NURSING AND MIDWIFERY TRAINING COLLEGE -

DADIESOABA

A PATIENT/FAMILY CARE STUDY ON A PATIENT WITH

CELLULITIS

BY

SEI CHOWIETEY SHADRACK

INDEX NUMBER: C320230115

SUBMITTED TO:

NURSING AND MIDWIFERY COUNCIL-GHANA

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 JULY, 2025

PREFACE
The patient family care study is carried out by student nurses as a partial fulfillment for the
awards of Diploma in General Nursing Certificate by the Nurses And Midwifery Council (NMC) of
Ghana.

It is a written report of comprehensive care given to a particular patient within a specific period
of time. It also involves study of the cause, clinical manifestations, treatment and prevention of
pathological condition. Modern professional nursing emphasizes the use of scientific approach
to render a unique and holistic care to patients. This calls for the nursing process which allows
the nurse to help client meet his/ her physical, psychological, social and spiritual needs.

Through patient/family care study, student nurses get to relate well with people such as health
staff and patient’s relatives.

The patient family care study also allows the student nurse to put into practice the theoretical
knowledge and skills acquired during training.

Finally, the patient family care study affords the student nurse the opportunity to conduct
research focused on a particular condition.

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ACKNOWLEDGEMENT

My foremost thanks go to the Almighty God for seeing me through all these years, for
His strength, knowledge and understanding He gave me in my academic work and for
helping me complete this work successfully.

The next thank the tutorial staff of Nursing and Midwifery Training College, Dadiesoaba,
especially my supervisor Rev. Kingsley Ansu Asare who read continuously through this
script, offering assistance and guidance to make this work successful. My sincerest
thanks go to Mr. O.K and family, who is the main subject of this study for allowing me to
use him for the study and for their cooperation, which contributed significantly to the
success of this care study.

Also, my profound appreciation goes to the nursing staffs and doctors of the Male
Surgical unit at Municipal Hospital, Goaso, for their corporation, guidance and teaching
during my study. My profound gratitude goes to my Mum, my friend and my siblings for
their support and encouragement which have led to the success of this study. I say God
richly bless you all.

My appreciation also goes to all the authors and publishers whose text books was used
for the care study as references, may the good Lord grant them more knowledge in
their work and continue to write more books to help students.

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INTRODUCTION
The Nursing process approach has been adopted in Ghana since 1980 to promote an
individualized total patient care.

The care is designed to promote, maintain and prolong life as well as alleviating pain
and meet patient’s psychological needs. Nursing is the process of assisting the
individual either sick or well in the performance of those activities contributing to
health and his/her recovery or to peaceful death that he would perform unaided if he
had the necessary strength, will or knowledge.

The study was carried out on Mr. O.K. who is twenty-one years old and was admitted
into Male Surgical ward at the Municipal Hospital, Goaso. My interaction with Mr. O.K.
and his family started on the14th July, 2025 around 1:25pm.

On admission, patient presented the following; wound on the right leg, high body
temperature.

A comprehensive care plan was developed, and relevant nursing interventions were
implemented to ensure speedy recovery of the patient.

With the co-operation and support from patient, family and other health care givers at
Male surgical ward, Mr. O.K.’s condition improved tremendously, subsequently, he was
discharge on the 19th July, 2025

At the time of discharge, Mr. O.K. looked cheerful and had improved remarkably.
Patient and family were very happy that he had recovered safely.

The reason for choosing this condition was to have more knowledge about the disease
condition that is, its diagnosis, treatment regimen and the specific nursing
management.

Laboratory investigations ordered was Full Blood Count (FBC)

Plan of treatment for Mr. O.K was as follow;

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 • Zincite 1tab od x 3/7
• Tab Paracetamol 1g tds x24
• I.V Clindamycin 300mg qid x 72hours

The major items of this study have been arranged in six chapters according to the
nursing process and organized as follows;

• Chapter one (1) consists of Assessment of the patient and family

• Chapter two (2) consists of Analysis of data collected
• Chapter three (3) deals with the planning of patient/ family care
• Chapter four (4) consists of implementing patient/ family care
• Chapter five (5) deals with Evaluation, Summary and conclusion of care of
patient/ family

CHAPTER ONE

ASSESSMENT OF PATIENT/FAMILY

1.0 Introduction
According to Smelter and Bare (2010), assessment is the systematic collection of data to
determine the patient health status and any actual or potential health problems.

In the nursing process, it involves the gathering of information about the health status
of a particular patient, analysis and synthesis of data, and the making of clinical
judgment. The outcome of the nursing assessment is to identify the nursing problems of
the patient and the appropriate intervention. Assessment of patient involves collection
of data from the Patient, his family members, the community within which they live and
the health personnel. This is done through observations, interviews, physical
examination and laboratory investigations. These help the nurse to determine the
health status of the Patient and his family in order to plan an effective nursing care
towards recovery.

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1.1 Patient’s Particulars
This is the written information about someone or something.

Mr. O.K, the subject of this study is twenty-one years old. He was born on 14th
November, 2004 to the late Mr. A.B and Mrs. A.S and lives alone with his siblings at
Municipal hospital, Goaso in the Ahafo Region. Their house number is AS705, Harvest
Time LP with digital address number BU-0013-9498. He is a native of Goaso in the Ahafo
Region and a Christian who worships at Jesus Anointing Church. He speaks Asante - Twi.
He is dark in complexion with no tribal marks and weighs 55kg. He is the first born and
the only male child amongst his siblings. Patient further explained that he completed
form three and later went to senior secondary school but did not complete due to
financial problem.

Mr. O. K’s next of kin is his mother. A.S. who bears the same address.

1.2 Patient, Family Medical History and Socio-Economic History

During interaction with Mr. O.K, he claimed that his family does not have a history of
any chronic or hereditary diseases such as hypertension, asthma, diabetes mellitus,
epilepsy or any mental disorder. He continued to say that there is no communicable
disease in the family like Tuberculosis, Leprosy etc. They sometimes experience
headache and malaria, which they usually treated on Outpatient Department (OPD)
basis or sometimes buy over-the-counter drugs to treat or sometimes treat with herbal
preparations. The family has no known allergies.

Socio-economically, Mr. O.K is a tricycle driver. Mr. O.K lives with his mother and
siblings in the house. The patient and his family members are all registered with the
National Health Insurance Scheme (NHIS), which helps them to assess health care with
minimal cost involved. The patient and family have no particular family traditions but as
part of their faith they don’t smoke nor drink alcohol.

Mr. O.K belongs to a very good Christian family of which he takes active participation in
their religious activities. He visits the church regular for all Sunday and week activities

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and festivals. Mr. O.K also support his mother to cater for his sibling’s education and
other needs as well.

Mr. O.K had aspirations of becoming a teacher during his schooling period but failed
because he could not continue his education from Senior Secondary school due to
financial problems.

1.3 Patient’s Developmental History

According to Hornby (2010), growth is a process of increasing in size (growing)
physically, mentally or emotionally. According to Hornby (2010), development is the
gradual growth of something so that it becomes more advanced and stronger.
According to Hornby (2010), maturation is the process of becoming matured or
becoming an adult. According to my patient, he went through forty weeks of normal
pregnancy and was delivered spontaneously without any deformity at Municipal
Hospital, Goaso.

He was also vaccinated against the childhood killer disease such as whooping cough,
measles, poliomyelitis, tuberculosis etc. and was evidenced by the presence of the
Bacillus Calmette- Guerinscar on his shoulder and it was written in his weighing card as
well. Patient was breastfed and later introduce into their food. Patient passed through
the normal developmental milestone Patient began teething at three months. Patient
begun to sit when he was five months old, crawled at eight months and walked at one
and a half years. Patient is in a very healthy relationship with his peers and his family.

According to Erickson’s theory of development (1963), psychosocial development

describes the human life cycle as a series of eight ego developmental stages from birth
to death. Each stage presents a psychosocial crisis, the goal of which is to integrate
physical, maturation and societal demands. The theory focuses on psychosocial task
that are accomplished throughout the life cycle. An unsuccessful resolution leaves the
individual emotionally handicapped.

Intimacy vs. Isolation (Young Adulthood)

According to Erikson’s psychosocial theory of development, Mr. O.K., being 21 years
old, is in the stage of Intimacy vs. Isolation, which occurs in young adulthood

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(approximately 20–39 years). At this stage, the major developmental task is to form
close, committed relationships with others while maintaining a strong sense of self.
Successful resolution leads to deep and meaningful connections, love, and
companionship.

However, failure to achieve intimacy may result in social isolation, loneliness, and
emotional withdrawal. Individuals who struggle at this stage often find it difficult to
trust or bond with others.

In the case of Mr. O.K., despite the challenges of losing his father and supporting his
mother and siblings, he has shown maturity by caring for his family and contributing
positively to his community. This sense of responsibility and ability to maintain
meaningful social relationships reflects progress toward intimacy, showing that he is on
a positive developmental path.

1.4 Patient’s Lifestyle and Hobbies

Mr. O.K gets up at 6:00am and has his quiet time (devotion) with his son. He brushes his
teeth with toothbrush and Pepsodent toothpaste twice daily (Morning and evening). He
empties his bowel twice in a day and takes his bath twice daily with warm water. For
breakfast, Patient mostly takes Milo beverages or porridge with butter bread. Patient
has no known allergies for food or drugs. Mr. O.K.’s favorite food is rice with vegetable
stew. He takes three square meals a day with snacks in-between. He does not smoke
nor drink alcohol. If patient wants to go to his work he wakes at 5:00am and prepares
and goes to pick his customers to their destinations. At his leisure hours, he normally
watches television (news) and football.

During weekends, patient wakes up at 8:00am. He then observes personal hygiene and
elimination needs. He will then watch football matches and sometimes goes out to play
oware and return home at 12:00 noon and take his lunch. Mr. O.K stated that he usually
rests when he feels tired. He stays home till evening, take his bath and his supper. He
will watch television (news) till 8:00pm before he goes to sleep.

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Mr. O.K communicates well using verbal and non- verbal communications. He is the
extrovert type and dislikes being disgraced in public. The patient is sociable and always
happy. Impression about the patient is, he is hopeful and confident in all things.

1.5 Patient Past Medical History

According to Mr. O.K, he did not experience any childhood illness like measles,
whooping cough, diphtheria, etc. According to Mr. O.K, he has never had any serious
disease but he has once suffered from malaria and went to Municipal Hospital in Goaso
of which he was admitted. According to my patient, he didn’t encounter any disability
due to the illness. He stayed at the hospital for 2 days and was discharged home to
continue with the rest of the medication. He also added that he sometimes experiences
headache with he treats with over-the-counter drugs. Patient has an easy access to the
health facility.

