PATIENT / FAMILY CARE STUDY

( NURSING PROCESS APPROACH )

OF A PATIENT WITH A DIAGNOSIS OF

DECOMPENSATED HEART FAILURE

AT KORLE BU TEACHING HOSPITAL

WRITTEN BY

TAMATEY BELINDA

OF PENTECOST UNIVERSITY, ACCRA - GHANA

IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE AWARD OF

PROFESSIONAL LICENSE BY THE NURSES AND MIDWIVES COUNCIL OF

GHANA
PREFACE
The Patient/Family Care Study is a detailed written report of nursing care rendered to
a nursing client─an individual and his family within a specific period of time. It
explores nursing care rendered from the time of encounter to termination of nurse-
patient relationship. It gives an in-depth description and explanation of how a
patient’s response to a specified disease condition is diagnosed and given
intervention.
The Patient/Family Care Study involves a record nursing care, documenting the
problems of a nursing client and how they are dealt with by the nurse in the course of
finding solution to the problems. It provides a systematic way of collecting data,
analyzing information, and reporting the results of nursing care.
This Patient/Family Care Study is based on the concept of holistic care, taking into
account all factors impinging on the health of the individual. It includes a study of the
interaction between the patient, the family, the community and the health team. It is
done using the nursing process approach.
This care study is carried out in partial fulfillment of requirement for the award of
professional license by the nurses and midwives council of Ghana. It is an integral
part of the curriculum for educating nursing students hence a prerequisite for
completing the nursing course.
Care study offers the nursing student the opportunity to combine classroom academic
work with clinical study of the practices of the nursing profession. It encourages
learning by doing, the development of analytical and decision-making skills as well as
reporting skills. Being based on the nursing process, the students become familiar
with the use of the nursing process as a basis for practice thereby encouraging
evidence based nursing care.
ACKNOWLDGEMENT
All praise and thanks be to God, the Father of Mercy who has given me the
enablement in spite of all challenges to commence and conclude this care study
successfully.
My warmest gratitude is reserved for Mr. AA.O, my care study patient. Without his
consent to be studied, this care study would never have materialised. Not forgetting
his relatives, his wife and children for his affable cooperation and support throughout
the period of the study.
Exceptional thanks go to the Matron and nursing staff of Korle-Bu Medical ward
Four’. They ensured continuity of care for my patient and gave me support and
morale for this care study. The supporting staff and colleague students whom I
worked with on ward have not been forgotten for diverse manners of help.
Thanks go to my supervising tutor Mrs. Mercy Sagoe Her persistent guidance has
ensured the successful completion of this study.
And to my parents, Mr.& Mrs. Abledu Tamatey and my siblings who have ensured
my coming this far, I can’t thank you enough. You taught me that, by mustering the
force of inner will and determination, I can convert challenges into achievements.
Finally, I acknowledge and thank all authors and publishers whose works have been
used as references in this care study. Gracias!
 INTRODUCTION
“The unique function of the nurse is to assist the individual sick or well in the
performance of those activities contributing to health or its recovery (or to peaceful
death) that he would perform unaided if he had the necessary strength, knowledge or
will, and to do so in such a way as to help him regain independence as quickly as
possible”(Virginia Henderson, 1966).
The rationale behind a care study is to assist a patient to regain health (or peaceful
death) and present a report of that assistance giving account of problems that were
identified and how solutions were worked out from a nursing process perspective.
Presented in this care study is a report of nursing care rendered to Mr. A.A.O who
was diagnosed of Decompensated heart failure. He was admitted to the emergency
and later transfer to Medical ward of the Korle-Bu Teaching Hospital and stayed on
the ward for six days.
At the beginning of the morning shift, on Thursday 27th June, 20204, Mr.A.A.O
arrived on the ward on a wheel chair accompanied by his wife , dougher and a student
nurse from Surgical Medical Emergency (SME) Unit where he had already been
detained for about 5hours. He was in pain conscious with a persistent non-productive
cough. Happening to be at the nurse’s station with the sister in charge at the time of
his arrival, I was subsequently charged with the responsibility to carry out his
admission to the ward. Thus began my therapeutic relationship with the patient that
has resulted in this care study. Nursing care spanned about six days from the time of
admission to the ward till discharge on 2nd July. His condition at the time of
discharge was satisfactory. Interaction with Mr. A.A.O and his family continued after
discharge with home visit and regular phone communication, whatsapp video calls till
nurse-patient relationship was terminated finally on 26th July, 2023.
This care study report has been organized into five chapters in line with the five
phases of the nursing process. Chapter one deals with assessment of Mr. A A O and
his family. This involves collection of data about the patient to identify his problems.
Data collected for assessment includes biographical data, developmental, past and
present medical history, the family’s medical and socioeconomic history as well as
the patient’s lifestyle and hobbies. An account is also made of the admission of the
patient. Literature review on Decompensated heart failure as well as validation of data
is also discussed.
Chapter two deals with analysis of data. A comparison is made between the signs and
symptoms experienced by the patient and those obtained in literature review.
Diagnostic investigations, clinical manifestations and pharmacology of drugs are
analysed in tabular form. Causes of illness, treatment and complications are also
discussed. Data is analyzed to arrive at appropriate nursing diagnosis reflecting the
patient’s response to actual or potential health problems.
Chapter three comprises the planning phase of the nursing process and has the
tabulated plan of care for the stated nursing diagnoses spanning the objective criteria,
nursing orders, intervention and evaluation.
Chapter four tackles the actual implementation of the care plan giving summary
descriptions of activities which were undertaken from the moment of first contact
with the patient at the time of admission to the ward till discharge and subsequent
follow up with home visit.
In chapter five, evaluation of nursing care given to the patient and his family from
encounter till termination of nurse-patient relationship is discussed. A summary and
conclusion then ends this care study report by reviewing thematic issues that arose in
the care study from admission to last home visit after discharge
 CHAPTER ONE

1.0 ASSESSMENT OF PATIENT AND FAMILY

Nursing assessment begins the nursing process with appraisal of the health status of
the patient. Through observation, questioning and examination, data about the patient
and his family is gathered and analyzed. This chapter documents pertinent data
obtained during interaction with Mr A.A.O and his family at the assessment phase of
the nursing process. It entails biographical data, developmental, past and present
medical history, the family’s medical and socioeconomic history as well as the
patient’s lifestyle. Literature review on gastroenteritis and pneumonia as well as
validation of the data obtained is also discussed.

