PREFACE

Even though nursing has in recent times been recognized as a profession, there were a lot

setbacks and these persisted for decades. Obvious reasons among others were that the training of

nurses was standard, nurses were perceived as providing services which were provided at home

by untrained house wives and nurses lacked autonomy. Modern nursing has roots in Florence

Nightingale, who among other nursing theorist, attained higher levels of education, and

contributed immensely to advancement of nursing, including the establishment of colleges or

schools of nursing

Through research and continuous education, several concepts have been incorporated to provide

quality and holistic individualized nursing care. One of such is the introduction patient/family

care study. Client / Family care study is a detailed written account of the comprehensive nursing

care given to a particular client within a specific period of time. With the care study the nursing

process which comprises of assessment, diagnosis, planning, implementation and evaluation is

applied. The main objective of the study is to meet the physical, psychological, spiritual and

socio-economic needs of the client. The care is designed to promote, maintain and prolong life as

well as alleviate discomfort.

The care study offers the student nurse an opportunity to acquire much knowledge about the

condition being catered for and to put into practice the knowledge acquired throughout the three

years of training in giving of effective nursing care to client and family. In this work,

confidentiality of information is essential and therefore, patient/family are assured of privacy and

confidentiality of any information disclosed. Also, their initials are used instead of full names.

For this reason, the patient will be addresses as Miss S.S.Y throughout this report.

1
Finally, the care study is a partial fulfilment of the requirements for the award of the Registered

General Nursing Diploma certificate at the end of the three years training programme by the

Nursing and Midwifery Council of Ghana.

2
 ACKNOWLEDGEMENT

I wish to express my sincere gratitude first and foremost to Allah Almighty for granting me the

grace, strength, wisdom and direction throughout the writing of this care study. Without Him

nothing could have been achieved.

My sincere thanks go to the patient, Ms. S.S.Y. and his family for their co-operation and for

providing me with all the requisite information during our interactions which contributed

immensely to the success of this care study.

Am grateful to the entire staff of the Presbyterian Nursing and Midwifery Training College,

Dormaa Ahenkro for the guidance during the training and writing of this care study. Am

particularly indebted to my supervisor, Mr. I. G. Piilub for his commitment, hard work and

constructive criticisms which propelled the completion of this care study.

My profound gratitude also goes to the Nurse in-charge and all staff of the Goaso Municipal

Hospital who supervised the clinical session and provided assistance in the care of the patient

and family.

I am particularly grateful to my parents, Mr. Ibrahim Abubakar and Mrs. Ibrahim Hawa for the

prayers and financial support. I acknowledge all my siblings and friends for their words of

encouragement.

Finally, I acknowledge the authors and publishers of the literature used as references for the care

study.

3
 INTRODUCTION

Patient/family care involve the interaction between the patient and the health team. In this, a

patient is selected on the ward with a specific disease. The patient is nursed from the day of

admission to the day of discharge and follow-ups are made to help maintain good health and

ensure continuity of care. This care study is written on Ms. S.S.Y with a confirmed diagnosis of

Cellulitis. My interaction with patient began on 20 th November, 2022 at 9:00am, the day of her

admission to 25th November 2022 when she was discharged home. On admission, the nursing

problem identified was swelling of the left lower leg. To alleviate these problems, appropriate

objectives, nursing orders were formulated as well as interventions carried out to relieve patient

from these problems. After five (5) days of medical and nursing care, he was reassured and

discharged home without any complications. A pre-discharge home visit was made on 22 nd

November 2022. Follow-ups were made on 27th November, 2022 and on 2nd December, 2022 was

the day of review. Finally, the care was terminated on the 4th December, 2022.

This care study is organized into six chapters according to the nursing process. Chapter one deals

with the assessment of the patient, information on patient particulars, family medical history,

socio-economic history of the patient, patient developmental history, patient hobbies and

lifestyle and patient past and present medical/surgical history, chapter two comprises of analysis

of data, the pharmacology of drugs used to treat patient and the comparison of laboratory

investigations conducted on Ms. S.S.Y with standards. Also, gives a brief outline on the

comparison made on the signs and symptoms presented by patient in relation to those in the

review as well as the health problems, chapter three (3) focuses on planning for patient and

family care, chapter four (4) considers the implementation of patient and family care, chapter

4
five (5) entails the evaluation of the care rendered to patent and family and finally, chapter six

(6) summarizes and draws conclusion about the care rendered to patient and family.

5
 CHAPTER ONE

ASSESSMENT OF PATIENT/FAMILY

INTRODUCTION

Assessment is the component of the nursing process which involves collection, verification,

organization, interpretation and documentation of data. The completeness and accuracy of the

information obtained during assessment are directly related to the precision of the steps that

follow. (Delaune and Ladner P.K. 2010).

The information gathered for this particular care study was from the patient himself, the patient’s

folder, textbook and health care team. The collection of data includes patient’s particulars,

family’s medical and socio-economic history, patient’s lifestyle and hobbies, past medical

history, patient’s present medical history, admission of patient, patient’s concept about the illness

and literature review.

PATIENT’S PARTICULAR

Ms. S.S.Y a 21 year old female born on 22 nd March, 2001 at Goaso in the Ahafo Region to Mr.

S.A.O and Mrs. J.A.O. She is a Ghanaian by nationality and an Ashanti by tribe. She speaks Twi

and English language only, she is the second born of her parents and has a sibling she was born

in Goaso (lowcost) in the Ahafo Region of Ghana, where she lives with his parents. She is fair in

complexion, 1.5 meters tall and weighs 65kilograms. She does not have physical deformities.

She is a Christian and worships with the Roman Catholic at Goaso with her parent. Ms. S.S.Y

was calm and neat in his appearance on admission. His next of kin is Mr. S.K.

6
FAMILY’S MEDICAL HISTORY

According to Ms. S.S.Y, She said there are no known diseases such as diabetes, leprosy,

tuberculosis, hypertension and mental illness in her family. She also admitted that her family

occasionally suffers minor ailments such as malaria Headache Diarrhea cold and cough and

usually treated with drugs purchased from chemical shops. They do visit the Goaso Municipal

Hospital when symptoms persist. In his narration, she indicate that her grandparents are late even

though she did not know the cause of their death. There is however no history of mysterious

death such as suicide in the family. Her parents are alive and doing well. None of them has been

hospitalized for serious medical condition. They also rely on orthodox medicine when they have

health issues, and do not patronize traditional medicine. According to her, she does not have any

known allergy to drugs, food, or any other chemical substances.

FAMILY’s SOCIO-ECONOMIC HISTORY

Ms. S.S.Y explained she comes from a united and peaceful family, where there is love and

understanding among them. There is also peaceful co-existence and family cohesion. Even

though they do not have any support system on which they depend in times of difficulties, the

family’s needs are met from the earning from their farm. The love, bonding and cohesion in the

family is their strength. She also made it known that the cohesion among family members is their

source of strength as they always put their resources together to support each other when the

need arises. To cater for their health needs, family members have registered with the National

Health Insurance Scheme.

Ms. S.S.Y is a student who completed Ahafoman Senior High School, who does not work but

she depends on her parents for financial assistance. She goes to her parents from time to time to

7
collect money and some foodstuff. The father, Mr. S.A.O is a pensioner (GES) and the

breadwinner of the family and the mother is a trader who assists the father to care for the

children. Her elder brother sometimes also assists her financially. With respect to the standard of

living of Ms. S.S.Y and her family, it can be said that, they are below the average socio-

economic background by Ghanaian standard.

According to Ms. S.S.Y, there are no food taboos any other taboos or cultural practices within

the family that can adversely affect their health. Their family values hard work and respect for

human dignity. They are also guided by the culture of their community, for which they do not go

to farm on Tuesdays.

PATIENTS DEVELOPMENTAL HISTORY

Development is the process of growth and differentiation. Growth is the progressive

development of a living thing, especially the process by which the body reaches its point of

complete physical development. Maturation as the process of attaining full development.

According to Hornby (2010), growth is a process of increasing in size (growing) physically,

mentally or emotionally. According to Hornby (2010), development is the gradual growth of

something so that it becomes more advanced and stronger. According to Hornby (2010),

maturation is the process of becoming matured or becoming an adult.