1.6 Present Medical History

From Mr. O.K, had an accident with another tricycle which made him to sustain an
injury on his right leg on the 14h of July, 2025 he saw that he was heavily bleeding and
having high body temperature and chills. He was immediately rushed to the Municipal
hospital, Goaso and was rushed to the Emergency unit of the Municipal Hospital, Goaso
at 12:06 pm for treatment. Dr. Lawrence attended to him and base on his complained,
he was diagnosed Cellulitis due to RTA

On arrival at the hospital on 14th July, 2025 his vital signs were checked and recorded.
He was seen by Doctor Lawrence and was diagnosed of Cellulitis of the right leg. He
was admitted to the Accident and Emergency Ward and later trans-out to the male
Surgical Ward at Municipal Hospital, Goaso on the same day which was 14th July, 2025
at 12:20pm.

1.7 Admission of Patient

On 14 July 2025 at 12:20 pm, Mr. O.K was admitted to the Male Surgical Ward from
A&E, ambulatory, accompanied by his mother. Initial vitals: T-38.5 °C, P-106 bpm, R-22
breaths/min, BP-126/60 mmHg, SpO₂-98%. Diagnosis: Cellulitis of the right leg following
RTA-related wound. He was oriented to the ward; consent for care study was obtained.

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I confirmed his admission by glancing through his folder. The admission was ordered by
Dr. Lawrence who diagnosed Mr. O.K of having Cellulitis of the right leg due to RTA.
Patient was warmly welcomed to the ward and seats offered whiles his folder was
handed over by the staff nurse. Preparation of the patient and family started on the day
of admission. Patient and family were made to understand that, hospitalization is
temporal and condition will improve and will be discharged home. An admission bed
free from cramps and creases was prepared for him and made comfortable in bed.

During admission patient was conscious, alert and well oriented to time, place and
person. He complained of pains in the right leg, bleeding, wound, and high body
temperature. Patient and relative were reassured that they have found themselves in
the hands of competent and professional health team and will do everything to ensured
and promote speedy recovery.

Interaction with my patient made me understand that he has less knowledge about the
condition. He was made to understand that before he leaves the hospital, he will gain
more insight about his condition. General observations were made from head to toe.
The necessary particulars were ascertained and recorded in the admission and
discharge book and the ward statement respectively. History from patient was taken,
this includes name, age, sex, date and time of admission, place of residence, next of kin,
religion, ethnicity, nationality and hometown. A quick assessment of his general
condition was also made by checking and recording the vital signs. The recordings were
as follows:

• Temperature - 38.5 degrees Celsius

• Pulse – 106 beats per minute
• Respiration - 22 cycles per minute
• Blood pressure- 126/60mmHg
• Spo2- 98%

Explanation was given to Mr. O.K that the National Health Insurance Scheme does not
cover all drugs hence he will be required to buy for some drugs should the need arise.
Explanation was also given on the visiting hours of the hospital and was asked to
communicate the information to other family members.

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In order to reduce pain, a pain assessment was done using a scale of 0-10. Patient was
served with Injection Diclofenac 75mg stat, diversional therapy was also employed by
engaging patient in conversation.

To reduce his temperature to normal, tepid sponging was done, vital signs especially
temperature was assessed to determine the progress of the interventions, adequate
ventilation was ensured and excess clothing on the body was removed. Good
therapeutic relationship was established between the patient, relative and the staffs in
the ward.

Plan of treatment for Mr. O.K was as follow;

• Injection Diclofenac 75mg stat

• Tab Paracetamol 1g tds x 4days
• I.V Clindamycin 300mg qid x 72 hours

Laboratory investigations ordered was Full Blood Count (FBC)

A tray was set and the medical officer was assisted to set up an intravenous line for
withdrawing blood specimen for the above test to be carried out. The blood sample was
labeled and sent to the laboratory and patient was made comfortable in bed.

I introduced myself again as a final year nursing student of the Nursing and Midwifery
Training College, Dadiesoaba who wants to care for him with the aid of other staff and
would like to take him for my care study. I told Mr. O.K and his mother that, it is a
partial fulfillment for the award of license to practice as a Professional Registered
General Nurse and they agreed and were willing to cooperate.

Patient was chosen for the study because of the keen interest in nursing a patient with
cellulitis and also to gain more knowledge on the condition.

Mr. O.K was also informed about a visit which would be made to his house whilst he
was still on admission and after his discharge. I thanked them for their cooperation and
assured them that the information that will be given will be kept confidential. They
were also made to know that, the care would be terminated when patient’s condition is
under control and they would be handed over to a community health nurse for
continuity of care.

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Treatment was commenced and patient was reassured and made comfortable in bed.

1.8 Patient’s Concept of His Illness

My patient believed that it is normal to fall sick irrespective of whoever you are. Upon
interviewing the patient, he didn’t attribute his sickness to any spiritual factor but he
strongly said that by the grace of the Almighty God and with quality care from nurses,
he would soon get better.

He was pleased and happy with the warm reception from the hospital staff and became
convinced that he would recover quickly in order to go home. He however has a little
knowledge about the causes of his condition. He was optimistic that his condition will
improve.

1.9 Literature Review

ANATOMY AND PHYSIOLOGY OF THE SKIN

Gerald and Bryan (2009), outlined that the skin (also known as the cutaneous
membrane or integument) covers the external surface of the body and is the largest
organ of the body by other surface area and weight.

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 Structure of the skin

Figure 1: A Labelled Diagram of the Structure of the Skin

Component of the Skin

The skin consists of a superficial, thin epidermis, a deep thicker dermis, and the
subcutaneous layer.

EPIDERMIS
The epidermis consists of five layers namely; stratum corneum, stratum lucidium,
stratum granulosum, stratum spinosum, stratum Basale. The cells of the epidermis are
keratinocytes, which produces a strong protein (keratin) on the skin, melanocytes,

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which produces the pigment melanin; Langerhans cells, which participate in immune
responses; and Merkel cells, which functions in the sensation of touch.

DERMIS
The second, deeper part of the skin, the dermis is composed of a strong connective
tissue containing collagen and elastic fibers. This woven network of fibers has great
tensile strength (resist pulling or stretching forces). The dermis also has the ability to
stretch and recoil easily. Leathers which we use for belt, shoes, basketball, gloves and
baseballs, is the dried and treated dermis of other animals. The few cells present in the
dermis include predominantly fibroblast, with some microphages and a few adipocytes
near its boundary with subcutaneous layer.
Blood vessels, nerves, gland and hair follicle are embedded in the dermal layer. The
dermis is essential to the survival of the epidermis, and these adjacent layers form
many importance structural and functional relations. Based on its tissue structure, the
dermis can be divided into a superficial papillary region and a deeper reticular region.
The papillary region makes up about one-fifth of the thickness of the total layer. It
consists of areolar connective tissue containing thin collagen and fine elastic fibers.
Its surface area is greatly increased by dermal papillae small, fingerlike, structure that
projects into the undersurface of the epidermis. Some of these nipple-shaped papillae
also contain capillary loops (blood vessels). Some dermal papillae also contain tactile
receptors call Meissner corpuscles of touch, nerve endings that are sensitive to touch
and free nerve endings, dendrons that lack any apparent structural specialization.
Different free nerve endings initiate signals that give rise to sensation of warmth,
coolness, pain, tickling and itching. The reticular region, which is attached to the
subcutaneous layer consist of dense irregular connective tissue containing fibroblasts,
bundles of collagen, and some coarse elastic fiber.
The collagen fibers in the reticular region interlace in a netlike manner. A few adipose
cells, hair follicles, nerves, sebaceous (oil) glands and sudoriferous (sweat) glands
occupy the space between fibers the combination of collagen and elastic fibers in the
reticular region provides the skin with strength, extensibility and elasticity.

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SUBCUTANEOUS LAYER
Deep to the skin is the subcutaneous layer, which attaches the dermis to underlying
fascia. It also called the hypodermis; this layer consists of areolar and adipose tissue.
The subcutaneous layer serves as storage of blood, protection, cutaneous sensation,
excretion and absorption, and synthesis of vitamin D.

Definition of Cellulitis

Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissues,

characterized by localized erythema, warmth, swelling, and pain, often accompanied by
systemic features such as fever and malaise (Stevens et al., 2023). The common
causative organisms are Streptococcus pyogenes and Staphylococcus aureus, including
community-acquired methicillin-resistant S. aureus (CA-MRSA) (Cox et al., 2022).

Epidemiology
Globally, cellulitis is one of the leading reasons for hospital admissions due to skin and
soft tissue infections, with a lifetime risk estimated at 10% (Miller & Choi, 2019). In sub-
Saharan Africa, poor sanitation, barefoot walking, and neglected minor injuries
predispose individuals to cellulitis (Amoako et al., 2021). In Ghana, cellulitis cases are
frequently associated with minor trauma, road traffic accidents, and insect bites
(Boateng et al., 2020).
Investigations
Diagnosis is largely clinical, but laboratory investigations such as full blood count
(showing leukocytosis with neutrophilia), C-reactive protein (CRP), and blood cultures
may support clinical judgment (Weller & Cox, 2021).

Management
Management includes appropriate antibiotics, analgesia, limb elevation, and addressing
underlying predisposing factors. The Infectious Diseases Society of America (IDSA)
recommends oral flucloxacillin or clindamycin for mild cases, and intravenous therapy
for severe or systemic cases (Stevens et al., 2023). In Ghanaian hospitals, clindamycin,
flucloxacillin, and ciprofloxacin are commonly used based on local antimicrobial
sensitivity patterns (Boateng et al., 2020).

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Nursing Care
Nursing interventions focus on fever control, pain management, monitoring for spread
of infection, health education on skin care and hygiene, and adherence to prescribed
antibiotic regimens (Kozier et al., 2018). Nurses play a critical role in early detection of
complications and ensuring continuity of care after discharge.

Predisposing Factors

According to Amoako et al., (2021). Risk factors include breaks in the skin (trauma,
ulcers, surgical wounds), chronic venous insufficiency, lymphedema, obesity, and
immunosuppression

According to Cox et al., (2022). Local factors such as hygiene and environmental
exposures also contribute to cellulitis burden in rural communities Insect bite and sting,
animal bites or human bites, Injury or trauma with a break in the skin (skin wounds),
Ulcers from certain disease such as vascular disease, The use of corticosteroid
medications, Wound from a recent surgery.