1.1 PATIENT’S PARTICULARS

Mr A.A.O is a 75 years old man, born on 4th march, 1949. He is a Ghanaian and Akan
from Kwahu in the eastern region of Ghana but currently resides at weija in the grater
Accra rejoin of Ghana with his wife and two granchildren, He got married to Mrs
J.M and they are bless with five children four girls and one boy. He is a Christian and
fellowship at Catholic church at weija

.
1..2 FAMILY MEDICAL/SOCIO-ECONOMIC HISTORY
Mr. A.A.O. revealed that , there is no known history of diseases such as sickle cell
disease, hypertension, asthma . and there has not been any reported case of
communicable disease such as leprosy, tuberculosis etc,. Mr. A.A.O made mention of
minor ailment like common cold, headaches fever and malarial of which he seek
medical attention. They has good health seeking behavior.

1.3 PATIENT’S DEVELOPMENTAL HISTORY Mr. A.A.O comes from a family of

eight (8) children of the same parent .He is the fourth child of his parent He grew up
with his Auntie. He says he has been staying with his Auntie right from birth. He was
therefore weaned much earlier than usual. His immunization schedule was duly
completed and he grew up without any deformities.

1.4 PATIENT’S LIFESTYLE / HOBBIES

Mr.A.A.O wake up early in the morning, brush his teeth and do his morning devotion
with his wife, he leaves home around 7:30am and go to his wife's store and open it
and start selling before his wife will join him at the shop.But then the wife have
already prepared their grandchildren to go to school .He normally like reading news
papers and listen to radio to know the current issues in the country .He also like taking
note whenever he watches movie .On weekends, Saturday, he wake up early in the
morning and walk in his bare foot to exercise his feet and body, after that he take up
his bath and do his morning devotion alone , on Sunday, he prepare and go to church
with his wife and their grandchildren to worship God , because of traffic they live
home very early to avoid lateness. He says he don’t take in any alcoholic drink. He
likes taken in fruit juice prepared by his wife, he likes fufu and palm nut soap

1.5 PAST MEDICAL HISTORY

According to Mr A.A.O, he has been admitted to hospital several time which occurred
in last year and 4years ago. He normally diagnosed of malaria, severe headache and
sometimes general body and joint pain. He spent less than a week on admission. He is
not on any prescribed medication. He treated himself for cough about a 3days ago
with “multi action dry cough” and “paracetamol”. He gets it form his personal Doctor
for the family. He has no known allergies

1.6 PRESENT MEDICAL HISTORY

Mr. O.O.A was on his usual state of health until 4days ago prior to presentation when
developed a sudden onset of shortness of breath with was worse when he lied flat
especially at night. It was initially assertion then progress to dyspnoea at rest, he was
also associated with an intermittent cough and was productivity of clear non bloody
sputum, palpitation and fatigue but no fever, chills, chest pain or vomiting. He
reported to Weija Gkawe hospital where his personal Doctor is, and they diagnose
him of Compensated heart failure secondary to Anemia. He developed a return of
shortness of bread a day ago where he was rushed to emergency unit of Korle BU.

1.7 ADMISSION OF PATIENT

The client arrived on the emergency ward on 27th June 2024 at 7:45pm, on a stretcher
accompanied by his wife and their last born, being admitted for Dr. Apadu through
Surgical Medical Emergency (SME) unit of Korle-Bu Teaching Hospital with
diagnosis of Decompensated heart failure. During his detention at the Surgical
Medical Emergency. He was feeling difficulty in breathing and join pain. but fully
conscious with a persistent non-productive cough.
He arrived on the medical ward on 28th June 2024 at 10am on a wheeled accompanied
and a student nurse, he was admitted by Dr. Richard Kwabena Boateng through the
emergency unit of Korle Bu where he was diagnosed of decompensated heart failure
with a history difficulty in breathing in 4years ago. He was in pain and weak but fully
conscious with persistent non cough.
The patient’s identity was verified by mentioning his name for response. He was then
welcome and immediately admitted and made comfortable in a simple bed with head
end of the bed raised about 35 degrees to relieve difficulty in breathing. Vital signs
were then checked and recorded: Temperature: 36.2 degree Celsius, Pulse: 84beats
per minute, Respiration: 24cycles per minutes and Blood Pressure: 119/81mmhg,
SPo2 95%. Plan of treatment was to undertake series of investigations including Chest
X-Ray, FBC, urine test. Patient was to be kept on IV Furosemid 40mg 12hly,
Rivaroxaban 20mg daily, Bisoprolol 2.5mg daily, Amlodipine 10mg daily, 1L N/S in
24hrs (500mls N/S in 12hrs).
The patient’s name was entered into the admission and discharge book as well as the
daily ward state. He was told where the washroom could be located. Later the client’s
informed consent to be the patient for this care study was requested. How the project
would be done from commencement to termination including home visits was
explained to which he agreed.
1.8 PATIENT’S CONCEPT OF ILLNESS
According to patient, he does not know the cause of his illness but he believes that it
is an ailment which has no connection with witchcraft. However, his expectation was
that, he will feel healthy very soon with the good medical treatment and nursing
management.

1.9 LITERATURE REVIEW ON DISEASES

This section deals with documented information about the conditions Mr. A.A.O was
diagnosed with Decompensated heart failure.

1.9.1 DECOMPENSATED HEART FAILURE

Decompensated heart failure (DHF) is defined as a clinical syndrome in which a
structural or functional change in the heart leads to its inability to eject and/or
accommodate blood within physiological pressure levels, thus causing a functional
limitation and requiring immediate therapeutic intervention.

INCIDENCE
The incidence of decompensated heart failure in Ghana is reflecting in a study
conducted at korle-bu teaching hospital which found that heart failure accounted for
about 8percent of all admission the study also showed that hypertension was the most
common risk factor for heart failure, excessive alcohol use and family history of heart
disease.
Globally, heart failure is recognized as a public health crisis associated with high
morbidity and mortality. in 2013, cardiovascular disease led to 17.3 million deaths
worldwide however i couldn’t the exact incidence of decompensated heart failure
globally

EPIDEMIOLOGY
HF has a high incidence and prevalence worldwide. One to two percent of the
population of developed countries are estimated to have HF, and this prevalence
increases to 10% in the population 70 years of age or over. In Europe, 10 million
people are estimated to have HF with associated ventricular dysfunction, and other 10
million, to have HF with preserved ejection fraction (HFPEF). Brazilian 2012 data
demonstrated that 21.5% of 1,137,572 hospitalizations for diseases of the circulatory
system were for HF, with a 9.5% in-hospital mortality, and 70% of the cases in the
age range above 60 years Costs with hospitalizations for decompensation reach
approximately 60% of the total expenditures with the treatment of HF. Mortality rate
among patients discharged within 90 days is of approximately 10%, with roughly
25% of readmissions in the period. Ischemic cardiomyopathy is considered the most
common cause of HF.

