HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE,

BEREKUM

A PATIENT AND FAMILY CARE STUDY ON GASTRITIS

BY

KYEREMAA NAOMI

4120210033

A PATIENT AND FAMILY CARE STUDY SUBMITTED TO THE NURSING AND

MIDWIFERY COUNCIL OF GHANA IN PARTIAL FULFILMENT FOR THE AWARD

OF A LICENSE TO PRACTICE AS A PROFESSIONAL REGISTERED GENERAL

NURSE

AUGUST, 2024
 HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE, BEREKUM

A PATIENT AND FAMILY CARE STUDY ON GASTRITIS

BY

KYEREMAA NAOMI

4120210033

A PATIENT AND FAMILY CARE STUDY SUBMITTED TO THE NURSING AND

MIDWIFERY COUNCIL OF GHANA IN PARTIAL FULFILMENT FOR THE AWARD

OF A LICENSE TO PRACTICE AS A PROFESSIONAL REGISTERED GENERAL

NURSE

AUGUST,2024
 PREFACE

Modern nursing is a profession that requires knowledge, skills and attitude. Previously, care

for the sick was considered to be the responsibilities of priests and religious groups. For

instance, in the middle. Ages, care for the sick was then handled by the military and religious

orders. However, in the 19th Century, Florence Nightingale provided defined rules for the

preparation of nurses and redefined the face of the nursing practice. Since then, the scope of

nursing has expanded remarkably to its modern state of comprehensive nursing, which involves

a systematic process of data collection, problem diagnosis, analysis, care plan development and

evaluation. The main objective of the nursing practice today is focused on the promotion,

maintenance and restoration of healthy life for the individual, family and community as a

whole. The patient and family care study is a comprehensive study carried out on patient with

a particular disease condition. The study is based on the nursing process, a systematic method,

which has the assessment, analysis, planning, implementation and evaluation as its

components. The study provides knowledge and understanding of the causes, pathology,

diagnosis and treatment of the patient's condition. It also gives an account of the actual nursing

care rendered to a patient and his or her family from the time of admission until time of

discharge.

The patient /family care study is a project work carried out by the final year student as a partial

fulfilment for the award of license by the Nursing and Midwifery Council of Ghana. The

significance of the study is to help the student nurse exhibit the skills and knowledge acquired

from his or her training from the classroom into practice. The care also helps the student nurse

to acquire more knowledge on the signs and symptom, diagnosis, causes and management of

the specific disease condition studied by the student. The care study therefore helps the student

nurse have the opportunity to initiate and implement patient care. It is in this vein that the
nursing processes which include assessment, analysis, diagnosis, planning, implementation and

evaluation are employed. The reasons why I used patient’s initials is because of confidentiality.
 ACKNOWLEDGEMENT

My foremost thanks goes to the Almighty God for giving me the wisdoms and directions to

bring this work to a successful end. I am very grateful to Master. K.E.A. and his family for

their support and co-operation in providing all the necessary information needed to make this

study successful. Special thanks goes to my supervisor, Mr. Emmanuel Ali for making time

to guide me in my write up. I would also like to extend my appreciation to the staff of Holy

Family Hospital, Berekum who helped in diverse ways to make the writing of this patient and

family care study a success. Also, the staff at the Males ward and in-charge Mrs. Cynthia

Adjei.

Appreciation also goes to my family for their love, guidance, advice and financial support

especially to my grandmother, Mrs. Adu Agnes, my father, Mr. Kwabena Takyi and my

mother, Mrs. Beatrice Baffoe. Finally, to all the authors and publishers whose books I used as

reference for this study.

 INTRODUCTION

This care study looks at the full range of nursing care given to Master. K.E.A., a 14-year-old

boy who was admitted to Methodist Hospital, Wenchi with a diagnosis of Gastritis. Over the

course of six days, from August 22nd to September 16th, 2023, a structured nursing care plan

was put into place, which included medical treatment, nursing interventions, patient

education, and discharge planning. The study made use of the nursing process—assessment,

planning, implementation, and evaluation—to address a number of health issues and

guarantee that Master. K.E.A. and his family received appropriate care. During the hospital

stay and the ensuing home visits, the main goals were to improve Master. K.E.A.'s health

outcomes, educate him and his family about managing his gastritis, and get them ready for

ongoing care at home. All of the goals were met, and the treatment was rated as extremely

effective. This highlights the importance of specialised nursing assistance in the management

of chronic illnesses like gastritis. In addition to demonstrating how practical nursing

education can be, this care study reaffirms how crucial holistic, patient-centered care is to

enhancing clinical results and patient satisfaction.

He was managed on the following drugs during his admission;

1. IV Omeprazole 80mg Stat

2. IV metoclopramide 10mg tds x 24hours

3. Syrup Nugel O 15mls tid x 5 days

4. IV Tramadol 100mg bd x 1

5. IVF RL 500mg daily x 1

6. Caps iron lll 50mg 1bd x 14

7. IVF DNS 1L daily x 1

His condition improved as a result of the adequate nursing and medical care, and therefore was

discharged on 27th August, 2023. During the period of this study, three home visits were

embarked upon. The first visit occurred on 24th August, 2023 while patient was on admission.

The second was carried out on the 3rd September, 2023 while the third and final visit took place

on the 16th September, 2023 during which care was officially terminated. Master. K.E.A. and

his family were chosen for my care study in order to enable me wider my knowledge and

understanding of the condition (Gastritis). The following laboratory tests were carried out on

patient;

1. Full Blood Count

2. Upper G.I X-ray

3. Endoscopy

Patient spent six days on the ward and six nursing problems were identified. These were;

1. Patient complains of abdominal pain

2. Patient and relative (mother) was Anxious

3. Patient had difficulty in sleeping (Insomnia)

4. Patient had little knowledge about the condition

5. Patient presented with vomiting

6. Patient complained of loss of appetite.

The study has been organized into six chapters according to the nursing process.

Chapter one (1) Assessment of the patient and family.

Chapter two (2) Analysis of data collected.

Chapter three (3) Planning of patient/family care,

Chapter four (4) Implementing patient/family care.

Chapter five (5) Evaluation care of the patient/ family

Chapter six (6) Summary and conclusion.

 Table of Content

Contents Pages
PREFACE 1
ACKNOWLEDGEMENT
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INTRODUCTION
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TABLE OF CONTENTS
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CHAPTER ONE: ASSESSMENT OF PATIENT AND FAMILY

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1.1 Patient’s Particulars

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1.2 Patient/Family’s Medical History
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1.3 Patient/ Family’s Socio-economic History
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1.4 Patient’s Developmental History
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1.8 Admission of Patient
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1.9 Patient Concept of Illness
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2.0 Literature Review
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1.11 Validation of Data
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CHAPTER TWO: ANALYSIS OF DATA 29
2.0 Introduction
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2.1 Comparison of data with standards.
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2.2 Patient/Family Strength
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2.3 Patient’s Health Problems
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 2.4 Nursing Diagnoses
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CHAPTER THREE: Error! Bookmark not defined.PLANNING FOR
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3.0 Introduction
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3.1 Objectives/Outcome Criteria for Patient/ Family Case Study
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CHAPTER FOUR: IMPLEMENTATION OF PATIENT/FAMILY CARE 45
4.0 Introduction
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4.1 Summary of actual nursing care
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First Day of admission (22nd August, 2023)
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Second day of admission (23rd August, 2023)
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Third Day of Admission: (24th August, 2023)
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Fourth day of Admission (25th August, 2023)
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Fifth day of admission (Day of Discharge) – 27th August, 2023.
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4.2 Preparation of Patient/Family for Discharge and Rehabilitation.
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4.3 Follow Up, Home Visit and Continuity of Care
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First Home Visit (24th August, 2023)
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Second Home Visit (3rd /08/2023)
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Day of Review (6th August, 2023)
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Third Home Visit (16th September, 2023)
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CHAPTER FIVE: EVALUATION OF CARE RENDERED TO PATIENT AND
FAMILY
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5.0 Introduction
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 5.1 Statement of evaluation.
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1. Patient was relieved of abdomina pain . (23/08/2023).
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2. Patient was relieved of anxiety. (23/08/2023).
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3. Patient regained his normal sleeping pattern. (25/08/2023) Error!
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4. Patient and family would gain adequate knowledge on Gastritis. (25/08/2023)
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5. Patient maintained his normal fluid volume. (27/08/2023) Error!
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6. Patient regained his normal nutritional pattern (27th August, 2023) . Error! Bookmark
not defined.
5.2 Amendment of Nursing Care Plan for partially Met or Unmet Outcome Criteria.
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5.3 Termination of Care
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CHAPTER SIX: SUMMARY AND CONCLUSION 67
6.0 Introduction
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6.1 Summary
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6.2 Conclusion
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BIBLIOGRAPHY
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APPENDIX 71
SIGNATORIES
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LIST OF TABLES
Table 1: Comparison of Diagnostic Tests Done to Literature Review

Table 2: Results of diagnostic investigation conducted on patient

Table 3: Comparison of clinical features in literature and those exhibited by patient

Table 4: Treatment Given to Patient Compared with That of Literature Review

Table 5: Pharmacology of Drugs Administered to Patient

Table 6: Nursing Care Plan for Patient/Family

LIST OF FIGURES

Figure 1.1: diagram of the Stomach……………………………………………………...17

Figure 1.2: Disease of the stomach……………………………………………………….17

 CHAPTER ONE

ASSESSMENT OF PATIENT / FAMILY

1.0 Introduction

Assessment is the systematic collection of data to determine the patient’s health status and any

actual or potential health problem (Hinkle, Cheever & Overbaugh 2022). It is the first step in

the nursing process. The information is collected through interviewing, observation and

laboratory investigations to help in analysis and diagnosis of client’s condition. This helps to

render the precise and holistic nursing care to the patient and family.

This chapter comprises of patient particulars, Family’s Medical history, Family’s Socio-

Economic history, Patient Developmental history, Patient’s Lifestyle/Hobbies, Patient’s Past

Medical history, Patient Present Medical history, Admission of patient, Patient’s Concept of

Illness, Literature Review and Validation of data. All information was gathered from patient

and relatives.

1.1 Patient’s Particulars/ Biographical Data

Patient particulars are defined as the biographical state of the individual within a particular

geographical area at a particular time (Myers, 2020).

Master. K.E.A is a 14year old boy born on 12th June, 2009 to Mr. J.A. and madam M.Y. at

Subinso No.2. He is a Ghanaian and comes from Wenchi in the Bono region but stays at

Subinso No.2. He is fair in complexion and weighs 48kilograms and about 1.5meters tall on

admission. His Body Mass Index (BMI) was 24.0kg/m2. He is a Bono by tribe, he speaks only

Bono and English language.

Master. K.E.A is the first born of his parents and has five other siblings in which three are

males and two are females apart from him. M.Y. is his next of kin. He is a student. He is a

Christian and a member of the Presbyterian Church of Ghana. He is a chorister. My patient has

registered with the national Health Insurance Authority (NHIS).

1.2 Patient and Family Medical History

According to my patient’s mother, there is no known familial disease such as diabetes,

hypertension or asthma but admitted that the family occasionally suffers from headache,

general body weakness and malaria and treated when reported to the hospital. She said they

sometimes visits the drug store for over the counter drugs whenever the child is sick. The

parents explain that, Master K.E.A grandparents and siblings are in good health and have no

health problems as at now. The father of child, Master K.E.A explained that there has been

situation of death in the family but specific cause of the death was unknown. Parents recounted

no major health problems have been noticed in the blood line and they are always in good and

perfect health. According to patient, they don’t take herbal medicine when sick but they do

visit the hospital when he or a family member is sick. Patient said that his grandmother has

ever being hospitalized before as a results of Malaria. There are no known allergies in their

family.