Pathophysiology

Cellulitis develops when a disruption of the skin barrier (such as trauma, insect bite,
ulcer, or surgical wound) allows pathogenic bacteria—most commonly Streptococcus
pyogenes or Staphylococcus aureus—to penetrate the dermis and subcutaneous tissue
(Stevens et al., 2023).

Once inside, bacterial toxins and enzymes trigger an acute inflammatory response. This
begins with vasodilation and increased vascular permeability, leading to plasma
exudation and tissue edema. Neutrophils and monocytes migrate to the site of
infection through chemotaxis, where they ingest and destroy bacteria via phagocytosis
(Weller & Cox, 2021).

The clinical signs reflect these processes:

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 • Redness (erythema): caused by hyperemia from dilated arterioles and
capillaries.

• Swelling (edema): due to exudation of fluid and migration of leukocytes.

• Pain: results from increased tissue tension and pressure on sensory nerve
endings.

• Warmth: caused by increased blood flow to the affected area.

Systemically, the release of pro-inflammatory cytokines (IL-1, TNF-α) produces fever,

chills, and malaise. Regional lymphadenitis may also develop as organisms spread
through lymphatic channels. If uncontrolled, cellulitis can extend rapidly along fascial
planes, predisposing to abscess formation, necrotizing fasciitis, gangrene, or
septicemia (Cox et al., 2022). In severe cases, surgical intervention such as debridement
or amputation may be required.

Clinical Manifestation

Cellulitis typically presents with a combination of local and systemic signs of infection.

Local manifestations:

• Erythema (redness): well-demarcated but poorly defined borders, often

expanding over time.

• Swelling (edema): due to inflammatory exudation into subcutaneous tissues.

• Warmth: localized increase in temperature over the affected area.

• Pain or tenderness: caused by tissue tension and pressure on nerve endings.

• Skin changes: may include tight, glossy skin, blistering, or in severe cases,
necrosis.

• Regional lymphadenitis: enlargement and tenderness of draining lymph nodes.

Systemic manifestations:

• Fever and chills

• Malaise and fatigue

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 • Myalgia (muscle aches) and arthralgia (joint pains)

• Headache

• Nausea and, occasionally, vomiting

• Leukocytosis (often revealed on full blood count)

Severe or rapidly progressing cellulitis may present with hypotension, tachycardia, or

altered mental status, indicating systemic inflammatory response syndrome (SIRS) or
sepsis (Stevens et al., 2023; Weller & Cox, 2021).

Diagnostic Investigation:

Diagnostic investigations help confirm cellulitis, rule out differential diagnoses, and
monitor the patient’s response to therapy. The following are commonly performed:

1. Physical Examination

• Careful inspection and palpation of the affected area for erythema, warmth,
swelling, tenderness, and regional lymphadenitis.

• Assessment of systemic signs such as fever, tachycardia, or hypotension to

detect possible sepsis.

2. Laboratory Investigations

• Full Blood Count (FBC): usually shows leukocytosis with neutrophilia, reflecting
acute bacterial infection.

• Blood cultures: indicated in patients with systemic symptoms or

immunosuppression to identify bacteremia.

• Wound/pus culture and sensitivity: to determine the causative organism and

guide appropriate antibiotic therapy.

• C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR): elevated

levels help assess the degree of inflammation and response to treatment.

• Fasting blood glucose: performed to rule out or monitor diabetes mellitus,

which predisposes to recurrent cellulitis.

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 • Renal function tests (urea, electrolytes, creatinine): to monitor kidney function,
especially when using nephrotoxic antibiotics.

• Liver function tests (LFTs): may be done if hepatotoxic antibiotics are prescribed
or systemic involvement is suspected.

3. Imaging (if indicated)

• Ultrasound: may detect abscess formation or deep venous thrombosis

(important differential).

• MRI/CT scan: considered in severe, rapidly spreading infections or when

necrotizing fasciitis is suspected (Stevens et al., 2023).

Medical Management:

The goals of medical management are to eradicate infection, relieve symptoms, prevent
complications, and treat underlying predisposing factors.

1. Pharmacological Management

Antibiotics

• Mild cellulitis (oral therapy): flucloxacillin 500 mg qid or clindamycin 300 mg qid
(for penicillin-allergic patients).
• Moderate to severe cellulitis (IV therapy): cefazolin, cefuroxime, or clindamycin.
In areas with high MRSA prevalence, vancomycin may be used (Stevens et al.,
2023).

Duration: 5–10 days, extended if the infection is slow to resolve.

Analgesics/Antipyretics

• Paracetamol (acetaminophen) 1 g every 6–8 hours for pain and fever.

• NSAIDs such as diclofenac or ibuprofen may be used cautiously for additional
pain relief.

2. Supportive Management

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 • Rest and limb elevation to reduce edema and promote venous/lymphatic
drainage.
• Hydration and nutrition to support immune function.
• Monitoring of temperature, vital signs, and the extent of erythema to assess
response to therapy.

Surgical Treatment

Surgery is rarely needed in uncomplicated cellulitis but may be indicated when

complications occur:

• Abscess formation: requires incision and drainage.

• Necrotizing fasciitis (rare, severe complication): requires urgent surgical

debridement of necrotic tissue.

• Gangrene or uncontrolled infection: may necessitate extensive debridement or,

in extreme cases, amputation (Weller & Cox, 2021).

Complications

If cellulitis is not promptly treated or is associated with underlying comorbidities,

several local and systemic complications may occur:

Local complications:

• Abscess formation: due to localized pus collection.

• Necrotizing fasciitis: rare but life-threatening, characterized by rapid spread of

infection along fascial planes.

• Chronic lymphedema: recurrent cellulitis may damage lymphatic vessels,

predisposing to persistent swelling.

• Gangrene (tissue necrosis): may occur in severe or untreated cases, particularly

in patients with diabetes or peripheral vascular disease.

• Osteomyelitis: bone infection resulting from direct spread of bacteria,

particularly in lower limbs.

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Systemic complications:

• Septicemia (bacteremia): bacteria spreading into the bloodstream, potentially

leading to septic shock.

• Endocarditis or metastatic abscesses: in rare cases of persistent bacteremia.

• Meningitis or brain abscess: very uncommon, but may occur in cellulitis of the
face, especially periorbital or facial cellulitis (Stevens et al., 2023; Weller & Cox,
2021).

Recurrent cellulitis is also considered a complication, as it predisposes patients to

progressive lymphatic damage, impaired mobility, and reduced quality of life (Miller &
Choi, 2019).

Nursing Intervention and Management

1. Psychological Care
Reassure patient and family that the condition is under control by competent
staff to allay anxiety. Explain all procedures to patient to gain patient
cooperation.
Allow patient to voice out all his views, thoughts and fears and relevant
solutions should be given. Engage the patient in diversional therapy such as
watching of television and explain any procedure before carrying it out. This
helps reduce anxiety.
2. Medications
All prescribed drugs should be administered by ensuring the rights of
medications which includes; the right dose, right patient, right time, right route,
right documentation. Make patient aware of the therapeutic and side-effects of
the drugs. Observe for any side effect of the drug.
3. Position
The patient is assisted to assume a comfortable position such as semi-fowlers
position or position which is not contraindicated to patient’s condition to
promote comfort, rest and to promote or facilitate breathing.
Extra pillows are provided to enhance comfort at painful areas.

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4. Rest and Sleep
The main aims of ensuring adequate rest and sleep are to conserve energy,
promote relaxation and also to relieve psychological and physiological stress.
Nursing measures carried out to attain maximum rest and sleep includes the
following; provide comfortable bed free from wrinkles and creases. Remove any
unpleasant smell from bed side and at the ward. Provide adequate ventilation
by opening nearby windows when patient feels hot. Provision of adequate
warmth by giving patient blanket to stimulate sleep.
5. Observation
Observe the affected part and immobilize it to reduce swelling and
complication.
Ensure aseptic techniques during dressing of wound. Vital signs should be
checked and recorded accurately. Observe and elevate the affected part to
reduce swelling and aid in circulation. Assess for patient’s level of pain and
appropriate measures should be taken to reduce it. Daily assessment of the site
should be done to assess signs and symptoms at the site. Assess for the
therapeutic and side-effects of drugs.
6. Education
Educate patient on diet rich in proteins and vitamins e.g. Vitamin c to promote
healing and food containing roughages to prevent constipation.
Educate patient on how to exercise the affected part to enhance circulation.
Teach patient on hand washing techniques and careful handling of soiled linen,
clothing and dressings to prevent cross contamination.
Educate the patient on the necessity for coming for follow up when discharged.
If surgery is done, management is just like any other surgical intervention.
Prophylactic antibiotics may be prescribed for 5 to 7 days.
Constant elevation of the affected extremity and observation for complication
are essential. The nurse instructs the patient or the care giver to inspect the
dressing daily. Unusual drainage or any inflammation around the wound
suggests infection and should be reported to the physician. The patient is
instructed to avoid the application of heating pads or exposure to direct sun rays
to prevent heat burns or trauma to the area.

xxii
7. Nutrition
A well-balanced meal should be provided containing carbohydrates, protein,
vitamins, fats and oil, roughages and minerals. Food should be extra rich in
vitamins especially vitamin C and protein to help boost the immune system and
facilitate healing.
Roughages as well as proper intake of fluids should be ensured to help prevent
constipation due to limitation in activities and movement of patient.
8. Prevention
Wound or cut should be washed to prevent the entry of any micro organism
Dermal problems should be reported and treated daily.
Educate patient on the practice of good personal hygiene to prevent the
recurrence of the episode.
9. Protection from Injury
Patient is protected from injury by using bed with side rails to prevent him from
falling. Also, all sharp instruments are taken away from patient vicinity to
prevent him from injuring himself. The floor of the ward is kept dry to prevent
the patient from slipping and falling.
Finger nails of the patient are cut short to prevent injuries as a result of
scratching the body with nail.
10. Validation of Data
Validation of data refers to the process of ensuring that the information
collected is accurate, reliable, and credible for the purpose of the study. In
nursing research and case studies, validation is essential to establish
trustworthiness and to avoid bias or misrepresentation (Polit & Beck, 2021).