PATHOPHYSIOLOGY

In 75% of cases, acute decompensation occurs in a patient with known chronic heart
failure; 25% have new-onset heart failure. Of importance, more than one-third of
patients experiencing acute decompensated heart failure will have preserved systolic
function, and the outcomes of patients with preserved systolic function seem to be
similar to those with decreased systolic function. Interesting data from a prospective
trial of patients with known heart failure are available from the Randomized
Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) pilot study.
This trial recruited 768 patients with congestive heart failure and an ejection fraction
of less than 40%. They were randomly assigned to receive either an angiotensin-
converting enzyme inhibitor or an angiotensin receptor blocker, or a combination of
both, for 17 weeks followed by randomization to a beta-blocker or placebo for 26
weeks. During a 43-week period, 180 patients experienced 323 episodes of worsening
heart failure, with 143 patients requiring hospitalization. Factors implicated in the
deterioration included noncompliance with salt and water restriction (22%),
noncardiac causes (mostly related to pulmonary infections) (20%), medication
adjustments (15%), use of an antiarrhythmic agent within two days (15%) and
arrhythmia (13%). These patients were thought to be clinically stable and under close
surveillance by investigators highly trained in managing patients with heart failure.
This set of data provides insight into the frequent confounding factors leading to a
hospitalization and the difficulty in preventing deterioration even with close follow-
up.

Apart from intercurrent problems, progressive heart failure can also lead to
deterioration and hospitalization. This usually involves deterioration in the New York
Heart Association functional class, decreasing ejection fraction and a reduction in
exercise capacity. This process leads to recurrent hospitalizations and death by
progressive heart failure or ventricular arrhythmia.

Heart failure is a multisystem syndrome characterized by abnormalities in cardiac and

skeletal muscle and renal function, stimulation of the sympathetic nervous system and
a complex pattern of neurohormonal changes. The deterioration in heart failure is not
only associated with hemodynamic changes such as increased right and left
ventricular filling pressures and reduced cardiac output, but are also associated with
increases in inflammatory cytokines such as tumor necrosis factor-alpha and
interleukin (IL)-1beta, IL-6, IL-18; and inflammatory chemokines such as monocyte
chemoattractant peptide-1, IL-8 and macrophage inflammatory protein-1 alpha. Thus,
therapies should target not only improvement in hemodynamic alterations, but also
have beneficial effects on the pathophysiological processes that contribute to the acute
hemodynamic decompensation and progression of heart failure.

CLINICAL MANIFESTATIONS

One of the main symptoms of decompensated heart failure is dyspnea, the medical
term for shortness of breath. Wheezing, edema, and coughing at night may also
appear. A 2017 review suggests that people with acute decompensated heart failure
usually have congestion and fluid retention symptoms, such as: weight gain shortness
of breath during exercise orthopnea, which is shortness of breath while lying down
that subsides in other positions dependent edema, where fluid pools in the lower parts
of the body. The review explain that acute heart failure can be life threatening and
requires immediate treatment as it can lead to fluid overload. According to
the National Heart, Lung, and Blood Institute (NHLBI), heart failure can cause health
problems such as: fluid buildup in the lungs kidney and liver damage an irregular
heartbeat a leaky heart valve sudden cardiac arrest

INVESTIGATIONS FOR MEDICAL DIAGNOSIS

Although the diagnosis of DHF is made based on data from history and physical
examination, diagnostic studies are important because, in addition to confirming the
diagnosis, they also provide data on the degree of cardiac remodeling, the presence of
systolic and/or diastolic dysfunction, etiology, cause of decompensation, presence of
comorbidities, and risk stratification (Figure 2). Among the diagnostic studies
available, the following are specially helpful.

Electrocardiography

Fundamental in the management of ACS. Some findings may suggest specific

etiologies: the presence of Q waves, absence of R wave progression in precordial
leads and repolarization abnormalities, especially of the ST-segment, suggest an
ischemic component; the association of right bundle branch block with left anterior
superior division block suggests Chagas disease; low voltage in the frontal plane
suggests storage disease and pericardial effusion. The presence of left bundle branch
block may correspond to acute myocardial infarction or pronounced myocardial
remodeling, thus characterizing a poor prognosis. Bradyarrhythmias and
tachyarrhythmias may be the cause of DHF, and have therapeutic and prognostic
implications.

Laboratory tests

Blood count, BUN, creatinine, blood glucose, electrolytes, and urinalysis are simple
methods that help define comorbidities, the cause of decompensation, prognosis and
treatment. When ACS is suspected, myocardial necrosis markers are important for the
diagnosis; also, increased levels in the absence of obstructive coronary disease have a
prognostic value. Arterial blood gases, central venous blood gases, lactate, and tests to
check liver integrity and function should be performed in more severely ill patients.
Thyroid profile and serologic test for Chagas disease may be considered.

Biomarkers

Biomarkers are useful in the diagnosis and prognosis of DHF. Among the several
biomarkers that have been studied, natriuretic peptides, BNP and NT-ProBNP are the
most widely used and well established in the clinical practice. They are produced
mainly in the ventricles, in response to increased ventricular wall tension.
Determination of their levels is indicated for the differential diagnosis of dyspnea in
the emergency room. Increased levels are found in systolic dysfunction and in HFPEF
(greater levels in systolic dysfunction). They have prognostic value and have been
considered markers of response to the treatment of DHF, despite controversial
findings. Recently, a Brazilian study demonstrated a diagnostic and prognostic impact
of exhaled acetone in DHF.

Echocardiography
This is the main noninvasive method for the diagnosis of HF. In patients with DHF, it
is indicated to help find the etiology and establish the prognosis, in addition to give
information on the type of dysfunction (systolic and/or diastolic), chambers affected,
heart valve lesions, segmental contractility abnormalities and pericardium. In DHF, it
may show the progression of dysfunction and the cause of decompensation
(pericardial effusion, pulmonary embolism, and acute ischemia). It also may be used
for the definition of the hemodynamic profile and to guide therapy (hemodynamic
echo).

Pulmonary artery catheter

It permits the direct analysis of intracardiac and intravascular pressures, as well as of

microhemodynamics parameters. It is indicated to help treat patients with DHF,
especially in the presence of shock and for the assessment of the pulmonary vascular
resistance, to indicate cardiac transplantation. The ESCAPE study did not show
benefit of the use of a pulmonary artery catheter in the treatment of DHF without
cardiogenic shock.