1.3. PATIENT SOCIO ECONOMIC HISTORY

Socio- economic history talks about the social standing or class of an individual or group often

measured as a combination of income, education and occupation.

Members in the family are not socially known for alcoholism, smoking and anti- social

behaviors.

Master. K.E.A is a student. He is in J.H.S two (2). Parents basically belongs to the medium

class economic status. He said there are some taboos in the family which says, is a taboo for

brothers and sisters to marry each other and also eating of pork is a taboo in the family.
They live in a well-built house with toilet facilities. He and the other siblings together support

their parents. Master. K.E.A said, his parents are all working. He said, his father is a farmer

and at the same time a susu collector while his mother is a trader which they use the income

they receive to cater for the family. My patient and his family members are registered with the

national Health Insurance Scheme (NHIS) which they use for health care. Sometimes, there

are some financial difficulties in the family which they depend on the extended family in times

of financial hardships. So the family’s main source of income is from these works they do.

They use electricity and drink from pipe borne. He said the family is a good Christian family.

No allergies are known to client or any of the family members. My patient father is a farmer

and he exposed to occupational hazards like waist pains and snake bites while the mother is a

trader and she is exposed to occupational hazard like arm robbery and losses.

1.4 Patient’s Developmental History

Development is the process in which someone or something grows or changes and becomes

more advanced. Growth is the series of physical changes that occurs from conception through

maturity. Maturation is the biological processes involved in an organism’s becoming functional

or fully developed. (American Psychological Association, 2020).

Atindanbila (2020) defines Development as “a qualitative change in which there is an increase

in skills or the ability to function”. Development is the pattern of change that starts from

conception and continues throughout the lifespan. According to him, he was told by his mother

that he was immunized against the vaccine preventable diseases that are Bacillus Calmette-

Guerin (BCG), Diphteria, Measles, Poliomyelitis, Yellow fever and Whooping cough and

more. Madam M.Y said, Master K.E.A went through the normal developmental milestone and

developmental characteristics of a child.

According to Erik Erikson psychosocial theory of development, every human being undergo

eight stages of development, which ranges from childhood to old age (from trust versus mistrust
to ego identity versus despair), each of these stages have a distinct characteristic the individual

exhibit. For example, in infancy, (0-1 year) is where children demonstrate trust versus mistrust.

Children who are treated with consistent love and care have their needs met by their parents

should develop the capacity of trust and children who are maltreated in other terms do not have

their needs met most definitely will develop an identity of mistrust. In the case of Master K.E.A,

he fell within the adolescence stage that is identity versus role confusion.

In the stage of psychological development as propounded by Erik Erikson, young people seek

a sense self and their place in the world. If they lack a sense of belonging to any identity group,

they may develop uncertainty about their that lasts into adulthood.

My patient mother said, at two (2) months, Master K.E.A was able to lift his head on his own,

and was able to roll over at four months. At six (6) months he was able to sit up without support

and then started crawling and walked at nine months. At one year, four months he was able to

say mama and dada. He was breastfed by his mother for four (4) months and continued with

weaning foods like porridge from the fifth (5) month onwards and was weaned at the age of

two years. He started schooling at age 4.

He is yet to complete junior high school. He said that his secondary sexual characteristics

(growing of hair at the pubic areas) began to show at the age of thirteen.

1.5 Patient’s Lifestyle / Hobbies

Master. K.E.A. usually wakes up around 6:00am and sometimes around 8:00 am. He cleans his

teeth with tooth brush and paste every morning. He empties his bowel and takes his bath. He

is a devoted Christian. He said, he sometimes goes for morning devotion at his Church that is

Presbyterian church. The household chores are done by him and other siblings.

He leaves for school around 6:00 am and normally returns at 5:30 pm or at times 6:30pm.

Master, K.E.A takes his breakfast and lunch at the school campus. At times if the work load

becomes too much, he even forgot to take his breakfast. He said, he eats thrice daily but at
times twice. His best food is ampesi and kontomire stew. He goes to church on Sundays. He

said, his hobbies are playing of football, studying his scriptures and praying at his leisure

periods. He enjoys “Ampesi” with kontomire stew as well as “fufu” with palm nut soup. He

said usually, supper is taken at 5 o’clock in the evening, he baths and go to bed. He said he

does not entertain many friends but free with anybody and people have been saying he is

introvert. He stays indoors after school except Saturdays when he goes for singing band

rehearsals and sometimes, he goes to the field to play football after school. He likes listening

to music, news and other information when he is less busy. According to Master K.E.A., he

does not smoke neither does he take in any drug not prescribed. Also, he has no known allergies

to food and drugs.

1.6 Patient’s Past Medical History

My patient verbalized that he did not suffer from any of the childhood killer disease like

tuberculosis, diphtheria, measles and others, yet he experienced road traffic accident once with

his mum at the age of 10 years. According to patient, he experienced no physical injury. Patient

also said, he has ever been hospitalized before with the complains of headache and abdominal

pains. He verbalized he uses over- the- counter drug such as paracetamol, when he experiences

symptoms like headaches and abdominal pain. He has no known allergies. My patient said he

visits a nearby clinic, thus Subinso No. 2community clinic when not feeling well. My patient

has no physical disability.

1.7 Patient’s Present Medical History

Patient started exhibiting signs and symptoms such as headache, vomiting, and severe

abdominal pains four days before the actual day of admission at Methodist hospital, Wenchi.

When the signs and symptoms began, he was taken to a nearby clinic for treatment the next

morning but no progress was seen. The night on 21st August, 2023, at 8:00pm he became very
restless and was found in serious distress. On 22nd August, 2023, the subsequent morning at

10:30am, he was rushed to the Methodist hospital, Wenchi and was admitted. On arrival,

physical examination and laboratory investigations were conducted, patient complains of

severe abdominal pains anytime the abdomen is palpated and haemoglobin level was (7.8g/dl).

1.8 Admission of Master. K.E.A

According to Esena (2020), admission is the initiation of care, usually referring to inpatient

care, either lasting for a day or more. It is a change of environment to the patient and relatives.

This change of environment could either be elective/planned or emergency/unplanned.

On 22nd August, 2023 at 11:10, Master K.E.A. was seen at the outpatient department and was

admitted to the male’s ward. He was brought into the ward by his mother, accompanied by a

nurse from the outpatient department. Patient was diagnosed of Gastritis. He appears weak and

irritable on arrival.

They were warmly welcome at the entrance of the ward and escorted to the nurse’s station.

Mother was offered a seat and reassured that the admission process was temporary, and that

the child will be discharged immediately he gets well to the house, again she was told that,

Master. K.E.A. was in the hands of competent nurses and doctors, and that complete nursing

care will be instituted for Master. K.E.A. During assessment, he complained of abdominal pain

at the epigastric region, nausea and vomiting, loss of appetite and difficult sleeping. He was

reassured to allay fears and anxiety.

His particulars such as name, sex, age, occupation, health insurance status and residential

address were recorded in the admission and discharge book. His name, sex and age were written

in the daily ward state.

Hospital policies regarding visiting hours, payment of bills and time for vital signs were

checked and administration of medications were explained to him and relative.

Client was made comfortable in bed and his vital signs were checked and recorded as
 1. Temperature – 36.4 degrees Celsius

2. Pulse -79 beats per minute

3. Respiration -20 cycles per minute

4. Blood pressure -103/66 millimeters of mercury

Oxygen Saturation was 96%

A head to toe physical examination was conducted on the patient and no abnormalities were

seen.

Client was oriented to time, place and person. Master K.E.A. and relative were oriented to the

ward environment by first introducing them to the staffs present to get them acquainted, the

nurses station and the nurses room were also shown to them. The patient’s toilet and bathroom

was shown to them so that they can visit them anytime they feel to void. Master. K.E.A. was

introduced to patients who had suffered the same condition and were recovering in other to

enable hope and anxiety. They were then shown the in-patient pharmacy and laboratory where

all in- patients medications are received and investigations were carried out. Lastly, Master

K.E.A. and his mother were informed about the time for every visit which starts from 5:30am

– 6:00am in the morning, 12:00pm -1:00pm in the afternoon and 5:30pm -6:00pm in the

evening.

I reintroduced myself to the patient as a student nurse of Nursing and Midwifery Training

College, Berekum, who would like to take him and his family for my care study. Master. K.E.A.

and his family were informed that the care study is a requirement by the Nursing and Midwifery

Council of Ghana in partial fulfilment towards the award of license to practice as a Registered

General Nurse. I explained to the patient and his family the concept of the patient/family care

study and assured them of privacy and confidentiality. Introduction was made to them and l

asked permission to use him for my care study as a student which they agreed.
Discharge planning was initiated with the relatives, thus they were told that the hospital will

be a temporary place for their care and would have to continue the care at home once there is

an improvement in his condition.

I decided to choose this patient for my care study because I wanted to get more understanding

about the causes, signs and symptoms, prevention and treatment of gastritis and to able to

differentiate it from other similar abdominal conditions.

The following were drugs requested;

8. IV Omeprazole 80mg Stat

9. IV metoclopramide 10mg tds x 24hours

10. Syrup Nugel O 15mls tid x 5 days

11. IV Tramadol 100mg bd x 1

12. IVF RL 500mg daily x 1

13. Caps iron lll 50mg 1bd x 14

14. IVF DNS 1L daily x 1

These investigations were to be carried out on the patient

4. Full Blood Count

5. Upper G.I X-ray

6. Endoscopy

The mother was educated to feed the child frequently with a balanced diet, and to avoid fruits

such as oranges since it can cause gastric irritation. They also informed her that, a time will

come that the care will be terminated. The nurse in-charge, also grant me the permission and

thank the patient and relatives for me. At 6:00pm, patient vital signs were monitored and

documented per chat. Prescribed medications Syrup Nugel O 15mls and IVF Dextrose Normal

saline 500mls were served.

Client was made comfortable in bed and left in the hands of the afternoon nurses to continue

the care as my shift was over.

1.9 Patient’s Concept of Illness

At the time of admission, my patient and relatives had no insight into the condition. Patient did

not attribute the illness to any evil forces, they could not figure out what exactly was going

wrong. He was very anxious because the pain was very severe until interventions were given

but he believed that he will be relieved of the symptoms and recover fully to continue his

schooling and perform other activities for his daily living.

1.9 Literature Review

Definition

“The stomach is a J- shaped dilated portion of the alimentary tract situated in the Epigastric,

umbilical and the left hypochondriac region of the abdominal cavity”. It is a muscular organ

that is responsible for digestion of food (Wagh &Grant, 2019).

Structures of the Stomach

The stomach continuous with the esophagus at the cardiac sphincter and with the duodenum at

the pyloric sphincter. It has two curvatures. The lesser curvature which is short and lies on the

posterior surface of the stomach and is the downwards continuation of the posterior wall of the

esophagus. Just before the pyloric sphincter, it curves upwards towards to complete the J-shape.

Where the esophagus joins the stomach the anterior region angles acutely upwards, curves

downwards forming the greater curvature and then slightly upwards towards the pyloric

sphincter. It is divided into three regions, the fundus, the body and the pylorus.
Gastritis

This is an inflammation disease affecting the mucosal surface of the stomach, which may be

acute or chronic. It is also an inflammatory disorder of the stomach lining. Gastritis may be

acute, lasting several hours to few days, or chronic resulting from repeated exposure to

irritating agent or reoccurring episodes of acute gastritis. Acute gastritis is often caused by

dietary indiscretion, thus eating too highly seasoned foods, over use of aspirin and other
NSAIDS, excessive alcohol intake, among others. Chronic gastritis may be caused by benign

or malignant ulcers of the stomach or by bacteria Helicobacter pylori.

