response to nursing care and make alterations when necessary. This chapter also include the

preparation of the patient and family towards discharge, home visit and continuity of care.

4.1 Summary of Actual Nursing Care

The nursing care rendered to patient and her family started on the day of her admission which

is on the 23rd of August 2023 to the day care was terminated which was the 5th of September

2023. The care and management of patient and her family was planned to meet their

physiological, emotional, and physical needs. While she was on admission routine nursing care

were done and all necessary documentations were also done. The care rendered to the

patient/family is discussed on daily basis.

Day of admission (23RD JANUARY 2023)

Patient came to the ward walking with assistance at 12:00pm after going through the Outpatient

Department (OPD). She arrived fully conscious accompanied by her husband and with a

diagnosis of Traumatic cellulitis of the right lower limb. Being at the ward with the staffs and

in - charge at time of patient’s arrival, I was charged to carry out her admission process. I

welcomed patient and relative warmly, introduce myself to them and the necessary documents

and her identity was verified by mentioning her name and which she responded. she was

48
reassured to alley anxiety and was introduced to the staffs on duty and other patients at the ward.

she was immediately given an admission bed and her leg elevated. Patient /relative was oriented

to the ward and its annexes, Hospital protocol regarding visiting hours, time for checking vital

signs were explained to patient. Physical examination on patient was done. Her vital signs were

checked and recorded as

Temperature – 38.C

Pulse – 84.b/m

Blood pressure - 110/80 mmHg

Random blood sugar – 4.7mmol/L

She was managed with the following prescribed medications:

1.IV paracetamol 500mg tid ×3days

2.Tablet ibuprofen 400mg tid×1day.

3.IV metronidazole 500mg 8hourly×7days

The following laboratory investigations were requested for;

1.Full blood count

2.Liver function test

3.Doppler ultrasound scan

4.Serum electrolyte sedimentation

49
On admission, patient was having fever so IV Paracetamol 500mg was setup. Nursing diagnosis

of alteration in body temperature (fever) related to inflammatory process was formed at

12:00pm. An objective was set to help relieve patient of fever within two hours.

The following nursing interventions were carried out; adequate room ventilation was ensured

by opening windows and switching on fans, prescribed Intravenous(IV) Paracetamol 500mg

was administered Heavy bed clothes were removed, and light clothing provided. Nearby

windows were opened for adequate ventilation. Cold drinks were served. Temperature was

checked 30 minutes after drug administration to determine the improvement in the temperature.

She was allowed to ask questions and express her fears. Patient right leg was swollen. At

12:30pm, Nursing diagnosis of impaired skin integrity related to inflammation was formulated.

An objective was set to help patient leg return to normal size within the stay in the hospital was

formulated. The following nursing interventions were carried out; patient and her family were

reassured that condition would resolve with appropriate measure put in place, ice packs were

applied to the affected limb to reduce swelling, patient right leg was elevated to help in blood

flow. She was made comfortable in bed with noise in the environment minimized to allow her

relax. Patient’s particulars were entered into the admission and discharge book and the daily

ward state. When patient was calm, I reintroduced myself to her as a final year student Holy

Family Nursing and Midwifery Training College, Berekum, and as a requirement by the Nursing

and Midwifery Council of Ghana that I had to fulfill as a partial fulfillment towards the award

of License to Practice as a Professional Registered General Nurse in the country. As part of the

requirement, I am to take a patient and take care of the patient and family throughout their

admission. And visit their home during admission and after discharge. I explained that I would

like to take she and her family for my case study. I explained to patient and her family on the

50
concept of the study and reassured them of privacy and confidentiality. Mrs. K.M. and her

family agreed and said they are willing to give me the necessary information and assistance

needed in the study. I thanked them and expressed my sincere gratitude to them. Discharge

planning was initiated with the relative, thus, they will continue the care at home once she is

well. I chose her because I wanted to know more about Cellulitis and tinea pedis. At 2:00pm the

objective set to enable patient to maintain her normal body temperature that is (36.20C to 37.40C)

was evaluated and it was fully met as evidence by patient temperature falling back to normal

upon recheck (37.4°c).

At 2:30pm patient also complained of pain on the right leg, nursing diagnosis were formulated

as; pain related to inflammatory process of disease (Cellulitis). With an objective that patient

would be relieve of pain of the right leg and gain physical mobility within 2hour were set.