TREATMENT / MANAGEMENT

The initial objective of the treatment of DHF is to achieve hemodynamic and

symptomatic improvement. In addition, other targets should be sought, including the
preservation and/or improvement of the renal function, prevention of myocardial
damage, modulation of the neurohormonal and/or inflammatory activation, and
management of comorbidities that could cause or contribute to the progression of the
syndrome. Based on the hemodynamic profiles proposed by Stevenson, on the
assessment of volemia, on the definition of the time of onset of symptoms, on the
cause of decompensation, and on the SBP, it is possible to establish a rationale for the
treatment of DHF (Figure 3).
CLINICAL TREATMENT
Non-pharmacological measures
Despite limited evidence, water and sodium restriction should be used in a customized
fashion, and the daily weight should be used as a parameter of response to treatment.

Monitoring and ventilatory support

Patients presenting with any sign of instability should be monitored by continuous
electrocardiogram (ECG), noninvasive blood pressure and oximetry. Regardless of
the form of presentation, hypoxia should be corrected in an attempt to ensure adequate
oxygenation and reduce the respiratory work. Noninvasive ventilation (CPAP or
BiPAP) resulted in a reduction of intubations and mortality, especially in acute
pulmonary edema.

Vasodilators
Vasodilators act on the preload and afterload, requiring less myocardial consumptions
than inotropic drugs. Retrospective studies have demonstrated lower mortality in DHF
with the use of vasodilators(23,24). They are indicated in situations of pulmonary and
systemic congestion (profiles B and C) and in individuals with poor peripheral
perfusion and SBP>90mmHg (profile C). The use of these agents requires intensive
SBP monitoring and dose titration. In profile B patients who are asymptomatic at rest
and with SBP>120mmHg, it is possible to use oral vasodilators and diuretics.
Intravenous vasodilators should be used in patients with dyspnea at rest, and in acute
pulmonary edema. These drugs should be avoided in patients with hypotension
(SBP<90mmHg), hypovolemia and recent use of phosphodiesterase-5 inhibitors
(sildenafil, vardenafil and tadalafil).

Nitroglycerin
Nitroglycerin is a short-acting intravenous vasodilator. Small doses (30 to 40μg/min)
induce vasodilatation, whereas higher doses (250μg/min) cause arteriolar dilatation.
Its benefits derive from venous dilatation, with relief in pulmonary congestion and
increase in coronary flow, thus justifying its use in DHF associated with ACS.
Headache and nausea are common side effects
.

Sodium nitroprusside
A potent arterial and venous vasodilator, sodium nitroprusside reduces the preload
and afterload, thus improving the biventricular systolic performance. The usual dose
is 0.5 to 10μg/kg/min. It should be avoided in ACS because of the risk of decreasing
the coronary perfusion pressure and “coronary steal”. Arterial hypotension is the most
common side effect and may lead to hypoperfusion and worsening of the renal
function. Sudden discontinuation may cause a rebound effect. Thus, gradual
withdrawal is advised, with the use of oral vasodilators. When high doses are used for
a long period, especially in patients with renal and/or hepatic dysfunction, there is a
risk of intoxication by thiocyanate and cyanide. Inotropic agents.
In patients with low cardiac output, with or without congestion (profiles L and C),
inotropic therapy may be required to improve tissue perfusion. Although these drugs
have been effectively used to increase perfusion and cardiac output, these
hemodynamic parameters are not associated with better outcomes in patients with HF.
They are associated with ischemia, and the intermittent use is not recommended.
These agents are appropriate for short-term therapy in patients with hemodynamic
deterioration, patients with chronic HF, increased levels of nitrogenous waste, and
those who did not achieve satisfactory diuresis with diuretics and vasodilators. They
are also efficient in the hemodynamic support of patients awaiting cardiac
transplantation or revascularization, and may save lives in situations of cardiogenic
shock. These drugs are not indicated in patients with HFPEF. Dobutamine
Dobutamine is a beta-adrenergic agonist. It stimulates beta-adrenergic receptors 1 and
2, thus promoting elevation of adenyl cyclase and the subsequent increase in the
intracellular calcium concentration, resulting in inotropism and chronotropism.
Its most common adverse effects are ischemia and arrhythmias, because of increased
oxygen consumption. Despite data suggesting increased mortality, dobutamine is the
most widely used inotropic agent (27). It provides hemodynamic improvement, with a
dose-dependent increase in the cardiac output, and usually does not cause
hypotension. It should be restricted to patients with DHF in profiles C and L, at a dose
of 3 to 20μg/kg/min. In hypotensive patients (SBP<70mmHg), combination with a
vasopressor (dopamine or norepinephrine) may be considered. Milrinone
Milrinone is a phosphodiesterase-III inhibitor, it increases cardiac contractility and
produce arterial and venous dilation by means of the increase in intracellular
concentrations of cyclic AMP and calcium. It promotes an increase in cardiac output
and reduction in the pulmonary and systemic vascular resistance.
A study has demonstrated increased mortality, especially in the ischemic etiology
(28). Because its mechanism of action does not depend on the adrenergic system,
milrinone may be an option for patients using betablockers (aiming at maintaining
them). Among its side effects, we should point out its arrhythmogenic potential (atrial
and/or ventricular). The recommended dose ranges from 0.3 to 0.75μg/kg/min. Due to
the risk of hypotension, the loading dose is not recommended. In patients with renal
failure, dose should be adjusted.

COMPLICATIONS
Decompensated heart failure can lead to sever complications, include

1. Cardiac arrest; sudden loss of cardiac function

2. Respiratory failure; inadequate oxygenation and carbon dioxide removal

3. Renal failure; impaired kidney function due to reduced blood flow

4. Hepatic congestion; liver damage from fluid buildup

5. Hypotension dangerously low blood pressure

6. Pulmonary edema ; fluid accumulation in lungs

1.10 VALIDATION OF DATA
Information utilised in rendering care to the patient as reported in this care study has
been gathered is from well informed sources and efforts were made to ensure that they
are accurate and valid. Subjective data was taken from the patient himself while
objective data is obtained from significant others (the patient relatives) and various
tests to identify the patient’s problems and their sources. Data about the plan and
progress of treatment as instituted by the physician team was collected from the
patient’s folder, as well as from direct discussion with them.
Literature reviews on the conditions were obtained from textbooks. Others were
obtained through my own observation and questioning and examination of the patient.
 CASE STUDY CHAPTER TWO
2.0. The next phase of nursing process, is the analysis phase.Data is a collection
of facts (Weller, 2014). Data analysis is the second phase of the five step nursing
process. Data gathered in the assessment phase of the nursing process needs to be
analysed to enable the nurse to diagnose the presence of potential and actual
health problems of the patient and how he responds to them. This chapter tackles
comparison of the data collected about the patient with standard, exploration of
the strength and weaknesses of the patient and his family as well as patient’s
health problems. It ends with statement of nursing diagnosis for problems
identified.