According to Ms. S.S.Y, she was born on 22nd March, 2001 at home by a traditional birth

attendance at term, with no complication. She was immunized against vaccine preventable

diseases which are tetanus, diphtheria, whooping cough, polio, tuberculosis, and measles. She

was breastfed for 4 months of which she was weaned and started eating fluid diet such as

porridge etc. She had a normal growth process which includes sitting at the age of 7 months,

8
crawling at 9 months and walking at 12 months without any complication. She started her basic

education at Goaso Roman Catholic at age six (6) and completed middle school form three at age

sixteen (16) and then continued her education to Ahafoman Senior High School at Goaso and

completed 20th June, 2021. She said she started developing her female secondary characteristics

such as growing of pubic hairs, broadening of hips, breast enlargement and menstrual cycle

gradually when she was twelve (12) years.

OBSTETRICAL HISTORY

Ms. S.S.Y has not been pregnant before. Ms. S.S.Y had her menarche at the age of twelve (12)

years with regular monthly flow of blood. She has normal secondary sexual characteristics such

as development of breast, low tone of voice, broadening of hips, and growth of pubic hair on the

private part with no abnormalities. She is into intimate relationship and has used contraceptives

before since she is sexually active.

PATIENT’S LIFESTYLE/HOBBIES

Ms. S.S.Y is a Catholic, who goes to church every Sunday. Her favorite diet is Fufu and palm

nut soup. She also like taking in soft drinks like Fanta. She usually baths twice a day with soap,

sponge and cold water and brushes her teeth once a day with toothbrush and paste. She empties

her bowels usually once a day

Her hobbies are cooking and charting with friends. She is an introvert but goes on well with

friends. She sleeps as early as 8p.m and wakes up around 5:00am. When she wakes up in the

morning; she prays to God and begins her daily activities. She sweeps the house and fetches

9
water; afterwards, she prepares breakfast for herself and other siblings or sometimes buys food

from outside. She then goes to work.

According to Ms. S.S.Y, she does not usually eat in the afternoon except water and sometimes

snacks like ice kenkey and bread. Around 4:30p.m, she closes from work and goes home to

prepare the evening meals or buys food outside. All these assertions by the patient were

confirmed by her mother, Mrs. J.A.O

PATIENT’S PAST MEDICAL HISTORY

According to my patient, Ms. S.S.Y, she has no previous major illness or admission into the

hospital. She has not been involved in any serious accident or injury affecting her health.

However, she occasionally has headache and stomach ache, which are managed with

paracetamol tablet from nearby drug store. She has no known food or drug allergies.

PATIENT’S PRESENT MEDICAL HISTORY

Ms. S.S.Y started feeling pain and swelling at the left lower limb on 17 th November, 2022. Her

relatives did not rush her to the hospital but decided to manage her with traditional medicine

until the situation became serous with pain and swelling

On the 20th November, 2022, they reported to the Outpatient department of Goaso Municipal

hospital, at 8:30am. At the consulting room, she complained pain, swelling and redness of the

left lower leg. The doctor upon examination diagnosed her of cellulitis and she admitted her into

the Female Surgical ward for monitoring and treatment.

10
ADMISSION OF PATIENT

Ms. S.S.Y, was admitted to the Female Surgical Ward, of Goaso Municipal hospital on 20 th

November, 2022 through Out Patient Department (OPD) by attending physician with the

diagnosis of cellulitis. She was brought to the ward accompanied by her mother and a nurse in a

wheel chair. She was in a conscious state. They were welcomed to the unit and offered a seat.

Her folder was collected from the nurse with patient particulars and name confirmed by

mentioning it. Patient was reassured that she was in the hands of competent health practitioners

who would will do everything in their capacity to ensure her recovery.

Patient was introduced to other nurses who were on duty and was taken to her bed side and

introduced to patients around her bed. Her vital signs were checked and recorded as;

Temperature 37.8 degrees Celsius

Pulse 78 peat per minute

Respiration 18 cycles per minute

Blood pressure 126/70 millimeters of mercury

The following laboratory investigations were requested to be done blood film for malaria

parasite, fasting blood sugar, and hemoglobin level estimation and white blood cell count.

She was assisted to change into her night gown and was made comfortable in bed. She was

introduced to other patients around. Patient valuables were collected and handed over to the

nurse in-charge. A consent form for treatment was given to patient and her mother to sign after a

thorough explanation. Patient is a beneficiary of the National Health Insurance Scheme (NHIS)

so she did not make any deposit but was informed that NHIS does not cover all the treatment so

they should be ready to make such payment when the need arise. Patient relative were oriented to

the ward and its annexes, the nurse’s station, other cubicles in the ward and the washroom.

11
Patient was informed of ward activities such as ward rounds, vitals sign, medication and also

visiting hours which start from 5.30am to 6.30am ,12.30pm to1.30pm and 5.30 to 6.30pm .

Patient was to be managed on the following medications;

1. Intravenous Clindamycin 300mg qid x 7 days

2. Capsule Flucloxacillin 500mg qid x 7 days

3. Tablet paracetamol 1g tid x 5days

Patient particulars were entered into the admission and discharge book.

Due to the high temperature she was experiencing at the time of admission, immediate nursing

intervention were initiated to reduce discomfort and promote comfort. She was assisted to have a

cold bath, she was served with cold milo drink, fans were switched and windows opened to

improve ventilation in the room, and was encouraged to rest in bed.

After implementation of treatment and patient was now relaxed in bed, the opportunity was used

to explain the concept of the patient/family care to patient and family. It was disclosed that it was

a mandatory exercise and part of the requirements for all final year student nurses to qualify to

practice nursing. They were made to further understand that the care included health education

on the condition and related health issues and home visits but it would be terminated after their

discharge from the hospital. This made them get interested and agreed to get involved when the

intension was made known to them, and assured me of their co-operation and support. The ward

in-charge was informed about the choice of patient for the write-up, and after reviewing her

records, approval was given. Phone numbers were exchanged and directions to was taken and

date and time for home visit scheduled and agreed. They were thanked for their acceptance and

assured that they would be given holistic care

12
PATIENT CONCEPT OF ILLNESS

The patient believed that it was normal to fall sick irrespective of whoever you are. Upon

interviewing the patient, she did not attribute her sickness to any spiritual factor but she strongly

believed the Almighty Allah (God) would intervene through the work of nursing and medical

staff.

She was pleased and happy with the warm reception from the hospital staff and became

convinced that she would recover quickly in order to go home. She however has a little

knowledge about the causes of her condition. She was optimistic that her condition will be

relieved by the time she was discharged.

LITERATURE REVIEW ON PATIENTS CONDITION

Definition/description

Cellulitis is an inflammation of the cell or connective tissue or it is a bacterial infection that

spreads into tissue planes. It can also be described as the direct spread of infection in the extra

cellular space. This can be as a result of a wound, furuncle (boil) or carbuncle. It begins as a

localized infection and spreads affecting deeper tissues. It may be primary or secondary to a

condition. Cellulitis may affect the upper and lower extremities as well as the eyes.

CAUSES OF CELLULITIS

The most common cause of cellulitis in adults with no medical conditions is group a

streptococcus, which is a bacterium commonly found in the throat and on the skin as normal

flora. But if they get under the skin they can cause cellulitis in cases where there is a break in the

skin caused by an ulcer, a burn, a bite, a cut or some skin conditions, such as eczema, athlete's

foot, or psoriasis. The bacteria may also enter by some other route, such as through the blood or

13
lymphatic system. This is most likely if no potential entry route can be identified on the skin of

the patient.

According to Gould (2004), another common cause in adults is Staphylococcus aureus (S.

aureus), which is a bacterium that is commonly found on human skin and mucosa (lining of

mouth and nose). Other causative organisms include:

 Methicillin-resistant S. Aureus (MRSA)

 P. Aeruginosa

 Vibrio Vulnificus

 Clostridium Septicum

 Pasteurella Multocida (from dog or cat bites)

 Erysipelothril (from aquatic environments such as lakes, stream and oceans

 Escherichia coli

 Group B streptococcus

INCIDENCE OF CELLULITIS

Because cellulitis is not a reportable disease, the exact prevalence is not certain. However, it is

relatively common infection, affecting all race and ethnic groups. There is no statistically

significant difference in the incidence of cellulitis in men and women. Nonetheless, studies have

found a higher incidence of cellulitis in individuals older than 45 years.

According to Lozano 2012, Cellulitis as of 2010 results in about 27,000 deaths a year. The

incidence rate of cellulitis is 24.6 per 1000 person a year, with a higher incidence among males

and individuals aged 45–64 years. The most common site of infection was the lower extremity

(39.9%). Out of the majority of patients who are seen in an outpatient setting and being

diagnosed with cellulitis.