According to Weller and Cox (2021), data validation involves confirming that the
measures and indicators used truly reflect the phenomena being studied. This
includes checking for internal consistency, comparing findings with existing
literature, and seeking expert or peer review of data collection methods.
In this case study, validation was achieved through:
• Cross-checking patient information from the history, laboratory results, and
treatment charts.

xxiii
 • Triangulation of data sources including observation, patient interview, and
hospital records.
• Consultation with supervising tutors and senior nurses to confirm the accuracy
of clinical interpretations.
• Referencing current textbooks and journal articles to support findings and
nursing interventions.
Thus, the data presented are sound, credible, and aligned with accepted nursing
standards, ensuring that the care plan is based on valid and trustworthy
evidence.
The data collected from Mr. O.K was validated based on the fact that counter
interviews with Mr. O.K and relative revealed the same response. The doctor’s
notes, nurse’s notes, investigations and their results, literature review of the
condition and observation made on Mr. O.K were cross checked with the
information he gave me and all of them strongly confirmed the data collected.
Laboratory investigations and physical assessment were checked with literature
review to ensure that information collected was free from errors, bias and
misinterpretation. Patient was also reassessed when symptoms had abated to
confirm information provided on admission. Also, the information gathered
during home visits helped in validating the data as they were all in line with
those given by the patient. All these indicate that the data was free from errors,
misinterpretation and biases and hence appropriate for the study.

CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction
Analysis refers to the systematic examination and interpretation of collected
information in order to identify significant patterns, relationships, or meanings (Polit &
Beck, 2021). In the nursing process, data analysis is the second step, following
assessment, and is essential for identifying the patient’s actual and potential health
problems (NANDA International, 2021).

xxiv
During data analysis, the nurse compares the patient’s subjective and objective data
with normal values, clinical guidelines, and relevant literature to determine deviations
from expected health status. This process also involves clustering related cues,
recognizing risk factors, and distinguishing between actual and potential nursing
problems (Wilkinson & Treas, 2020).

In this case study, analysis was done by reviewing the patient’s presenting complaints,
laboratory results, and nursing observations, then linking them to the pathophysiology
of cellulitis. This helped in formulating accurate nursing diagnoses and planning
individualized care interventions.

This is the process by which the assessment data are sorted and analyzed so that
specific, actual and potential health problems are identified.

This aspect of the care study deals with the critical examination and interpretation of
the data collected during the assessment of the patient. Here, there is a comparison
between the results of the investigations carried out and the normal values to detect
any abnormality from normal. This chapter also deals with the patient and family
strengths, their health problems and the corresponding nursing diagnosis.

2.1 Comparison of Data with Standards

Investigation refers to the systematic process of gathering and examining information or clinical
data to understand the nature, causes, and severity of a patient’s health problem. In nursing pr
actice, investigation is an essential component of the assessment phase of the nursing process,
as it provides the foundation for accurate diagnosis and effective care planning (Wilkinson & Tr
eas, 2020).Full blood count was ordered and carried out for my patient.

xxv
 Table one: Comparison of data with standard diagnostic investigation.

Diagnostic investigations outlined in the literature Diagnostic investigations ordered for

review my patient

A thorough health history taking Done for Mr. O. K

A complete physical examination Done for Mr. O. K

Full blood count Done for Mr. O. K

Hemoglobin level estimation Done for Mr. O. K

26
 2.1.1Table two: Diagnostic investigations carried out on Mr. O.K

Date Sample Investigation Results Normal Range Interpretation Remarks

14/07/25 Blood Full Blood Red blood 4.5 – 5.9 Within normal No
Count cells - ×10⁶/µL range treatment
was given
6.26 ×10⁶/µL

14/07/25 Blood Full Blood White blood 4.0 – 11.0 Values are above Antibiotic
Count cells- ×10³/µL the normal range was given
indicating the
12.0 ×10³/µL
presence of
infection

14/07/25 Blood Full Blood Haemoglobin 12.0-16.0g/dl Within normal No

Count -13.6 g/dL range treatment
was given

14/07/25 Blood Full Blood Hematocrit - 45% - 52% Within normal No

Count range treatment
47%
given

2.2 Causes of Patient’s Illness

With reference to the literature review some of the causes of Cellulitis are insect bite,
animal or human bites injury or trauma with a break in the skin. The cause of my
patient’s condition was as a result of an accident he had and he sustained an injury on
his right leg and this conforms to the causes of the patient’s condition as outlined in the
literature.

27
 2.3 Table three: Clinical manifestations exhibited by Mr. O.K compared with those in
the literature review.

Clinical features outlined in the literature review Clinical features exhibited by patient

Fever Patient experienced fever

Chills Patient experienced chills

Fatigue Patient did not experienced fatigue

Rapid feeling of unwell Mr. O.K experienced rapid feeling of unwell

Muscle aches and pain Muscle aches and pain was present.

Warm skin Warm skin was present.

Sweating Sweating was not present

Nausea and vomiting Nausea and vomiting were not present

Localized redness Localized redness was present

Regional lymph nodes become tender and enlarged Mr. O.K did not experience regional lymph
node enlargement.

Joint stiffness caused by swelling of the tissue over He did not experience any joint stiffness.
the joint.

Swelling of the right leg Swelling of the right leg was present

Itches Patient complained of itches around the

affected site

From the comparison in the table above, Patient presented with some of the signs and
symptoms outlined in the literature review such as fever. However, patient did not
exhibit some of the signs and symptoms stated in the literature such as nausea and

28
vomiting, sweating, joint stiffness etc. because he reported early to the hospital and
was given the right and immediate care.

2.4 Treatment

The following were the treatment which was given to Mr. O.K

• Diclofenac 75 mg IM stat
• Tab Diclofenac 50 mg bd for 4 days
• I.V Clindamycin 300 mg IV qid for 72 hours
• Tab. 1 g tds for 4 days

29
 Table Four: Comparison of Treatment in Text Book to Treatment Given to Patient.

Treatment outlined in the literature review Treatment given to my patient

Antibiotics Antibiotics such as I.V Clindamycin 300mg qid

x72hrs was given

Antipyretics Antipyretics such as Tab Paracetamol 500mg

tds x 12hrs was given.

Analgesics Analgesics such as Tab Diclofenac 50mg tds x

was given

Elevation and immobilization of the affected site The affected site was immobilized and elevated

Comparing the treatment given to my patient and that of the literature review, it could
be seen that the treatment given to my patient was in line with that of the treatment in
the literature review and this contributed greatly to the recovery of my patient.

30
31
 Table Five: Pharmacology of Drugs Administered

DATE NAME OF DOSAGE AND ROUTE OF DOSAGE AS CLASSIFI- ACTION OF DRUG ACTUAL SIDE EFFECTS OF
DRUG ADMINISTRATION PRESCRIBED FOR CATION ACTION DRUG AND ITS
AS IN LITERATURE REVIEW THE PATIENT OBSERVED REMEDY
17/07/25 Tab Diclofenac Route: oral 50mg bd x 4days Analgesic, It inhibits Patient was Rash, sweating,
prostaglandin relieved from dysuria, bleeding
Adults’ dosage:75-150mg (NSAID)
biosynthesis to pain and body constipation,
daily in 2-3 doses
cause antipyretic temperature stomatitis. None was
Children dosage:25-50mg and anti- subsides. observed on patient.
daily in 2-3 doses
inflammatory
effect

17/07/25 Intravenous Route: intravenous 300mg qid x Antibiotic To treat infections Patient was Diarrhea, abdominal
Clindamycin 72hours relieved from discomfort,
Adults: 300mg-1.2g/day in (Lincosamide
infection. jaundice,
two, three or four doses s)
esophagitis,
Children: (>1 month of
Nausea and
age) serious infection:15-
vomiting. None was
observed

32
 25mg/kg/day in three or
four equal doses

17/07/2025 Injection Route: Intramuscular 75mg stat Analgesics, It inhibits Patient was dysuria, bleeding
Diclofenac prostaglandin relieved from constipation,
Adults’ dosage: 75mg in 2- (NSAID)
biosynthesis to pain. stomatitis. None was
3 doses
cause antipyretic observed on patient.
Children dosage: 25-50mg and anti-
in 2-3doses inflammatory
effect

33
2.5 Health Problems

Health problems according to Hornby (2010). Is an unmet health need to which the
patient responds in a variety of ways. With respect to information collected from
patient and some observations made. The under mentioned problems were identified
in my patient.
• Patient had pyrexia of 38.50c (14/07/25)
• Patient has wound on the right leg (15/07/25)
• Patient complained of headache (16/07/26)
• Patient was unable to sleep well at night (17/07/25)
• Patient and relatives were anxious (18/07/25)
• Patient/Family had deficient knowledge on his condition (18/07/25)

2.6 Patient and Family Strengths

Strength is a resource and ability that an individual has which can help him/her cope
with the stress resulting from his/her condition. It also involves those that the family
can also do to help in speedy recovery of the patient.

Patient/family strength includes healthy physiological functioning, coping skill,

communication skills, financial support, cognitive abilities etc.

General Strengths

• Patient understands Ghanaian Language and English Language and

communicates well.
• Patient and relative cooperate well and understand all procedures explained to
them.
• Patient is fully registered with the National Health Insurance Scheme (NHIS) and
therefore most of his bills are being paid by the NHIS.

Specific Strengths

• Patient’s temperature reduces when tepid sponged.

• Patient could walk with assistance.

34
 • Patient’s headache subsides with bed rest.
• Patient could sleep for 1-2hours during the day when the ward is quiet.
• Patient and relatives were able to verbalize their fears.
• Patient and family were willing to know much about his condition.

2.7 Nursing Diagnoses

Nursing diagnosis is a clinical judgment about an individual, family, or community’s

response to actual or potential health problems or life processes, which provides the
basis for selecting nursing interventions to achieve outcomes for which the nurse is
accountable (NANDA International, 2021).

The following nursing diagnosis was formulated for patient and family.

• Ineffective thermoregulation imbalance (38.50c) related to inflammatory

process.
• Impaired skin integrity related to wound on the right leg.
• Acute pain (headache) related to inflammatory process.
• Disturbed sleep pattern (insomnia) related to change of environment.
• Anxiety related to unknown outcome of the condition
• Deficit knowledge related to inadequate information on the condition.