2.1 COMPARISON OF DATA WITH STANDARD

Appropriate comparison is made between actual experiences of the patient and
standard documented evidence to identify deviations. This includes the investigations
requested by physicians for medical diagnosis; causes of the patient’s illness, clinical
manifestations of the patient’s condition as well as pharmacological and non-
pharmacological management ordered.

2.2 DIAGNOSTIC INVESTIGATION

This information is on series of investigations requested by physicians to diagnose
MR. A.A.O condition included urine FBC and Renal test, Urine test and Chest X-
RAY. A detailed account of the diagnostic investigations and test has been outlined in
table of diagnostic investigations (table 1 and table 2) on the next page.

TABLE I: DIAGNOSTIC INVESTIGATIONS

 SPECIMEN INVESTIGA RESULT NOMALITY INTERPRET
DATE TION ATION

28/06/2024 BLOOD WBC 6.79*10^9/L 2.5-8.5*10^9/L Normal count

3.86*10^12/L
BLOOD RBC 4.24-6.32*10^12/L No anaemia
9.6g/dl present
BLOOD HB 11.0-18.0g/dl
136*10^9/L
BLOOD PLATELET 132-340*10^9/L Patient have
low HB level

Normal
platelet count

Blood SODUIM 175mmol/L 135-150 Normal renal

POTASIUM 7.3mmol/L 3.5-5.5 function
BUN 40.9mg/L 9-20
UREA 14.6mmol/L 2.0-7.0
329umol/L 71-133
CREATINE

2.3 CAUSES OF PATIENT ILLNESS

From the result of the diagnostic investigations, presenting signs and symptoms and
history as well as literature review, the doctor deduced that , MR. A.A.O had
Decompensated heart failure. Decompensated heart failure is when the heart is unable
to pump enough blood to meet the body’s need, leading to a collection of fluid in the
lungs, liver and other organs. Factors that can contribute to MR. A.A.O condition
include high blood pressure, fluid overload, Anaemia etc.

2.4 CLINICAL FEATURES

MR. A.A.O complained of difficulty in breathing, chest pain. Which is typical sign
and symptoms of Decompensated heart failure.Details of the manifestations of
Decompensated heart failure exhibited by MR. A.A.O are compared with those from
literature review in the table below.

Table III
Table III: Comparison of Clinical Features Clinical features presented by MR. A.O.A.
Exhibited by patient with that of Textbook
Documented clinical features from text books

1.Joint pain 1. Patient experienced joint pain

2. Difficulty in breathing 2. Patient experienced difficulty in breathing

3. Anxiety 3. Patient experienced anxiety

4.less knowledge on the condition 4. Patient has less knowledge on the

condition

Comment: From the clinical manifestations listed above in table 3, patient

experienced all of the signs and symptoms listed in the literature review.

2.5 MANAGEMENT
Management of Mr. A.A.O comprised of medical and nursing care. Medical
management was undertaken with the following medications:
7. Iv furosemide 40mg 12hrly

8. Iv 10% calcium gluconate 10mls 6hrly

c) Nebulize with 5mg salbutamol 6hrly

d) Sc soluble insulin 5iu + 50mls of 50% dextrose 6 hrly
e) Suspend Tab linsinopril and soironolactone
 f) oral flusemide 40md daily
g) Isosobide 10mg 12hrly
h) Amlodipine 10mg daily
i) Bisoprolol 2.5mg daily
j) Rivaroxaban 20mg daily
Nursing care :
Patient was mainly cooperative with the medical team in the care and management of
his condition ,and was encouraged to sleep in a semi Fowler's position to reduce
difficult in breathing, the bed was elevated to 30decree and pillows was used to
support both sides of the bed to make him comfortable in bed

2.6 PHARMACOLOGY OF DRUGS

The patient was in initially managed on parenteral medications from the day of
detention at the Emergency unit. His injections were later changed to oral tablets
when he was admitted to the ward as outlined in Table IV on the next page.
Date Drugs Dosag Classificatio Desired Actual effect Side effect
e and n effect of drug observed
rout of
admini
stratio
n
Iv furosemide 40mg Loop IV Increase urine Swelling,
27/06/2 12hrly diuretics furosemide is production shortness of
4 indicated as breath and
adjunctive high blood
acute pressure
Iv 10% pulmonary As mineral
calcium edema supplement
28/06/2 gluconate 10mls Minerals and and
4 6hrly electrolyte Treatment of medication Skin rushes,
low blood when there is hives,
calcium insufficient swelling,
calcium in the irregular,
10mg Nitrate class
 Isosobid 12hrly of diet heartbeat
28/06/2 drug(vasodil Relax the
4 ation) Treatment of blood vessels Blurred
angina and increasing vision,Heada
10mg pectoris supply of the che,heart
Daily blood and arrhythmia
Amlodipine Calcium oxygen to the dizziness
29/06/2 channel heart
4 blockers Affect the
Low blood movement of Dizziness,
2.5mg pressure by calcium into fatigue, extra
Bisoprolol daily relaxing the cellof the heartbeat
29/06/2 2.5mg daily Selective blood vessels of the heart
4 beta blockers and blood
Alone or vessels Headache
others Relaxing dizziness,
20mg medication to blood vessels constipation
daily treat high BP and slowing
Rivaroxaban Factor heart rate to
30/06/2 Xainhibitor improve and
4 decrease bp Dark urine,
Treatment of dizziness,he
blood Lower the risk mopysis
pressure of heart attack

2.7 PATIENT’S AND FAMILY HEALTH PROBLEM

Patient's and family health problems are conditions that hindered the patient health.
These include both actual and potential ones and it was solved by involving the
patient and family.
The outline health problems recorded were following:
1. Patient complains of joint pain
2. Patient has difficulty in breathing
3. Patient is anxious due to unknown outcome of the condition
4 Patient and family has inadequate knowledge on the condition
2.8 PATIENT / FAMILY STRENGTH
Patient and Family strengths are those abilities they exhibit which are favorable for
specific nursing interventions. Nursing interventions are built on the patient and
family strengths.
The following strength were noticed in patient and his family,
1.Patient can verbalize the site and the intensity of pain
2.Patient can tolerate oxygen therapy
3.Patient can verbalize the cause of anxiety
4.Patient was willing to learn about the condition and its clinical manifestations.

