PATIENT AND FAMILY CARE STUDY

(A NURSING PROCESS APPROACH)

ON

A PATIENT WITH

PNEUMONIA

WRITTEN BY: NAOMI PRAH

INDEX NUMBER: B52015135

A FINAL YEAR STUDENT OF NURSES’ TRAINING COLLEGE,

SAMPA

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF

REGISTERED GENERAL NURSING DIPLOMA CERTIFICATE

JULY, 2018
PATIENT AND FAMILY CARE STUDY

(A NURSING PROCESS APPROACH)

ON

A PATIENT WITH

PNEUMONIA

WRITTEN BY: NAOMI PRAH

INDEX NUMBER: B52015135

A FINAL YEAR STUDENT OF NURSES’ TRAINING COLLEGE,

SAMPA

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF

REGISTERED GENERAL NURSING DIPLOMA CERTIFICATE

JULY, 2018
CONTENTS

LIST OF TABLES

ACKNOWLEDGEMENT

INTRODUCTION

CHAPTER ONE

1.0 ASSESSMENT OF PATIENT/FAMILY

1.1 PATIENT PARTICULARS - 1

1.2 FAMILY MEDICAL AND SOCIO-ECONOMIC HISTORY - 1

1.3 PATIENT DEVELOPMENTAL HISTORY - 2

1.4 PATIENT LIFESTYLE/HOBBIES - 3

1.5 PAST MEDICAL HISTORY - 4

1.6 PRESENT MEDICAL HISTORY - 5

1.7 ADMISSION OF PATIENT - 6

1.8 PATIENT CONCEPT OF HIS ILLNESS - 7

1.9 LITERATURE REVIEW ON BPH - 8

1.10 VALIDATION OF DATA

i
CHAPTER TWO

2.0 ANALYSIS OF DATA

2.1 COMPARISON OF DATA WITH A STANDARD

2.2 DIAGNOSTIC INVESTIGATIONS TESTS

2.3 CAUSE

2.4 STANDARD CLINICAL FEATURES COMPARED WITH THOSE EXHIBITED BY

MR. KASSIM MUSAH

2.5 COMPLICATIONS

2.6 PATIENT AND FAMILY STRENGTH

2.7 HEALTH PROBLEMS

2.8 NURSING DIAGNOSIS

CHAPTER THREE

3.0 PLANNING FOR PATIENT/FAMILY CARE

3.1 PATIENT/FAMILIY CARE OBJECTIVE

3.2 NURSING CARE PLAN

CHAPTER FOUR

4.0 IMPLEMENTING PATIENT/FAMILY CARE STRATEGIES

ii
4.1 SUMMARY OF ACTUAL CARE RENDERED TO PATIENT/FAMILY

4.2 PREPARATION OF PATIENT/FAMILY FOR DISCHARGE

4.3 FOLLOW UP, HOME VISIT, CONTINUITY OF CARE

CHAPTER FIVE

5.0 EVALUATION OF CARE RENDERED TO PATIENT/FAMILY

5.1 STATEMENT OF EVALUATION

5.2 AMENDMENT OF PARTIALLY OR UNMET OUTCOME CRITERIA

5.3 TERMINATION OF CARE

5.4 SUMMARY AND CONCLUSIONS

BIBLIOGRAPHY

LIST OF TABLES

TABLE ONE: DIAGNOSTIC INVESTIGATIONS/TESTS

TABLE TWO: STANDARD CLINICAL FEATURES COMPARED WITH THOSE

EXHIBITED WITH MR KASSIM MUSAH

TABLE THREE: PHARMACOLOGY OF DRUGS

TABLE FOUR: NURSING CARE PLAN

iii
PREFACE

The study of this patient/family care is a report on the total nursing care rendered to a patient

and his/her family, and involves the interaction between the patient(including family and

community members) and health team occurring within a specified period of time as long as

the patient care lasts.

This study has broadened my knowledge on the causes, clinical features, incidence,

complications, medical and nursing management on the disease condition (BPH). The study

has given me the opportunity to get a clear understanding of the psychological, spiritual,

socio-economic and physical needs of the patient as well as the family in times of illness and

health.

It has further enable me to apply the knowledge acquired in the field of nursing in meeting

the health needs of Mr. KassimMusah as a unique being.

The patient/family care study is also a requirement in partial fulfillment for the award of a

Diploma in Registered General Nursing by the Nurses and Midwives Council for Ghana to

final year student nurses.

It is therefore my hope that this report will be of benefit to other student nurses and

professional nurses alike in the care of patients using the nursing process.

iv
ACKNOWLEDGEMENT

My sincere thanks go to God Almighty for his indelible love, protection, knowledge and

health throughout the course of this study.My special thanks go to my dear father for his

love and care to see my future dream of becoming a nurse come true. Also to the

administrative body and tutors of Sampa nursing training college especially my

supervising tutor, for going through this script.

I also wish to render my profound gratitude to my family members for their diverse

support and love. I will not forget of the Matron, the Director and the entire staff of

Wenchi Methodist hospital for their support.

I will also like to extend my thanks to the in-charge and entire staff of Urology ward of

Methodist hospital, Wenchi for a great work done by advising and correcting me anytime I

went wrong.

My profound gratitude also goes to my client and family for allowing me to take

MrKassim for my study.

My final thanks goes to all my friends, especially my roommates for creating a perfect

environment for me during my study, and to all the authors and publishers of the various

books I used during the course of my study. And to all who in diverse ways contributed to

the success of this study. May God richly bless you.

v
INTRODUCTION

The patient/family care study is on Mr.KassimMusah a sixty five (65) year old man who

was admitted into the urology ward of the Wenchi Methodist Hospital on the 11

September 2017 and diagnosed of Benign Prostate Hypertrophy (BPH)

On admission, MrKassimwas looking anxious and complaint of lower abdominal pains,

general body pains and was looking ill. My interaction with MrKassim and his family

began the following morning of his admission into the ward, when I performed a nursing

procedure on him, hence my interest in taking him for my care study.