35
CHAPTER THREE

PLANNING FOR PATIENT AND FAMILY CARE

3.0 Introduction
It is the third stage of the nursing process, the nurse determines how to prevent,
reduce, or solve patient’s identified problems. In planning, objectives are set and
prioritized in short-term and long-term goals. Goals set are developed upon and a plan
of care drawn to resolve the nursing diagnosis within a stipulated time frame.
3.1 Objective/Outcome Criteria
1. Patient’s temperature will be reduced to the normal body temperature (36.2-
37.2°C) within 6 hours, as evidenced by;
a. Patient verbalizing comfort.
b. Nurse’s thermometer registering a normal body temperature on
assessment.
2. Patient’s wound will be free from infecting microorganism within (72hours) as
evidence by;
a. Patient reporting that serial fluid exudation has ceased.
b. Repeated wound swap indicate negative for microorganism.
3. Patient’s will be relieved of headache within 24 hours as evidence by;
a. Patient verbalizing the absence of headache.
b. Nurse observing patient being relaxed in bed.
4. Patient will have a sound sleep for 7 hours as evidenced by;
a. Patient verbalizing, he felt refresh at last night sleep.
b. Nurse observing patient sleep continuously 2hours during the day and 5hours
during the night.
5. Patient would be relieved of anxiety within 48 hours as evidence by;
a. Patient verbalizing, he no longer feels anxious.
b. Nurse observes patient have good facial expressing.
6. Patient will gain adequate knowledge on the disease condition within 72hours
as evidence by;
a. Patient and family verbalizing that they have now understood the condition.

36
b. Nurse witnessing that patient and family are able to provide simple answers to
questions.

Table Six: Nursing Care Plan for Mr. O.K

37
DATE/ TIME NURSING OBJECTIVE/ OUTCOME NURSING ORDERS NURSING INTERVENTIONS EVALUATION
DIAGNOSIS CRITERIA
14/07/2025 Patient’s temperature will 1. Reassure patient. 1. Patient was reassured that, by Goal fully met as
Hyperthermia
At be reduced to the normal the time the outlined measures patient verbalized
(38.50c) related to
1:20pm body temperature (36.2- 2. Monitor vital signs to control temperature are that he is no longer
infection.
37.2) within 24hours as especially temperature completed, temperature will be feeling hot.
evidence by; every 15minutes for 1hour reduced. On
a. Patient verbalizing that until temperature subside. 15/07/2025
he is no longer feeling hot. 2. Patient’s vital signs especially At
b. Nurse’s thermometer 3. Tepid sponge patient to temperature was monitored 10:00pm
registering a normal body reduce temperature. every 15minutes for 1 hour until
temperature on temperature subsides.
assessment. 4. Advice patient to wear
light dresses and remove 3. Patient was tepid sponged
excess clothing. with water and towel, leaving
drops of water on the skin to be
5. Ensure adequate dried by evaporation.
ventilation. 4. Patient was encouraged to
wear light clothes.

38
 6. Administer prescribed 5. Adequate ventilation was
antipyretics and ensured by opening of windows
antibiotics
6. Prescribed analgesic Tablet
Diclofenac 50mg and IV
Clindamycin 300mg was served
to patient.

Table Six: Nursing Care Plan for Mr. O.K Continue

39
DATE/ TIME NURSING OBJECTIVE/ OUTCOME NURSING ORDERS NURSING INTERVENTIONS EVALUATION
DIAGNOSIS CRITERIA
15/07/25 Risk for infections Patient will be free from 1. Reassure patient 1. Patient was reassured Goal fully met as
At related to open infections throughout 2. Inspect the wound 2. Wound was inspected Patient verbalized
8:30am wound on leg hospitalization as at least once per per every shift understanding of
evidenced by: shift 3. Aseptic techniques were effective wound
1. Patient verbalizing 3. Maintain strict employed during wound healing.
an understanding aseptic techniques care and nurse observed
on at least 3 during wound care 4. Hands were washed with that patient was
infection and dressing soap and water before relaxed in bed.
prevention changes and after every wound On
measures 4. Perform hand dressing procedure 19/07/25
2. Nurse checking and hygiene before and 5. Wound dress was At
recording stable after wound care changed as prescribed by 9:30am
vital signs procedures the physician
5. Change wound 6. Vitals were checked
dressing as every 4hourly, especially
prescribed and temperature

40
 keep wound clean
and dry
6. Monitor vitals,
especially
temperature, every
4-8hours

Table Six: Nursing Care Plan for Mr. O.K Continue

41
DATE/ TIME NURSING DIAGNOSIS OBJECTIVE/ OUTCOME CRITERIA NURSING ORDERS NURSING INTERVENTIONS EVALUATION
16/07/25 Altered body comfort Patient’s will be 1. Reassure patient. 1. Patient was reassured Goal fully met as
At (headache) related to relieved of headache that by the time measure Patient verbalized
8:30am inflammatory process. within 24 hours as 2. Assess level of headache. put in place to control the absence of
evidence by; headache comes to an headache.
a. Patient verbalizing 3. Prepare a comfortable bed for the end, his headache would and nurse observed
the absence of patient. be reduced. that patient was
headache. relaxed in bed.
b. nurse observing 4. Elevate and rest the leg on a soft 2. Patient’s level of On
patient being relaxed in pillow. headache was assessed. 17/07/25
bed. At
5. Provide diversional therapy. 3. Simple bed was 8:30am
prepared for patient.
6. Administer prescribed analgesics to
help relieve headache. 4. Patient’s leg was
elevated and rested on a
soft pillow.

42
 5. Diversional therapy was
provided.

6. Prescribed analgesics
was administered to help
relieve headache.

Table Six: Nursing Care Plan for Mr. O.K Continues

43
DATE/ TIME NURSING DIAGNOSIS OBJECTIVE/ OUTCOME CRITERIA NURSING ORDERS NURSING INTERVENTIONS EVALUATION
17/07/25 Disturbed sleep Patient will have a sound sleep for 1. Reassure patient. 1. Patient was reassured of Goal fully met as
At pattern (insomnia) 24hours as evidenced by; getting enough and patient
8:30am related to change of a. Patient verbalizing he felt 2. Prepare a comfortable bed continuous sleep without verbalizing, he
environment. refresh at last night sleep. for patient. interactions. felt refresh at last
b. Nurse observing patient sleep night sleep and
continuously 2hours during the 3. Reduce noise at the ward. 2. A comfortable bed from nurse observing
day and 5hours during the night. cramps and creases was patient sleep
4. Regulate visitors to ensure prepared for patient. continuously
good sleep. 2hours during the
3. Television set and other day and 5hours
5. Organize nursing care to noise making articles were during the night.
and perform at a go to minimized. On
minimize sleep interruption. 18/07/2025
4. Number of visited At
received by patient were 2:30pm
restricted to allowed good
sleep.

44
 5. Patient’s vital signs and
serving of medications were
done at a go to promote
minimal interruption in
sleep

45
Table Six: Nursing Care Plan for Mr. O.K Continue

46
DATE/ TIME NURSING DIAGNOSIS OBJECTIVE/ OUTCOME CRITERIA NURSING ORDERS NURSING INTERVENTIONS EVALUATION
18/07/25 Anxiety related to Patient would be relieved of 1. Reassure patient and 1. Patient and family were Goal fully met as
At unknown outcome of anxiety within 24 hours as family. reassured to allay their anxiety. Patient verbalizing,
10:45am the condition. evidence by; he no longer feels
2.patient and family were
(Cellulitis) a. Patient verbalizing he no anxious and nurse
encouraged to expressed to
2. Encourage patient
longer feels anxious. observe patient
express their anxiety
and family to express
b. Nurse observe patient have have good facial
their fear and anxiety
good facial expressing. expressing.
3. Patient and family were
On
3. Educate patient and educated on the condition and
19/07/25
family on the condition its treatment regimen.
At
and its treatment
10:45am
regimen.
4. Patient and family were
allowed to ask questions and all .

4. Allow patient and the questions were answered

family to ask questions. tactfully.

47
 5. Involve patient in 5. Patient was involved in every
every procedure you procedure performed to
perform on him. encourage compliance.

6.administer prescribed
anxiolytic

Table Six: Nursing Care Plan for Mr. O.K Continue

48
DATE/ TIME NURSING DIAGNOSIS OBJECTIVE/ OUTCOME CRITERIA NURSING ORDERS NURSING INTERVENTIONS EVALUATION
19/07/25 Deficit knowledge Patient will gain adequate 1. Establish rapport with 1. Rapport was established and Goal fully met as
At related to inadequate knowledge on the disease patient and family. patient reassures of competent patient and family
7:00am information on the condition within 24hours as nursing care. verbalizing that
disease condition. evidence by; 2. Assess patient’s they have now
(Cellulitis) a. Patient and family verbalizing knowledge about the 2. Patient’s knowledge about the understood the
that they have now understood condition. condition was assessed. condition and
the condition. nurse witnessing
b. Nurse witnessing that patient 3. Educate patient and 3. Patient/family were educated that patient and
and family are able to provide family on the causes, risk on the causes and predisposing family are able to
simple answers to questions. factors, signs and factors, signs and symptoms and provide simple
symptom, mode of prevention of the condition. answers to
treatment and preventions questions.
on condition. 4. Misconception and On
misinformation about condition 19/07/25
4. Clarifying their not being manageable were At
misinformation and clarified by providing correct 7:00am
misconceptions about the information.
disease.

49
 5. They were provided with
5. Provide patient and leaflet containing information on
family with leaflet the condition.
containing information on
the disease.

50
CHAPTER FOUR

IMPLEMENTATION OF PATIENT/FAMILY CARE PLAN

4.0 Introduction
According to Smelter and Bare (2010), implementation is the actualization of the plan of
care through nursing intervention.
Implementation is also the fourth phase in the nursing process. It is the process of
putting into action nursing orders and interventions designed for the management of
the patient.
It involves the actual task and procedure performed on the patient throughout the
period of hospitalization till the time of discharge.

4.1 Summary of Actual Nursing Care Rendered to Patient

Day of admission (14th July, 2025)

On the 14th July, 2025 at 12:20pm patient was admitted to the Accident and Emergency
ward ambulatory with his son accompanied by a nurse. I confirmed his admission by
glancing through his folder. The admission was ordered by Dr. Lawrence who diagnosed
patient of having Cellulitis of the right leg. Patient was warmly welcomed to the ward
and seats offered whiles his folder was handed over by the staff nurse. Preparation of
the patient and family towards discharge started on the day of admission. They were
made to understand that, hospitalization is temporal and condition will improve and
will be discharged home. An admission bed free from cramps and creases was prepared
for him and made comfortable in bed.