Incidence

Epidemiologic studies reflect the widespread incidence of gastritis. In the United States, it

accounts for approximately 1.8-2.1 million visit to doctor’s offices each year. It is especially

common in people older than 60 years.

Causes

Acute gastritis is often caused by dietary indiscretion the person eats food that is contaminated

with disease-causing microorganisms or that is irritating or too highly seasoned. Other causes

of acute gastritis include;

 1. Eating irritating foods, too high seasoned diets or contaminated foods,

2. excessive alcohol intake,

3. bile reflux, and

4. Radiation therapy.

5. Ingestion of strong acid or alkali.

6. Overuse of aspirin and other NSAIDS

7. Helicobacter pylori

Clinical Manifestation

Acute gastritis may be asymptomatic. But some patients present with

1. abdominal discomfort,

2. headache,

3. lassitude,

4. nausea,

5. anorexia,

6. vomiting,

7. Hiccupping.

8. Belching

9. Feeling of fullness

10. Epigastric tenderness

Chronic Gastritis

Chronic gastritis may result from repeated exposure to irritating agents or recurring episodes

of acute gastritis.
Causes

It can be caused by either benign or malignant ulcers of the stomach

1. The bacteria Helicobacter pylori.

2. Chronic gastritis is sometimes associated with,

3. autoimmune diseases such as pernicious anemia;

4. dietary factors such as caffeine;

5. the use of medications, especially NSAIDs;

6. Smoking; or alcohol;

7. Reflux of intestinal contents into the stomach.

8. By benign or malignant ulcers of the stomach.

Clinical Manifestation

The patient with chronic gastritis may complain of

1. Anorexia,

2. Heartburn after eating

3. Belching

4. A sour taste in the mouth

5. Nausea and vomiting

6. Patients with chronic gastritis from vitamin deficiency usually have evidence of

malabsorption of vitamin B12 caused by antibodies against intrinsic factor.

Pathophysiology

In acute gastritis, the protective mucosal layer is altered. Acid secretions produce mucosal

reddening, edema and superficial erosion. Many of the important, noninfectious acute

inflammatory lesions of the stomach lining are small superficial erosion in which the

epithelium of the surface, superficial pits and the superficial lamina propria are necrotic. This
result in a superficial mucosal defect with no surface epithelium and a cell-poor granular lamina

propria that may have few extravasated erythrocytes in it.

In chronic gastritis, there is progressive thinning and degeneration of gastric mucosal. In either

form, as mucous membrane become more eroded, gastric juices, containing pepsin and acid,

come into contact with erosion and an ulcer forms.

Diagnostic Investigations

Diagnosis can be done by;

1. Endoscopy

2. Clinical features

3. Upper G.I X-ray studies

4. Histological examination of tissue specimen obtained by biopsy.

5. Serological testing for antibodies against the H. pylori antigen.

Medical Management

Medical management is aimed at;

1. Diluting and neutralizing the offending agent.

2. reduce and control secretions

3. To protect the mucosal barrier

4. And to subside inflammation

The various medications that can be used include;

1. H2 receptor antagonist; they inhibit pepsin secretion and reduces the volume of gastric

secretions and reduces the volume of gastric secretions. Examples are; Ranitidine

2. Hydrochloride (Zantac), Cimetidine (Tagamet) 400mg bd for 4 to 6 weeks. (Bear,

2016)

3. Antacids: they decrease acidity thus neutralizing acid content in the stomach. Examples

include; Magnesium Trisilicate 5-15mls tds for 3-6 weeks.

 4. Antibiotics and Bismuth salts; to treat Helicobacter pylori. Examples include; Bismuth

subsalicylate (Pepto-Bismol); tetracycline, Amoxicillin etc.

5. Proton (Gastric Acid) Pump Inhibitor; Suppresses H. pylori bacteria in the gastric

mucosa and assists with healing of mucosal lesions. It also inhibits acid secretion by

blocking the action of histamine on the histamine receptors of the parietal cells in the

stomach. Examples include Omeprazole (Prilosec), Lansoprazole (Prevacid), and

Rabeprazole (Aciphex).

6. Supportive treatment includes: nasogastric (NG) intubation,

7. Analgesic agents and sedatives, and intravenous (IV) fluids.

8. If corrosion is extensive or severe, emetics and lavage are avoided because of the danger

of perforation and damage to the esophagus.

9. Alcohol intake is avoided as well as irritating diet

Nursing Management

Reassurance

Reassurance can be given to both patient and family by telling them that they are in the hands

of qualified and competent staff and that effort are being made to ensure client’s recovery. This

helps to relax both client and family from anxiety. The nurse must also build trust for the patient

to have confidence in him or her by ensuring security, establishing trust and confidentiality.

Both patient and family should be allowed and encouraged to ask questions to help them

understand things about the condition. In order to gain patient’s cooperation and confidence,

explain every procedure to be performed to the patient. Introduce patient to other patients with

similar conditions who are now improving.

Rest and Sleep

Adequate rest and sleep enhance recovery and therefore necessary for the client. If there are

domestic problems, then a change in environment may be indicated possibly hospitalization

for a week or two. This may take the combined effort of a physician, nurse, family and the

social workers to help the patient understand the need for complete rest and to secure his

cooperation in achieving it.

Dietary Management

Patient must take at least 6 or more small meals in a day at regular. The diet should be blunt

spice free and pepper free. Patient should be advice to take his time when eating and food

should not be too hot or cold. Advice patient to avoid smoking, alcohol and food containing

acid.

Stress reduction

Patient may need help in identifying situations that are stressful or exhausting. In addition to

stress reduction, suggestions. The patient may also benefit from suggestions about regular rest

period during the day at least during the acute phase of the disease.

Patient must participate in recreational activities and hobbies that promote relaxations and must

avoid factors found to increase symptoms if possible.

Smoking and Alcohol

Smoking and alcohol should be avoided as they stimulate acid secretions. Smoking decreases

the secretion of bicarbonate from the pancreas into the duodenum. Therefore the acidity in the

duodenum is higher when one smokes, thus smoking having an anti-healing effect.

Personal hygiene

Assist client to carry out personal hygiene practices like bathing at least twice daily. This

promote circulation to prevent and eliminate offensive odour from the client’s body.it also

enhances the nurse in offering informal education on personal hygiene like bathing.

Surgical Treatment

Pyloroplasty: is a drainage operation in which a longitudinal incision is made into the pylorus

and transverse sutured closed to enlarge the outlet and relax the muscle
Gastrostomy: it involves removal of a portion of the stomach, most commonly the distal half

or two thirds of the stomach resected.

Antrectomy (a type of Gastrectomy). It involves removal of that portion of the stomach

containing gastric secreting cells.

The remaining portion of the stomach is anastomosed either to the duodenum (Billroth I) or

jejunum (Billroth II). Usually some combination of these procedures is performed

Prevention

1. Making lifestyle changes, such as avoiding the long-term use of alcohol, NSAIDs, coffee,

and drugs, may help prevent gastritis and its complications (such as a peptic ulcer).

2. Reducing stress through relaxation techniques

3. Avoid intake of alcohol

Complications

1. Peptic ulcers

2. Gastric cancer

3. Haemorrhage

4. Gastric Perforation

5. Anaemia

1.11 Validation of Data

Validation is to state officially that something is useful and of an acceptable standard.

Validation of data is the act of confirming or verifying data collected from the patient in order

to keep it free from error, bias or misinterpretation.

Master K.E.A. subjective data was taken from him and his attendant. The objective data about

Master. K.E.A. was obtained from observations, from the doctor’s case histories about his

disease conditions. Various textbooks were used to compile the literature review about his

disease condition. The data was validated by comparing the diagnostic investigations and
treatment regimen requested by the physician with the literature review. Upon repeated

comparison of the data in the patient’s folder and particulars at the ward, to that which was said

by the patient and his relatives, the information was found to have something in common. There

were no discrepancies, hence the data is valid.

 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction

Analysis is an examination of data and facts to uncover and understand cause-effect

relationship, thus providing basis for problem solving and decision making. Analysis is the

categorization of information in order to draw a final conclusion about the patient’s

condition. The patient’s health problems are then identified to enable the nurse to establish

nursing diagnosis.

2.1 Comparison of Data with Standard

This is comparing data collected with that of standards which include diagnostic

investigations, causes, clinical features and complications.

A. Diagnostic Tests/ Investigations

A procedure intended to establish the quality, performance or reliability of something,

especially before it is taken into widespread use and investigation is the action of

investigating something or someone; formal or systematic examination or research.

From day of admission (22nd August, 2023) to the day of discharge (27th August, 2023), the

following were the diagnostic investigations that were carried out on Master. K. E.A.

1. Full Blood Count

2. Upper G.I X-ray

3. Endoscopy

4.Blood film for Malaria

 Table 1. comparison of diagnostic tests carried out

DIAGNOSTIC TEST IN LITERATURE DIAGNOSTIC TEST CARRIED OUT ON THE

PATIENT

Physical examination Physical examination was conducted

A thorough history taking Done for patient

Upper G.I x-ray Was conducted for patient

Endoscopy This examination was conducted

Serology for H. pylori Was not conducted

Biopsy This was not conducted

Blood film for isolating malaria parasites Done for patient

not in literature review.

Erythrocytes sedimentation rate Was not done for patient

Sickling Done for patient

Full blood count not in literature review Full blood count was done

Table 2.1 below shows the comparison of diagnostic test carried out on client

and those listed in the Literature Review.

 Table 2. Results of Diagnostic investigations carried Out on Patient

Date Specimen Investigation Results Normal value Interpretation Remarks

22/08/24 Blood Full Blood Count

Hemoglobin 8.8g/Dl Males-12- Slightly low Hb Patient was given

18g/dl Hematinic

Females- 11-

16g/dl

Red blood cells

3.52x10/L Males- 3.0- Red blood cell No treatment was

5.0x10/L count was within given

Females- 2.5- normal range

5.0x10/L

White blood cells

5.2x10L Males-4.0-10.0 No treatment was

given
22/08/24 Blood BF for mps White blood cell

No mps seen Positive or count was within No treatment given

Negative normal range

No malaria

present

22/08/24 Gastro- Endoscopy Hemorrhagic Smooth gastric Patient had an IV Omeprazole, IV

intestinal gastritis and mucosa with no active ulcer and tramadol,

tract active gastric ulcers and hemorrhagic Suspension Nugel O

ulcer bleeding gastritis.

 Table 2.3: Result of Diagnostic investigation carried out on Patient Cont’d

DATE SPECIMEN INVESTIGATION RESULTS NORMAL INTERPRETATION REMARKS

VALUES
23/08/23 Oesophagus, Upper G.I X-ray Oesophagus: no varices No Patient had Gastritis Syrup Nugel O

or inflammation seen inflammation 15mls tds x

stomach and Stomach: gastric folds should be 5day

and walls appeared to be detected

duodenum thicken with the IV omeprazole

presence of ‘’halo’’ 80mg stat x 1

Duodenum: normal

mucosa; no

demonstrable mucosal

abnormality seen.
23/08/23 Oesophagus, Upper G.I Oesophagus; OG No Patient had Gastritis Syrup Nugel O

Endoscopy junction at 38cm, island inflammation 15mls tds x

Stomach and of pinkish mucosa. should be 5days

No variation seen detected

Duodenum Stomach; patchy

erythema seen in the IV Omeprazole

antrum. The antral 80mg stat x 1

mucosa inflamed

fundus, pylorus and the

body normal.