My approach to MrKassim and family for taking him for a patient/family care study

yielded positive results. Following his acceptance and that of his family to be taken for the

study, he was assessed, his health problems identified, goals were set and how to achieve

those goals outlined.

A carefully developed plan of care was implemented and evaluated at each stage. The

whole process lasted for a period of eleven days from the day of admission to discharge

and patient condition improved. The report of this study is organized in five chapters;

CHAPTER ONE: This deals with the assessment of patient and family.

CHAPTER TWO: This chapter covers the analysis of data collected.

CHAPTER THREE: This covers the plan of nursing strategies for the care of Mr. Kassim

Musah and family

CHAPTER FOUR: This states the implementation of the patient and family care

strategies; i.e. the natural nursing care rendered to the patient and family

vi
CHAPTER FIVE: This chapter deals with evaluation of the care rendered to Mr. Kassim

Musah and family. It also includes summary conclusion and bibliography.

vii
 CHAPTER ONE

ASSESSMENT OF PATIENT/FAMILY

1.0 Introduction

Assessment is the first component of the nursing process which gives accurate information

about the client so that his needs can be met. It includes systematic collection of data

through interview, observation and physical examinations. Assessment includes patient’s

particulars, family’s medical and socio-economic history, patient’s developmental history,

patient’s life-style/hobbies, past medical history, present medical history,admission of the

patient, patient’s concept of his illness, literature review on disease condition and

validation of data.

1.1 Patient Particulars

Mr.K M a sixty five years old man, born on 22, August 1956 to late Mr. M K and Miss M

K all from Techimantia in the Brong Ahafo Region of Ghana. He is 2.5 meter in height,

weighs 52kg and dark in complexion. He is a Ghanaian and lives with his wife at

Techimantia. He has seven children, which are three female and four male

Mr. K M speaks Twi and Banda, he is a Muslim by religion and worship with his family in

the mosque, he is Banda by tribe. Mr. K and his wife are both farmers, he is illiterate, his

first born (Musah Kassim) is his next of kin.

1.2Patient’s Family Medical and Socio-Economic History

Information gathered from patient revealed that no family member has suffered any medical

and surgical condition which demanded hospitalization and no known hereditary disease

such as epilepsy, diabetes or mental illness has been identified in the family but occasionally,

1
when any member of the family has a minor illness such as abdominal pain, bodily pains,

headache or fever, they buy drugs from a drug store to treat it, they however seek medical aid

at the community clinic when symptoms persist. His family derives their source of income

from the sales of farm products such as yam, maize, groundnut, cassava etc. Members of their

extended family are very close to them and they have intimate inter personal relationship,

they are willing to help in terms of difficulty, the children of Mr. and Mrs. K also support the

family in time of difficulties

1.3 Patient’s Developmental History

According to what the mother told him, Mr. M K was spontaneously delivered per vaginum

as a term baby. He was delivered at home with the assistance of Traditional Birth Attendance

at Techimantia in the Brong Ahafo Region. He cannot really remember if he had any

immunization against any childhood disease. He said that his mother told him he was

breastfed for four (4) months and weaned off gradually with supplementary foods such as

porridge. From age one to two, he was introduced to some of the family foods which included

banku and rice. At age two he was completely weaned off breast milk and introduce to every

food he can tolerate. According to Mr. M K he was circumcised on the 8th day of life as said

by his mother.

He never been to school, so he always followed his parent to farm and through that he also

engaged himself in farming.

He started having his secondary sex characteristics at age 14 such as deepening of voice,

growth of pubic and axillary hair and broaden of chest.

Mr. M K is a married man with seven (7) children all of them are alive.

2
According to Erik Erikson psychosocial theory of ageing, he believed that as we grow older

(65+ yrs) and become senior citizens, we tend to slow down our productivity and explore life

as a retired person. It is during this time that we contemplate our accomplishments and can

develop integrity if we see ourselves as leading a successful life.

Erik Erikson believed if we see our lives as unproductive, feel guilt about our past, or feel

that we did not accomplish our life goals, we become dissatisfied with life and develop

despair, often leading to depression and hopelessness.

Success in this stage will lead to the virtue of wisdom . Wisdom enables a person to look

back on their life with a sense of closure and completeness, and also accept death without

fear.

1.4 Patient’s Lifestyle and Hobbies

Mr. M K said that, he wakes up at 5:30am everyday and maintain his personal hygiene by

washing the face, brushing the teeth and then moves his bowel and takes his bath. At about

7:00am he takes porridge and bread as breakfast and then goes to farm. He normally cooks

rice or yam for lunch at the farm. Though he eats all kinds of food and does not dislike any

food, His favorite meal is fufu and garden eggs soup.

Mr. M K use four days in the weeks to go to farm and use the rest of the remaining three days

to rest. But he usually goes to mosque on Friday. When he returns home after work, he takes

his bath, eats supper, listens to radio or watches television and retires to bed at 9:30pm

sometime 10pm

During his leisure time, he visits his friends to chart. Sometimes, he watches football with his

friends.

3
1.5 Past Medical History

According to Mr. M K, he has ever been hospitalized at Sunyani Municipal as a result of

hernia repair. Notwithstanding this, he said he sometimes experience some symptoms like,

headache and abdominal pain which he normally treat with traditional medicine or buys over-

the-counter drugs until he was hospitalized on the 09, March

2017 at Sunyani Municipal Hospital with inability to urinate and a catheter was passed. Mr.

M K is a known hypertensive patient who always go for checkup and takes his drugs at

Bechem Hospital. There are no known chronic illnesses apart from hypertension and no

known allergies.

1.6 Present Medical/Surgical History

Client was well until 20th August when he noticed he strains whenever he wants to urinate

and the urge to urinate was painful which made him to report to the hospital for management

on 11th September, 2017. The urine volume which was about 200ml per day and colour was

occasionally stain with blood. There was oedema in the lower limbs, he was examine by Dr.

BB, and diagnose of BPH (Benign Prostatic Hypertrophy). TURP(Transurethral Resection of

the Prostate) was ordered for him on the next day of admission which was successfully done.