On admission, patient was conscious, alert and well oriented to time, place and person.
He complained of pains in the right leg, and high body temperature. Patient and relative
were reassured that everything will be done to ensured speedy recovery.

Interaction with my patient made me understand that he has less knowledge about the
condition. He was made to understand that before he leaves the hospital, he will gain
more insight about his condition. General observation was made from head to toe. The

51
necessary particulars were ascertained and recorded in the admission and discharge
book and the ward statement respectively. History from patient was taken, this include
name, age, sex, date and time of admission, place of residence, next of kin, religion,
ethnicity, nationality and hometown. A quick assessment of his general condition was
also made by checking and recording the vital signs. The recordings were; Temperature
- 38.5 degrees Celsius, Pulse - 92 beats per minute, Respiration - 24 cycles per minute

Explanation was given to Mr. O.K that the National Health Insurance Scheme does not
cover all drugs hence he will be required to buy for some drugs should the need arise.
They were also the visiting hours of the hospital and were asked to communicate the
information to other family members.

On this day at 1:20pm, Patient complain of fever .Patient fever was tackled by the
following; nursing diagnosis of thermoregulation imbalance (38.50c) related to
inflammation process. An objective was set to reduced patient body temperature to
normal (36.2-37.2) within 10hours as evidence by; Patient verbalizing that he is no
longer feeling hot. Nurse’s thermometer registering a normal body temperature on
assessment. Nursing orders include; Reassure patient. Monitor vital signs especially
temperature every 15minutes for 1hour until temperature subside. Tepid sponge
patient to reduce temperature. The following re nursing intervention that were put in
place; Patient was reassured that, by the time the outlined measures to control
temperature are completed, temperature will be reduced. Patient’s vital signs
especially temperature was monitored every 15minutes for 1 hour until temperature
subsides. Patient was tepid sponged with water and towel, leaving drops of water on
the skin to be dried by evaporation.

Patient’s right leg wound was infected relative to the invading micro-organism. The
objective was set to get rid of the infecting microorganism within (72hours) as evidence
by; patient reporting that serial fluid exudation has ceased. Repeated wound swap
indicate negative for microorganism.

Nursing orders carried on patient to free him from infection were reassure patient that
his wound would be improved after the interventions put in place, serve nutritional diet
to aid in wound healing, educate patient on good personal hygiene, encourage patient

52
to eat fruits containing vitamin C to aid in wound healing, dress patient wound
aseptically, serve prescribed antibiotics.

Plan of treatment for Mr. O.K were Injection Diclofenac 75mg stat, Tab Diclofenac 50mg
bd x 4days, I.V Clindamycin 300mg qid x 72hours.

Laboratory investigations ordered was Full Blood Count (FBC). A tray was set and the
medical officer was assisted to set up an intravenous line for withdrawing blood
specimen for the above test to be carried out.

Patient had his lunch after which medication was served. He was then encouraged to
rest.

At 1:20pm a goal set to relive patient from high body temperature was evaluated and
goal was fully met as evidence by patient verbalizing that his body is warm to touch and
he feels relax and nurse recording normal body temperature (36.2ᵒc-37.2ᵒc).

Patient had his supper around 6:00pm in the evening. He was then handed over to the
night nurse for continuity of care.

Second day of admission (15th July, 2025)

Patient woke up around 4:00am in the morning. Patient was assisted to maintain his
personal hygiene, patient wound on his leg was well cared and monitored for any form
of abnormalities found on the wound site. Patient had his breakfast at 7:30am which
was a cup of rice porridge and a slice of bread. His vital signs were checked and
recorded indicate ng normal values as shown in the appendix. Medications were served
as in treatment regime. Ward round took place at 8:30am. On this day at 8:30am during
ward round patient complain of headache. Doctor ordered to continue treatment
regime. Nursing diagnosis of altered body comfort (headache) related to inflammatory
process. An objective was set to relive patient of headache within 24 hours as evidence
by; patient verbalizing the absence of headache and being relaxed in bed. Nursing
orders which was outline include the following; Reassure patient. Assess level of
headache. Prepare a comfortable bed for the patient and the following the nursing
interventions were implemented to relive patient of headache; Patient was reassured
that by the time measure put in place to control headache comes to an end, his

53
headache would be reduced. Patient’s level of headache was assessed. Simple bed was
prepared for patient.

Patient also verbalized that he was not able to sleep at night, therefore patient was
diagnosed of insomnia related to change of environment. The objective was patient will
have a sound sleep for 7 hours as evidenced by; Patient verbalizing he felt refresh at
last night sleep and nurse confirming that patient slept continuously for 2hours during
the day and 5hours during the night.

Nursing orders included; Reassure patient, prepare a comfortable bed for patient and
reduce noise at the ward. Nursing interventions carried on patient to enhance him to
sleep at night. Patient was reassured of getting enough and continuous sleep without
interactions. A comfortable bed from cramps and creases was prepared for patient.
Television set and other noise making articles were minimized.

Patient had his lunch in the afternoon which was rice and beans stew with fried fish.
Medications were administered and patient was allowed to rest. He had his supper
around 6:30pm in the evening.

Third day of admission (16th July, 2025)

On the third day of admission, patient woke up at 6:00am. Patient’s condition had
improved than the previous days. Patient performed the activities of daily living
including oral care, bathing, and grooming were performed by the patient with little
assistance. Mr. O.K wound was cared for and he had a warm bath and maintain his oral
hygiene. He took his breakfast at 8:00am. The patient’s morning vital signs were
checked and recorded as per appendix. A doctor came to conduct ward rounds at
8:30am and ordered continuation of the patient’s treatment regimen and also was
encouraged to take more fluids.

Interactions with patient and relative revealed that they were anxious about the
condition since they have never heard of it and don’t know the outcome the condition
will be.

A nursing diagnoses of anxiety related to unknown outcome of the condition was

formulated and objectives were set to relieve patient and family from anxiety was

54
outline as follows; Patient would be relieved of anxiety within 48 hours as evidence by;
Patient verbalizing he no longer feels anxious. Nursing orders include; Reassure patient
and family. Encourage patient and family to express their fear and anxiety. Educate
patient and family on the condition and its treatment regimen.

The following nursing interventions were carried out; patient and family were
reassured, patient and family were encouraged to express their anxiety, patient and
family were educated on the condition and its treatment regimen and were also
introduced to other patients on the ward with similar condition who were recovering
well.

At 2:0pm vitals were checked and recorded as in the appendix. He ate fufu with light
soup and fish for supper at 6:00pm. His vital signs were checked and recorded as in the
appendix and due medications also served. He had his warm bath and brushed his teeth
with paste and tooth brush before going to sleep at 9:00pm

Fourth day of admission (17th July, 2025)

On this day, the patient woke up at 7:30am and performed the activities of daily living
including oral care, bathing, and grooming were performed by the patient without
assistance. Patient was reviewed on ward rounds and observations made were that
patient’s looked good with no new complains. Vital signs were checked and recorded at
8:00am as shown in the appendix. During ward rounds the medical officer ordered
continuation of the patient’s treatment.

Interaction with the patient and relative indicates that they had insufficient knowledge
about the condition. A nursing diagnoses of Knowledge deficit related to inadequate
information on the disease condition (Cellulitis). The following interventions were
carried out; rapport was established by gaining patient and family trust, patient’s
knowledge about the condition was assessed, patient and family were educated on the
causes and predisposing factors, signs and symptoms and prevention of the condition,
misconception and misinformation about condition not being manageable were

55
clarified by providing correct information, they were provided with leaflet containing
information on the condition.

Fifth day of admission (18th July, 2025)

On the fifth day of admission, the patient woke up at 5:00am. Activities of daily living
such as oral care, bathing, grooming were done by the patient himself and bed linen
was changed. He was served with warm tea and bread. Patient looked better and had a
cheerful facial expression.

Medications were served and vital signs monitored and recorded as in the appendix.
They were within normal range. Ward rounds was done at 8:00am. On review by the
doctor, patient had no complains. After thorough physical examination doctor ordered
continuity of care and assured patient of full recovery.

His evening meal served was Kenkey with fried fish at 6:00pm. Patient’s vital signs were
checked and recorded. Patient’s evening medications were also served and recorded at
8:30pm.

Sixth day of admission (19th July, 2025)

Patient woke up around 4:50am in the morning. Patient maintained his personal
hygiene. Patient had his breakfast at 7:00am which was a cup of tom brown and a slice
of bread. Patient vital signs were checked and recorded indicating normal values as
shown in the appendix.

Medications were served as in treatment regime. Ward round was conducted at

8:00am. On review by the doctor, patient had no complains. Doctor ordered continuity
of care and assured patient of discharge if condition is stable the next day.

His evening meal served was Yam with fried fish at 6:00pm. Patient’s vital signs were
checked and recorded at 8:00pm. Patient’s evening medications were also served and

56
recorded at 8:30pm. Patient had his bath around 8:15pm and went to bed after
bathing.

Day of discharge (19th July, 2025)

Patient woke up at 6:00am and performed his personal hygiene including bathing and
mouth care. He verbalized that his condition has really improved. Patient had his
breakfast and due morning medications served. Morning vital signs were checked and
recorded as per appendix. Patient looked cheerful and happy. He was grateful to the
nursing and medical staff. He took his warm bath and maintained his oral hygiene.

During the ward rounds, on doctor’s assessment, patient did not have any complain and
he was discharged home on the following drugs: Cap Flucloxacillin 500 mg qid × 7 days
on discharge to his medications.

Around 10:10am Patient’s relative was informed about patient’s discharge. Mr. O.K was
so grateful to the medical and nursing staff for helping him to recover without any
complications. Patient and relative were informed to report to the hospital for review
on 27th July, 2025. Settlement of hospital bills was not a problem since patient was
insured with the National Health Insurance Scheme. Patient’s folder was taken for
assessment of non-insured services and those bills were paid for at the account office. A
receipt was issued to his patient. Patient and relative were educated on the need to eat
balance diet to boost his immune system.

Again, patient was educated on the need to continue his medications. Patient’s name
was entered into the admission and discharge book and in the daily ward state
indicating that he has been discharged. Bed linen was removed and sent to the sluice
room and the mattress was also carbonized while the patient and his relatives waited
for me. I assisted the patient’s relatives in packing the belongings of the patient. I then
thanked the patient and his mother for their cooperation during hospitalization and my
first home visit as well. Permission was subsequently obtained to accompany the
patient and his relatives to the lorry station. Upon arrival, farewells were exchanged,
and the patient was respectfully seen off

4.2 Preparation of Patient and Family towards Discharge and Rehabilitation

57
Preparation of the patient and family started on the day of admission that is 14th July,
2025. On admission, patient and family were made to understand that, hospitalization
is temporal and patient will improve and will be discharged home. During admission,
the patient and family were assured good care. The causes, signs and symptoms,
management and possible prevention were explained to them.