Duodenum; normal

mucosa no demonstrable

mucosal seen in the first

and second part of the

duodenum.
B. Causes of Master, K.E.A condition

With reference to the literature review on the causes of gastritis, Master. K E. A. condition
can be caused by the abuse of non-steroid anti-inflammatory, bacterial infection (helicobacter
pylori).

Table 3: Causes of Gastritis

Causes According to Literature (Text Causes According to Patient

Books)

1. Microorganisms: such as Helicobacter There was a possible cause as patient eats

pylori, Salmonella through indiscriminate indiscriminately.

eating.

2. Drugs: such as NSAIDS, example as There was no possible cause because patient

Aspirin. was not on such drugs.

3.Diet: a. Patient sometimes eats spicy diets.

a. Eating spicy food. b. Patient does not take alcohol.

b. Chronic alcohol consumption c. Patient does not take coffee.

c. The use of caffeine.

4. Gastric reflux. These were not possible causes

5. Stress. Patient had no gastric reflux or stress.

2.4 Clinical Manifestations

Table 4. Comparison of clinical Features in the literature.

LITERATURE MASTER, K.E.A REMARKS

COMPLAINTS

Abdominal pain This was present This was elicited by the

medical officer.

Headache He complained of headache He verbalized of headache

which was not all that severe.

Lassitude Patient did not experience

lassitude

Nausea Patient experienced nausea This was evident as patient

complained of it.

Anorexia Present This was present and patient

was not able to eat well for

some days.

Vomiting Present He vomited severely

Hiccupping Absent

Belching Absent

Patient will get diarrhea Absent

Epigastric pain Patient complained of pain in This was evident as patient

the epigastric region complained of it bitterly

Taking references from the table above, patient presented some clinical manifestations as

stated in the literature like abdominal discomfort, nausea and vomiting, anorexia, epigastric

pain and others. However, Master. K.E.A. did not experience the clinical manifestations like

belching, hiccupping, heartburn after eating, and diarrhea. Patient however did not experience

all the clinical features of the disease.

C. Specific Medical Treatment

Treatment refers to as a therapy intended to stabilize or reverse a morbid process or state.

Treatment may be pharmacologic, using drugs, surgical, involving operative procedures, or

supportive, building the patient’s strength. It may be specific for the disorder, or symptomatic

to relieve symptoms without affecting a cure.

The following drugs were used in the treatment of the condition

1.IV Omeprazole 80mg Stat x 1

2. IV metoclopramide 10mg tds x 24hours

3.Syrup Nugel O 15mls tid x 5 days

4.IV Tramadol 100mg bd x 1

5.IVF RL 500mg daily x 1

6.Caps iron lll 50mg 1 bd x 14

7. IVF DNS 1L daily x 1

Table 5. Below Shows the treatment given to client compared with those in the

Literature Review

Treatment outlined to Literature Review Treatment Given to My

Patient

1. Antiemetics 1. Antiemetics

a. Metoclopramide a. metoclopramide was given

b. Dexamethasone b. Dexamethasone was not

c. Droperidol given

c. Droperidol was not given

2. Antacids 2. Antacids

a. Aluminium hydroxide was

a. Aluminium hydroxide
not given

b. Magnesium hydroxide b. Magnesium hydroxide was

not given
c. Magnesium Trisilicate
c. Magnesium Trisilicate was

d. Suspension Nugel O not given

d. Suspension Nugel O was

given

3. Proton pump inhibitors 3. Proton pump inhibitors

a. Omeprazole a. Omeprazole was given

b. Esomeprazole
 c. Pantoprazole b. Esomeprazole was not
d. Lansoprazole given

c. Pantoprazole was not given

d. Lansoprazole was not given

4. Hematinics 4. Hematinics

a. Folic acid a. Folic acid was not given

b. Iron sucrose b. Iron sucrose was not given

c. Iron dextran c. Iron dextran was not given

d. Iron lll d. Caps Iron lll was given

Table 7: Pharmacology of Drugs Used

Date Drug Dosage/Route Classification Desired Actual Action Side Effects Comment

effect Observed
Of Administration

22/08/23 IV Dosage:80mg stat, Proton (Gastric It reduces Patient’s Headaches, Patient

Omeprazole then IV 40mg bd x Acid) Pump acid stomach pain flatulence, experienced excess

48 hours Inhibitor production was decreased Dizziness flatulence

in the No other side

Route: Intravenous
stomach by effect was

blocking the observed

action of

proton

pumps in

the stomach

lining
22/08/23 Tramadol Dosage: 100mg bd Narcotic Patient was Constipation, Patient did not
It binds to
x1 analgesics relieved from nausea, black experience any of
mu-opioid
bodily pain tarry stools, these side effects
Route: intravenous receptors in
vomiting
the central

nervous

system

(CNS),

inhibiting

the reuptake

of

neurotransm

itters,

serotonin

and
 norepinephr

ine.

22/08/23 Nugel O 15mls tid × 5 days Antacids It forms a Patient was Dizziness, Patient did not

protective relieved of his drowsiness, have any of the

Route: Oral
layer on abdominal pruritus, side effects

the pain fainting

stomach

lining,

which

helps to

alleviate

symptoms

by

reducing

the
 irritation

caused by

stomach

acid.

22/08/23 Caps Iron lll Dosage :1 bd x 14 Hematinic It bounds to Patient was Skin rashes, Patient complained

proteins like relieved of micturition, of dizziness,

Route: Oral
transferrin aneamia dizziness however, no

for transport treatment was

and ferritin given

for storage.
 Date Drug Dosage/Rout Classification Desired Actual Action Side Effects Comment

e effect Observed

Of

Administrati

on

22/08/23 Intravenous Dosage: Hypertonic To correct Patient Fluid volume Patient experienced

dextrose saline 500mls solution dehydration, maintained a overload, none of the side

6hourly × 48 replaces fluid normal body edema effects

hours sodium, and electrolyte

Route: chloride and level

Intravenously calories

22/08/23 Ringers Lactate Dosage: Isotonic IV Correct fluid Patient fluid Sweating, None of these side

1liter x 24 fluid solution electrolyte electrolytes weight gain, effect was observed
(R/L)
hours Crystalloid imbalance status was micturition

fluid maintained
 Route:

intravenously

22/08/23 Metronidazole Dosage: Antimicrobial To eradicate It treated any Nausea, dry Patient did not have

500mg tds x (antiprotozoal) any possible possible mouth metallic any side effect

48hours, infection in infection taste

Route: the gastric

Intravenously mucosa

when

administered
D. Complication: is an accident or second disease process arising during the course of or

following the primary condition.

Comparison of complications in literature with what patient developed

Complications in Literature review Complications developed by patient

Peptic ulcers Not developed by patient

Gastric cancer Not developed by patient

Haemorrhage Not developed by patient

Gastric perforation Not developed by patient

Anaemia Not developed by patient

With reference to the complications listed in the literature review, Master. K.E.A. exhibited

no complication out of his condition due to the appropriate medical and nursing care rendered

and his cooperation to the treatment regimen.

2.3 Patient / Family Strengths

According to Hornby (2020), strengths are the factors that contribute to the patient's

wellbeing. The following strengths were observed in my client and family during their period

of hospitalization.

1. Patient could communicate, verbally the location of his pain. (22/08/23)

2. Patient could express level of anxiety. (22/08/23)

3. Patient could sleep for about eight hours in a calm environment. (23/08/23)

4. Patient showed interest in gaining knowledge on his condition and treatment. (24/08/23)

5. Patient could describe the frequency and color of the vomitus. (25/08/23)

6. Patient could eat seven tablespoonsful of food served. (25/08/23)

2.3 Patient’s Health Problem

These are conditions that affect the patient physically, mentally and socially which could

hinder recovery if special attention is not given to the patient. The following health problems

were identified;

1. Patient complains of abdominal pain (22/08/23)

2. Patient and relative (mother) was Anxious (22/08/23)

3. Patient had difficulty in sleeping (Insomnia) (23/08/23)

4. Patient had little knowledge about the condition (24/08/23)

5. Patient presented with vomiting (25/08/23)

6. Patient complained of loss of appetite. (25/08/23)

2.4 Nursing Diagnosis

Nursing diagnosis is the second step of the nursing process. According to the north America

Nursing Diagnosis Association (NANDA), a nursing diagnosis is a clinical judgement about

individual, family or community responses to actual or potential health problem or life

process.

1. Abdominal pain related to acute inflammation of the gastric mucosa as evidenced by

patient verbalizing pain, moaning and crying, narrowed focus and altered passage of time.

(22/08/23)

2. Anxiety related to unknown outcome of the condition and its management as evidenced by

patient showing signs of persistent worrying. (22/08/23)

3. Insomnia related to exposure to new environment and disease process (gastritis) as

evidenced by having hard time falling asleep at night (23/08/23)

4. Knowledge deficit related to a lack of exposure to information as evidenced by

verbalization of a lack of understanding. (24/08/23)

5. Risk for fluid volume deficit as evidenced by prolonged vomiting. (25/08/23)

6. Imbalanced nutrition: less than body requirement: related to anorexia nervosa, as

evidenced by muscle weakness. (25/08/23)

 CHAPTER THREE

PLANNING FOR CLIENT AND FAMILY CARE

3.0 Introduction

Planning is the process in which the nurse and patient together consider the goals to achieve in

meeting the patient’s identified or potential problems in daily life and produce an individual

care plan (Weller, 2019). Planning for patient/family care is the third stage of the nursing

process. A nursing care plan commences with the nursing diagnosis, the goals and objectives.

Once these goals are identified, unique nursing actions are outlined to achieve the goals and

objectives. It is based on the potential and actual problems identified. The nurse further goes

on to evaluate the care given to find out whether set goals and objectives are fully met, partially

met or unmet.

3.1 Objectives/Outcome Criteria for Patient and Family care

Objectives are what the nurse and patient want to achieve in terms of observable patient

responses rather than nursing activities. Based on the health problems identified on my patient,

the following nursing objectives were set for him and his family during his period of

hospitalization.

1. Patient would have control of his abdominal pain within 24 hours as evidenced by;

a. Patient verbalizing he is relieved or no more feels pain.

 b. Nurse observing patient having cheerful facial expression.

2. Patient and relative anxiety will resolve within 24 hours as evidenced by;

a. Patient and his mother verbalizing that they no longer feel anxious.

b. Nurse observing patient and relative are relieved of anxiety by putting on cheerful

facial expression and are cooperative to the treatment being rendered.

3. Client will maintain his normal sleeping pattern (6-8 hours in the night and 2hours in the

day time) within 48 hours as evidenced by:

a. Client verbalizing that he had uninterrupted sleep.

b. Nurse observing that client has uninterrupted sleep for 6-8 hours during night and

for 2 hours during the day.

4. Client and family would gain adequate knowledge on Gastritis within 24 hours as

evidenced by;

a. Patient and relatives verbalizing understanding of what they are taught on Gastritis.

b. Nurse observing that patient and relatives practice what was taught.

5. Patient will maintain his normal fluid volume within 48 hours as evidenced by:

a. Nurse observing patient has urine output greater than 40mls per hour and a normal

skin turgor.

b. Patient verbalizing that he no more feels nauseous and vomits no more.

6. Patient will regain his normal nutritional pattern within 48 hours as evidenced by;

a. Nurse observing patient been able to eat 2/3 of his usual food being served.

b. Patient regaining normal weight.

3.2 Nursing Care Plan

This is the last step in the series of approaches used for presenting the patient’s plan of

nursing care. It enables the staff nurse to meet the needs of the patient and his family at a

given time. The nursing care plan consists of date and time, nursing diagnosis,

objectives/outcome criteria, nursing orders/interventions and evaluation.