1.7 Admission

On 11th September, 2017 at about 11:15am, client was admitted to Urology ward B2 for

TURP. He came in accompanied by his son and one nurse through OPD. He was fully

conscious and well oriented to time, person and place. Mr. M K was made comfortable into

an admission bed while his personal particulars such as full name, address and next of kin

were obtained and recorded in the admission and discharge book as well as the daily ward

state.

Vital signs were checked and recorded as follows:

4
Temperature : 36.6 degrees Celsius

Pulse : 78 beat per minute

Respiration : 19 cycles per minute

Blood pressure : 133/66 mmHg

Mr. M K was reassured to allay his fears, oriented on ward routines such as visiting hours,

meals and medication time and introduced to staffs on the ward as well as patients whose bed

was close to him. The mode of payment of bills was explained to him and a beneficiary of the

National Health Insurance Scheme (NHIS).

There were no drugs to be given as stat doses. However, client was put on the following

treatment which was to be started after procedure.

 Intravenous ceftriaxine 1.5g bd x 5 days

 Intravenous normal saline 2 liters x 72 hours

 Intravenous ringers lactate 1 liter x 72 hours

 Intravenous dextrose saline 1 liter x 72 hours

 Tablet Diclofenac 50 bd x 4days

1.8 Client’s Concept Of His Illness

Client attributed his illness to ageing. Although client expressed slight anxiety about his

illness as evidenced by his speech, he was hopeful that he will get better after the surgery. He

believed strongly that the treatment to be given to him at the hospital would enable him

recover.

5
1.9 Literature Review

Benign Prostatic Hypertrophy (BPH):

Is a non-malignant increase proliferation of glandular and intercellular tissues of the prostate.

The prostate gland becomes enlarged extending upwards into the bladder and obstructing the

outflow of urine by encroaching in the vesicle orifice. It is common in men over 50 years of

age. More than 80% of men in their eighty’s have this condition.

BPH is hyperplasia of the lateral and sub cervical lobes of the prostate gland that results in

enlargement of the structure

Aetiology

The cause is unknown. Evidence suggests that benign prostatic hypertrophy results from

changes in estrogen and androgen level and aging process. As men age, production of

androgen hormones decrease causing an imbalance in androgens and estrogen levels and high

levels of dihydrotestosterone which is the main prostatic intracellular androgen.

Other predisposing factors are arteriosclerosis, inflammation, cancers, and diet high in fat,

hereditary and excessive sexual intercourse.

Pathophysiology

The process of ageing and hormones like androgen in circulation are the developing factors

of benign prostatic hypertrophy. There is proliferation of the glandular tissues and the fibro

muscular stroma which may lead to lateral or middle lobe enlargement. The prostatic tissue

form nodules as the enlargement occur. The normally thin and fibrous outer capsule of the

prostate becomes spongy and thickened as the enlargement progresses.

6
The prostatic urethra becomes compressed, narrowed and distorted requiring the bladder

musculature to work harder to empty the urine in the bladder. The diverticulum musculature

tends to retain urine when the rest of the bladder empties.

Stones may form and infections may occur in the stagnant residual urine. Serious

complications such as bladder enlargement can arise from benign prostatic hypertrophy.

Clinical Features

 Difficulty in urination.

 Urgency and frequency of urination due to incomplete emptying of the bladder which

reduced bladder capacity.

 Acute retention of urine

 Post voiding dribbling.

 Sensation of incomplete emptying of the bladder.

 Pain on urination.

 Fever from infections.

 Constipation from pressure of the bladder on the gastrointestinal tract(GIT)

 Nocturia

 Strangury: A painful, frequent desire to micturate. but in which only few drops are

passed with difficulty

 Haematuria

Diagnostic Investigations

1. Percussion over the distended bladder will produce a kettle-drum sound.

2. Digital rectal examination for prostate size.

3. Urine analysis of culture and sensitivity to indicate infection or inflammation.

4. Urography to rule out obstruction of the neck of bladder.

7
 5. Residual urine test to access obstruction, residual urine exceeding 60mls must be

reported (post void).

6. Prostatic specific antigen test is examined to rule out cancer of the prostate.

7. Serum creatinine concentration would be determined to access renal function

Treatment

Medical treatment

1. Medical treatment depends on the severity of the obstruction and the condition of the

patient. Treatment involves hormonal manipulation with anti androgen and

progesterone agents’ example estrogen, progestin’s and flatumide. The medication

decreases the size of prostate and improves urine output.

2. Alpha adrenergic receptors containing phenoxybenzamine are used to reduce bladder

obstruction.

3. Catheterization of the patient; A stylet (thin wire) is placed into a catheter to make it

more rigid thus enabling the catheter to be inserted.

Surgical Intervention

Surgery is indicated to relieve symptoms to prevent urinary tract and renal damage. If the

amount of residual urine in the bladder is above 75 to 100mls, surgery is necessary though

symptoms may not be severe.

Surgery to remove the hyperplasic prostate tissue frequently is necessary to provide

permanent relieve of the obstruction. The procedure is referred to us prostatectomy. Four

different approaches are used;

8
a. Transurethral resection of the prostate; in this procedure, the prostate tissue is

removed through the urethra. It is the most common approach that is frequently used

and is a closed method. The operation is performed with a resectoscope. During the

operation, the gland is removed in small chips with electrical cutting loop. The

bladder and urethra are also continuously irrigated with a sterile isotonic, non-

conductive clear fluid. Immediately after the operation, a triple lumen catheter is

inserted through the urethra into the bladder and a closed irrigation system

maintained. This provides a means of continuous irrigation to flash out small clots of

blood.

b. Suprapubic prostatectomy; this method is performed when a bladder abnormality

(diverticular or calculi) exist or when a mass of tissue must be resected. A lower

abdominal incision is made into the bladder and the adenoma is removed by a blunt

dissection through the bladder neck. Both Suprapubic and urethral catheter are

inserted to facilitate drainage. A haemostatic agent may be placed in the prostatic

fosse to reduce bleeding. Blood loss in this procedure is greater than the other

approaches. It is with few complications and can be used for a gland of any size.

c. Retropubic prostatectomy; this approach is used when the hyperplastic tissue is too

large to be removed transurethrally and a severe urethral stricture is present. An

abdominal incision is made above the bladder. The surgeon dissects down between

the pubis and the bladder to reach the prostate. The capsule is opened and the

adenomatous tissue is removed. A urethral catheter is inserted and a cystostomy tube

is used to facilitate drainage.

d. Perineal prostatectomy; this is the less common method. It is done when prostate

calculi are present and a cancer of the prostate is suspected and confined. An incision

9
 is made in the perineum, the area between the scrotum and anus and the adenoma is

enucleated. A urethral catheter is inserted following the procedure.