They were also educated on good personal and environment hygiene. Patient and
relatives were advised to wash clothes frequently, proper disposal of refuse and
weeding around the immediate environment. He was encouraged to should ensure
good drainage systems because chocked and stagnant water can result in breeding of
mosquitoes. He was encouraged to bath and brushes his teeth twice daily and to keep
finger nails short, in order not to harbor micro-organisms. They were encouraged to
adhere to the education given in order to promote and maintain a good personal and
environmental hygiene.

Mr. O.K and his family were also educated on the importance of a well-balanced diet
and was encouraged to take enough fruits and adequate proteins and enough fluids in
order to improve the immune system and prevent constipation respectively. He was
also advised to limit the intake of fatty and salty foods to help prevent hypertension
and other conditions.

Patient and family were educated to avoid self- medication and should report to the
hospital any time they fall sick. Mr. O.K was also educated on the need to come for
review.

Patient and family were educated on the need to prevent injuries to themselves.
Emphasis was made on the need to wear protective clothing when going to the farm,
the need to keep slippery floors dry and the need to keep sharp objects in the
appropriate place and not leaving them on the floor, which may cause injury. Mr. O.K
relative were also advice to help him take his medications regular to ensure continuity
at home and enhance speedy recovery.

Finally, Mr. O.K was discharged on the 19th July, 2025. His bills were assessed and paid
by NHIS and other bills which were not covered by NHIS were paid by his relative.
Proper documentation of his name, date, bed number and final diagnosis were entered

58
in the admission and discharge book as well as the daily ward state to indicate they
have been discharged. Mr. O.K was reminded of the second home visit. They both
entered into a taxi after expressing their gratitude to the staff and friends on the ward
and bid them goodbye.

4.3 Follow-Up/ Home Visit/ Continuity of Care

This is the act of rendering health service to a patient in his/her home environment to
ensure continuity of care. Follow up, home visit, and continuity of care play an
important role in the care of the patient and family before and after discharged. It helps
in observing the health and environmental conditions of the patient and family as well
as helping to know the predisposing factors and hazards which could be dangerous to
the health of patient and the family and to know whether condition of patient is from
the surroundings.

First home visit

The first home visit was done on the 16th July, 2025 which was patient’s second day of
admission at 4:00pm. The aim of the visit was to find out about the home environment
as well as health problems and how to find solutions to solve them before patient’s
discharge to the house. The house is located in Goaso-lodge. About 5 minutes’ walk
from the Assemblies of God Church. His mother met me on the road side and escorted
me to the house. On reaching the house the environment was clean. I was warmly
welcomed by some relatives of my Mr. O.K., and other members of the house present.
A self-introduction was done. I went to use the wash room and took the opportunity to
look around the house, washrooms and I got to know that they had nice and well-
ventilated rooms. They had toilet and bathroom in their house. Their source of water
was running water. The house was supplied with electricity and had a proper drainage
system. They were reassured that Mr. O.K was recovering and they were also given
education on Mr. O. K’s condition, the predisposing factors, possible complications,
treatment and prevention of the diseases as well as ways to keep their surroundings
clean to prevent malaria and other infections. They were also educated on proper
waste disposal. After allowing them to ask questions bothering their minds and

59
interacting with them, they were assured of another visit. I thanked them and then left
for school.

Second Home Visit

The second home visit was made on 21st July, 2025 two days after patient was
discharge. The aim was to find out about patient’s health status after discharge and to
remind patient and family about the review date.

On assessment, the patient was doing well and he was taking his medications as
ordered. I emphasized on the need to continue his treatment regimen and to be
present for the review on the given date (27th July, 2025). I asked him of how he is doing
after I was welcomed. I again emphasized on the need to eat nutritious diet and
exercise regularly and take preventive measures to avoid reoccurrence of the disease
condition.

Patient was again reminded of the review date which is 27th July, 2025. Patient assured
me that he will be in the hospital on the day of review. They were assured of another
visit and which would be done to terminate the care and hand them over to the
community health nurse to ensure the continuity of care. I took permission to leave
after scheduling to visit them again on 30th July, 2025.The family thanked me for the
visit and I was seen off.

Review (27th July, 2025)

Patient came for review on the 27th July, 2025, patient and his son was met at the out-
patient department as planned. Patient’s folder was retrieved from the record room
and taken to see the doctor at the consulting room one.

After examination, the doctor expressed satisfaction and advised the patient to take
good care of himself. The following drugs were prescribed for the patient; Tablet
Clindamycin 300mg tid x 7. Tablet Ciprofloxacin 500mg bd x 7. Patient was advised on
the need to continue the medications giving to him and to take good care of himself. I
escorted Mr. O.K to the road side in front of the hospital to take a car home. I finally bid
him goodbye.

Third home visit

60
The third home visit was made with a community health nurse on 30th July, 2025. The
aim of the visit was to terminate care with the patient and family and hand over to the
community health nurse to ensure the continuity of care.

On arrival to the house at 10:30am, we were warmly welcomed by the patient and
relatives who offered us a seat. The mission of the visit was asked by one of the
relatives and explanation was given to her on the termination of care with them and
also hand them over to the community health nurse. Upon assessment, the patient was
doing very well and they were also following the treatment regimen and the education
given to them. Patient and family were then handed over to the community health
nurse for continuity of care. Patient and family were encouraged to give their maximum
cooperation to the community health nurse. They expressed their sincere appreciation
for the care rendered to them throughout hospitalization and after discharge. I showed
them my gratitude and asked permission to leave for school at exactly 11:00am.

CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

5.0 Introduction

61
This is the measuring of the outcome of nursing orders against previously determined
goals. The nursing care given to the patient was also evaluated in order to determine
whether the plan indicated earlier was successful or not. This is the final phase of the
nursing process.

5.1 Statements of Evaluation

On 14th July, 2025 when patient was admitted at the ward till discharge, the following
health problems were identified;

1. Patient had pyrexia of 38.50c (14/07/25)

2. Patient has wound on the right leg (15/07/25)
3. Patient complained of headache (16/07/25)
4. Patient was unable to sleep well at night (17/07/25)
5. Patient and relatives were anxious (18/07/25)
6. Patient/Family had deficient knowledge on his condition (19/07/25)

1. Patient’s Regained Normal Body Temperature (15th July, 2025).

On the 14th July, 2025, a goal was set to reduce patient’s temperature from 38.5 to the
normal range (36.2 to 37.2) within 4hours. The following interventions were carried
out; Patient was reassured that all measures outline will be put in place to control the
rise in temperature. Patient’s vital signs especially temperature was monitored every
15minutes for 1 hour until temperature subsides. Patient was sponged with tepid water
and towel, leaving drops of water on the skin to be dried by evaporation. Patient was
encouraged to wear light clothes. Adequate ventilation was ensured by opening of
windows. Prescribed analgesic Tablet Diclofenac 50mg and IV Clindamycin 300mg was
served to patient.

Goal fully met as evidence by patient verbalized that his body is warm to touch and he
feels relax and nurse recorded normal body temperature (36.2ᵒc-37.2ᵒc)

62
 2. Patient was free from infections throughout hospitalization (14th July, 2025-
19th July, 2025).

On the 15th July, 2025, a goal was set to prevent patient from infectious micro-
organisms. The following interventions were carried out; Reassure patient, Inspect the
wound at least once per shift, maintain strict aseptic techniques during wound care and
dressing changes, perform hand hygiene before and after wound care procedures,
change wound dressing as prescribed and keep wound clean and dry Monitor vitals,
especially temperature, every 4-8hours

Goal fully met as Patient verbalized understanding of effective wound healing.

and nurse observed that patient was relaxed in bed

3. Patient’s Headache Subsided (17th July, 2025).

On the 17th July, 2025, a goal was set to relieve patient of headache within 5hours. The
following interventions were carried out; 1. Patient was reassured that by the time
measure put in place to control headache comes to an end, his headache would be
reduced Patient’s level of headache was assessed. Simple bed was prepared for patient.
Patient’s leg was elevated and rested on a soft pillow. Diversional therapy was
provided. Prescribed analgesic was administered to help relieve headache.

Goal fully met as evidence by patient verbalized the absence of headache and was
observed relaxed in bed.

4. Patient was able to have a sound sleep (17th July, 2025).

On the 16th July, 2025, a goal was set to help patient have a sound sleep within
48hours. The following interventions were carried out; a comfortable bed free from
cramps and creases was prepared for patient. Television set and other noise making
articles were minimized. Number of visitors received by patient were restricted to allow
him have a good sleep. Patient’s vital signs were checked and serving of medications
were done at a go to ensure minimal interruption in sleep

63
Goal fully met as patient verbalized ability to fall asleep within few minutes and the
nurse observed that patient slept very well.

5. Patient/family were relieved of anxiety (18th July, 2025).

On the 17th July, 2025, a goal was set to relive patient of anxiety within 24hours. The
following interventions were carried out; Patient and family were reassured.
Patient/family were encouraged to expressed to express the cause of their anxiety
Patient/family were educated on the condition and its treatment regimen;
Patient/family were allowed to ask questions and all the questions were answered
accordingly. Patient was involved in every procedure performed to encourage
compliance.

Goal fully met as evidence by patient/family able to verbalize their fears and nurse
observed that patient/family have good facial expressing.

6. Patient and Relative Gained Knowledge about the Condition (19th July, 2025).
On the 18th July, 2025, a goal was set for patient and relatives to gain enough
knowledge about the disease causes, management and treatment throughout the
period of hospitalization within 24hours. The following interventions were carried out;
Rapport was established and patient reassures of competent nursing care. Patient’s
knowledge about the condition was assessed. Patient/family were educated on the
causes and predisposing factors, signs and symptoms and prevention of the condition.
Misconception and misinformation about condition not being manageable were
clarified by providing correct information. They were provided with leaflet containing
information on the condition.

Goal fully met as evidenced by patient/ family verbalized that they have now
understood the condition and the nurse witnessed that patient and family are able to
provide simple answers to questions.