2.10 NURSING DIAGNOSES

1. Impaired body comfort (joint pain) related to inflammatory process
2.. Ineffective breathing patterns related to accumulated fluid in the lungs
3. Anxiety related to unknown outcome of condition
4. Deficit knowledge related to inadequate information on the cause, treatment and
prevention of the condition
 CHAPTER THREE
3.0 PLANNING FOR PATIENT AND FAMILY CARE
Planning is the process in which the nurse and the patient together consider the goals
to achieve in meeting the patient’s potential problems in daily life and produce an
individual care plan (Weller B, 2014). In the five step nursing process, planning is the
third phase. It is the category of nursing behaviors in which strategies are designed to
achieve the goals of care. Planning involves developing and modifying a care plan for
the patient. To design the care plan, the nurse anticipates the patient’s needs according
to established priorities and involves the patient, his family and significant others to
decide on outcome criteria to be achieved at the end of a specified period of time.
Outlined in this chapter are the objective or outcome criteria for the care MR. A.A.O.
Followed by his nursing care plan table.

3.1 OBJECTIVE / OUTCOME CRITERIA

These objectives were made in relation to their corresponding nursing diagnosis:
1. Patient will be relieved of joint pain within 24hrs as evidenced by
a. Patient verbalizing absence of pain
b. Nurse observing patient with relaxed facial expression of patient

2. Patient will be able to breathe normal within an hour as evidence by

a. Patient verbalizing that he can now breathe well
b. Nurse observing patient chest rise and fall normal rhymes

3. Patient will be able to feel comfortable at the ward as evidence by

1. Patient verbalizing he is now comfortable in the ward
2. Nurse observing that patient is playing games on his phone after his
prescribed was medication served
4. Patient and his relatives will have adequate knowledge about disease condition by
the time of discharge as evidenced by:

a. Patient and his wife verbalizing that they understand the actual cause of the
condition
b. Nurse observing that patient and his wife being able to answer simple question
correctly about the disease condition

Date/ Nursing Outcome Nursing orders Nursing Evaluation

Time diagnosis criteria/objectiv intervention
es
27/06/24 Acute pain Patient will be 1. Assess the level of 1. Patient’s Goal fully
at (Arthritis) relieved of pain pain by using the pain level of pain met as
5:55 pm related within 4hours scale. was assess patient
joint pain as evidenced verbalizing
by; 2. Monitor and record 2.vital sign was that he has
vital sign cheeked and been
The patient recorded relieved of
verbalizing pain
absence of pain
3. Put patient in a 3. patient was
The nurse comfortable positions put in a
observing comfortable
patient with a position
relaxed facial
expression.
4. Serve 4. Prescribed
Prescribed medications medication was
(Analgesics) served
(Analgesics)
Date/ Nursing Outcome Nursing orders Nursing Evaluation
time diagnosis criteria/object intervention
ives
27/06/24 Ineffective Patient will 1. Monitor breathing 1. Breath patterns Goals was
at breathing be to breath patterns was monitored fully as
5:55 pm patterns normal within evidenced
related to an hour as 2. Pop up patient in 2. patient bed was by patient
accumulate evidence by bed at an angle of pop up at an angle verbalizing
d fluid in 1. patient 30decree of 30decree that he can
the lungs verbalizing he can breath
can breath 3. Patient was well.
well now assisted in the use
3. assist patient in the of relaxation
2. nurse use of relaxation technique
Patient technique
observing 4.prescribed
patient chest 4. Administer medication was
rise and fall prescribed medication served
normal
rhythms
DATE DIAGNO NURSING NURSING NURSING EVALUATIO
SIS OBJECTIVES ORDERS INTERVENTION

27/6/24 Anxiety Patient will 1. reassure patient 1. Patient was Goal fully me
At 8pm related to allayed from reassured evidenced by
unknown anxiety within 2. assess patient 2. Patient level of patient verbal
outcome 24hours as level of anxiety anxiety was assessed that he has be
of evidence by relieved of
condition. 2. Allow patient Patient was allow anxiousness
1.The patient to ask questions ask questions and
verbalizing that and providers providers
he feel okay at appropriate appropriate answers
the ward. answers with with simple terms
simple terms
2.The nurse
observing that
patient is calm 4. patient’s wife 4. patient’s wife was
and relaxed and is encouraged to encouraged to stay
interacting stay with patient. with patient.
freely with
relative .

28/06/ 4.Knowle At the end of 1.Assess 1. Patient and his

02/07/2024 dge deficit educating knowledge about wife’s knowledge on
(family) patient and condition the condition was
related to relative on the assessed
unfamiliar condition, they
ity with will get to know 2.Educate patient 2. patient and his Goal fully me
informatio about the and family about wife knowledge on evidence by p
n about condition, disease process were educated on verbalizing th
disease causes, risk and treatments priapism has now unde
process factors and first -Causes, risk factors, the causes an
and aid management signs and symptoms treatment of t
treatment of the condition -first aid condition
as evidence by management of
1.The patient priapism
verbalizing that
he has now
understand 3.Ask patient and 3. Patient and his
everything about his simple wife were asked
the condition. questions about about causes,
the disease management and
2.The nurse conditions after prevention of
Observing educating them priapism
that patient and
his wife being
able to answer
simple question
correctly about
the disease
condition

CHAPTER FOUR
4.0 IMPLEMENTATION OF PATIENT AND FAMILY CARE PLAN
Implementation of patient and family care is the fourth phase of the nursing process
that follows the formulation of the nursing care plan. This is the stage where the
summary of actual nursing care given to Mr. A, A.O throughout the period of his stay
on the ward is discussed. Preparation for his discharge as well as home visit for
identification of factors that affect their health is also discussed.

4.1 SUMMARY OF ACTUAL NURSING CARE

Mr. A.A.O was admitted to the medical ward of the korle bu teaching hospital from
Friday 27th June 2024 till Tuesday 2nd July 2024 . Where I encountered him together
with his wife and daughter during the ward admission Nursing process care
subsequently continued till the following Tuesday when he was discharged home

DAY OF ADMISSION: 27TH JUNE

Mr A.A.O was admitted to the ward at about 10:27 am by Dr. Richmond Kwabena
Boateng with the diagnosis of Decompensated heat failure. He wheeled into the ward
in a wheel chair in a state of dyspnea and chest pain and also with peripheral canunula
in situ .Mr. A.A.O identity was verified by mentioning his name for response, I
welcome them to the ward and make them comfortably seated. The patient was
reassured that he was in the hands of a competent health team and that the necessary
measures will be put in place to relieve him of his sickness. Mr. A.A.O was then
immediately made comfortable in an already made simple bed, he was propped up in
the bed at an angel of 30 decrees semi Fowler's position to maximize lungs expansion
and relieved difficulty breathing, and vital signs were checked and recorded as
follows T-36.2 P-84, R-24 spo2-92 Bp119/81. Patient name and other particular were
entered into the admission and discharges book and the other patient documentation
sheets His wife was helped to arranged his toiletries in the patient cupboard , patient
and his wife were orientation to ward I further told him about my intentions of using
him for my patient and family care study, I gave him the details of how the study was
going to be done which include my visits to their home. He agreed and then I started.
The investigation ordered were as follows full blood count (fbc), Blood urea
nigtrogen (BUN)
Other were chest x ray
He was managed the following medications, IVF Furosemide 12hrly, IV 10% calcium
gluconate 10mls 6hrly, Nebulize with 5mg Salbutamol 6hrly, suspended Tab
Lisinopril and spironolactone Hyperkalaemia, unfractionated heparin 10000IU 12hrly,
oral hydration 2L/ day strict input/output monitoring.
I informed them about the first home visit which will be done on 30th June 2024,
whilst he is still on admission to familiarize myself with their home an environment