14
RISK FACTORS / PREDISPOSING FACTORS

• History of peripheral vascular disease

• People with cracks or peeling between the toes

• Wound from the recent surgeries

• Animal bites

• Injury or trauma with a break in skin

• Blockage in blood supply to a site

• Ulcers from diabetes

• Weakened immune system

• Obesity

• Carbuncles and furuncles

• Use of drugs that suppress the immune system

• Malnutrition

• People with dry skin

TYPES OF CELLULITIS

According to CREST (2005), the most common areas that are affected by cellulitis are the legs,

feet, arms, and hands.

Cellulitis of the Extremities: Being afflicted with other skin disorders _potentially creates an

environment for cellulitis of the extremities to occur. The damage to the skin caused by athlete's

foot can cause breakage in the skin, and bacterial species that normally live on top of the skin

15
may now get entry into the skin and cause a skin infection. Extremities are also common sites of

cellulitis because cracks in dry and flaky skin can serve as entry points for the bacteria, which

are common on the hands and feet. Below are some types of cellulitis of the extremities.

• Leg cellulitis: Is similar to arm cellulitis where infection of the legs occurs from bacteria

permeating the skin surface.

• Hand Cellulitis: Is mainly caused by bacterial entering through a break on the surface of the

skin.

• Arms Cellulitis: Is a common bacterial skin infection and may appear as well as red swollen

area that feels warmth and tender to touch. It can spread to the lymph nodes.

• Feet Cellulitis: It occurs commonly on the lower extremities including the feet which are

prone to edema in people with poor circulation like diabetic and those with sedentary

lifestyle.

Other types are:

Orbital Cellulitis: Orbital cellulitis is a bacterial infection of the skin immediately lining the eye

socket. The infection that results in orbital cellulitis often spreads from an infected sinus. Injury

to the skin around the eye can also cause this type of infection.

Perianal cellulitis: Cellulitis (a bacterial skin infection) that occurs around the anal orifice is

called perianal cellulitis. This condition is most commonly seen in children, and is more

common in boys than girls. It is characterized by bright red skin around the anus.

Peri-orbital Cellulitis: Peri-orbital cellulitis, also called pre-septal cellulitis, is an infection of

the eyelid and the skin around the eye. Peri-orbital cellulitis is often caused by a spread of

infection that begins due to trauma to the eye, or after insect or animal bites.

Breast cellulitis: Breast cellulitis is a bacterial infection of the skin that occurs on the breast

16
PATHOPHYSIOLOGY

There may be obvious portal of entry for infection such as recent abrasions. It occurs when an

entry point through a normal skin barrier allows the bacteria to enter and release their toxins into

the subcutaneous tissue.

The spread of infection is facilitated by the formation of the substance that breaks down the

connective tissue and normally isolates an area of inflammation. If untreated, the product of the

inflammation may enter the bloodstream and cause septicemia.

There is an acute onset of swelling, localized pain and redness is frequently associated with

systemic signs of fever, chills and malaise. Regional lymph nodes may also be tender and

enlarge. When this happen, the infection can spread throughout the body. If the infection is not

controlled, it can lead to gangrene of the whole leg which necessitates debridement or even an

amputation (Bare and Smelter 2010).

SIGNS AND SYMPTOMS

Sign and symptoms are abnormalities that indicate a potential medical condition

(New Zealand Government Ministry of Health) stated that cellulitis present with the following;

17
• Swelling of the site

• Tenderness

• Sore skin or rashes

• Warmth over the site

• Tight, glossy and stretched appearance of the skin

• Fever

• Itching

• Chills

• Blisters (occasionally)

• Headache

• Redness

• Joint stiffness

• Pain.

• Nausea and vomiting.

• Lymphadenopathy may be present.

DIAGNOSTIC INVESTIGATIONS

• Fasting blood sugar to rule out diabetes mellitus.

• Full blood count to determine white blood cell level.

• Wound swabs for culture and sensitivity, if discharging pus to reveal the causative organism.

• X-ray [Maxine L.P etal (2010)], to rule out if any foreign objects have found their ways into

the skin.

• Physical examination reveals warmth, redness and swelling.

MEDICAL MANAGEMENT

18
Give systemic antibiotics to reduce inflammation such as clindamycin and flucloxacillin

• Give analgesics such as diclofenac to relieve pain

• Give antipyretics to combat pyrexia eg. paracetamol

• Immunosuppressed people may be given immune boosters.

• Patient with cutaneous inflammation may be given topical antibiotics such as gentamicin

cream.

NURSING MANAGEMENT

PSYCHOLOGICAL SUPPORT

• Reassurance: Patient and relatives are reassured to allay fear and anxiety and also in the

hands of competent staff and all nursing care will be rendered or delivered.

• Establishment of rapport: A good nurse-patient relationship is ensured. This is done by

communicating and introduction of self.

• Explanation of all procedures: All procedures and care given to patient should be well

explained to gain client cooperation before procedures are being carried on.

2. POSITION, REST AND SLEEP

This was ensured to enhance recovery process, conserve energy, reduce metabolic activity, help

reduce stress and relax patient. Put patient in a position comfortable for his and a comfortable

bed free form cramps to promote sleep. The room should be well ventilated by opening

windows. Restrict visitors to prevent sleep disturbances. Give warm bath and serve warm

beverages. The lighting should be dimmed and regulated to patient’s satisfaction to enhance

sleep.

3. OBSERVATION

19
Monitor vital signs thus temperature, pulse, respiration and blood pressure 2 hourly and 4 hourly

as patient condition improves and record accurately to determine the progress of the disease

condition. Monitor intake and output, record chart 24 hourly to help maintain fluid and

electrolyte balance. Assess the level of pain using the pain scale (0-10) and also the

consciousness of the patient. Monitor the therapeutic and adverse effect of drugs administered.

4. NUTRITION

A well balanced diet meal should be provided containing protein, carbohydrates, vitamins,

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 fluid should be ensured to help prevent constipation due to

limitation in activities and movement of client.

5. PERSONAL HYGIENE

Assist patient to maintain personal hygiene such as bathing twice daily and brushing of teeth

twice as well as nail care and grooming should be done accordingly. All pressure areas should be

treated. Change soiled linens and dry clothes frequently as possible. Ensure that patient looks

clean always.

6. EXERCISE

Encourage patient to undertake moderate exercise such as walking around, extension and flexion

of the joints and sitting up in bed to improve circulation, prevent muscle wasting and prevent

20
constipation as well as joint stiffness. Tell patient the importance of exercise as stated above to

win his cooperation and assist him to perform those exercises.

7. ELIMINATION

Serve patient with bed pan on request for micturition and bowel movement. Privacy should be

ensured. Roughages and fluids should be given to lubricate gastrointestinal tract (GIT) for easy

movement of bowel.

8. SURGICAL MANAGEMENT

The surgical treatment for cellulitis is incision and drainage of the pus for those that suppurate

and debridement for cellulitis with slough in the wound as well as careful wound care after the

surgical procedure.

9. PREVENTION

Prevention is the action of stopping something from happening or arising

• Keep skin moist with lotion or ointment to prevent cracking

• Avoid contact with corrosive substances that can cause break to the skin.

• Learn how to firm your nails to avoid harming the skin around them.

• Apply antibiotic cream or ointment

• Watch for redness, pain, drainage or other signs of infections.

10. PATIENT AND FAMILY EDUCATION

• Advice patient and family to ensure personal and environmental hygiene.

21
• Educate a patient on protective measures for the skin as application of lotions and skin cream

to prevent cracking.

• Patient should also be educated to take good care of insects and animals bite and avoid

scratching them as it may result in a wound.

• Educate patient to eat well balanced diet with aid of vitamins to boost immunity and

facilitate healing.

• Educate patient on the need for proper intake of drugs and the importance of review.

COMPLICATIONS

• Osteomyelitis

• Meningitis

• Lymphadenitis

• Tissue death

• Sepsis

• Bacterial infection

• Deformity

VALIDATION OF DATA

Validation of data is the process of confirming or verifying patient’s data. The purpose of

validation data is to keep it free from errors, biases and misinterpretation. The data was gathered

from Ms. S.S.Y and her family, the medical and nursing staff of female ward. The data

information obtained was cross checked and compared with literature review, textbooks, the

internet which proves and confirmed valid and accurate without biases.

22
23
 CHAPTER TWO

ANALYSIS OF DATA

INTRODUCTION

This is the second step in the nursing process and simply means a detailed examination of

information gathered from patient in order to understand its nature or determine its essential

features.

Analysis of data is the second stage of the nursing process which involves careful comparison of

the patient’s problem or the information gathered from patient and relatives with standards and

then putting these problems on order of priorities to plan for the care of the patient and family.