Table 3.1 below shows the nursing care plan used to render care to Master K.E.A
Table 8: Nursing Care Plan for patient
Date/Time Nursing Objectives/ Outcome Nursing Nursing Intervention Date/Time Evaluation Sign

Diagnosis Criteria Orders

Abdominal pain Patient would have 23/08/2023 Goals was fully

1. Reassure 1. Patient and relatives
22/08/2023 related to acute control of his met as patient
patient. were reassured that the
inflammation of abdominal pain within verbalizing he is
necessary intervention
the gastric 24 hours as evidenced 2. Assess pain 11:30am relieved or he no
will be carried out to
11:30am mucosa as by: characteristics. more feels pain
aid in alleviating his
evidenced by and nurse
1.Patient verbalizing he 3. Engage pain.
patient observing
is relieved or he no patient in
verbalizing pain, 2. Assess pain patient having
more feels pain. diversional
moaning and characteristics such as cheerful facial
activities.
crying, 2. Nurse observing the quality, severity expression.
4. Assist (scale of 0(no pain) to
narrowed focus patient having cheerful
patient to 10(the most severe
and altered facial expression.
assume pain), location and
passage of time.

duration.
comfortable

position.
3. patient was engaged

with diversional

activities such as
5. Encourage
listening to music,
the intake of
watching of televisions
copious fluids
and reading of story
that do not
books.
irritate the

gastric 4. Patient was assisted

mucosa. to assume a lateral

position.
6. Administer

prescribed 5. Patient was

drugs. encouraged the intake

of more fluids like

 water that do not irritate

the gastric mucosa.

6. IV Omeprazole 80mg

was administered to the

patient

Table 3.1: The Table Below Shows the Nursing Care Plan for Master. K.E.A
Date/Time Nursing Objectives Nursing Orders Nursing Date/Time Evaluation

Diagnosis Intervention

22/08/2023 Anxiety Patient and family 1. Reassure the patient and family. 1. Patient and 23/08/2023 Goals was fully

related to anxiety will resolve 2. Orientate patient to hospital family was met as patient and

unknown within 24 hours as environment and routine activities reassured that the family verbalizing

11:50m outcome of evidenced by: disease condition 11:50am that they are no
3. Educate patient on the disease
the can be managed. longer anxious
condition
condition 1. Patient and family and nurse
2. Patient was
and its verbalizing that they are 4. Encourage verbalization of fear observing that the
oriented to hospital
managemen no longer anxious. and anxiety client and family
environment and
t as are relieved of
5. Encourage other patients who routine activities
evidenced 2.Nurse observing that anxiety and being
have had the condition before to which will help
by patient client and family are cooperative.
share their experience with the patient to adjust
showing relieved of anxiety and
patient more quickly to the
signs of being cooperative and
hospital
persistent relaxed facial 6. maintain a calm manner while environment,

worrying. expression. interacting with the patient to allay aiding in their

anxiety. overall well-being

and recovery

process.

3. Patient was

educated on the

disease condition to

help alleviate fears

and uncertainties,

which are often

sources of anxiety

4. Patient was

encouraged to

verbalize fear and

anxiety to

recognize the

factors leading to

anxious feelings.

5. Other patients

who have had the

condition before

was encouraged to

share their

experienced with

the patient to relief

patient from

anxiety.

6. A calm

environment was
 maintained while

interacting with

patient to allay

anxiety.

Date/Time Nursing Objectives Nursing Orders Nursing Intervention Date/Time Evaluation

Diagnosis
23/ 08/2024 Insomnia related Patient will maintain 1. Reassure patient 1. client was reassured that 25/08/2023 Goal was

to exposure to his normal sleeping 2. Ensure quiet appropriate measures will be laid fully met as
8:30am 8:30am
new pattern (6-8 hours in the environment for the down to allow him to have
6- Patient
environment and night and 2hours in the purpose of allowing him uninterrupted sleep.
verbalizing
disease process day time) within have good sleep. 2. Noise was reduced on the
that he had
(gastritis) as 48hours as evidenced 3. Make a comfortable bed ward by regulating volumes of
uninterrupte
evidenced by by; for patient to enhance television set and radio as well.
d sleep and
having hard time sleep. 3. A comfortable bed, free from
1. patient verbalizing Nurse
falling asleep at creases and cramps was made
that he had observing
night. 4.Ensure enough for patient to boost patient’s
uninterrupted sleep. that, patient
ventilation at the ward to sleep.
had
2.Nurse observing that, allow fresh air to circulate 4. Adequate ventilation was
uninterrupte
patient had properly. provided by opening nearby
d sleep for
uninterrupted sleep for windows and leaving patient in
8hours
6-8 hours during night light clothing to ensure enough
during night
and 2hours during day. sleep.
5.Restrict visitors 5. Client’s visitors were and 2hours

as visitors distract restricted to prevent undue during day

client’s good sleep. disturbances to help client’s

6.Encourage sleep.

patient to have 6. Patient was served with warm

warm drink and milo and also took warm bath to

warm bath enhance his sleep.

Date/Tim Nursing Diagnosis Objectives Nursing Orders Nursing Date/Time Evaluation

e Intervention

24/08/23 Knowledge deficit Patient and family would 1. Assess patient’s 25/09/2023 Goal was fully met
1. Patient level
related to a lack of gain adequate knowledge level of knowledge as;
of knowledge 12:15pm
exposure to on Gastritis within 24hours about the disease Patient and
was assessed
12:15pm information as as evidenced by; condition. relatives
by asking
evidenced by 1.Patient and relatives 2. Educate patient on verbalizing
patient questions
verbalization of a lack verbalizing understanding the nature of the understanding of
about the
of understanding. of what they were taught disease condition. what they were
disease
on Gastritis. 3. Encourage patient taught on Gastritis
condition.
to ask questions when and

2. Nurse observing patient understanding is not 2. Patient was nurse observing

and relatives practice what clear. educated on the patient and

was taught. 4. Show patient audio nature of the relatives practice

visual aids. disease what was taught.

condition,
5. Question the patient predisposing

regarding previous and precipitating

experience and health factors using

teaching. diagrams

6. Identify any pictures and

existing videos to

misconceptions illustrate

regarding material to complex

be taught. concepts.

Medication

regimen, the

need to report

symptoms of

complications,

Prevention of
the disease

condition.

3. Patient was

Encouraged to

asked questions

when

understanding is

not clear.

4. Patient was

showed audio

visual aids to

help to

understand it

easily and better

like charts,
diagrams on the

affected organs.

5. The patient

was questioned

regarding

previous

experience and

health teaching.

6. Existing

misconception

regarding

material to be

taught were

identified.
Date /Time Nursing diagnosis Objectives Nursing orders Nursing interventions Date/time Evaluation

23/08/23 Fluid volume deficit Patient will 1.Assess the The possible signs of 27/08/23 Goal was fully

as evidenced by maintain his possible signs of dehydration such as met as patient

prolonged vomiting normal fluid dehydration weakness, decreased skin verbalize he

8:30am volume within turgor and thirst were 10:00am vomits no more

48hours as assessed. and nurse

evidenced by; observing patient

2.patient was encouraged
nurse has a urine
2. Encourage to eat and drink a little to
observing output greater
patient to eat and reduce the chance of
patient has than 40mls per
drink a little. vomiting.
urine output hour and a

greater than 3. fluid balance was normal skin

40mls per hour assessed for every 24hours turgor.

and a normal
3. Assess the 4. patient was encouraged
skin turgor and
balance of fluid to avoid foods and
patient
every 24hours. beverage that contains
verbalizing that
4. Encourage caffeine to avoid irritation
he no more
client to avoid to the stomach lining.
feels nauseous
consuming foods
and vomits no 5. the procedures
and beverages
more. performed was
that contain
documented into the
caffeine.
nurses notes.
5. Document

procedures into

the nurse’s notes

6.intake and out was
6. Monitor intake
monitored and recorded in
and output
the intake and output

chart.
Date/Time Nursing Objective/Outcome Nursing Orders Nursing Date/Time Evaluation

Diagnosis Criteria Interventions

25/ 08/23 Imbalanced Patient will regain 1. Serve patient his 1. Patient’s preferred 27/08/23 Goal was fully met as

At nutrition his normal preferred meals. meals ampesi with At patient gaining his

12:00am :less than nutritional pattern kontomeri stew was normal weight and
2. Provide mouth 09:00am
body within 48 hours as served. nurse observing patient
care twice daily.
requirement: evidenced by. been able to eat 2/3 of

related to 3. serve food in bit his usual food served.

1. Nurse observing
anorexia and at regular 2. Mouth care was
patient been able to
nervosa, as intervals provided twice daily
eat 2/3 of his usual
evidenced before and after meals
food being served. 4.serve balanced
by muscle to improve his
diet.
weakness appetite.
2. Patient regaining 3. Food was served in

normal weight. bits and at regular

5.Daily weighing of
intervals to improve
patient on the same
digestion.
scale, at the same

time and with the 4. Balanced diet such

same clothing. as oat and milk with

bread and egg and

6.serve prescribed
fruits such as banana
medication
and water melon was

served.

5.Patient was weighed

daily on the same time

and with the same

clothing.
6. IV metoclopramide

10mg was served.

 CHAPTER FOUR

IMPLEMENTATION OF PATIENT/FAMILY CARE PLAN

4.0 Introduction

This chapter forms the fourth part of the patient/family care study. Implementation is the

actualization of the nursing care plan through nursing intervention. It gives a vivid account of

the actual nursing care given to the patient / family from the day of admission until discharge

based on the health problems identified. It also deals with the home visits and follow-ups to

ensure continuity of care. Nursing intervention is any treatment based on clinical judgment

and knowledge that a nurse performs to enhance patient outcomes. It entails carrying out both

medical and surgical interventions. The patient and relatives are encouraged to participate by

playing their role in patient’s recovery. The nurse should bear in mind the individuality of

patient and family.

4.1 Summary of Actual Nursing Care Rendered to Patient

The nursing management of the patient started on the day of admission thus from 22nd

August, 2023 to the day of discharge 27th August, 2023. The management aimed at

alleviating patient’s abdominal pain and treating other presenting signs and symptoms of the

condition, treating underlying cause and preventing complications. During the period of

admission, daily routine care was carried out such as bed making, maintaining the personal

hygiene, serving of prescribed medication to the patient and others.

First Day of Admission (22/08/2023)

On 22nd August, 2023 he sets off from the house at 10:30am, at 11:10 Master K.E.A. was

seen at the outpatient department and was admitted to the male’s ward. He was brought into

the ward by his mother, accompanied by a nurse from the outpatient department. Patient was

diagnosed of Gastritis. He appears weak and irritable on arrival.

They were warmly welcome at the entrance of the ward and escorted to the nurse’s station.

Mother was offered a seat and reassured that the admission process was temporary, and that

the child will be discharged immediately he gets well to the house, again she was told that,

Master. K.E.A. was in the hands of competent nurses and doctors, and that complete nursing

care will be instituted for Master. K.E.A. During assessment, he complained of abdominal pain

at the epigastric region, nausea and vomiting, loss of appetite and difficult sleeping. He was

reassured to allay fears and anxiety.

His particulars such as name, sex, age, occupation, health insurance status and residential

address were recorded in the admission and discharge book. His name, sex and age were written

in the daily ward state.

Hospital policies regarding visiting hours, payment of bills and time for vital signs was checked

and administration of medications were explained to him and relative.