Nursing intervention carried out was; pain was assessed using the numerical pain rating scale

(which she rated her pain 7), patient was put in a comfortable position, prescribed analgesic

(Tablet. ibuprofen) was served, warm compresses were applied. Patient was served with boiled

yam with garden - egg stew which she could eat 2/4 of the food after which she was given some

watermelon and water. At 4:30pm, objective set at 2:30pm that patient would be relieved of pain

of the right leg was evaluated and goal was fully met as evidence by patient verbalized that she

is no more having pain on the affected leg. Patient was then handed over to afternoon nurses for

continuity of care.

Second day of Admission (24THAugust, 2023)

At 7:00am on the second day of admission, I went and continue with my care for Mrs. K.M. Her

morning vital signs was checked by the night staffs and recoded as;

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Temperature 36.5ºC

Pulse 89bpm

Respiration 21cpm

Blood pressure 120/70mmHg

Patient was assisted to carry out her personal hygiene needs. At 7:30 she had her breakfast

(porridge and bread). At 9:30 she was reviewed by Dr. M.E. and asked that all his medications

should be continued. IV Metronidazole 500ml was set up and recorded. At 10:00am his vital

signs were checked and recorded as BP: 120/8mmHg, Pulse: 83bpm, Respiration: 19cpm and

Temp: 36.8oc. she again expressed worry over the absence of any improvement in her condition.

Nursing diagnosis of Anxiety related to unknown outcome of disease was formulated 10;30am.

With an objective that patient would be relieve of anxiety within 48hour. Nursing interventions

were carried out by reassuring patient that the condition will resolve with time and with

appropriate management. To reduce oedema, warm compresses were applied; the site was also

dressed aseptically with normal saline and elevated with a pillow. Other routine care including

serving of medication were carried out. At 12:30, patient was served with banku with okro stew

which she was able to eat halve of the meal served. Her 2:00pm vital signs were checked and

recorded as shown in the appendix. All other routine activities were carried out during the shift

and patient was handed over to the afternoon nurse. IV Metronidazole 500mg was setup on

patient and recorded. Patient was then handed over to the afternoon nurse.

Third day of admission (25TH August 2023)

52
On the third day of admission, patient was awake when I got to the ward at 7:30am. the night

staffs have already checked and recorded her 6:00 vital signs as;

Temperature 35.80C

Pulse 92bpm

Respiration 21cpm

Blood pressure 100/70mmHg

Patient was assisted to carry out her personal hygiene needs. Her linen was also changed. Patient

refused to have her breakfast due to a complain of nausea. At 8:30am, Nursing diagnosis of

altered nutrition (less than body requires) related to inadequate interest in food was formulated

with an objective that patient would be able to eat well and maintain her nutritional status within

72 hours. The following nursing intervention was carried out; meals were planned according to

patient’s desire. Diet was planned according to patient’s likes and dislikes and patient was

engaged in planning her diet. She was encouraged to brush her teeth twice daily and rinse mouth

before after meals, fruit were served before meals, and all nauseating factors were remove away

from patient. During review, the doctor assessed patient and prescribed Enoxaparin. (as a

prophylaxis for deep vein thrombosis) and ordered for continuity of care. After review, patient

was asked to name her food of choice for breakfast as well as lunch and supper. She was served

with tea and bread which was well eaten. She was also allowed to rinse her mouth before and

after eating. Enoxaparin was collected from the pharmacy and 120mg was administered

intramuscularly and recorded. All other routine activities such as drug administration, wound

dressing and checking of vital signs were carried out and recorded. IV metronidazole was setup

on patient and recorded on her medication chat. I asked patient if she has encountered any
53
problem since she was admitted and she complained that she was not able to sleep during the

night. At 9:30, a nursing diagnosis of disturbed sleeping pattern (insomnia) related to change of

environment as evidence by patient having less sleep in the night. An objective to help patient

restore her normal sleeping pattern within 24 hours was set. The following interventions were

carried out to achieve the said objective; patient was reassured that her sleeping pattern would

be restored after interventions are carried out, volumes of television sets at the ward were

lowered, patient was provided with warm water for bathing in the evening to induce sleep,

patient’s bed was properly made free from creases and nearby windows were opened to ensure

ventilation. All necessary nursing procedures were planned and carried out together to prevent

disturbance of patient sleep. Patient was reviewed by the ward doctor during ward rounds, and

he ordered to continue with the treatment. At 12:30 pm, Patient had her lunch which was fufu

with light soup, but she was able to consume one-fourth of the food. Her 2:00pm vital signs

were checked and recorded as shown in the appendix.