(Delaune and Ladner, 2010). This section covers the below areas;

1. Comparison of data with standards

2. Patient and family health problems

3. Patients strength

4. Nursing diagnosis

COMPARISON OF DATA WITH STANDARDS

This is the process of comparing the information collected from 3 patient or family and

significant others, care given with the standards set in the literatures. These include:

1. Diagnostic investigations

2. Causes

3. Clinical features

4. Treatment

5. Complications

24
DIAGNOSTIC INVESTIGATIONS

With reference; (New Zealand Government ministry of health), cellulitis is diagnosed from its

characteristics appearance. Blood test and tissue cultures may be used to confirm the presence of

bacterial infection. In the case of orbital cellulitis, a CT (computerized tomography) may be

recommended in other to precisely identify the extent of infection.

However, the diagnostic investigations carried out on patient were

• Blood film for malaria parasite (mps)

• White blood cells (WBC)

• Fasting blood sugar (FBS)

• Haemoglobin level estimation

Details of the above can be found in table 2.

Table 1: Comparison of Diagnostic Investigations stated in the literature with those carried

out on

Diagnostic investigations in the literature Diagnostic investigations carried out on the

patient

1. Blood film for malaria parasite (mps) Blood film malaria parasite was done

2. White blood cells (WBC) White blood cells was done

3. Fasting blood sugar (FBS) Fasting blood sugar was done

4. Haemoglobin level estimation Haemoglobin level estimation was done

5. Lipid profile test Lipid profile test was not done

6. Doppler ultrasound scan Doppler ultrasound scan was not done

25
Date Specimen Investigations Results Normal Values Interpretation Remarks

20/11/2022 Blood Hemoglobin level 14.5g/dl 13.5-17.5g/Dl Hemoglobin is within normal No treatment was given

He was not anemic.

20/11/2022 Blood White blood cells 12.0x109/L 4.5-11.0x109/L Infection present (above the Antibiotics given

normal range)

20/11/2022 Blood Fasting blood sugar 5.8mmol/L 3.9-6.0mmol/L The value was within normal No treatment was given

range and hence indicating no

diabetes in

my patient

20/11/2022 Blood Malaria parasite Negative Negative No malaria parasites were seen No treatment was given

therefore

patient has no malaria

TABLE 2: DIAGNOSTIC INVESTIGATIONS OF PATIENT

26
27
Comment:

From the table, it can be observed that majority of the investigations stated in the literature

were carried out for patient, and this clearly indicates that patient diagnosis was correct and

accurate and that led to the speedy recovery and discharge.

CAUSES

With reference to the literature review, cellulitis is caused by streptococcus pyogens,

staphylococcus aureus, clostridium perfringens, injury or trauma (pin or needle prick). Miss

S.S.Y condition could be as well as a result of micro infections like streptococcal or

staphylococcal infection.

CLINICAL FEATURES

CLINICAL FEATURES IN CLINICAL FEATURES EXHIBITED

LITERATURE REVIEW BY PATIENT

Fever Patient exhibited fever

Headache Patient complained of headache

Itching Patient complained of itching

Nausea and vomiting Patient experienced nausea but no vomiting

Pain at the site Patient experienced pain at the site

Redness Patient left leg appeared reddened

Myalgia Patient complained of myalgia

Sore skin or rashes Patient did not experienced any rashes

Tenderness Patient complained of tenderness

Malaise Patient exhibited malaise

Swelling at the site Patient left leg was swollen

28
 Hair loss over the site Patient did not experience hair loss

Warmth over the site Patient left leg was warm to touch

TABLE 3: COMPARISON OF CLINICAL FEATURES WITH STANDARDS

TREATMENT

According to the literature, the medical treatment for cellulitis is the use of systemic

antibiotics therapy to eradicate the organism after culture and sensitivity has been conducted

and daily wound dressing is performed. Analgesics are also administered to relieve pain. Also

the best surgical treatment for cellulitis is incision and drainage of pus. Patient was managed

with the following drugs:

Intravenous Clindamycin 300mg qid x 7days

Capsule Flucloxacillin 500mg qid x 7days

Tablet Paracetamol 1g tid x 5days

Details of the above can be found table 3.

29
 TABLE 4: PHARMACOLOGY OF PRESCRIBED DRUGS FOR MS. S.S.Y

Date Drug Dosage & Classification Mechanism of action Desired effects Actual Side Effect Remarks

Routine Effect

Observed

20/11/22 Intravenous 300mg qid Lincosamide Inhibit protein It works by stopping Infection was treated Joint pain, rashes, None of

Clindamycin x72hours antibiotics susceptible bacteria. from bacteria from Diarrhea, urticarial. these side

intravenousl To treat infection producing the protein effects

y caused by streptococci. they need to reproduce were

and spread infection in observed

the body

21/11/20 Capsule 500mg qid Antibiotics Interferes with DNA It kills bacteria Swelling reduced Diarrhea, rashes, None of

22 Flucloxacilli x7, replication in inhibiting cell wall pain, Anaemia, these were

n Orally susceptible bacteria synthesis Fever. seen

cell reproduction.

30
22/11/20 Tablet 1g tid Analgesic and To relief bodily pain, May block pain Patient verbalized Nausea, stomach None of

22 Paracetamol x5days Antipyretic reduce body impulses peripherally reduction in pain and pain, dark urine. these side

temperature that occurs in body temperature effects

Orally response to pain were

observed

31
COMPLICATIONS

With reference to the complications stated under the literature review, the patient did not

experience any complication due to comprehensive and intensive nursing and medical care given

to her.

PATIENT/FAMILIES HEALTH PROBLEMS

Experience any complications due to comprehensive and intensive nursing and medical care

given to him.

• Patient had elevated body temperature (38.0 degrees Celsius)

• Patient was anxious about the outcome of the disease condition

• Patient had pains at the affected leg (left lower leg)

• Patient had swollen at the left lower leg

• Patient has loss of appetite

• Patient has inadequate information on his diseases condition.

PATIENT/FAMILIES STRENGTH

• Patient could tolerate antipyretic, cold bath and drinks

. Patient was able to cope with unfamiliar environment and expressed his fears and worries

• Patient can describe the intensity of pain

• Patient could walk with assistance or with walking aid

• Patient can purchase for all his antibiotics

• Patient can take light diet

Patient expressed interest in knowing more about his condition

32
NURSING DIAGNOSIS

This is a clinical judgment about an individual, family or community that is derived through a

deliberate, systematic process of data collection and analysis. It provides the basis for

prescription for definitive therapy for which the nurses by virtue of their education and

experience are licensed to treat (Keane, 2003).

• Hyperthermia (38.0 degrees Celsius related to on-going inflammation processes.

• Anxiety related to unknown outcome of condition and unfamiliar environment.

• Pain at left lower leg related to swelling pressing on the nerve endings.

• Fluid volume excess (swelling of the left leg) related to inflammatory process.

• Nutritional imbalance (less than body requirement) related to loss of appetite.

• Deficient knowledge (patient and relative) related to inadequate information of the cause,

treatment and prevention of disease condition.

33
 CHAPTER THREE

PLANNING OF PATIENT/FAMILY CARE

Planning is the process of designing a strategy to achieve the goal of care for an individual

patient and family (Mosby’s Medical Dictionary, 2009). It involves nursing diagnosis, objectives

and outcome criteria, nursing orders, intervention and evaluation.

NURSING OBJECTIVES

1 Patient will have reduced body temperature within 2 hours as evidenced by:

a. temperature dropping to a range of 36.2 to 37.2 degree Celsius

b. Patient verbalizing that body is not warm to touch.

2. Patient will have reduced pain within 2hours as evidenced by:

a. Patient verbalizing, he is relieved of the pain.

b. Nurse visualizing that the swelling has subsided and relieved of the pain.

3. Patient will have reduced anxiety within 4 hours as evidenced by:

a. Nurse visualizing the patient relating freely with nurses and other patients.

b. Patient verbalizing that he is no longer anxious

4. Swollen will reduce within 24 hours as evidenced by:

a. Patient verbalizing the size of swollen has reduced.

b. Nurse observing reduction in swelling of the affected leg

5. Patient will maintain optimal nutritional status throughout the period of hospitalization as

evidenced by:

a. Nurse observing patient eating more than half of food served.

34
 b. Patient verbalizing increase of appetite

6. Patient will have adequate knowledge on his condition within 4 hours as evidenced by:

a. Nurse visualizing that patient is answering questions.

b. Patient verbalizing or describing disease process, causes and factors contributing to

condition.