Client was made comfortable in bed and his vital signs were checked and recorded as

5. Temperature – 36.4 degrees Celsius

6. Pulse -79 beats per minute

7. Respiration -20 cycles per minute

8. Blood pressure -103/66 millimeters of mercury

Oxygen Saturation was 96%

A head to toe physical examination was conducted on the patient and no abnormalities were

seen.

Client was oriented to time, place and person. Master K.E.A. and relative were oriented to the

ward environment by first introducing them to the staffs present to get them acquainted, the

nurses station and the nurses room were also shown to them. The patient’s toilet and bathroom

was shown to them so that they can visit them anytime they feel to void. Master. K.E.A. was

introduced to patients who had suffered the same condition and were recovering in other to

enable hope and anxiety. They were then shown the in-patient pharmacy and laboratory where

all in- patients medications are received and investigations were carried out. Lastly, Master

K.E.A. and his mother were informed about the time for every visit which starts from 5:30am

– 6:00am in the morning, 12:00pm -1:00pm in the afternoon and 5:30pm -6:00pm in the

evening.

I reintroduced myself to the patient as a student nurse of Nursing and Midwifery Training

College, Berekum, who would like to take him and his family for my care study. Master. K.E.A.

and his family were informed that the care study is a requirement by the Nursing and Midwifery

Council of Ghana in partial fulfilment towards the award of license to practice as a Registered

General Nursing. I explained to the patient and his family the concept of the patient/family care

study and assured them of privacy and confidentiality. Introduction was made to them and l

asked permission to use him for my care study as a student which they agreed.

Discharge planning was initiated with the relatives, thus they were told that the hospital will

be a temporary place for their care and would have to continue the care at home once there is

an improvement in his condition.

I decided to choose this patient for my care study because I wanted to get more understanding

about the causes, signs and symptoms, prevention and treatment of gastritis and to able to

differentiate it from other similar abdominal conditions.

Dr. K.M. who firstly attended to the patient, after history taking and physical examination later

prescribed the following as a continuous medication to manage the patient at the ward which

were administered as prescribed by the physician;

1.IV Omeprazole 80mg Stat

2.IV metoclopramide 10mg tds x 24hours

3.Syrup Nugel O 15mls tid x 5 days

4.IV Tramadol 100mg bd x 1

5.IVF RL 500mg daily x 1

6.Caps iron lll 50mg 1bd x 14

7.IVF DNS 1L daily x 1

These investigations were to be carried out on the patient

7. Full Blood Count

8. Upper G.I X-ray

9. Endoscopy

The mother was educated to feed the child frequently with a balanced diet, and to avoid fruits

such as oranges since it can cause gastric irritation. They also informed her that, a time will

come that the care will be terminated. The nurse in-charge, also grant me the permission and

thank the patient and relatives for me. At 6:00pm, patient vital signs were monitored and

documented per chat. Prescribed medications Syrup Nugel O 15mls and IVF Dextrose Normal

saline 500mls were served.

Client was made comfortable in bed and left in the hands of the afternoon nurses to continue

the care as my shift was over.

At 11:30am, patient abdominal pain was managed and a Nursing diagnosis thus abdominal

pain related to acute inflammation of the gastric mucosa as evidenced by patient verbalizing

pain, moaning and crying, narrowed focus and altered passage of time was made for patient.

As such, an objective to help client to be relieved of his pain was set within 24 hours. The

following nursing interventions were carried out; Patient and relatives were reassured that the

necessary intervention will be carried out to aid in alleviating his pain, patient’s pain

characteristics was assessed such as the quality, severity, location and duration, explanation

was made to the patient the relationship of pain to disease process.

Patient was assisted to assume a lateral position and patient was encouraged the intake of

more fluids like water that do not irritate the gastric mucosa.

IV Omeprazole 80mg was administered to patient as prescribed.

At 11:50am, patient complained to me that he feels nervous due to the exposure to the

unfamiliar hospital environment, therefore a nursing diagnosis of Anxiety related to unknown

outcome of the disease condition and its management as evidenced by patient showing signs

of persistent worry was made. The following nursing interventions were implemented based

on a 24hours objective set to relieve patient and family from their anxiety; patient and family

were reassured that the disease condition can be managed, patient was oriented to the hospital

environment and routine activities which will help patient to adjust more quickly to the hospital

environment aiding in the overall-being and recovery process, patient was encouraged to

verbalization of fear and anxiety to recognize the factors leading to anxious feeling, other

patients who have had the condition before was encouraged to share their experienced with the

patient to relief patient from anxiety.

At 2pm,patient vital signs were checked and recorded as indicated in the appendix. He was

made comfortable in bed and left in the hands of the afternoon nurses to continue taking care
of him as my shift was over. Later in the evening patient was assisted to take his bath. He took

his supper around 5:30pm. At 6:00pm, vital signs were checked and recorded as indicated in

the appendix. At 10pm, patient vital signs were checked and recorded as indicated in the

appendix and due medications were served as care continues. Patient slept at 11:00pm.
Second Day of Admission (23/08/2023)

On the second day of admission as I went to the ward to continue with my nursing care to my

patient, Master. K.E.A., I went to his bedside to greet him and asked of his wellbeing. At

6:00am, his prescribed medications were served. His vital signs had been checked at 6:00am

by the night nurses and were recorded as in the appendix. Patient performed his personal

hygiene as his bed was straightened to be free from creases and crumps.

At 8:30am, patient verbalized he has difficulty sleeping at night which he started

experiencing recently. Nursing diagnosis was formulated as sleeping pattern disturbance

(insomnia) related to exposure to new environment and disease process (Gastritis) as

evidenced by having hard time falling asleep at night. An objective was set to restore client’s

normal sleeping pattern within 48hours. Nursing actions implemented are as follows:

client was reassured that suitable measures would be laid down to allow him to sleep for 6-

8hours during the night and 2 hours during the day. All forms of noise from television set and

radio were reduced especially during periods of sleep. A comfortable bed free from creases

and cramps was made with the prime concern of boosting client’s good sleep. Visitors of

client were restricted in order to prevent any undue sleep disturbance. Enough ventilation was

allowed by opening nearby windows and leaving client with light clothing. Patient was

served with warm milo and also took warm bath to enhance his sleep. Patient was served with

warm milo and also took warm bath to enhance his sleep

At 11:30am, an evaluation was made on the objective to relieve patient of his abdominal

pain. Goal was fully met as patient verbalizing he is relieved or he no more feels pain and

nurse observing patient having cheerful facial expression.

 At 11:40am, patient was reviewed by the medical team and together with the nurses

available was the plan was to continue current treatment and report any signs of abnormalities

as quickly as possible.

At 11:50am, Patient was evaluated on my objective set to relieve patient’s anxiety by a night

staff, Goal was fully met as: Client and family verbalizing that they are no longer anxious and

nurse observing that client and family are relieved of anxiety and being cooperative.

Patient had ampesi and stew as his lunch at 12:30pm before he decided to take a rest in his

comfortable bed.

At 4:00pm, patient was engaged in another conversation about some personal life stories

which served as a diversional therapy

At 6:00pm, patient was served with rice and stew as his supper before his vital signs were

checked

Vital signs were checked at 6:00pm and recorded as in the appendix:

I gave my patient and his relatives a prior notice that I would want to go and see their house

and a permission was granted after they gave me the direction to their house.

Notwithstanding, the day for the visit wasn’t made known to them. My patient’s mother gave

me her husband’s contact to call when I am ready so that he will meet me and send me home.

At 10:00pm, his vital signs were checked and recorded, prescribed medications were

administered and recorded as documented in the appendix. Patient slept at 10:30pm

Third Day of Admission (24/08/2023)

Patient was seen at exactly 6:30am in bed talking to his relatives that came to visit him during

the early times of the morning. His vital signs were already checked and recorded as stated in

the appendix and all due medications to be given were also administered by the night nurses.

He went to take his bath around 7:38am. A comfortable bed was made for patient with clean

sheets and pillow case. Patient then took his breakfast which was porridge and bread he was

revealed by Dr K.M and was ordered to continue current medications as signs of

improvement of condition was evident. At 10:00am, his vital signs were checked and

recorded, due medications were served as documented as shown in the appendix

After the ward rounds, thus at 12:15pm, I had a chat with my patient about his condition and

realized he has little knowledge about the condition he presented with at the hospital. He

showed interest in being a learner to know more about his condition, based on that, this

nursing diagnosis was formulated; knowledge deficit related to lack of exposure to

information as evidenced by verbalization of lack of understanding.

clinical features, management and the care of gastritis. An objective was set to enable patient

demonstrate understanding of the condition (gastritis) within 24hours. The nursing actions

that were executed include the following: client and his family’s level of knowledge and their

motivation and willingness to learn was assessed.

A conducive environment was created for learning by minimizing noise and putting away all

forms of destructors (example putting client’s mobile phone on silence). Inter-personal

relationship was created by way of sitting close to patient’s bed side, sharing jokes and asking

questions about their health status, unclear understanding about the material to be taught were

identified, Client and family were educated on the causes, clinical manifestations as well as
the treatment of gastritis in ‘Twi’. They were allowed to ask any question and tactful answers

were provided.

At 2pm patient vital signs were checked and recorded as indicated in the appendix. Patient

was made comfortable in bed free from creases as care continues.

I left the ward for my first home visit at 4:00pm without my patient’s awareness.

Patient’s care continued by other nurses on duty. He had his supper (rice and soup) at

5:00pm before taking his medication at 6:00pm, his vital signs were checked and recorded as

shown in the appendix.

At 10:00pm, his vital signs were checked and recorded as due medication were served and

documented as shown in the appendix. He slept at 11:00pm.

At 6:00am, insomnia was assessed and patient verbalized he was able to sleep for 4hours

during the night.

Fourth Day of Admission (25/08/2023)

Master. K.E.A. was seen in bed in good health and was responding to treatment given. The

usual routine nursing care was provided and documented in the nurses’ notes. Patient gave no

new complains per my conversation with him, likewise during ward rounds. Current

treatment being given was to be continued.

At 8:30am, I evaluated my set goal on insomnia. Goal was fully met as client verbalizing that

he had uninterrupted sleep and nurse observing that client has uninterrupted sleep for 6-8

hours

At 11:15am, patient complains of vomiting and a nursing diagnose was formulated as risk for

fluid volume deficit as evidenced by prolonged vomiting. An objective was set to maintain

his normal fluid volume within 48hours. Nursing action implemented are as follows; the

possible signs of dehydration such as weakness, decreased skin turgor and thirst were

assessed and intake and output was monitored, patient was encouraged to eat and drink a little

to reduce chances of vomiting, fluid balance was assessed every 24hours, procedures

performed was documented into the nurses note.

At 12:00pm, patient complained of loss of appetite after asking questions regarding his

condition. A nursing diagnosis was made as imbalanced nutrition: less than body

requirement: related to anorexia nervosa, as evidenced by muscle weakness. Objectives were

set for Patient that, he will regain normal nutrition within as evidenced by; Nurse observing

patient been able to eat 2/3 of food being served and patient regaining weight. Patient was

served his preferred meals, mouth care was provided twice daily and food was served in bits

and at regular intervals.

Evaluation was made at 12:15pm on my set objective to help my patient gain sufficient

knowledge about his condition. Goal was fully met as patient and relatives were able to

provide correct answers to questions they are asked regarding the features, management and

nurse observed patient and relatives practice what was taught

At 2:00pm, patient had roasted plantain with groundnut for lunch. His vital signs and due

medications were served and documented as shown in the appendix. He had a nap at 4:00pm

before his family came to visit him at the ward. In the evening, he took rice and stew around

5:30pm for supper. He stayed glued to the ward Television afterwards watching the news and

other programs as well.