Fourth day of admission (26TH August 2023)

Patient looked cheerful in the morning and took care of her personal hygiene needs with very

little help. Her 6:00 am vital signs were checked and recorded as BP:120/70mmhg,

Temperature:36.8°c, Respiration: 22cpm, pulse:89bpm. At 7:30am, objective set on 24th august

2023 to help patient relieve anxiety was evaluated and goal was fully met as evidence by patient

looking cheerful, relaxed, and comfortable in bed and patient verbalizing that she is no more

anxious. Due to patient’s high risk for clotting factors, a nursing objective was formulated that,

patient would not develop any clotting disorders within time of hospitalization. The following

nursing intervention were carried out; patient was assisted to do mild to moderated exercises as

she could tolerate to aid circulation, she was also assist to walk short distances in the ward.

54
Enoxaparin 120mg (which had been prescribed by the doctor as prophylaxis for deep vein

thrombosis) was also administered as prescribed. At 9: 30 pm an objective set on 25th August

2023 was evaluated and goal was fully met as evidence by patient verbalized that she is able to

sleep in the night. Patient was also informed that she would be taken for a scan the next day.

Patient had no problem and looked very cheerful.

Fifth day of admission (27TH AUGUST 2023)

This day marked significant improvement in the patient’s physical, psychological, and social

state. Patient carried out her personal hygiene needs with little help. Her 6:00am vital signs were

checked and recorded as shown in the appendix. Patient had her breakfast (porridge with koose)

which was brought by her relative and was able to eat well. After reviewed by the doctor, patient

was informed again, prepared, and sent to the scan and x-ray department for her X- ray. After

the X-ray she was brought back to the ward and made comfortable in bed. The prescribed

medications were given (IV metronidazole 500mg). She was educated on her disease condition

and was allowed to ask questions which were answered appropriately. Her knowledge was

assessed by asking questions to which she provided answers. Patient had no problem and looked

very cheerful. IV metronidazole 500mg was setup on patient All other routine activities were

also carried out during the rest of the day.

Sixth day of admission (28TH August 2023)

Patient woke up cheerful and well 5:30. She was able to cater for her personal hygiene needs

without help, she was served with her breakfast (tea with bread) which she was able to eat all

that was served and expressed her satisfaction over her improvement. Her 6: 00am vital signs
55
were checked and recorded as shown in the appendix. During review at 8:00, she was informed

of possible discharge the next day. At 8:30, the objective set on 25th August 2023 to help patient

eat well and maintain her nutritional status within 72 hours was evaluate and goal were fully

met as evidence by patient being able to eat all the food served at a time. All other routine

activities like serving of medication, dressing of wound were carried out with no difficulties.

Her 10:00 vital signs were checked and recorded as shown in the appendix. At 2:00pm, patient

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

Day of discharge (29TH AUGUST 2023)

Patient was excited concerning the reality of discharge. At 6;00am her personal hygiene was

maintained. Patient had her breakfast which was tea with bread at 7;30 am. All other daily

activities such as checking of vital signs, wound dressing, and drug administration. During

routine ward rounds, she was discharged by the doctor. At 9:00, an objective set on 26th August

2023 to prevent patient from developing clotting disorders was evaluated and goal was fully met

as evidence by laboratory results confirm no clotting disorder.

Patient was registered with the health insurance scheme and her bills was assessed. The bills

which were not covered by the insurance were not paid. Around 12:00pm, patient’s husband

came to the facility. He then went and pay for the bill and took the receipt. I helped her to pack

her belonging and helped patient to dress up. Discharge of the patients was stated in the

admission and discharge book and daily ward state. The duplicate of her receipt was also kept

in the ward and the original copy given to her husband. At 12:30pm, an objective set on 23rd

August 2023 was evaluated and goal was fully met as evidence by patient leg returning back to

the normal size. Patient was also advised on the need to return for review on the said date. They

56
were also advised to report promptly to a health facility whenever they are ill and continuing

with the medication regimen. They were also educated on why they need to complete their

medication. They expressed gratitude to all staff and bid farewell to the rest of the patient on

the ward. Bed linens were removed and sent to the sluice room. The mattress was also cleaned

and decontaminated. At 1;00pm I escorted them to board a taxi at the station.