35
Date/ Nursing Nursing Nursing Orders Nursing Date/ Evaluation Sign
Time Diagnosis Objective Interventions Time
20/11/22 Hyperthermia Patient body 1. Reassure patient. 1. Patient was reassured that temperature will 20/11/22 Goal fully met

At 38.0 related to temperature will be reduced within the said time. at as nurse

10:00am on-going reduce by 0.1OC 2.Tepid sponge patient 2. Tepid sponging was done every 15-30 12:00pm observed

inflammation within 2 hours as every 30 minutes minutes to reduce reduction in

processes evidenced by: body temperature patient’s body

1. Nurse checking 3. Check and record vital 3. Vital signs were checked and recorded temperature,

and recording normal signs specifically specifically temperature to detect the rise or recorded to be

body temperature temperature. fall in patient temperature. 37.0

2. Patient 4. Serve patient cold drinks 4. Cold drinks were served

verbalizing, he is not 5. Ensure ventilation by 5. Nearby windows were opened for fresh

warm to touch. opening nearby windows. ventilation

6. Administer prescribed 6. Prescribed antipyretic were served to

antipyretic eg paracetamol reduce body temperature.

TABLE 1: NURSING CARE PLAN ON MS.S.S.Y

36
Date/ Nursing Nursing Nursing Orders Nursing Date/ Evaluation Sign

Time Diagnosis Objectives Interventions Time

20/11/22 Acute Pain (at Patient pain will 1. Check vital signs and monitor 1. Patient vital sign was checked and 20/11/22 Goal fully

At the left lower reduce within 45 patient. monitored. 11:00am met as the

10:30am leg) related to 2. Apply cold compress at the 2. Cold compress was applied at the site to patient
minutes as
swelling affected part to reduce the level of reduce the level of pain. verbalized
evidenced by;
pressing on the pain. that he is
1. Patient
3. Ward environment was kept calm and
nerve endings. 3. Ensure that the ward relieved of
verbalizing, he is
quiet.
environment is quiet. the pain.
relieved of pain.
4. Patient’s level of pain was assessed
4. Assess patient of pain using the
2. Nurse
using the pain rating scale (scale of 5).
pain rating scale (0-10).
verbalizing that
5. Prescribed analgesics (paracetamol)
5. Administer prescribed
swelling has
were served to reduce the level of pain.
analgesics (paracetamol) as
subsided and
6. Patient was engaged in diversional
ordered to reduce the pain.
relieved of the pain.
therapy.
6. Engage patient in diversional

therapy eg. Watching television

37
Date/ Nursing Nursing Nursing Orders Nursing Date/ Evaluation Sign
Time Diagnosis Objectives Interventions Time
21/11/22 Anxiety related to Patient will have 1. Assure patient to allay any 1. Patient was assured. 21/11/22 Goal fully met
reduced anxiety fear.
At unfamiliar regain her normal 2. Orientate patient to the ward 2. Patient was orientated to the At 6:40pm as nurse
emotional state and its environment. ward and its environment.
12:40pm environment and visualized the
within 2 hours as 3. Explain all procedures that is 3. All procedures performed on
unknown outcome evidenced by: performed on patient to him. patient were explained to him patient having a
1. Nurse before doing it.
of condition visualizing patient 4. Introduce other patient who 4. Other patient who has cheerful face
relating freely with has recovered from the same recovered from the same
(cellulitis). nurses and other and relating
disease condition to the patient. condition were introduced to the
patients. patient. well with health
2. Patient 5.Encourage patient to clarify 5. Patient was encouraged to
verbalizing that he any doubt clarify any doubts. care team and
is no longer 6. Allow patient to ask questions 6. Patient was encouraged to ask
anxious. and provide clear and precise questions and clear answers were other patients.
3. Visualization of answers. given.
patient having
relaxed facial
expression by the
nurse.
4.patient vital
signs within
normal range

38
Date/ Nursing Nursing Nursing Orders Nursing Date/ Evaluation Sign
Time Diagnosis Objectives Interventions Time
21/11/22 Fluid volume Patients leg 1. Reassure patient to allay any 1. Patient was reassured to allay 22/11/22 Goal fully met as
fear.
At excess (swelling will reduce in fear. at 10:30am nurse visualized
2. Provide comfortable bed for
10:30am of the left lower size within 72 2. Comfortable bed was provided. the reduction of
patient to rest to conserve
leg) related to hours as energy. swelling at the
3. Elevate the swollen leg on a
inflammation evidenced by: 3. Patient swollen leg were affected leg.
pillow to enhance venous
1. Nurse observing elevated on a pillow to
return.
relieved of swelling enhance venous return

on the affected leg. 4. Apply warm compress on the 4. Warm compress was applied

2. Patient swollen leg to reduce on swollen leg.

swelling
verbalizing the size

of swollen has 5. Administer prescribed anti- 5. Prescribed anti-biotic

reduced. biotic medications e.g. medications were

Clindamycin
administered.

39
Date/ Nursing Nursing Nursing Orders Nursing Date/ Evaluation Sign
Time Diagnosis Objective Interventions Time
22/11/22 Nutritional Patient will maintain 1. Administer vitamins and 1. Patient was given vitamins and 22/11/22 Goal fully met as

At imbalance (less optimal nutritional minerals. minerals to meet body requirement At 11:00am nurse visualized

11:00am than body status throughout the 2. Plan diet with patient and 2. Diet was planned with patient patient eating more

requirements) periods of dietician to make choice of and dietician. than half of meals.

related to loss hospitalization as his favorite’s meal. 3. Oral care was ensured by

of appetite. evidenced by: 3. Do oral care to boost assisting patient to brush with tooth

1. Nurse observing appetite. paste and brush.

patient eating more 4. Ensure nutritious diet. 4. Nutritious diet was ensured by

than half of meal serving balance diet.

served. 5. Serve diet in bits and at 5. Meals were served in bits but at

2. Patient verbalizing regular intervals regular interval.

increase of appetite. 6. Encourage patient to eat. 6. Patient was encouraged to eat

food been served.

40
Date/ Nursing Nursing Nursing Orders Nursing Date/ Evaluation Sign
Time Diagnosis Objectives Interventions Time
22/11/22 Deficient Patient will have 1. Reassure patient and Family 1. Patient and family were 22/11/2022 Goal fully met as

At knowledge adequate knowledge on on all the information about reassured on all the at 1:00pm patient was able

9:00am related to his condition within the disease condition necessary information to answer simple

inadequate next 4hour as evidenced 2. Assess patient’s level of about the condition questions on

information on by: knowledge on the condition 2. Patient’s level of cellulitis and

disease condition. 1. Nurse visualizing that 3. Educate patient on the knowledge was assessed express his

patient is answering condition 3. Patient was educated on the understanding on

questions 2. Patient 4. Allow patient to ask condition disease condition.

verbalizing or questions 4. Accurate answer were

describing disease 5. Educate patient using given to patient to clear all

process, causes and simple languages he can doubt.

factors contributing to understand 5. Patient was educated in

condition 6. Make use of teaching simple language(Twi)

materials like pamphlet 6. Teaching materials like

pamphlet were used.

41
 CHAPTER FOUR

IMPLEMENTATION OF PATIENT/FAMILY CARE

Implementation is the fourth step in the nursing process, it involves the execution of the

nursing plan of care derived during the planning phase of the nursing process. It involves

completion of nursing activities to accomplish predetermined goal and to make progress

towards achievement of specific outcome. (Baillieres nurse’s dictionary, 2009).

SUMMARY OF ACTUAL NURSING CARE

The holistic care given to Ms. S.S.Y started on the first day of admission 20 th November,

2022 to the day of her discharge: 25rd November, 2022 and at home after her discharged.

Below are the actual nursing care rendered to my patient and her family members.

DAY OF ADMISSION (20TH NOVEMBER, 2022)

Ms. S.S.Y was admitted to the Female Ward, of the Goaso Municipal hospital on 20 th

November, 2022 at 9:00am, through the Out Patient Department (OPD) with diagnosis of

cellulitis of the left leg. She was brought to the ward accompanied by her Mother and a nurse

in a wheel chair. Patient was in a conscious state. They were welcomed to the unit and also

offered a seat. Her folder was collected from the nurse with patient particulars and name by

mentioning it. Patient was reassured that she is in the hands of competent health practitioners

and will do everything in their capacity towards her recovery. Patient was introduced to other

nurses around, patient was taken her bed which was bed number 8 and locker was also shown

to her.