FIRST DAY ON ADMISSION (28th June, 2024)

I reported for duty in the morning, and according to the night nurses he woke up from
sleep around 4 am to maintain his personal hygiene. He had porridge and bread as
breakfast after which his due medications were served and recorded accordingly. His
vital signs were checked and recorded as follows:
Temperature-36.7’C, Pulse-90, Respiration-22, spo2-96, Blood Pressure -
121/80mmHg.
Investigations carried out on the chest pain he was experiencing revealed the that
there was accumulation of fluid in the chest. At 12:20pm his children came over to
visit him in the afternoon, vital signs were checked and recorded as within the ranges;
Temperature - 36.1-36.5 degrees Celsius Pulse – 68-71 beats per minute Respiration-
18-22 breaths per minute Blood pressure -125-128/76-82millimeters in mercury.
Meals and prescribed medications were served and administered at appropriate time
and care continued.

SECOND DAY ON ADMISSION (29th June 2024)

Patient verbalized that he no longer have anxiety. His vital signs were checked and
recorded and was sered with breakfast and due medication. Mr A.A.O had his lunch
which was yam with “kontomire” and tolerated half of the meal. Patient medication
were served and patient was ask to reduce the intake of water and fluid diets, this is
because there is too much accumulated fluid in lungs. He had his supper later in the
day as well as routine nursing care was done. Patient was made comfortable in bed
and congratulated for his cooperation. At 2pm, vital signs checked and recorded are as
follows T-36.7’C, P-82bpm, R-18bpm, Spo2-97%, BP-96/68mmHg.
THIRD DAY OF ADMISSION (30TH JUNE, 2024)
Patient looked cheerful in the morning. He was able maintain his personal hygiene
unassisted as usual. Vital signs were checked and recorded Recorded accurately as
folllows T-36.5’C, P-90bpm, R-20bpm, Spo2-97%, BP-100/80mmHg. He was served
30mls of porridge and toasted bread as breakfast. It was assessed that client lacked
information on the causes, signs and symptoms and prevention of his condition. To
solve this health problem, the following nursing interventions were carried out. The
knowledge level of patient and family was assessed; education was given in English
language for easy understanding. The health education on decopensated heart failuer,
its causes, signs and symptoms and prevention was done. Questions asked by patient
were addressed accordingly. He was then asked simple questions to evaluate the
impact of the health education given to him .He was also educated on the need to
avoid self-medication. The doctor ordered for continuation of his medications. Vital
signs were checked and recorded as within the ranges;
T -36.5 , P -9bp 0 R-22 BP-122/84mmhg
Meals and prescribed medications were served and administered at appropriate time
and care continues.

FOURTH DAY ON ADMISSION (1st July 2024)

On this day, physical examination made on patient did not show any health problems
and He did not lodge any complains. His breakfast and due medications were served.
His vital signs were checked and recorded after client had taken care of his personal
hygiene. During the ward rounds, the doctor was satisfied with Patient’s progress in
health after examination and therefore Declaimed him fit hence possible discharge the
next day. Prescribed medication was served . He was encourage not to take fluid
diet .he was serve with his supper later in the day as well as routine nursing care done.
Patient was made comfortable in bed and congratulated for his cooperation. His
afternoon vitals are as follows T-36.7’C, P-82bpm, R-18bpm, Spo2-97%, BP-
119/81mmHg.

FIFTH DAY ON ADMISSION DISCHARGE DAY (2nd July 2024)

On this day, physical examination made on patient, he did not show any health
problems and He did not lodge any complains. His vital signs were checked and
recorded after client had taken care of his personal hygiene.
During the ward rounds, the doctor was satisfied with Patients’ progress in health
after examination and therefore declared him fit. Hence, he should be discharged.
Patient was informed to come back in a week for review. This was documented into
the admission and discharge book as well as daily ward state. Patient was assisted to
pack his belongings and were free to go home because he had no outstanding bills to
settle. The rest of the medication was handed over to patient and reminded of the
dosage and the number of times each drug was supposed to be taken. He was told to
always report to the hospital early any time they he is sick and also the need to take in
nutritious diet and to avoid self-medication. Patient was also advised to maintain good
personal hygiene. Patient was helped to pack their belongings.

PREPARATION OF PATIENT/FAMILY ON DISCHARGE AND

REHABILITATION DISCHARGE
The preparation of Mr. A.A.O towards discharged started on the day of his admission
into the ward and made aware that his admission was temporal and he would recover
soon and be discharged. The patient was educated on the causes, signs and symptoms,
prevention and treatment of Decompensated Heart failure. The early signs and
symptoms were explained to the patient and were encouraged to report to the nearest
health facility as soon as he feels unusual. He was advised to continue the treatment at
home but discouraged him from self-medication. The side effects of the drugs were
explained to the patient. He was educated also on personal and environmental
hygiene. The health hazards of alcohol, smoking cigarette and chewing cola were
explained to the patient and was advised not to take them. He was told to avoid fluid
diet like, tea, drinks soups and the rest. They thanked the nurses and doctor present for
their necessary support during hospitalization. At 3:45pm, He was escorted to the exit
of the hospital as he entered a chartered taxi and the parking spot and left.
4.2 FOLLOW-UP/HOME VISITS/CONTINUITY OF CARE
Friendly but purposeful visit to the home of patient with the aim of preventing
disease, maintaining health and promoting life through health education, counseling
and rehabilitation were carried out before and after patient was discharge from the
hospital.