4.2 Preparation of Patient/Family for Discharge

Preparation towards discharge was established on admission day until the day of discharge.

Patient and family were reassured that patient will return home fully recovered to reduce anxiety.

According to the night nurse, patient woke up early around 5:30am feeling strong and better.

Her personal hygiene routine had already been kept and maintained. Her 06:00am vital signs

were checked and recorded as shown in the appendix. During routine ward rounds, patient was

discharged since her condition was stable and had no complains. The doctor then informed her

to be coming to the facility for her wound dressing and which she agreed. Review date was

scheduled on 5th September 2023. Patient were informed to pay her bills. Patient/family were

educated on her drugs as well as how and the need to maintain good health. Health education

was done after their knowledge on the condition was assessed. They were told to report animal

and insect bites to health professionals for adequate treatment. They were also told to protect

their skin, by the application of lotions and creams to avoid cracks and wear the appropriate and

protective clothing during activities (work and sports). On the prevention of tinea pedis, they

were advised to wear comfortable shoes, keep area in - between toes clean and dry.

They were also advised to keep wounds dry and clean and report to the hospital if any

abnormality was detected. Finally, they were told to take in balanced diet and report to the

hospital whenever they were sick. Patient was officially discharge on the 29th of August 2023

57
during general ward rounds and was put on the following medication: Tablet Metronidazole

200mg tid × 7days Tablet. Paracetamol 200mg b.i.d ×7days.

All the routine nursing cares were rendered. After settling the bills, I asked her husband to reecho

all that I taught about the condition which he was able to do, I informed them about the day of

review which was 5th September 2023 and advised her how to take the drugs and the need to

continue taking them. Patient name was then entered into the admission and discharge book as

well as the daily ward state. I helped her pack her belongings and she thanked me other staffs.

She bade goodbye to the other patients in the ward. I escorted them to the bus stop and bid them

goodbye. On return bed linen and pillow case were sent to the laundry and the mattress and side

lockers were cleaned with 0.5% bleach.

4.3 Home visit /follow up/ continuity of care.

A home visit is a friendly but purposely visit to the home of the patient with aim of promoting

health through education and assessment. It is carried out before and after discharge.

4.3.1 First home visit (24th August 2023)

Prior to discharge, I visited patient’s home at Abetifi Zongo in Sunyani with the help of the

directions and the house address she gave me after I closed from work at 2:00pm. Zongo Abetifi

is an area with both mud houses and block houses. She lives in a compound house of about 12

rooms with one toilet and bathroom. The house is built with blocks and have enough windows.

It has a good lighting system, communication system, good water supply and good roads which

facilitate good transportation. On reaching patient’s home, I was welcomed by her family

members and co-tenants. I then introduce myself to them as a student nurse who is taking care

of their relative in the Municipal Hospital. Upon observation patient’s home was neat with well-

ventilated rooms and good roofing. There is adequate supply of pipe borne water. Refuse is

58
collected in a well-covered dustbin and disposed of at a refuse dumping site when it is full. I

assessed their toilet and bathroom when I asked them, I wanted to ease myself. Their toilet is a

water closet and was kept clean. Their bathroom was also neatly kept.

On interaction with the family, certain issues arose pertaining to health and food hygiene and

preservations, based on this; I educated them on better methods of preparing foods and

preserving it. I also advised them on the use of over-the-counter drugs, herbal preparations, and

the need to report to health facility for proper treatment when sick. I praised them for their

cleanliness and hospitality and assured them that Mrs. K.M would return home in good health.

They in turn expressed their gratitude for my visit and saw me off at 3;00pm.

4.3.2 Second home visit (2nd September 2023)

On the 2nd of September 2023, I paid my second visit to patient’s home after her discharge. I was

warmly welcomed by patient and the family and we exchanged pleasantries asked her how she

was doing. Upon observation, patient was looking healthy and cheerful. I then assessed the

wound and it was looking dry and clean. I congratulated them for keeping the wound clean and

dry. After which I reemphasized the need to continue with the drug regimen and to be present

for review on the given date. I also reechoed on the need to eat well, exercise and take preventive

measures to avoid reoccurrence. According to patient, she had no problems and assured me that

she would be in the hospital on the day of review. I informed them that my interaction with them

will end on my next visit. I took permission to leave after scheduling to visit them again on the

8th of September 2023. The family thanked me for the visit and saw me off.