Vital signs on admission were checked and recorded as;

Blood pressure 126/70 millimeters of mercury

42
Temperature 37.8 degrees Celsius

Pulse 78 beats per minute

Respiration 18 cycles per minute

The following laboratory investigations were done;

1. Hemoglobin level estimation

2. White blood cell count (WBC)

3. Fasting blood sugar (FBS)

4. Blood film for malaria parasite.

Patient was assisted to change into a hospital gown and was made comfortable in bed. She

was introduced to her roommate. A consent form for treatment was given to patient and

relative to sign. Patient is a beneficiary of the NHIS so she did not make any deposit but was

informed that NHIS does not cover all the treatment so her relatives should be ready to make

such payment when the need comes. Patient and her mother were oriented to the ward and its

annexes, the nurse’s station, other cubicles in the ward and the washroom. Patient was

informed of ward activities and visiting hours.

Patient was to be managed on the following medications;

1. Intravenous Clindamycin 300mg qid x72hrs

2. Capsule flucloxacillin 500mg qid x 7days

3. Tablet Paracetamol 1g tid x 5days

Patient particulars were entered into the admission and discharge book.

On the day of admission, it was observed that patient had fever and the following were the

necessary nursing intervention given to her.

She was tepid sponge every 15-30 minutes till temperature fell within normal range, vital

sign were checked especially temperature to see whether temperature has dropped or reduced

43
to normal, cold drink were served, nearby window were open to ensure good ventilation,

antipyretics were administered to reduce temperature.

On that same day, patient level of pain was assessed using the pain rating scale, patient was

engaged in diversional therapy by reading magazines, listening to music and watching of

television. Analgesics were administered to relieve pain, adverse and therapeutic effect were

monitored.

Patient was also observed to be anxious due to unknown outcome of condition and unfamiliar

environment. The following were the nursing interventions done for my patient, she was

reassured to allay fears, orientate patient to the ward and its environment, explain all

procedure that will be performed on patient to him, introduce other patient who has recovered

from the same disease condition to the patient

Patient had her lunch in the afternoon which was rice and beans stew with fish. Medications

were administered as in treatment regime and patient was allowed to rest. She had her supper

around 6:30pm in the evening.

FIRST DAY POST ADMISSION (21ST NOVEMBER, 2022)

On the first day of her admission patient woke up around 5:30am. After that, she was

assisted to take her bath and perform oral hygiene, vital signs were checked and recorded as

follows;

Blood pressure 100/60 millimeters of mercury

Temperature 36.6 degrees Celsius

Respiration 20 cycles per minute

44
Pulse 74 beat per minute

She took porridge and bread as breakfast around 6:30am but fortunately, she ate small of the

meal been served. Her due medications were served at 9:30am and documented and there

were no adverse and therapeutic effect or reactions. An objective was set to relieve patient

from swelling which include patient was reassured to allay fears, comfortable bed was

provided, patient swollen leg were elevated on a pillow to enhance venous returns, cold

compress were applied on swollen legs, prescribed anti-biotic was served.

Rice with soup were served as lunch and also took pineapple drink as dessert, afternoon vital

signs and due medications were served, patient was left comfortable in bed.

She took tom brown with 3 slice of bread in the evening. Her vital signs were check and

recorded and were in normal range.

Blood pressure 106/60 millimeters of mercury

Temperature 36.4 degrees Celsius

Respiration 20 cycles per minute

Pulse 74 beat per minute

She took her bath and was served with her 6:30pm medication; capsules flucloxacillin 500mg

at 10:00pm, due medications; IV Clindamycin 300mg, tablet Paracetamol 1g, was

administered and recorded. She was then handed over to the night nurse for continuity of care

at 10:30pm.

SECOND DAY POST ADMISSION (22ND NOVEMBER, 2022)

45
On this days, patient woke up around 5:30am, she expressed her gratitude to God for a

wonderful day. She brushed her teeth with tooth paste and tooth brush and was assisted to do

bed bath.

Vital signs were checked and recorded as;

Blood pressure 100/60 millimeters of mercury

Temperature 36.6 degrees Celsius

Respiration 20 cycles per minute

Pulse 74 beat per minute

Due medication was served. Patient bed linens were changed. Patient took rice porridge for

breakfast. Patient bed was laid with clean linens to prevent infections. On ward rounds at

9:30am, patient complained of loss of appetite and so diet was planned with patient, family

members and dietician, patient was encouraged to perform oral hygiene, all nauseating items

were removed, meals were served attractively and in bits and at regular intervals, patient was

given vitamins and minerals to meet body requirement, nutritious diet was served. In the

afternoon, patient vital sign was checked and recorded, due medications were served and

lunch was served by her mother.

THIRD DAY POST ADMISSION (23RD MOVEMBER, 2022)

Patient woke up at 5:30am and was assisted to perform her personal hygiene. At 6:00am her

vital signs were checked and recorded as;

Blood pressure 110/80 millimeters of mercury

Temperature 36.3 degrees Celsius

Respiration 18 cycles per minute

46
 Pulse 78 beat per minute

She took porridge and bread as breakfast and Tab Paracetamol 1g, Tab flucoxacillin 500mg

were served. Normal vital signs checked and recorded. She slept well no complains

according to the night nurse. An objective was set that patient will understand cause, sign and

symptoms and prevention within 4hours, some intervention made include reassuring patient

and family on all information about disease condition, patient level of knowledge was

assessed, I educated patient on the condition, accurate answers were given to patient clear all

doubt, I educated patient in simple language, teaching materials like pamphlet were used.

In the afternoon, she had boiled yam palava sauce as lunch and she ate about one third of

food served, vital sign were checked and recorded and due medication were serve.

In the evening, she was served with rice with tomato stew and she ate almost half of the food

served. Her vital signs were checked and recorded at 6:00pm as follows;

Blood pressure 110/80 millimeters of mercury

Temperature 36.3 degrees Celsius

Respiration 18 cycles per minute

Pulse 78 beat per minute

She took her bath (with soap and water) and Capsule flucloxacillin 500mg was administered

and documented at 6:00pm, due medications were served as follows, tablet Paracetamol 1g.

Patient was patient comfortable in bed.

FOURTH DAY POST ADMISSION (24TH NOVEMBER, 2022)

47
Ms. S.S.Y woke up around 6:00am in a cheerful mood. She brushed her teeth and took her

bath. Patient complaint of mild pain. Due medications were served and vital signs were

checked and recorded as;

Temperature 36.3 degrees Celsius

Pulse 74 beat per minute

Blood pressure 100/70 millimeters of mercury

Respiration 20 cycles per minute

At 7:30am she had milo with bread and egg as breakfast. Due medication was served and

recorded. As form of diversional therapy to allay boredom, I engaged her in a conversation.

Through the conversation she verbalized that she has seen much improvement in her

condition as compared to the previous days. I therefore took the opportunity to stress on the

need to continue with the elevation of leg on pillow despite the fact that the edema has

reduced, and also to drink, eat diet high in protein and vitamins to support a strong immune

system.

At 10am, the attending physician came for wards rounds and stated that she might be

discharged the next day. She had cheerful face for the news regarding the impending

discharge. Later in the day, she had her hands and feet cared for and had rice and stew with

fish at 1:30pm. Her vital signs were checked and recorded at 12pm;

Temperature 36.3 degrees Celsius

Pulse 86 beats per minute

Respiration 18 cycles per minute

Blood pressure 120/70 millimeters of mercury

Around 6pm, she took her supper which was banku and okro stew with fish, after which she

had a warm bath and was made comfortable in bed. After this, her medication was served and

48
recorded at 8pm. She was engaged in a short conversation and then handed over to the night

nurses for continuity of care.

FIFTH DAY POST ADMISSION/DAY OF DISCHARGE (25TH NOVEMBER, 2022)

Patient woke up early in the morning around 5:30am. She performed her personal hygiene by

herself without assistance and looked cheerful and active. All medications were administered.

Vital signs were checked and recorded as:

Temperature 36.4 degrees Celsius

Pulse 82 beat per minute

Respiration 22 cycles beat minute

Blood pressure 110/70 millimeters of mercury

During ward rounds at 10:30am, patient laid no complain. The attending physician examined

her and she was fit for discharge. And therefore she was discharged to go home and come for

review on 9th December, 2022. The prescribed medications were collected from the pharmacy

and bills which were not covered by the National Health Insurance were settled at the

hospital cashier. After which the receipt was shown to the nurse in-charge at the female ward

before they were allowed to leave the ward or hospital premises.

Ms. S.S.Y was educated on causes, signs and symptoms, treatment regarding to her

condition. Patient was discharged in the admission and discharge book and the daily ward

state. They were asked to take the rest of her drugs home. She was educated prior to

discharged and also take her drugs according to the doctor’s orders and also reminded of

follow ups or review and was told to feel free to report immediately to the hospital for

treatments. I packed all her things and escorted her to the car station.