NURSING MANAGEMENT

Pre-Operative Preparation

a. Relieve of anxiety; Reassure and encourage client to express fears and

misconception. Provide straight forward answers to help clear any misconception and

emphasize on the positive aspect of the surgery. Discuss problems related to sexuality

that are likely to occur following surgery because some types of prostatectomy can

result in impotency. If necessary arrange for sexual counseling to help client and

partner to cope with sexual difficulties.

b. Observation; Take and record vital sign that is, temperature, pulse, respiration and

blood pressure. Monitor client voiding patterns and maintain input and output chart.

An indwelling catheter is passed if there is urinary retention or if there is evidenced of

azotemia (accumulation of nitrogenous waste products in the blood). Observe the

catheter for drainage. Observe whether the patient can tolerate the catheter or

cystostomy may be performed. Weigh client daily.

c. Client education; Reinforce what will take place during surgery. Let client know the

nature of incision which could be directly over the bladder, low on the abdomen, in

the Perineal area or no external incision may be made at all. The patient is also

informed about the type of drainage system expected. Let client know he may have a

urethral catheter in situ for several days or weeks following surgery to insure proper

drainage and healing.

10
Post-operative care:

a. Observation; Observe vital signs that is temperature, pulse, respiration and blood

pressure every 2 hours. Observe the client closely for possible post-operative

complications like shock and haemorrhage. Check the incision site frequently for

bleeding and signs of infection such as swelling, fever, tenderness and notify surgeon

immediately if these occur. Secure the catheter to the leg or abdomen to decrease

tension and to prevent bladder irritation. Observe for leakage or blood clot and

maintain patency of urethra and Suprapubic catheters through intermittent or

continuous irrigation. Monitor the amount and character of drainage. Drainage should

be amber or slightly blood stained.

b. Relieve of pain; Apply warm compresses to the pubis. Encourage and assist the

patient to have sitz baths which can relief pain. Smooth muscle relaxants and

analgesics can also be administered to reduce Perineal pains and discomfort. Keep the

collection container of Suprapubic tube if inserted, below the patient’s bladder level

to promote drainage and to avoid pain.

c. Client’s education or teaching; client will not regain bladder control immediately

after removal of catheter, he may also experience transient urinary frequency,

therefore teach the patient leg exercises to tighten the perineum and speed the return

of sphincter control.

Advise client not to indulge in strenuous activities including sexual intercourse until

he is permitted by the doctor. Educate the patient to drink enough fluid to avoid

dehydration which may cause low urine production which could increase the tendency

of blood clotting in the urinary catheter. Teach client to recognize signs of urinary

tract infection and to report immediately. Instruct client to follow orders of prescribed

drugs.

11
Complications

1. Shock

2. Clot retention

3. Renal failure

4. Urinary tract infection

5. Recurrent retention of urine

6. Incontinence of urine

7. Bladder neck stones

8. Impotency

9. Infertility

10. Wound infection

11. Epididymo-ochitis

12. Severe hypernatremia (Transurethral or prostatectomy syndrome): This occurs as a

result of the absorption of the irrigation fluid. The features are increasing B.P

tachycardia, nausea and confusion

Teaching / Education On Discharge

1. Must take copious fluids

2. Diet: Increase intake of tomatoes, dried fruit {dates}, soymilk, garlic and Vitamin E but

avoid red meat, milk, animal fat and calcium foods and supplements

3.Identification of abnormalities in urine such' as blood pus severe pain on urination

4. Activity levels: Must avoid strenuous activities for the first three weeks of surgery e.g.

driving and riding

12
5. Daily activities can resume after 6weeks but vigorous activities can only resume around

the 3rd month after surgery and as allowed by the surgeon base on the condition.

6. Sexual intercourse - this may resume 6-8weeks after surgery when prostatic fossa has

healed.

7. Personal hygiene must be observed e.g. bath oral and perinealhygiene.

Prevention

Encourage awareness of Benign Prostatic Hypertrophy in the community.

Risks include being black, over age 50.

Routine screening should begin on all men by age 50; earlier for those at risk.

Reduce intake of read meat and high-fat diet. Take more fruits and vegetables.

Encourage and perform routine screening – includes yearly digital rectal examination and

PSA testing.

If PSA is 1 to 2 ng/mL, then test yearly.

1.10 Validation Of Data

The information obtained from client was confirmed by his wife and children. Signs and

symptoms exhibited by client in addition to the diagnostic investigations carried out

confirmed that Mr. Kassimwas suffering Benign Prostatic Hypertrophy (BPH). These were

done to ensure that data collected was free from errors, biases and misinterpretations hence

they were valid.

13
 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction

This is the process of examining information collected from client and family member and

identifying any deviation from normal by comparing it with standard. It involves comparison

of data with standard, covering client and family strength, client health problems, diagnostic

investigations, causes, clinical features, treatment, pharmacology of drugs, complications and

appropriate nursing diagnosis.

2.1. Comparison of standard with data

Table One: Comparison Of Clinical Manifestations In Client To That Of Literature

Review

CLINICAL MANIFESTATION IN CLINICAL MANIFESTATION

LITERATURE REVIEW EXHIBITED BY CLIENT

1. Urgency and frequency in urination. Client experienced urgency and frequency in

urination.