4.3.3 Day of review (5TH September 2023)

On the said date of review, I met patient at the Outpatient’s department. After exchanging

pleasantries, I helped patient to activate her hospital card and her vital signs were checked and

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record as BP:120/70, Pulse:86bpm, Temperature:36.6c, Respiration:20cpm. Her vital signs

were normal. I went in with the patient when it was her turn. After examination, the doctor

expressed satisfaction as patient was able to keep the wound dry and clean and was looking

healthy and advised her to continue taking good care of herself. The Doctor then told her to

continue coming to the facility for her routine wound dressing. Patient was informed not to

hesitate to report to the hospital if she encounters any health problem. She was also encouraged

to practice good personal and environmental hygiene to protect herself and family from getting

diseases. Patient had no complaints. The doctor prescribed tablet Metronidazole 200mg which

we went to the pharmacy and collect. I took the opportunity to introduce Mrs. K.M and husband

to a senior staff, Mr. A. O, a nurse at the Municipal Hospital whom I would be handling patient

to. He also assured Mrs. K.M and family of her readiness to help them achieve the best health

status. They also assured nurse A.O for their corporation. I reminded them of my last home visit,

termination of care and handling her over to nurse A. O. I then escorted patient and her

relative(husband) to board a car and bade them goodbye.

4.3.4 Third home visit (8th September 2023)

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 and to hand over the patient to a health worker. I visited patient on 8th September 2023 at

1:30pm for the last home visit. After being welcomed, I interacted with both patient and her

family. On observation Mr. K.M was looking very healthy. I then proceed to assess the affected

site and the wound was very clean. There were no complaints, and the family expressed their

joy over patient’s recovery. Since that day was the last visit I re-emphasized on the health

education and stressed on the need to avoid self-medication and report promptly to the health

facility when sick. Also I Stress on the need to eat well and to keep their environment clean to

60
prevent them from falling sick. Also I re-emphasized on the routine wound dressing at the health

facility to prevent the wound from infection. I asked Mrs. K.M and family to reecho what I said

and they were able to mention most of what I said which indicated that they have understood

what I taught them. They intend asked questions which answered them clearly. I told them that

since Mrs. K.M. has fully recovered, I am therefore handling over the care to Mr. A. J. (a nurse

at the Municipal Hospital) whom I have already introduced them to. I terminated my care and

thanked them for their cooperation which made my study a success. Patient and her family

expressed their gratitude by showing how grateful they were to me for the support and care

rendered. I eventually sought permission to leave and bade them the final farewell at 3:20pm.

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 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO CLIENT AND FAMILY

5.0 Introduction
Evaluation in nursing care seeks to measure the effectiveness of assessment, diagnoses and

implementing. (Nurses dictionary,2016) Patients health status is compared to goals of health

care to determine goals achieved. It involves the members of the health team, patient, and her

family. Unachieved goals of nursing care plan are amended, and care is terminated afterwards.

5.1 Statement of Evaluation

According to Weller (2014), evaluation is defined as the final stage in the nursing process and

is a measure of the degree to which the patient has mastered the nursing objectives.

Patient was admitted to the Surgical Ward with the diagnosis of Cellulitis and Tinea pedis. All

goals and objectives were fully met. Below is the summary of the interventions carried out and

to what extent the goals were met. After seven days of admission and maximum cooperation

from the patient, her family and stuff of surgical ward, patient fully recovered from her illness

and was finally discharged with all goals fully met. The following problems presented by patient

were resolved.

1. Patient’s body temperature was reduced to normal

On the 23rd of August at 12:00pm patient had fever of 38.0°. A nursing diagnosis of alteration

in body temperature related to inflammation process of disease(cellulitis) was made. With

appropriate nursing intervention, an objective set to reduce patient’s body temperature within 2

hours were set and the following interventions were carried out; patient/family were reassured,

adequate room ventilation was ensured by opening nearby windows, IV Paracetamol 500mg

62
was administered as prescribed cold drinks and liberal fluids were served and temperature was

rechecked 30 minutes afterwards and recorded as 36.4oc. Evaluation was made on 23rd August

2023 at 2:00pm and goal was fully met as evidence by patient’s body temperature was reduced

to normal (36.50c).