49
I told her about my second home visit the next three (3) days and they gave me all the

directions

PREPARATION OF PATIENT/FAMILY TOWARDS DISCHARGE AND

REHABILITATION

Preparation towards discharge and rehabilitation process of the patient started on the day of

admission. Patient/family were made to understand that, their stay in the hospital would not

be permanent but rather temporal and that they will go home at any time patient’s condition is

stable. Patient/family were encouraged to ask questions on anything bothering their mind.

From time to time, patient and families were educated on the disease condition that includes

the causes, signs and symptoms and the preventive measures. Again, patient/family were

made to understand that, they were in the hands of competent, dedicated and experienced

staff hence her condition would be managed successfully and she will be discharged to home

very soon.

Patient was discharged on the 25 th November, 2022 to continue her treatment at home and

also informed about the review and follow-up visits after discharged and the need to honor

the review on 9th December, 2022.

FOLLOW-UPS/HOME VISITS/ CONTINUITY OF CARE

Home visit is the act of providing preventive health care services to clients in their own home

environments. Services rendered includes prevention of illness or disability, promotion and

maintenance of health, encouraging individuals and families to live healthy lives and improve

their health standards.

Follow-ups are very important in the care of a patient because it helps the nurse to know the

family well, it promotes continuity of work, it also helps the nurse to identify special cases

50
and defaulters and counsel them etc. On the part of my patient, three effective home visits

were made after discharge.

FIRST HOME VISIT (22ND NOVEMBER, 2022)

The first home visit was carried out while patient was on admission. I had the opportunity to

visit Ms. S.S.Y family for the first time in her house at Goaso (lowcost) at 9am.The visit was

to find out the causes and risk factors that contributed to patient disease and those that can

impede her total recovery after discharge so since the place was not far from the hospital, I

came along with patient mother., The house was a five bed room including kitchen and well-

furnished and was painted in pink color and roofed with aluminum roofing sheets. They are

connected to electricity and building has a good ventilation. The family was happy to see me

due to the information given to them by Ms. S.S.Y about my visit to them. There was

exchange of greetings and I was offered a seat and glass of water. Ms. S.S.Y father revealed

to me that he was scared when he saw his daughter legs swollen and thought his daughters

leg would be surgically remove, this gave me the opportunity to educate them on the causes,

sign and symptoms, management and complications of cellulitis. After the discussing I

realized that some barrel containing water was covered, food was covered and the

environment was left clean and tidy. Based on the above findings, I reinforced the need to

continue to cover water and food with container to prevent contamination. The need to ensure

proper ventilation was also stressed on. Hand washing with soap and water before and after

eating and after visiting the toilet. Also, patient was educated on the need to wear protective

clothing and standards to minimize injuries.

They were also encouraged to continue good refuse disposal to prevent environmental

pollution and breeding of mosquitoes. They were therefore reassured that Ms. S.S.Y will get

well soon. They were encouraged to ask questions and answers will be provided in simple

51
terms to enhance their understanding. I thanked them for their hospitality and they also

thanked me too and I left their premises around 11:00am.

SECOND HOME VISIT (27TH NOVEMBER 2022)

On the 28th November 2022, a second home visit was made to Ms. S.S.Y at Goaso to see how

far my patient was doing and to review the health education given during my first home visit.

Once I had pre-informed them of my visit, they were already prepared for me. My aim was to

find out how Ms. S.S.Y, and the family was coping with the condition and check her health

and see whether all that given to the family has being well followed. Her general condition

was encouraging based on my observation. I requested to see the remaining of her drugs to be

sure she was taking them correctly and it was observed she was taking them as prescribed.

She was advice to take in nutritive diet to help boost the immune system. I also observed that,

patient’s environment was clean and I encouraged them to keep it up. They were grateful for

the role I played in the patient recovery and thanked me.

They were reminded on the date for review at the hospital, that is, 2 nd December, 2022. They

were also informed they would be visited for the third and final time after their review at the

hospital, and that the visit would be in the company of the public health nurse who would

continue with the care as they were informed during admission. They were thanked for their

time and reception and permission was sought to leave. One of her relative escorted me to the

road side to board a car.

DAY OF REVIEW (2ND DECEMBER, 2022)

On this day, I report to the hospital at 7:30am to meet Ms. S.S.Y, Few minutes later, she also

arrived with her mother. I took patient’s card to retrieve her folder. Patient’s folder was

collected from the records and sent to the O.P.D. Vital signs were checked and recorded.

Temperature 36.7 degrees Celsius

52
Pulse 84 beats per minute

Respiration 20 cycles per minute

Blood pressure 110/60 millimeters of mercury

After taking her vital signs, we entered into the consulting room three (3) where Dr. Abigail

was. She asked of any problem and Ms. S.S.Y gave no complaints. They were thanked her

for their cooperation to the treatment regime and encouraged to continue practicing good

health habits. We left the hospital premises and I escorted them to the car station to board a

car. They were reminded of the last home visit.

THIRD HOME VISIT (4TH DECENBER, 2022)

This visit was made on the 4th December, 2022. On this day Ms. S.S.Y was visited at Goaso

with a community health nurse. The aim of this visit was to further assess patient health,

discontinue the care and hand her to the community health nurse. On our arrival we were

welcomed and made comfortable as usual. We exchanged greetings, I introduced the

community health nurse and our mission was stated. She was glad that she could walk and do

her activities. Ms. S.S.Y was encouraged to continue with her daily activities after she was

declared fit on the review day and also encouraged her to always wear protective cloths to

reduce her chances of any injury that can predispose her to the condition.

At this time, I made them to understand that, the community health nurse would continue

with the care. I therefore gave them the opportunity to ask any question for clarification. The

community health nurse spoke to the entire family members and willingness to give out his

best regarding their health issues. Patient and family were therefore educated to report any

abnormalities which were noticed any time Emphasis was made on the condition and its

53
preventions. At this time their permission was sought to leave and they escorted us to the

station.

54
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIET/FAMILY.

Evaluation of care rendered to patients is a professional appraised or judgment of the

effectives of the nursing care rendered. It is the fifty and the final stage of the nursing

process. At this stage that the nurse judges the success of the care by examining the patient’s

responses and comparing them with action put up by patient and was stated in the expected

outcomes in order to determine whether the process of care will be terminated

STATEMENT OF EVALUATION

The major purpose of evaluation is to determine the effectiveness of those activities in

helping clients achieve expected outcomes. The set objectives and the extent in which they

were evaluated are indicated below.

PATIENT EXPERIENCED REDUCED TEMPERATURE

On the first day, Miss. S.S.Y had Hyperthermia (38.0 related to on-going inflammation

process. A goal was set that patient will have reduced body temperature within the next 2

hours. The interventions carried out include; patient and family were reassured, patient was

tepid sponge, patient was served cold drinks, vital signs were checked and ensure ventilation

by opening nearby windows. On the same day (at 12:00pm goal was fully met as patient’s

temperature reduced to 37.0oC).

PATIENT EXPERIENCED REDUCED PAIN

On 20th November, 2022 at 10:30am patient had acute pain at the left lower leg related to

swelling pressing on the nerve endings. An objective was set for patient to have reduced pain

within the next 6 hours The following were the nursing intervention provided; patient was

reassured to allay any fear, quiet and serene environment was ensured, cold compress was

55
applied at the site to reduce the level of pain, prescribe medications were administered and

patient was engaged in diversional therapy such as watching television and listening to music.

Goal was fully met on the same day at 11:00am as patient verbalized reduced pain intensity

PATIENT HAD REDUCED ANXIETY

On 21st November, 2022. Miss S.S.Y had anxiety related to outcome of condition and

unfamiliar environment. A goal was set that patient experienced anxiety within 4hours.The

intervention carried out include patient was, patient was oriented to the ward, encourage

patient to clarify and doubt, allow patient to ask question and provide clear and precise

answers. On the same day goal was fully met as nurse visualized and the patient had a

cheerful face and relating well with the health care team and other patient.

PATIENT HAD REDUCED SWELLING OF THE LEFT LEG

On 21th November, 2022 at 10:300am, patient had fluid volume excess (swollen at the left

lower limb) related to inflammatory process. An objectives was set as patients will

experience reduced swelling within 24hours. The following were the interventions patient

and relatives were reassured, comfortable bed was provided to conserve energy, warm

compresses were applied to the affected site to reduce swelling, the left leg was elevated on a

pillow to enhance venous return and prescribed medications were administered. At 10:30am

on (24nd November, 2022) goals were fully met as patient verbalized the size of swollen had

reduced and nurse observed there was a reduced swelling of the affected leg.