2. Dysuria Client experienced dysuria

3. Haematuria Client saw traces of blood in his urine

occasionally.

4. A feeling of incomplete voiding. Client complained of feeling incomplete

voiding.

5. Acute urine retention. Client experienced acute retention of urine.

6. Dizziness and palpitation Client complained of dizziness and

palpitation.

14
Diagnostic Investigation

DATE SPECIMEN INVESTIGTATION RESULTS NORMAL INTERPRETATION REMARKS

VALUE
11/09/17 Blood White blood cell 5.0 x109/L 4 – 10 x 109/L Within normal range No treatment

given

11/09/17 Blood Sickling test Negative Normal shape of Client have no sickle No treatment

RBC cell trait give

11/09/17 Blood Haemoglobin level 14.2g/dl Males: 14 – Within normal range No treatment

estimation 18g/dl given.

Female: 11 –

16g/dl

11/09/17 Blood Grouping and cross Group AB Group A, B, AB Client belongs to No haemo-

matching Rhesus positive and O. blood group AB with transfusion done

rhesus positive.

11/09/17 Blood Urea and creatinine 1.60mg/dl 0.6mg/dl – Client’s blood urea No treatment

level estimation 1.4mg/dl and creatinine level given.

were above normal

15
Causes Of Client’s Condition

According to the literature review, benign prostatic hypertrophy may be caused by aging,

obstruction, and decline in the production of hormone androgen, arteriosclerosis and

neoplasm. From the data collected, results from diagnostic investigations and literature

review the cause of Mr. M K condition was ageing and obstruction of the gland by a growth.

Specific Treatment Given To The Client

With reference to the literature review, Transurethral resection of the prostate was done and

Mr. M K was put on the following medications as indicated in the pharmacology of drugs:

 Intravenous Tranexamic 500mg 6 hourly x 24 hours

 Intravenous Normal saline 2 liters x 3 days

 Intravenous Ringers lactate 1 liter daily x 3 days

 Intravenous Dextrose normal saline 1 liter daily x 3 days.

 Intravenous Tramadol 500mg tid x 1 day.

 Intravenous steritax 1.5g bd x 1 day

 Tablet Nifedipine 20mg daily x 30 days

 Intravenous Gentamycin 240mg daily x 48 hours

 Tab Cefixime 400mg daily x 5 days

 Tab Oxybutymin 3.5mg tid x 5 days

 Amino BP forte 10ml bd x 10 days

16
 Table two

Pharmacology of drugs

DATE DRUG DOSAGE \ ROUTE CLASSIFICATION DESIRED EFFECT ACTUAL SIDE EFFECT
OF ACTION
ADMINISTRATION OBSERVED
12/09/17 Tranexamic 500mg 6 hourly for1 Relaxes bronchial Patient was relief Headache, fever,
Acid day smooth muscles causing from dyspnoea dizziness, tremors.
bronchodilator and Headache was
increasing vital capacity observed
12/09/17 IV Normal 4mls for 30 minutes Isotonic Solution Maintains fluid volume It corrects fluid and Kidney failure,
Saline and electrolyte balance electrolyte balance hypocalcaemia
cardiovascular failure.
None of these was
observed
12/09/17 IV Dextrose 3mls for 30 minutes Isotonic Solution Maintains fluid volume It corrects fluids Kidney failure,
Normal Saline and electrolyte balance and electrolyte cardiovascular failure.
balance None of those was
observed
12/09/17 Ringers 500mls over 3hours Hypertonic Solution To maintain body fluid It correct fluid and Circulatory
Lactate intravenously and electrolyte balance electrolyte balance Overload. This was
and energy requirement not observed

17
 Pharmacology of drugs continued

DATE DRUG DOSAGE \ ROUTE CLASSIFICATION DESIRED EFFECT ACTUAL SIDE EFFECT
OF ACTION
ADMINISTRATION OBSERVED
13/09/17 IV Tramadol Intravenously Analgesics They are use to relieve

pain

13/09/17 IV steretax Intravenously Antibiotics To prevent wound There were no signs Headache, dizziness,

infection of infection nausea, vomiting,

dysuria,

thrombophlebitis,

none of the signs

were present

16/09/17 Tablet Orally Analgesics It relieves pain at It relieved patient’s Nausea, vomiting,

Nifedipine incision site and pain pain postoperatively constipation,

accompanied by depression. None of

inflammation the side effects were

observed.

18
DATE DRUG DOSAGE \ ROUTE CLASSIFICATION DESIRED EFFECT ACTUAL SIDE EFFECT
OF ACTION
ADMINISTRATION OBSERVED
17/09/17 IV Intravenously Antibiotics To prevent post - There was no signs Headache, dizziness,

Gentamycin operative infection. of infection nausea, vomiting,

dysuria,

thrombophlebitis,

none of the signs

were present.

18/09/17 Tab Cefixime Orally Antibiotics (third Prevent and inhibits Infection was Nausea, vomiting,

generation of bacterial cell wall controlled diarrhea, abdominal

Cephalosporin’s) synthesis and in doing pain

so causes cell death None was observed

19
Complications

With effective nursing management client did not develop any of the complications stated in

the literature review.

2.2 Patient And Family Strength

This involves the activities that the client can do and what the family can do to aid in the

speedy recovery of the client.

During clients stay on the ward, his relatives were very supportive and cooperative as they

pay regular visit to him. Client was also able to pay his hospital bills. He was also able to

communicate effectively with health professionals which facilitated his care. Client was also

very cooperative during the performance of procedures on him and was mentally stable and

well oriented to time, place and person.

2.3 Health Problems

The following health problems were identified during interaction with Mr. K M and his

family on the ward before and after surgery.