FIRST HOME VISIT

On the 30thJune, 2024, I visited Mr. A.A.O house for the first time whiles patient was
still on admission as part of the preparations for the patient and family discharge. The
purpose of my visit was to know the home environment of my client that could be
helpful in the choice of care and education to be rendered. I got to his house at weija
old barrier with house number A6A at 10:00 am. They welcomed me and offered me
a seat and a bottle of water. We exchanged greetings and I introduced myself to the
daughter and his grandchildren and the purpose of my visit. The house was well
furnished which was enclosed with a main gate
My assessment revealed that the environment was tidy and neat. I educated them to
always keep their surrounding clean, the need to eat well balanced diet was explained
to the family and were discouraged from smoking, and alcohol consumption. I also
educated them to cook their food well and to cover them. They were commended for
keeping their environment relatively clean and were tasked to improve on it before
my subsequent visits. I thanked them for the co-operation and promised them of my
next visit

SECOND HOME VISIT

On the 9th July 2024, I made my second follow-up visit to the patient’s home which
is located at weija old barrier .I was warmly welcome by the patient and the family
and which we exchanged greetings and pleasantries. From my observation, I noticed a
positive response to treatment from the patient’s cheerful mood. I interacted with
them and asked about their general health condition which they said there was no
problem. There was a general improvement in the environmental hygiene. The
medications were cross-checked to make sure that they were effectively been taking
as prescribed. I was told by the patient that he did not have any problem with taking
the drugs and their side effects but rather asked whether he could buy those drugs
after completing his dosage. He was advised not to since the course given was
enough to treat his. They were allowed to ask questions and all the questions raised
were answered appropriately. The patient and the family were advised against self-
medication and were told to report any abnormal development to a nearby health
facility, client and family were also reminded of their review date on 15th July, 2024.

REVIEW
On Sunday evening, 14th July I called Mr. A.A.O to inform him that I would meet him
at the hospital for his review on the next day. I therefore met him at Korle–Bu
Teaching Hospital around 9am on Monday, 15th July. He came to the hospital with
his wife. I explained to them that the purpose of the 15 th July review was to ascertain
progress of treatment and address any complaints he might have. He said he had no
complaints. I accompanied him to the ward to take his folder for the review with Dr.
Priscilla Serwaa Akoto, according to Mr A.A.O. his chest were assessed of chest for
any pain and he was advised by the doctor to come to the hospital if he had any
problem and to make sure to finish all his drugs. I reminded him of my last home
visit and the arrangement to be made with the Public health nurse in his area for
continuity of care

THIRD HOME VISITS

On 26th July, 2024 my last home visit was made in other to handover Mr. A.A.O to a
community health nurse (Miss. Olivia) who was contacted on my second day of visit.
On arrival, we were warmly welcomed and offered seats, after which I introduced her
to the family members and informed them, she will be responsible for their further
care and assistance, and also informed them to always seek her attention at any time
of ailments.
On observation I could see that client was very fit and had finished taken his
medications.
I then thanked Mr. A.A.O and his family members for their co-operation and for
given me the opportunity to use them for my care study.
I also thanked the community health nurse for her acceptance of the responsibility to
visit the patient and continue with the health care. The family expressed their
gratitude for the knowledge acquired during admission and after discharge.
We thanked Mr. A.A.O and the family and seek for permission to leave.

CHAPTER FIVE
5.1 EVALAUTION OF CARE RENDERED TO PATIENT BAND FAMILY
In the five-step nursing process, assessment of the nursing interventions in relation to
set goals and appropriate recording and extent to which the established goals of care
have been met is determined and recorded. It is considered the final phase of the
nursing process but in practice, it is integral to effective nursing practice in all phases
of the nursing process. It is a continuous process and occurs concurrently with an on-
going assessment, analysis, planning and implementation of nursing care. Outlined in
this chapter is the statement of evaluation, amendment of nursing care plan and
termination of care rendered to patient.

5.1. STATEMENT OF EVALUATION

Goals outlined in the nursing care plan of Mr. AA O were met in line with the
objective criteria. The goals fully met included the following:
1. Patient was relived from chest pain
2. Patient breathing pattern was restored to normal as evidence by patient verbalizing
that he can breathe without difficulties
3. Patient was relieved from his anxiety about the unknown outcome of his condition
as evident by patient verbalizing that he is no more anxiety.
4. Patient and his relative had adequate knowledge about disease condition as
evidenced by patient and his family being able to answer questions correctly about the
disease process, treatment and prevention of recurrence.

5.2. AMENDMENT OF CARE PLAN FOR PARTIALLY MET OR UNMET

OUTCOME CRITERIA
During care for MR. A.A.O. all objectives set as outcome criteria were fully met.
Therefore, there was no need to amend the care plan used for his care. Education on
the cause of the condition and the need to avoid taking in too much fluid high blood
pressure medication, and drugs was however repeated several times until patient was
able to give good feedback about the education given to him concerning the cause,
management and prevention of Decompensated heart failure

5.3 TERMINATION OF CARE

This is the last phase of the nurse -patient relationship. It is a gradual process which
started on the day of my first interaction with MR. A.A.O. and his relatives. From the
first day, I made them aware that my interactions with them will be temporal. I also
made them aware that the relationship will formally end after the last follow up visit.
On last follow-up visit (26thjuly2024)I reminded MR. A.A.O. that it was the last
home visit and thanked him for their co-operation. I encouraged him to adhere to all
the education and advice given him as well as the restricted fluid intake In order to
achieve optimum health .

SUMMARY AND CONCLUSION

This Patient/Family Care Study has given an account of how the nursing process
approach was used in nursing MR. A.A.O. who was admitted to the medical ward of
the Korle- Bu Teaching hospital with difficulty in breathing after 24-hours detention
at the korle bu emergency unit. He was admitted on the 27th June and discharged on
2ndt July, 2024. He came with joint pain, dry cough. He was discharged with a report
from the doctor having been partially cured of his condition with evidence from
patient verbalizing feeling better than before No complications developed. Home
visits were done to continue care of patient and his family and emphasise education
about condition and importance of hospital review attendance. The care was finally
terminated with the client when I made my last home visit. This care study has been
beneficial to me and has allowed me to gain an in-depth knowledge about
Decompensated heat failure and the nursing management. Particularly, the writing of
this report has improved my report writing skills for several nursing procedures. It has
also provided me with adequate knowledge about the nursing process approach and
how to use it in the care of patient. Furthermore It has enabled me to understand the
unique essence of the care study and nursing profession which is “to assist the
individual sick or well in the performance of those activities contributing to health or
its recovery (or to peaceful death) that he would perform unaided if he had the
necessary strength, knowledge or will, and to do so in such a way as to help him
regain independence as quickly as possible.─ Virginia Henderson, 1966.

SIGNATORIES

NAME OF DOCTOR…………………………………………………………

SIGNATURE…………………………………………………………………. DATE

………………………………………………………………..………

NAME OF CLINICAL SUPERVISOR………………………………………

SIGNATURE…………………………………………………………………
DATE…………………………………………………………………………..

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

SIGNATURE…………………………………………………………………..

DATE……………………………………………………………..……………

NAME OF CANDIDATE……………………………………..………………

SIGNATURE...………………….………………………………………………

DATE…………………………………………………………………..……….

SIGNATURE OF HEAD OF INSTITUTION………………………………..

DATE......................................................................................................................