At 10:00pm, his due medications were served, his vital signs were checked and recorded as

shown in the appendix. Patient went to bed around 10:20pm

Fifth Day of Admission (26/08/2023)

Master. K.E.A. was seen in bed in good health and was conscious and sound. The usual

routine nursing care was provided and documented in the nurses’ notes

Patient was very well and active with no new complains. He was responding well to

treatment and verbalized his intentions to be discharged. I made my patient aware that the

physician is the one responsible for ordering discharges and I assured him that if the Dr.

assesses you and he finds it fit for you to be discharged, he will do so without hesitation. All

the needed medical and nursing care were provided and documented.

At 10:30am, patient was reviewed.

His vital signs checked at 10:36am and recorded as indicated in the appendix. I had

diversional therapy with my patient and his mother through conversation and asking about

the diet he was served with, to know whether patient and family have been putting what they

learnt into practice or not

At 2:00pm, vital signs were checked and recorded as indicated in the appendix. Patient ate

Ampesi with garden eggs stew and patient took only 3 slices. At 6:00pm, patient was served

fufu with light soup for supper but he was able to take only two morsels of fufu before taking

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

Moreover, I informed them about my next home visit on the 3rd September, 2023 which he

agreed to after seeking his consent. Happily, for me, they had adapted the new knowledge

and was putting into practice. Patient was assessed for the vomiting and he said it has

subsided hence interventions continued.

When it was around 8:15pm, I bid my patient goodbye and a goodnight and he was left into

the hands of the night nurses.

Sixth Day of Admission and Day of Discharge (27/08/2023)

Master. K.E.A. was doing very well in health when seen at 7:00am, talking with his relatives

that came to visit as usual. We exchanged pleasantries, patient and family reported no new

complains. I reminded them about my second home visit on the day of discharge, I then left

to the nurses’ station to check her vital signs readings for the morning and it was within the

normal ranges as recorded in the appendix.

At 9:00am, evaluation was made on patient’s loss of appetite. Goal was fully met as patient

was able to eat 2/3 of his usual food being served.

I evaluated my objective I set that patient will restore his normal body fluid and stop

vomiting at 10:00am, I met my goal fully as I observed patient has a urine output greater than

40mls per hour and a normal skin turgor and Patient verbalizing he vomits no more.

At 10:55am, patient was reviewed by Dr. K.M. and patient was generally well with no new

complaints. Doctor informed patient that he will be discharged on oral medications of Tab

Metronidazole 400mg tds x 7 and Tab Omeprazole 40mg x 7 together with the Nugel O he

already had. The treatment plans were as follows; Counselling with the dietician, continue

current medications to do Abdominal USG to check if any abdominal organ abnormality is

present and bring results on the day of review on 6th September, 2023. He was educated on

the need to take the rest of his medications and how to take the medications, side effect of the

medications and the need to report any illness and abnormalities were made known to him.

He was also encouraged to report any unusual feelings that he will experience before the date

of review if any. I called the dietician through the ward phone to come and see my patient
before he leaves for home. I, together with the dietician provided Master. K.E. A. and his

mother with a clear and understandable education on how he should live his life, creating an

awareness on his diets, emphasizing on education given to him on Gastritis. All his bills were

fully settled, because he was an insured client. The interventions undertaken were

documented for continuity of care and for references. All procedures were documented

especially into the admission and discharge book and the daily ward state. I assisted in

packing patient’s belongings, decontaminate the bed of patient and locker to enhance

infection prevention.

At exactly11:55am, patient and relative left the ward, a taxi was boarded in front of the

Male’s ward and got to his resident in less than 30minutes time.

4.2 Preparation of Patient/Family for Discharge and Rehabilitation

Preparation for discharge commenced from the time of admission at the hospital, at 10:30am

on 22nd August, 2023 till the last day of visit, 16th September, 2023. The client and family

were informed that staying in the hospital was for a temporary period of time. Education of

client and family on the causes, clinical features, treatment and management of Gastritis were

enhanced.

This was aimed at helping the client and relatives in the provision of adequate care. Prior to

client discharge, health education was given to the client and relative on the importance of

avoiding self- medication and ensuring proper personal hygiene. Also, I emphasized on the

need for client to avoid irritating or contaminated diets, avoiding smoking, alcoholism,

caffeinated beverages as well as foods that contain high amount of acid or alkali. Client was

encouraged to take in food rich in the essential food nutrients and eating well healthy

balanced diets. Client and his family were also educated on the need to maintain personal and
environmental hygiene to help improve immunity. A great emphasis was made on the need to

continue with his medication and to report to the hospital if any problem does occur. Client

was informed to come for review on the 6th September, 2023. Necessary documents were

recorded into the admission and discharge book as well as the ward state. Assessment of

client bills were made with the help of National health insurance scheme. Patient was

educated about the disease condition, it cause, signs and symptoms, treatment, complication

and prevention of his disease condition. The need to ensure good sleep was also emphasized.

4.3 Follow Up/ Home Visits/ Continuity of Care

Home visits were done before and after patient’s discharge. It was friendly but a purposeful

visit to patient’s home. Health educations were given and the need for the prevention of

complication was reemphasized. It provided a good account on the causes and predisposing

factors of client’s illness.

First Home Visit (24th August, 2023)

First home visit was made on 24th August, 2023 on Thursday while patient was still on

admission. I gave a prior notice to my patient and other family members and they willingly

gave me the permission. The aim of the visit was to know patient’s home for subsequent

visits and also to see if there is any problem in the house that could serve as a predisposing

factor for patient’s illness and to identify any health facility nearby. I left the ward at exactly

4:00pm to my patient’s house. He stays at Subinso No.2 near Anglican School, a suburb of

Wenchi in the Bono region. They live in their own apartment with toilet, bath and a kitchen,

well ventilated rooms roofed with aluminium roofing sheet. The house consists of chamber

and hall with three-bedroom built with blocks and plastered but yet to be painted with a porch

in front and roofed with Aluminium sheet. Ventilation was very good since each room in the
house has two windows covered with net which prevents mosquitoes from entering the room

and also there was a ceiling fan.

The environment was hygienic with a neat compound that was neatly swept and the bathroom

was also neat and well-scrubbed. The toilet was also a water closet with the water pipe in it

working which allows them to flush whenever they go to the toilet. They have a well-

constructed in the middle of the house which gives them an alternative means of getting

water whenever the pipe ceases to flow. Their source of water is from a pipe- borne and they

have access to electricity supply. Their refuse is collected in a well-covered dustbin.

My interaction with my patient’s father revealed to me that there was a nurse staying the next

house behind them, who works at the Subinso No.2 Community clinic. I took this opportunity

to introduce myself to the nurse, interacted with her and pre informed her of my intention to

hand over my patient to her come the day of termination of patient and family care for the

continuity of care. The nurse willingly and gladly accepted to do so and I thanked her for

that.

After having some interaction with the father, I thanked them and left at 5:50pm. Patient

became happy when he was informed about my visit and I told his father I will have

subsequent visits.

Second Home Visit (3rd September, 2023)

This visit was made on the 3rd September, 2023, at 11:55am, seven days after client was

discharged from the hospital. Master. K.E.A. and his mother received me, offered me a seat

and water to drink.

As usual, I asked about their health especially about Master. K.E.A. who said he had not

experienced any problems since he came home. I requested for his drugs to ensure that he had

really been taking them and was happy to see that he followed the said instructions given him

at the hospital.

He expressed his gratitude to me for my care and the education I gave them and promised to

adhere to everything I said, especially to lifestyle modifications. We talked about other social

matters and later asked permission to leave at 2:04pm after reminding him of the date for his

review which was on 6th August, 2023.

Review (6th September, 2023)

On the 6th September, 2023, client was met at the Out Patient Department of Methodist

Hospital, Wenchi at 8:20am looking cheerful and lovely as noted from facial expression. I

accompanied them to go and verify the hospital identification number on their card as done

by every client who visits the hospital. The vital signs were checked and recorded as follows;

1.Temperature- 36.0 degree Celsius

2. Pulse - 80 beats per minute

3.Respiration - 20 cycles per minute

4.Blood Pressure - 110/70MmHg

Weight was 52 kilograms

At the Out Patient Department, client was seen by the medical officer at consulting room 3.
Upon assessment by Doctor K. M, Master. K.E. A. was healthy. He did not complain of any

pain or body weakness. He came along with his results for the abdominal Ultrasonography as

ordered on the day of discharge. The physician received it and he told my patient that the

results show that all the abdominal organs are normal in structure, size and function. He was

told not to hesitate to report to the hospital if he should encounter any health problem instead

of buying drugs from the over-the- counter drug sellers for self- medication. He was

encouraged to eat healthy diets and to live a healthy life. Patient was assured of a third home

visit. I then accompanied him to the hospital gate where he boarded a taxi to the house.

Third Home Visit (16th September, 2023)

On the 16th September, 2023, the last home visit was paid to Master. K.E. A. and his family.

My main reasons for conducting the third home visit were to:

1. See how Master. K.E.A. was doing at home.

2. Assess the general condition of client’s family.

3. Reinforce the need to comply with treatment

regimen and

4. Eventually terminate care.

On the said date, I set off in the morning around 8:00am with a taxi. I got to their place

around 8:30am. On arrival, my patient’s friend had paid him a visit and they were seen

chatting happily.

Patient, his friend and family were happy to see me. Patient and family were doing well as

they looked cheerful and had no complains. The environment was tidy as there were no

rubbish nor stagnant water around. I handed over client to the nurse which I met in the house
during my first home visit and encouraged his mother who was always with him to continue

with his care at home to continually monitor client’s blood pressure and ensure he

compliance on the treatment regimen. Master. K.E. A’s. mother and his younger sister

commended me for good work done and accepted to continue the care of Master. K.E.A. at

home. However, I re-enforced that they should always report to the nearest health facility or

hospital whenever they fall sick and they should not practice self-medication. Interaction with

client and his family showed that client had being taking the prescribed drugs and the

recommended foods had also been paid heed to.

After interacting with patient and family for a while, I reemphasized on health educations that

had been given to them already. Since it was my last day of therapeutic relationship with

client and family, I terminated my care and thanked them for their cooperation which made

my study a success. Again client and his family expressed their gratitude by showing how

grateful they were to me for the support and care given to them. I finally sought permission to

leave and bid them the final farewell. I board a taxi and returned to my place when it was

12:10pm.
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

5.0 Introduction

According to the Encarta Dictionary (2020), evaluation is the act of considering or examining

something in order to judge its value, quality, importance, extent or condition. This is the

fifth stage of the nursing process that seeks to test the effectiveness of the nursing care

rendered to the patient and the family. The chapter talks about the following;

• Statement of evaluation.

• Amendment of the patient/family care plan for partially met and unmet objectives.

• Termination of care
5.1 Statement of Evaluation

Throughout the period of admission, six health problems were recorded, an objectives were

set to solve them. Below is the summary of the interventions carried out and to what extent

the goals were met.

1. Patient was relieved of his abdominal pain

On 22nd August, 2023. At 11:30am, a Nursing diagnosis of abdominal pain related to acute

inflammation of the gastric mucosa as evidenced by patient verbalizing pain, moaning and

crying, narrowed focus and altered passage of time was formulated. As such, an Objective to

help patient to be relieved of his pain was set within 24 hours as; Patient would have control

of his abdominal pain within 24 hours as evidenced by: Patient verbalizing he is relieved or

he no more feels pain. Nurse observing patient having cheerful facial expression.

The following nursing interventions were carried out; patient and relatives were reassured

that the necessary intervention will be carried out to aid in alleviating his pain, patient was

engaged with diversional activities such as listening to music, watching of televisions and

reading of story books. Patient was assisted to assume a lateral position and patient was

encouraged the intake of more fluids.