5.2 Amendment of Nursing Care Plan

64
Mr. O.K was admitted on the 14th July, 2025, at 12:20am accompanied by his mother.
During period of hospitalization, six (6) health problems were identified. Goals set to
deal with the problems through various nursing interventions, which led to
achievement of each goal. There were no partially met or unmet objectives; hence
there was no need for amendment of the care plan.

5.3 Termination of Care

Termination of care is the period that ends the therapeutic relationship with Mr. O.K
and his family. They were prepared for discharge from the day of the patient’s
admission to prevent anxiety. Patient and his family members were educated on their
diet, precipitating factors of the condition and personal hygiene and environmental.
They were informed about the need to continue with the medications prescribed.
Patient and family were entreated to report to the nearest health facility in their
community or the hospital should he experience any complication, and they were
informed about the review date. Generally, there were three different home visits. The
first home visit was made on 16th July, 2025 during which patient’s environment was
assessed to find out about factors that contributed to the patient’s health problems.
The second home visit was made on 21st July, 2025. The patient’s condition was also
assessed to find his progress after discharge and how well he was taking his
medications. The patient’s condition was fair. The care was terminated on 30th July,
2025, which was during the last home visit. During this visit, the patient and his family
were assessed for the progress in the patient’s condition and patient was doing very
well so he was handed over to a Community Health Nurse from the Municipal hospital,
Goaso Patient and family were thanked for their cooperation. They also showed their
gratitude for the help and care rendered. Permission was sought to leave their home at
11:00am and was escorted by the patient relatives. They were assured of a visit when
appropriate

5.4 Summary

According to Hornby (2010), summary is a brief account giving the main point to a
health problem. This is the last stage of the patient and family care study and it contains

65
a summary of all the care rendered to Mr. O.K and family throughout the period of
hospitalization to the time the care was terminated.

Summary of Care Rendered to Patient and Family

Mr. O.K was admitted to the Male surgical ward, Municipal hospital, Goaso on 14th July,
2025 with diagnosis Cellulitis of right leg. Mr. O.K, the subject of this study is twenty-
one years old and a native of Goaso in the Ahafo region of Ghana. After going through
the admission process, he was made comfortable in a simple unoccupied bed and was
reassured of competent health care that would be rendered to him. Drug prescribed for
the patient included;

• Injection Diclofenac 75mg stat

• Tab Diclofenac 50mg bd x4
• I.V Clindamycin 300mg qid x 72hours
• Tab Zincivite 1tab od x 3/7days

Laboratory investigation such as Full Blood Count (FBC) was requested and carried out.
Heath problems identified on patient included difficulty in walking, fever, anxiety,
headache, unable to sleep and knowledge deficit about the disease condition.
Objectives were set and nursing orders implemented to resolve them. Nursing
interventions such as reassurance, monitoring of vital signs, education and
administering of prescribed drugs were carried out successfully. All goals were fully met
during the evaluation and no amendment was made.

Patient condition improved considerably and discharged on 19th July, 2025 and was to
report on 30th July, 2025 for review. Three home visits were carried out. The first was
done whiles my patient was still on admission with the aim of knowing where my
patient resides, verifies his environment and also identify factors that might predispose
him to the disease condition. Second home visit was done after discharge to find out
how was doing after the discharge and also remind him and relatives about the review
date. My patient reported to OPD (Out Patient Department) on 30th July, 2025 for
review and was confirmed fit and healthy by the physician. Patient had no complains
and was given new medication. On the third home visit series of health education
centered on good personal and environmental hygiene, good nutrition, and adherence

66
to medical prescription for treatment, among others were given to patient and
relatives. On this same day 30th July, 2025, patient was handed over to a community
health nurse to enhance continuity of care. I thanked patient and relatives for their co-
operation throughout this study and sort for permission to leave. Patient and some
relatives escorted me and we bid each other goodbye.

5.5 Conclusion

According to Hornby (2010), conclusion is the end or finishing of something.

Briefly, writing the patient/family care study was of great benefit to me, it has made me
understand what complete and comprehensive nursing care is and how to render it to
an individual. It has given me the chance to put my knowledge acquired both
theoretically and practically over the three-year training as a nursing student in to use.

Choosing and nursing a patient with a disease condition and the writing of this care
study, has been challenging, good experience and very educative as well. This study has
enhanced my knowledge on the causes, signs and symptoms, diagnosis, treatment and
possible prevention of Cellulitis. It has also opened my understanding on family’s
attitude towards illness and behavior of individuals when they fall sick and the care
rendered to patients and its effectiveness when the nursing process is used.

Again, it has helped me to develop interpersonal relationship with patient and relatives.
The additional knowledge and experience I have acquired while nursing Mr. O.K and his
family would help me offer expert and comprehensive nursing care to other patients
and the community as a whole where ever my service would be needed.

Also, it is my recommendation that all student nurses should be given the opportunity
to embark on the patient/family care study, and implement the nursing process in order
to render individualized comprehensive care to patient/families.

In brief, I really enjoyed every bit of writing this script despite the challenges
encountered.

67
5.6 Recommendations
Finally, I would like to recommend that all student nurses should undertake this
exercise to broaden their knowledge and skills in patient care.

Bibliography

• Amoako, Y., Mensah, J., & Osei, P. (2021). Skin and soft tissue infections in rural
Ghana: Epidemiology and challenges in management. Ghana Medical Journal,
55(3), 210–218. https://doi.org/10.4314/gmj.v55i3.9

• Boateng, F., Asiedu, E., & Owusu, D. (2020). Patterns of bacterial infections and
antibiotic use in a regional hospital in Ghana. African Journal of Infectious
Diseases, 14(1), 45–52. https://doi.org/10.21010/ajid.v14i1.6

• Cox, N. H., Williams, H., & Morton, C. A. (2022). Skin infections and infestations.
In R. A. Burns et al. (Eds.), Rook’s Textbook of Dermatology (10th ed., pp. 1230–
1250). Wiley-Blackwell.

• Habif, T. P. (2016). Clinical Dermatology: A Color Guide to Diagnosis and Therapy

(6th ed.). Elsevier.

• Kozier, B., Erb, G., Berman, A., & Snyder, S. (2018). Fundamentals of Nursing
(10th ed.). Pearson.

• Miller, L. G., & Choi, S. H. (2019). Epidemiology of skin and soft tissue infections.
The Lancet Infectious Diseases, 19(11), e361–e370.
https://doi.org/10.1016/S1473-3099(19)30190-7

• NANDA International. (2021). NANDA International Nursing Diagnoses:

Definitions and Classification, 2021–2023 (12th ed.). Thieme.

• Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing
evidence for nursing practice (11th ed.). Wolters Kluwer.

• Stevens, D. L., Bisno, A. L., Chambers, H. F., & Dellinger, E. P. (2023). Practice
guidelines for the diagnosis and management of skin and soft tissue infections.
Clinical Infectious Diseases, 76(3), e1–e33. https://doi.org/10.1093/cid/ciac993

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 • Weller, P. F., & Cox, N. H. (2021). Infectious diseases of the skin. Elsevier.

• Wilkinson, J. M., & Treas, L. S. (2020). Fundamentals of Nursing: Theory,

Concepts, and Applications (4th ed.). F.A. Davis.

APPENDIX

DATE TIME TEMPERATURE PULSE RESPIRATION BLOOD PRESSURE

14/07/25 12:06pm 38.5ᴼC 96 bpm 24cpm 119/80 mmHg

12:15pm 38.2ᴼC 97 bpm 22 cpm 116/70 mmHg

12:19pm 38.0ᴼC 90 bpm 18 cpm 123/60 mmHg

14/07/25 12:20pm 38.5ᴼC 92bpm 24cpm 105/60mmHg

1:30pm 36.2ᴼC 80bpm 24cpm 110/60mmHg

6:00pm 36.1ᴼC 89bpm 23cpm 110/70mmHg

10:10pm 36.1ᴼC 87bpm 24cpm 120/70mmHg

15/07/25 6:10am 36.1ᴼC 82bpm 24cpm 120/80mmHg

10:00am 36.0ᴼC 86bpm 22cpm 120/90mmHg

2:05pm 36.0ᴼC 85bpm 23cpm 120/70mmHg

6:20pm 36.0ᴼC 84bpm 20cpm 110/80mmHg

10:00pm 36.0ᴼC 80bpm 21cpm 120/80mmHg

16/07/25 6:00am 36.0ᴼC 78bpm 20cpm 100/70mmHg

69
 10:00am 36.5ᴼC 85bpm 19cpm 110/70mmHg

2:00pm 36.2ᴼC 63bpm 19cpm 100/60mmHg

6:00pm 36.6ᴼC 70bpm 22cpm 120/90mmHg

10:00pm 36.2ᴼC 63bpm 19cpm 110/80mmHg

17/07/25 6:00am 36.80ᴼC 73bpm 15cpm 120/60mmHg

10:00am 36.2ᴼC 62bpm 18cpm 120/60mmHg

2:00pm 36.6ᴼC 70bpm 20cpm 110/70mmHg

6:00pm 35.9ᴼC 66bpm 20cpm 110/70mmHg

10:00pm 36.0ᴼC 80bpm 17cpm 130/60mmHg

18/07/25 6:00am 36.5ᴼC 70bpm 18cpm 120/80mmHg

10:00am 37.0ᴼC 85bpm 24cpm 110/80mmHg

2:00pm 36.2ᴼC 84bpm 22cpm 110/70mmHg

6:00pm 36.0ᴼC 80bpm 16cpm 110/80mmHg

10:00pm 36.2ᴼC 70bpm 18cpm 120/60mmHg

19/07/25 6:00am 36.4ᴼC 85 bpm 22cpm 120/70 mmHg

10:00am 36.7ᴼC 70 bpm 16cpm 110/60 mmHg

2:00pm 36.5ᴼC 84 bpm 24 cpm 110/80 mmHg

6:00pm 36.0ᴼC 80 bpm 20 cpm 110/70 mmHg

10:00pm 36.2ᴼC 70 bpm 18 cpm 120/60 mmHg

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SIGNATORIES

PRINCIPAL

NAME:

SIGNATURE…………………………………………………………

DATE…………………………………………………………………

SUPERVISOR

NAME:

SIGNATURE…………………………………………………………

DATE…………………………………………………………………

NURSE IN CHARGE

NAME ………………………………………………………………….

SIGNATURE………………………………………………………….

DATE…………………………………………………………………..

STUDENT

NAME ………………………………………………………………...

SIGNATURE…………………………………………………………

DATE……………

71