Pre-Operative Health Problems

1. Anxiety

2. Patient has a catheter in situ

3. Insomnia

4. Ignorance

5. General body pain

20
Post-Operative Health Problems

6. Pain on incision site

7. Wound

8. Inability to maintain personal hygiene after surgery.

NURSING DIAGNOSIS

1. Anxiety related to unknown outcome of impending surgery.

2. Potential for urinary tract infection related to catheter in situ.

3. Altered sleeping pattern (insomnia) related to frequency urination.

4. Alteration in comfort (incisional pain) related to surgical intervention.

5. Knowledge deficit related to lack of information on his condition.

6. Partial self care deficit related to weakness

21
 CHAPTER THREE

PLANNING FOR CLIENT AND FAMILY CARE

3.0 Introduction

Nursing care plan is the third step in the nursing process. It is a written guide that directs the

efforts of the nursing team to meet health goals. It ensures that nursing team works efficiently

to deliver holistic goal-oriented and individualized care to client. All nursing interventions

will be evaluated after implementation to know if the objectives were of success.

3.1 Objectives

1. Client will be less anxious towards surgery within 1 hour as evidenced by;

a. Nurses observation of client signing the consent form without hesitation.

b. Nurse observing relaxed facial expression.

2. Client will not have urinary tract infection throughout the period of hospitalization as

evidenced by nurse not observing any signs and symptoms of urinary tract infection.

3. Client will have a sound sleep within 48 hours for at least 8 hours during the night and 2

hours during the day as evidenced by;

a. Client verbalizing that he had a sound sleep.

b. Nurse observing that client is sleeping undisturbed for at least 8 hours.

4. Client will be relieved of pain within 30 minutes as evidenced by;

a. client verbalizing a decrease level of pain and discomfort.

b. client having a relaxed facial expression.

22
5. Client will obtain adequate knowledge about his condition within 2 hours as evidenced by

patient answering questions related to the causes, signs and symptoms and complications of

Benign Prostatic Hypertrophy (BPH).

6. Client will be able to bath and groom on his own without any assistance within 72 hours as

evidenced by nurse observing patient maintain his personal hygiene without any assistance.

7. Patient’s wound will heal within 7 days as evidenced by

a. nurse observing absence of signs and symptoms of infection

b. patient’s wound healing by first intention

23
 Table Four : Nursing Care Plan

DATE/ NURSING OBJETIVE/ NURSING NURSING DATE/ EVALUATION SIGN

TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION TIME
CRITERIA
11/09/17 Anxiety related a-Client will be less 1-Reassure client 1.Patient was reassured Goal fully met

8am To unknown anxious towards that he is in the hands of 9am as client

outcome of surgery within competent staff so he signed

impending surgery 1hour as evidenced shouldn’t worry consent form

by a nurse 2-Establish rapport with 2.Rapport was established without

observing client client based on trust and hesitation and

signing the consent confidentiality presented a

form without 3-Introduce client to those 3.Client was introduced to relaxed facial

hesitation who have undergone a same a client who has expression

surgery successfully undergone a similar

surgery has recovered

without any complication

to allay his fears

24
 Client was introduced to a

client who has undergone

b- nurse observing 4.Educate client on surgical a similar surgery and has

a relaxed facial TURP and theatre setting recovered without any

expression complication to allay his

5.Allow patient to ask fears

question and give answers 4.client was educated on

simple language TURP as well as the

theatre setting

11/09/17 Potential for Client will not have 1.Reassure client 1. Rapport was 18/9/17 Goals fully

2:30pm urinary tract any urinary tract 2. Explain the established and 3:00pm met as client

infection related to infection essence of patient reassured that exhibited no

catheter in situ. throughout the catheter hygiene all necessary signs and

period of to client. measures will be put symptoms of

25
hospitalization as in place to prevent urinary tract

evidenced by nurse any infection of his infection

not observing any 3. Empty urine urinary tract and throughout the

signs and bag. return his condition periods of

symptoms of to normal. hospitalization

urinary tract

infection 4. Care for 2. The procedure and

catheter rationale for catheter

aseptically. hygiene was

explained to patient

5. Document to gain his

procedure. cooperation.

3. The urine bag was

emptied and the

amount was recorded

26
into the intake and

output chart.

4. Catheter was

cared for by

swabbing the

urethral orifice with

diluted savlon. The

exterior of the

catheter was

swabbed carefully at

its insertion.

5. The procedure

was documented in

the nurse’s notes

according to the

27
 ward’s protocol.

12/9/17 Altered sleeping Client will have a 1. Reassure 1. Client was 13/09/17 Goals fully

8:00pm pattern (insomnia) sound sleep within client. reassured that he was 8:00am met as patient

related to change 24 hours at least 8 able to have an verbalized

of environment. hours during the undisturbed sleep for that he had a

night and 2 hours at least 8 hours sound sleep

during the day as during the night and during the

evidenced by; 2. Make client’s 1-2 hours during the night.

a. client verbalizing bed comfortably. day.

that he had a sound

sleep. 2. A comfortable bed

b. nurse observing free from creases

that client is 3. Reduce noise and cramps was

sleeping on the ward. made for the client

undisturbed for at with washed and

28
least 8 hours. ironed linen to

promote comfort and

induce sleep.

4. Provide good

ventilation. 3. Movement in the

ward was limited

5. Serve warm and visitors allowed

drinks. in only at visiting

hours. The volume

6. Switch off of television set on

bright light and the ward was turned

provide dim light. down to allow client

to sleep.

4. Windows and

29
curtains at the ward

were adjusted to

ensure adequate

ventilation and

induce sleep.

5. Warm tea was

given to client at bed

time to help induce

sleep.

6. Main light on the

cubicle was switched

off and dim light at

bed side was put on

during the night to

facilitate sleep

30
13/09/17 Alteration in Client will be 1. Reassure 1. Patient was 13/09/17 Goals fully

4:30pm comfort (pain) relieved of pain client. reassured that pain 10:30pm met as client

related to surgical within 6 hours as would be relieved by verbalized a

incision. evidenced by; both nursing and decrease level

a. client verbalizing medical of pain and

a decrease level of 2. Help client to interventions being presented a

pain. assume a put in place. relaxed facial

b. client having a comfortable expression.

relaxed facial position. 2. Patient was put

expression. into a semi fowler’s

3. Ensure rest and position in a firm

sleep. comfortable bed

which was not

contraindicated.