On 23rd August, 2023 at 11:30pm that, the objective that was set to relieve patient from his

abdominal pains was evaluated and my goal was fully met as patient verbalizing he is

relieved or he no more feels pain and nurse observing patient having cheerful facial

expression.

7. Patient and family were relieved of anxiety.

 At 11:50pm on 22nd August, 2023, patient revealed he was anxious due to his exposure to

the unfamiliar hospital environment, therefore a nursing diagnosis of Anxiety related to

unknown outcome of the condition and its management as evidenced by patient showing

signs of persistent worry was made. The following nursing orders were implemented based

on a 24-hour objective set to relieve patient and family from their anxiety; patient and family

was reassured that the disease condition can be managed, patient was oriented to the hospital

environment and routine activities which will help patient to adjust more quickly in their over

well-being and recovery process, patient was educated on the disease condition to help

alleviate fears and uncertainties, which are often source of anxiety, patient was encouraged to

verbalize fear and anxiety to recognize the factors leading to anxious feelings, other patient

who have had the condition before was encouraged to share their experienced with the patient

to relief patient from anxiety and a calm environment was maintained while interacting with

patient to allay anxiety.

At 11:50am on the 23rd August, 2023, I evaluated my objective I set that patient will be

relieved of his anxiety. This was evidenced by; patient and family verbalizing that they are no

longer anxious and nurse observing that the client and family are relieved of anxiety and

being cooperative. Therefore, my goal was fully met.

8. Patient’s normal sleeping pattern was restored.

Patient made a complaint of not being able to sleep on the 24th August, 2023 at exactly

10:30am and an objective was set to restore client’s normal sleeping pattern within 48 hours.

Nursing diagnosis was formulated as insomnia related to exposure to new environment and

disease process (Gastritis) as evidenced by lack of energy. Nursing actions implemented are

as follows: client was reassured that appropriate measures will be laid down to allow him to

have uninterrupted sleep, noise was reduced on the ward by regulating volumes of television
set and radio as well, a comfortable bed, free from creases and cramps was made for patient

to boost patient’s sleep, adequate ventilation was provided by opening nearby windows and

leaving patient in light clothing to ensure enough sleep, client’s visitors were restricted to

prevent undue disturbances to help client’s sleep and patient was served with warm milo and

he took a warm bath.

At 10:30am on the 26th August, 2023, an evaluation was done. I had a fully met goal as

patient verbalized he had uninterrupted sleep and Nurse observing that, patient had

uninterrupted sleep for 6-8hours during the night and 2hours during day time.

4. Patient and her relatives demonstrated knowledge into the treatment and care of

gastritis

I had a chat with my patient on 25th August, 2023 at 8:00am about his condition and realized

he has little knowledge about the condition he presented with at the hospital. They showed

interest to know more about his condition and based on that a nursing diagnosis was

formulated as: knowledge deficit related to lack of exposure to information as evidenced by

verbalization of lack of understanding. An objective was set to enable patient demonstrate

understanding of the condition (gastritis) within 24hours. The nursing actions that were

executed include the following: client and his family’s level of knowledge and their

motivation and willingness to learn was assessed. A conducive environment was created for

learning by minimizing noise and putting away all forms of destructors (example putting

client’s mobile phone on silence). Inter-personal relationship was created by way of sitting

close to patient’s bed side, sharing jokes and asking questions about their health status,

existing misconceptions about the material to be taught were identified, Client and family

were educated on the causes, clinical manifestations as well as the treatment of gastritis in

‘twi’. They were allowed to ask any question and tactful answers were provided.
I evaluated my objective at 8:00pm and goal set fully met as patient and relatives were able to

provide correct answers to the questions they are asked on the material they were taught and

were also seen putting what they learnt into practice

5.Patient’s vomiting ceased

On the 22nd August, 2023, patient was seen vomiting and an objective was set at 10:30pm

for 48 hours to restore patient’s fluid volume to normal and will stop vomiting based on the

nursing diagnosis of risk of fluid volume deficit as evidenced by prolonged vomiting. These

interventions were carried out; signs of dehydration was assessed and a balance of fluids for

every 24hours was done, patient was encouraged to eat and drink little but frequent to reduce

her chances of vomiting, he was educated to avoid foods containing caffeine, Dextrose

Normal Saline 500mg was administered.

An evaluation of my goal being fully met was done at 10:30pm on 24th August, 2023 as

patient verbalized he does not vomit anymore and nurse observing patient has a urine output

greater than 40mls per hour and a normal skin turgor.

6.Patient regained his normal nutrition

On 25th August 2023 at 12:00am, several assessments revealed that patient was having loss of

appetite hence the nursing diagnosis of imbalanced nutrition: less than the body requirement

related: to anorexia nervosa, as evidenced by muscle weakness was made. An objective was

set to help patient regain his normal nutritional pattern within 48hours. The following

interventions were carried out; patient was reassured that measures would be taken to restore

his appetite, patient was assisted to perform oral hygiene before and after meals to improve

his appetite, patient preferred meal was served, patient was weighed and recorded, meals
were served attractively to improve appetite and IV. Metoclopramide 10mg had been

administered at 8:40am.

On 27th of August 2023 at 9:00am, the objective set on 25/08/23 to help patient regain his

normal nutritional pattern within 48hours was evaluated and goal was fully met as patient

verbalized that he had regained his appetite and nurse observing patient eating 2/3 of plate of

meal served and increased weight.

5.2 Amendment of Nursing Care Plan for Partially Met or Unmet Outcome Criteria

Due to quality care given with the help of patient and his family together with good medical

care, all objectives set were fully met. Therefore, no amendment of care was done.

5.3 Termination of care

Termination of care is the period that ends the therapeutic relationship with the client and

family. It started right from the day of admission till the day of last home visit. This is done

to enable the client and family to accept that the care would not be there forever. I made it

known to the client and his family that they were only in the hospital temporary but in the end

they will be discharged home to continue treatment in their environment. During my last

home visit, I stressed on the need to adhere to the education given to them during the period

of hospitalization and on the need to report any signs and symptoms. I re-enforced that they

should always report to the nearest health facility or hospital whenever they fall sick and they

should not practice self-medication. I explained to them that I was terminating my care

officially and handed over the client to the nurse who was staying in the same house with my

client for continuity of care, but would visit them on other times unofficially.
Education on the need for checkups and review was reemphasized. I finally thanked them for

their cooperation and sought for their permission to leave and bid them the final farewell. I

board a taxi and returned to my place when it was 2:10pm.

CHAPTER SIX

SUMMARY AND CONCLUSION

6.0 Introduction

Summary is a comprehensive and usually brief abstract, recapitulation, or compendium of

previously stated facts or statements. Conclusion is something that you decide when you have

thought about all the information connected with the situation. This is the last step of the

patient/family care study which entails the student’s personal appreciation of the therapeutic

relationship with the patient as well as the use of the nursing process.

6.1 Summary of Care Rendered

Master. K.E.A. was admitted to the Males Medical Ward of Methodist Hospital, Wenchi, by

Dr. K.M. on 22nd August, 2023 at 10:30am with the diagnosis of Gastritis.

It was a planned admission. Patient spent six days at the ward. On admission, routine

activities such as serving of meals, monitoring and documentation of vital signs and

medications were carried.

1.Laboratory investigation done for client

2.client blood sample for full blood count, and other investigations thus,

3.abdominal endoscopy,

4.abdominal x- ray were conducted for patient.

Six (6) nursing problems were identified during the time of hospitalization and these were;

client having abdominal pain, vomiting and feeling nauseated, anxiety, difficulty sleeping,

deficit knowledge on patient’s condition and loss of appetite. It was observed that successful

patient and family care depends on cooperation of patient and the health team. In order to

solve these problems, objectives were set, nursing orders were implemented and goals were

evaluated. Client experienced no complication on review after he was discharged on 27th

August, 2023, he was declared very fit in health and was advised to be extra careful on his

diets and to report to hospital whenever he is not feeling well and to come for regular

checkups. I went on three different home visits. The first home visit was made on 24th

August, 2023 during which patient’s environment was assessed to find out about factors that

could predispose patient to his health problems. The second home visit was made on 3rd

September, 2023, that was after the patient was discharged home. During this visit, patient

and family were reminded on how to take his medications and client was also reminded of

review date which was on 6th September, 2022. The last home visit was on 16th September,

2023. During this visit, patient and his family were assessed for the progress in client’s

condition after the review and client was handed over to a nurse who was staying in the

house. The following drugs were administered;

1.IV Omeprazole 80mg Stat

2.IV metoclopramide 10mg tds x 24hours

3.Syrup Nugel O 15mls tid x 5 days

 4.IV Tramadol 100mg bd x 1

5.IVF RL 500mg daily x 1

6.Caps iron lll 50mg 1bd x 14

7.IVF DNS 1L daily x 1

6.2 Conclusion

Conclusion is the end or finish of an event or process. Master K.E.A. and family’s care study

has helped me acquire a broadened knowledge and understanding in the care of a person with

Gastritis due to the experience I gained in giving care to my client. This study has really

affirmed the need and importance of comprehensive nursing of the patient and families. It

has also boosted my confidence in rendering holistic care to client and it helped me to be a

good member of the health care team. It has helped me gained much experience in using the

nursing process effectively. Moreover, I am grateful to apply the knowledge acquired as a

student both in theoretical and practical aspects through this patient and family care study. I

therefore recommend that the patient and family care study should be maintained in the

General Nursing program by the Nursing and Midwifery Council of Ghana. Patient and

Family care study should be continued as it has really given me a better understanding of

using the nursing process to give quality nursing care to patients in future. Based on the

testimonies given by patients who received individualized nursing care at the hospitals, it

prompts most of the community members to seek medical help at the various hospital. This

helps to redeem the image of the hospital and the staff as a whole. Also, this patient and

family care study also helps to change the community’s wrong perceptions about staff nurses
and also improve the people’s attendance to the hospital and it helps the family to gain more

knowledge on condition.

I recommend that all student Nurses should take the care study very serious in order to know

how to practically implement the nursing process.

APPENDIX

Table 6.2.1: Vital Signs of Master K.E.A

DATE TIME Temperature Pulse Respiration Blood Pressure

(0C) (bpm) (cpm) (mmhg)

22/08/23 10:30am 36.4 79 20 103/66

2:00pm 36.8 76 21 110/70

6:00pm 36.2 72 24 113/69

10:00pm 36.4 69 20 117/66

23/08/23 6:00am 36.2 62 23 120/60

10:00am 36.0 70 21 110/62

2:00pm 36.4 68 21 113/62

6:00pm 36.7 68 24 110/62

24/08/23 6:00am 37.0 80 27 113/71

10:00am 36.8 76 22 110/70

 2:00pm 36.3 82 20 100/60

6:00pm 36.4 72 23 130/60

25/08/23 6:00am 36.4 80 23 120/60

10:00am 36.5 76 21 110/70

2:00pm 36.4 87 24 113/71

6:00pm 36.6 70 23 103/66

BIBLIOGRAPHY

Hinkle, J. L., Cheever, K. H, & Overbaugh, K.J. (2022). Brunner & Suddarth's textbook for

medical-surgical Nursing (15th ed.). Philadelphia ; Walters Kluwer health.

Wagh, A., & Grant, A. (2019). Ross and Wilson anatomy and physiology in health and

illness (12th ed.). Edinburgh: Churchill Livingstone Elsevier.

Weller, B. F. (2019). Bailliere's nurses' dictionary: for nurses and healthcare workers (25th

ed.).London: Elsevier Health Sciences.

SIGNATORIES