2.Patient’s leg (right leg) returned to normal size

On 23rd August 2023 patient’s leg was swollen. A nursing diagnosis of impaired skin integrity

related to inflammation (cellulitis). Objective set to relieve patient of the swelling within the

stay in the hospital was made at 12:30pm. The following interventions were carried out; patient

was reassured, and her leg was elevated with a pillow, ice packs were applied. Evaluation was

made on 29th August 2023 at 12:30pm and goal was fully met as evidence by patient’s leg

returning to the normal size and appearing tight and glossy

3.Patient was relieved of pain of the leg (right leg).

On 23rd August 2023 at 2:30pm, patient complains of pains on the affected leg (right leg). A

nursing diagnosis of pain related to inflammatory process of disease(cellulitis) was made.

Objective were set to relieve patient of pain within 2 hours. The following intervention were

carried out; prescribed analgesic was administered(ibuprofen), warm compresses were applied,

patient was put in a comfortable position. Evaluation was made on 23rd August 2023 at 4:30pm

and goal was fully met as patient verbalized that she is no more having pains in the leg.

3.Patient’s leg (right leg) returned to normal size

On 23rd August 2023 patient’s leg was swollen. A nursing diagnosis of impaired skin integrity

related to edema of the lower extremity was made. Objective set to relieve patient of the swelling

within 5 days was set at 12:30pm. The following interventions were carried out; patient was
63
reassured, and her leg was elevated with a pillow, warm compresses were applied. Evaluation

was made on 28th August 2023 at 12:30pm and goal was fully met as patient’s leg returned to

the normal size.

4.Patient maintained her nutritional status

On the 24th of August 2023 at 8:00am, patient complained of nausea and a nursing diagnosis of

altered nutrition (less than body requirement) related to nausea was made. An objective to help

patient to eat well and maintain her nutritional status and requirement within 72 hours was set.

The following nursing intervention was carried out; patient was reassured, diet was plan with

patient according to her likes, proper mouth care was ensured, appetizers were served, food was

served in bit at regular intervals. Evaluation was made on 26th August,2023, and it was fully met

as patient could eat all the meals served at a time day.

5. Patient was relieved of anxiety

On 25th of August 2023 at 6:00am, patient was anxious about the condition and its outcome. An

objective to relieve patient of anxiety within 48 hours was set. The following nursing

intervention was carried out; patient was reassured, she was educated on condition, patient was

allowed to ask questions about condition and her knowledge about condition was assessed.

Evaluation was made on 27th August 2023 at 6:00am and goal was fully met as patient declared

her understanding of the condition based on the education about disease (Cellulitis) given to her

and looking relaxed.

6.Patient normal sleeping pattern was restored.

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On 25th August 2023 at 6:00am, patient complained that she cannot sleep in the night. An

objective to restore patient normal sleeping pattern within 24 hours were set. The following

nursing intervention was carried out; volume of television set in the ward were lowered, patient

was encouraged to have warm bath in the evening to help induce sleep, patient bed was made

properly and free from creases, ward fans and nearby windows were open to ensure proper

ventilation. Evaluation was made on 26th August 2023 at 6:00am and goal was fully met as

evidence by nurse observing patient sleep soundly in the night.

7.Patient did not develop any clotting disorders

On the 26th of August 2023 at 9:00am, due to immobility of patient, an objective was set to help

patient regain mobility and prevent clotting abnormalities within the stay the ward. The

following nursing intervention was carried out; patient and family were reassured, patient was

educated on the need to avoid clotting disorders, patient was taken through mild to moderate

exercise, patient was encouraged and assisted to ambulate early, prescribed anticoagulant was

served (Enoxaparin). Evaluation was made on 29th August 2023 at 9am and goal set was fully

met as evidence by diagnostic investigation revealing no clotting disorders and patient regaining

mobility.

5.2 Amendment for Partial Met or Unmet Goals

With maximum cooperation from Mrs. K.M, her family and the staff, all goals were fully met

thus no amendment was made.

5.3 Termination of care

This involves ending the care that was started on the patient. My interaction with Madam K.M

started from the 23rd of August 2023 at the Surgical ward. The interaction was smooth as

65
patient’s improvement began on admission through to discharge with good nursing and medical

care. Termination of care began from the Second follow up visit.

Patient and family were educated during admission and after discharge. They were also advised

during home visits on measures to promote health, the need for review and continuation of

medication and the need to report to the hospital when they are sick. Patient and family were

educated on the need to avoid self-medicating which is very harmful to their health. Patient was

told about the termination of care on my second home visit and care was finally terminated on

the 8TH of September 2023 thus the day of my last home visit. Patient and family was not happy

about the termination of care but noted that they would adhere to all that I told them. Patient

was handed over to a nurse at Municipal Hospital to ensure continuity of care.