PATIENT MAINTAINED NORMAL NUTRITIONAL STATUS

On the next day (22nd November, 2022) patient was identified with risk of nutritional

imbalance (less than body requirements) related to loss of appetite. The objective was that;

patient will maintain optimal nutritional status throughout the period of hospitalization.

56
Nursing intervention which were provided include; planning diet with patient and family to

make her choice of meal, oral hygiene was performed, nutritious diet was served but was

served in bits and at regular interval, patient was encouraged to eat. On 22 nd November, 2022

at 10:30am goal was fully met as evidence by nurse visualizing patient eating more than half

of meal been served.

PATIENT AND FAMILY GAINED ADEQUATE KNOWLEDGE ON DISEASE

CONDITION

22nd November 2022, patient had knowledge deficit related to inadequate information on

disease condition. An objective was set as patient will have adequate knowledge on her

condition within the next 4hours. Nursing interventions were; patient and relatives were

reassured on all the necessary information about the condition, patient level of knowledge

was assessed, patient was encouraged to ask questions. Goal was fully met at 1:00pm as

nurse observed patient was able to answer simple questions on cellulitis and expressed her

understanding on disease condition.

AMENDMENT OF NURSING CARE PLAN FOR PARTIALLY MET OR UNMET

OUTCOME CRITERIA

Amendment is drawn when a goal set for the nursing care plan is not fully met. The nurse

amends the objective set for the problems which were partially met or not met during the

specified period. With respect of the implementation of the nursing care plan drawn and

rendered to patient during her period of hospitalization all the goals set were fully met and

she recovered therefore no amendment of care was done.

TERMINATION OF CARE

This forms the last aspect of the nursing intervention between the patient, family and the

Nurse. Termination is a difficult process to go through, after a good relationship has been

57
established. For this reason, it was made clear to patient and her family that hospitalization

was temporal at the time of admission to prepare them psychologically for separation.

The interaction with my patient and her family started on 20 th November, 2022 at Goaso

Municipal Hospital and finally ended on the 4 th December, 2022 at 5:14 pm. On admission,

she was informed that our interaction was for a short period and as soon as her health

improved, she would be discharged home and our interaction will continue during home

visits. During the care, three follow ups visits were carried out, and the second visit, it was

made known to them that the third visit would be the last home visit, and that it would be in

the company of the community health nurse, to whom they would be handed over for

continuity of care. Also, during these visits, they were educated on the disease condition, and

other health related issues such as food and nutrition, rest and sleep, and exercise, among

important topics. The family members were also involved in the care, to eventually take over

her care after discharge.

On the 25th November 2022, patient was discharged home and was informed that our daily

interactions have ended but she will be visited at home to continue the care and see how she

is

Consequently, on the third home visit which was on the 4 th December, 2022, patient and

family were handed over to the community health nurse reminded that our official interaction

had come to an end after noticing a significant improvement in his condition. They were

encouraged to come to the hospital if they encountered any problem. They were also assured

that they would be visited unofficially from time to time and also called on phone to check on

them. Finally, they were thanked for their acceptance, co-operation and support during the

period of the care study. They also expressed their gratitude once again for the care and

education.

CHAPTER SIX

58
 SUMMARY AND CONCLUSION

INTRODUCTION

Summary is a brief description about the whole work you did for your client throughout her

stay in the hospital and house as far as care study is concerned.

SUMMARY

Ms. S.S.Y was admitted to the female surgical ward of Goaso Municipal Hospital on 20 th

November, 2022 with history of painful swollen of left lower leg, fever, poor appetite, and

difficult in walking. On examination, she was diagnosed as cellulitis of the left leg

She was treated with the following medications;

1. Intravenous Clindamycin 300mg qid x 7 days

2. Capsule Flucloxacillin 500mg qid x 7 days

3. Tablet paracetamol 1g tid x 5days

The following laboratory investigations were carried out to help aid her diagnosis:

Haemoglobin level estimation,

White blood cell count (WBC),

Fasting blood sugar (FBS)

Blood film for malaria parasite

A holistic nursing care plan was drawn to render care that includes; ensuring bed rest, tepid

sponging, checking and recording of patient vital signs, applying warm and cold compresses

on the affected leg, elevation of the affected leg, administration of prescribe medication,

observing patient for therapeutic and side effects of the medications, coupled with

reassurance of speedy recovery and health education on the condition.

59
Three home visits were made to ensure continuity of care: the first visit was on the 22 nd

November, 2022, the second was on 27 th November, 2022, and the third home visit was on

the 4th December, 2022. Her condition was satisfactory at the end of their hospitalization and

patient and family expressed their joy and gratitude.

CONCLUSION AND RECOMMENDATION

The patient and family care study did not only widen my knowledge on cellulitis. It also

helped me put the knowledge I have acquired for the three years nursing course into practice.

It has also helped me to understand nursing care that have to be given to individual patient for

maximum achievement of health. It has also improved my interpersonal relationship with

patient’s their family members and the community as a whole. I therefore recommend that all

students as part of the requirement as a nurse to be should do the patient/family care study

before the Nursing and Midwifery Council of Ghana award them the certificate of practice as

professional nurses.

Finally, with all knowledge and experience coupled with practical skills gained, I will

recommend that every nursing student should be encouraged to put nursing process into

practice to ensure quality and holistic nursing care. I wish that the nursing process should be

implemented on wider range that is in our various health institutions to aid in taking care of

patient to ensure their recovery and discharge.

60
 APPENDIX

TABLE 2: VITAL SIGNS OF MS. S.S.Y

DATE TIME TEMPERATURE PULSE RESPIRATION BLOOD

PRESSURE

20/11/2022 12:05pm 37.8 78bpm 18cpm 126/70mmHg

6:00pm 70bpm 20cpm 100/60mmHg
37.0
10:50pm
36.2 75bpm 16cpm 120/70mmHg
21/11/2022 6:00am 36.5 82bpm 22cpm 110/70mmHg

10:00am 36.5 72bpm 16cpm 120/80mmHg

2:00pm 37.1 75bpm 24cpm 100/70mmHg

6:00pm 36.9 69bpm 20cpm 110/60mmHg

10:00pm 36.3 70bpm 18cpm 100/60mmHg

22/11/2022 6:00am 36.6 74bpm 20cpm 100/60mmHg

10:00am 37.2 84bpm 18cpm 100/60mmHg

2:00pm 36.1 75bpm 20cpm 100/70mmHg

6:00pm 36.2 79bpm 22cpm 110/60mmHg

10:00pm 36.5 74bpm 18cpm 100/60mmHg

23/11/2022 6:00am 36.3 78bpm 18cpm 110/80mmHg

10:00am 37.2 70bpm 20cpm 110/60mmHg

2:00pm 79bpm 20cpm 110/70mmHg

36.8
73bpm
6:00pm 36.2 22cpm 110/60mmHg
80bpm
10:00pm 36.4 18cpm 100/70mmHg
24/11/2022 6:00am 36.3 74bpm 20cpm 110/70mmHg

10:00am 35.8 80bpm 20cpm 100/60mmHg

12:00pm 36.3 86bpm 18cpm 120/70mmHg

2:00pm 36.0 69bpm 22cpm 110/70mmHg

61
 6:00am 36.3 76bpm 18cpm 100/60mmHg

10:00pm 36.9 72bpm 16cpm 100/50mmHg

25/11/2022 6:00am 36.4 82bpm 22cpm 110/70mmHg

10:00am 36.8 78bpm 20cpm 110/80mmHg

9/12/2022 7:30am 36.7 84bpm 20cpm 110/60mmHg

References

62
 SIGNATORIES

THE PRINCIPAL, PRESBYTERIAN NURSING AND MIDWIFERY TRAINING

COLLEGE, DORMAA AHENKRO

NAME: AGYEMANG PREMPEH CHARLES

RANK: CHIEF HEALTH TUTOR

SIGNATURE………………………………

DATE……………………………………

THE SUPERVISOR, PRESBYTERIAN NURSING AND MIDWIFERY TRAINING

COLLEGE, DORMAA AHENKRO

NAME: MR. I.G. PIILUB

RANK: DEPUTY CHIEF HEALTH TUTOR

SIGNATURE ………………………………

DATE………………………………………

THE NURSE IN-CHARGE OF FEMALE WARD, MUNICIPAL HOSPITAL, GOASO

NAME: MRS. SARAH FORKUO

RANK: STAFF NURSE

SIGNATURE ………………………………….

DATE ……………………………………………

THE STUDENT NURSE

NAME: ABUBAKAR UMAR FAROUK

SIGNATURE …………………………………

DATE …………………………………………

63