4. Provide 3. A quite

31
diversional environment was

therapy ensured by reducing

noise and restricting

5. Administer visitors as well as

prescribed reducing the volume

analgesic. of television set to

ensure rest and sleep.

4. The television set

on the ward was

turned on and the

volume reduced to

encourage client to

view and divert his

mind off the pain.

32
 Injection pethidine

100mg was given

and 50mg was

repeated 6 hourly as

prescribed

14/09/17 Knowledge deficit Client will obtain 1. Reassure 1. Client was 14/09/17 Goal fully met

2:30pm related to disease adequate client. reassured that every 5:30pm as client was

condition (causes, knowledge about information about able to answer

signs and his condition the disease will be questions on

symptoms, within 3 hours as explained to him. the causes,

management and evidenced by 2. Assess client signs and

complications patient answering knowledge about 2. Client’s symptoms and

questions related to condition. knowledge about the complications

the causes, signs condition was of BPH

and symptoms and assessed to enable

complications of the education to start

33
benign prostatic 3. Educate client from the known to

hypertrophy. on the disease the unknown by

condition. asking what client

knew about his

4. Allow client to condition.

ask questions.

3. Client was

5. Ask client for educated on the

feedback. causes, signs and

symptoms and

complications of

Benign Prostatic

Hypertrophy (BPH).

4. Client was

allowed to ask

34
 questions based on

the education. His

questions were well

answered to clear his

misconceptions.

5. Client was asked

about related

questions based on

what he was told and

he was able to

answer questions

correctly indicating

his understanding of

the education given.

15/09/17 Partial self care Client will be able 1. Reassure client. 1. Patient was 18/09/17 Goal fully met

35
7:30am deficit (bathing to bath and groom reassured that he 7:00am as nurse

and grooming) on his own without will be able to bath observe

related to body any assistance and groom on his absence of

weakness. within 72 hours as own without any signs and

evidenced by nurse 2. Serve bed pan assistance. symptoms of

observing and urinal prior to wound

bathing. infection and

2. A warm bed pan patient wound

was served to patient heals by first

before the bathing of intention

3. Give bed bath. patient. Patient was without any

also served with infection.

urinal for him to

urinate before the

bed bath.

4. Change client’s

36
clothes and bed

linen. 3. Client was given

bed bath 2 times

daily with sponge

and mild soap and

pressure areas

treated to help

improve circulation,

remove dirt and

prevent pressure

sores.

4. Client’s soiled

linen were changed

and replaced with

new ones to provide

37
 comfort in bed.

38
 CHAPTER FOUR

IMPLEMENTATION OF CLIENT AND FAMILY CARE PLAN

4.0 Introduction

The nursing care given to Mr. Kassim Musah began on 11/09/2017 at ward Bed No- NM 13,

Urological ward. The care given was focused on alleviating his pain, preventing infection and

promoting early ambulation to maintain the normal function of his body organs.

4.1 Summary of care rendered to

DAY OF ADMISSION (MONDAY 11/1/2017)

Mr. Kassim Musah was admitted on Monday, 11/09/2017 at the Urology ward at about

12:45pm with a diagnosis of Benign Prostatic Hypertrophy (BPH) and booked for

Transurethral Resection of the Prostate. He came in ambulant accompanied by his son and

one nurse through OPD. He was fully conscious and well oriented to time, place and person.

Mr. Kassim was made comfortable into an admission bed whilst his personal particulars such

as full name, address and next of kin were obtained and recorded in the admission and

discharge book as well as daily ward state. Vital signs were checked and recorded as follows;

Temperature : 36.6 degrees Celsius

Pulse : 78 beat per minute

Respiration : 19 cycles per minute

Mr. Kassim and his son were reassured to allay fears, orientated on ward routines such as

visiting hours, meals and medication time and introduced to staff on the ward and also

patients sharing cubicle with him. The mode of payment of bills was explained to him. Client

was a beneficiary of the National Health Insurance Scheme. There was no drug to be given as

39
a stat dose; however he was put on the following drugs which were to be started after

surgery:

Intravenous Steritax 1.5g bd x 5 days,

Intravenous normal saline 2.0 liters x 3 days,

Intravenous ringers lactate 1litre x 3 days,

Intravenous dextrose normal saline 1litre daily x 3 days,

Intravenous Tramadol 50mg tid x 5 days,

Tablet Nifedipine 20mg daily x 30 days,

Client’s particulars such as name, age were recorded in the admission and discharge book as

well as also on the daily ward’s state.

He and relative were oriented to the ward and they were introduced to the nurses’ on duty and

also other patients in his abide. The concepts of hospital routines such as visiting hours were

explained to them.

PRE-OPERATIVE CARE

As part of preparing client for surgery, problem identified from the day of admission till the

day of surgery were tackled as follows;

Psychological Care:

Any human being is afraid of the unknown especially in matters that is concerned with

surgery, it is very important to allay fears and reduce anxiety in client and relatives as well.

Client was found to be anxious because of the impending surgery, so satisfactory rapport was

established and the purpose of admission was dearly defined to the client and relatives.

40
Mr. Kassim was introduced to the other clients on the ward and hospital routines and

procedures were explained. This was to allay his fears and make him more comfortable. The

doctor’s explanation of the surgery was reinforced avoiding over dramatization. Client was

introduced to other clients who had undergone similar surgery successfully in order to boost

his confidence and win his co-operation. Although client was concerned about lack of

privacy, loss of independence, the necessary reassurance was given as anticipated to allay any

misconceptions, fear and anxiety. Client was once again assured that he was in the hands of

competent staff who will assist him to undergo a successful surgery without any

complication.

Physiological Care:

This assessment is very important as it depicts the fitness of the client to undergo anesthesia.