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 CHAPTER SIX

SUMMARY AND CONCLUSION

6.0 Introduction
This is the last step of the patient/family care study which entails the student’s personal

appreciation of the therapeutic relationship with the patient as well as the use of the nursing

process.

6.1 Summary
Mrs. K.M was admitted to the Surgical ward on the 23rd of August 2023 through the

Outpatient Department (OPD) with a diagnosis of cellulitis by Dr. M. A. On admission, patient

was having high body temperature (fever 38.1ºC), her right lower leg was swollen, and She was

having pain on the affected lower extremity (right low leg). Patient and family were warmly

welcomed, and her particulars were entered into the admission and discharge book and daily

ward state, vital signs were checked and accurately recorded. Laboratory investigations such as

full blood count, liver function test, Doppler ultrasound and electrolyte sedimentation were

conducted. Patient was educated on Cellulitis, its causes, management and prevention. Patient

was also assisted in maintaining her personal hygiene, rest and sleep and adequate nutrition was

ensured. Patient was orientated to the ward and its surroundings and hospital protocol was

explained to her.

During admission patient was managed on the following drugs;

1. IV paracetamol 500mg tid ×7days

2. Tablet ibuprofen 400mg tid×1days

3. IV metronidazole 500mg tid×7days

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 Patient’s problem identified included; fever, anxiety, nausea, pain of the affected leg, swollen

leg. Objectives were set, nursing orders were implemented as expected and goals were fully met

within time after the nursing interventions. Some nursing intervention done for patient were;

dressing of wound aseptically, applying of warm compresses and ice packs, assisting patient in

mild to moderate exercise, educating patient on disease condition (Cellulitis and Tinea pedis)

etc. Patient was discharged on the 29th of August 2023. On the 5th of September 2023, patient

came for review as scheduled. Home visits were made to patient and family on three occasions

which the first visit was on 24th August 2023, the second home visit was on 2nd September 2023

and the third home visit which was the last was on 8thSeptember 2023. Also, all needed educated

was carried out and re-emphasized to patient/family. Patient’s care was finally terminated on

the 8th of September 2023 and patient/ family were thanked for their co-operation.

6.2 Conclusion/Recommendation
The study has equipped me with knowledge on how to care for a patient as an individual.

Through this stud, I have been able to put into practice actual and holistic nursing care that 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 the disease condition (Cellulitis), its prevention, management, and treatment.

It has deepened my relationship with patient, families, and the people in each community. The

study also provided the platform for the patient/family to receive individualized care. Based on

the testimonies given by patients who receives 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. Also, this patient/family care study also

68
helps to change the community’s wrong perceptions about staff nurses and 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 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: VITAL SIGNS OF MRS. K.M

Date Time Temperature Pulse (c / Respiration Blood

(0C) m) (bpm) pressure(mmHg)

23\08\23 12:30pm 38.1 100 21 130/80

2:00pm 37.8 100 21 120/70

6:00pm 37.5 91 22 120/80

10:00pm 36.4 96 22 120/70

24\08\23 6:00am 36.7 100 21 128/70

10:00am 36.9 100 22 120/60

2:00pm 37.1 100 22 120/70

6:00pm 36.2 99 24 110/80

10:00pm 36.1 100 22 110/80

25\08\23 6:00am 36.8 100 22 120/70

10:00pm 36.3 100 21 120/70

2:00pm 37.2 90 22 120/70

6:00pm 36.8 100 24 110/80

10:00pm 36.4 100 24 120/70

26\08\23 6:00am 36.1 100 22 120/70

10:00am 36.9 85 20 110/70

2:00pm 36.3 90 21 120/80

10:00pm 37.0 70 21 120/70

70
27\08\23 6:00am 36.2 80 22 100/70

10:00am 36.2 80 21 100/70

2:00pm 36.2 90 22 120/70

10:00pm 37.1 86 22 130 /80

28\08\23 6:00am 36.4 90 23 120/90

10:00am 36.3 96 20 130/80

2: 00pm 36.5 90 20 120/80

10:00pm 36.6 90 19 120/70

29\08\23 6:00am 36.4 90 22 120/80

10;00am 36.6 80 20 120/70

71
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OTHERS

IN-PATIENT NUMBER: BEA06-A E2915A

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