Client’s blood samples were obtained and sent to the laboratory for the following

investigations to be done;

Estimation of haemoglobin level

White blood cell count

Blood for grouping and cross matching

Sickling

Observation:

Client’s vital signs were monitored closely and observed for any deviations from normal

range that is temperature, pulse, respiration and blood pressure. They were also charted in the

appropriate records charts. Indwelling catheter was observed for signs of infection and

blockage. The urine bag in situ was emptied frequently and observed for the color, content

and amount.

41
Immediate Pre-Operative Care (Day of Operation, Tuesday 12/09/2017)

Mr. Kassim consented to the operation by signing an informed consent form when the need

for the surgery had been explained thoroughly to him and the surgeon’s explanation of the

procedure reinforced. It was witnessed by the nurse in charge.

Client was given an assisted bathroom bath with special attention to the abdominal skin folds

to minimize the incidence of infection after the surgery. Client was shaved from the xiphoid

process to the upper half of the thigh in the direction of the hair. The shaved area was treated

with povidine iodine and covered with a sterile towel. It was then secured with an adhesive

tape.

Client was reminded of post-operative deep breathing exercise. He was taught how to turn

from side to side and to support his abdomen with a pillow when coughing or sneezing. The

reason was to prevent gaping of the wound. Client was also educated on the importance of

early ambulation to facilitate early restoration of the body functions.

Immediate Post-Operative Care:

Mr. Kassim was received from theatre in a conscious state with Transurethral Resection of

the Prostate done under spinal anesthesia accompanied by two staff on a trolley at 1:00pm.

He was received into a comfortable operation bed with side rails to prevent him from falling.

Client was put in the left lateral position to help maintain patency of airway. His vitals were

monitored frequently. The pulse and blood pressure were recorded quarter hourly to half

hourly for the first hour and hourly for the next four hours to assess for the degree of shock

and hemorrhage. Client’s incisional site was checked for bleeding and dressing was

42
reinforced. Intravenous Ringers’ Lactate in situ was also monitored and observed for the flow

rate, patency of the apparatus and air tightness. The drainage bag in situ was emptied and

recorded. Client complained of pain and intravenous Tramadol was administered. He was

advised to put his hand on the incision site when coughing to prevent stress on the incision

site.

In the evening client’s vital signs were checked and recorded. Client was bathed in bed to

refresh him to be able to sleep. Due medications were served.

FIRST DAY POST-OPERATIVE.

THIRDDAY OF ADMISSION (WENESDAY 13/09/2017)

Client woke up at 7:00am and was given a bed bath with warm water, soap and sponge to

remove dirt, relax him and improve circulation. Pressure areas were also treated. The

incisional site was protected from getting in touch with water to prevent gaping of the wound.

Client’s mouth was cared for with toothbrush and toothpaste to prevent halitosis. Client

complained of pain at the incisional site. He was reassured that necessary measures would be

put in place to alleviate his pain. He was made comfortable in the semi-fowlers position to

facilitate lung expansion. Client was given Capsules Tramadol 50mg 6hourly for five days as

prescribed to relieve pain. Intravenous Steritax, Ringers Lactate and Dextrose Normal Saline

were also given to prevent dehydration and intake and output chart maintained.

43
SECOND DAY POST-OPERATIVE.

FURTH DAY OF ADMISSION (THURDSDAY 14/09/2017)

Mr. Kassim had a sound sleep in the night as evidenced by his relaxed facial expression and

verbalization. He was assisted to take his bath in bed using tepid water, soap and sponge. He

was also assisted to care for his mouth. His linen was changed and new ones replaced.

Client‘s drainage bags were emptied and measured. It was also observed for the color,

amount, consistency and content discarded. Findings were recorded and documented in the

nurses notes.

Client’s vital signs were checked four hourly and range were as follows throughout the day:

Temperature 36.80C – 37.00C,

Pulse 75 beats per minute,

Respiration 18 – 20 cycles per minute,

Blood pressure 130/75mmHg

Intravenous infusion in situ was monitored for the rate of flow and patency of the apparatus.

The canular site was inspected for swelling or infiltration. He complained of pain at

incisional site and was reassured and managed with the prescribed analgesics.

THIRD DAY POST-OPERATIVE.

FITH DAY OF ADMISSION (FRIDAY 15/09/2017)

Client’s condition was fairly good. He was assisted to take his bath and care for his mouth.

His pressure areas were treated. Client’s drainage bags were emptied and documented in the

fluid intake and output chart and in the nurses’ notes stating the observed color and amount.

44
Client’s wound was observed for bleeding and aseptic technique was used to change the

dressing and a sterile dressing reapplied. Client was encouraged to have a lot of rest to

conserve energy. Prescribed antibiotics were then given to combat any possible infection and

vitamin supplements to help in the wound healing process. He was served with breakfast and

was well taken.

FORTH DAY POST-OPERATIVE.

SIXTH DAY OF ADMISSION (SATERDAY 16/09/2017)

Client’s condition had improved and he verbalized that he had a sound sleep during the night.

Personal hygiene routine especially bathing and mouth care were under taken by the client

himself. Client was able to undertake some form of active exercises within the vicinity and

had elimination without any difficulties.

He was introduced to adapt an upright position to facilitate breathing and promote lung

expansion. Windows and curtains were opened to allow in fresh air and promote adequate

ventilation. Prescribed medications were served to client and were charted in the drug

administration chart and nurses notes.

FIFTH DAY POST-OPERATIVE.

SEVETH DAY OF ADMISSION (SUNDAY 17/09/2017)

Client woke up quite early in the morning and his condition was satisfactory. He took his

bath, brushed his teeth and took his breakfast. Client however complained of inadequate sleep

the previous night as a result of noise of the ward. His bed was straightened to make it more

comfortable.

45
The volume of the television set on the ward was also turned down. Adequate ventilation was

also ensured by opening of windows and curtains on the ward.

Prescribed analgesics and antibiotics were served and charted accordingly. Client had

adequate sleep during the night as observed by the night nurse.

SIXTH DAY POST-OPERATIVE.

EIGTH DAY OF ADMISSION (MONDAY 18/09/2017)

Client’s condition had improved tremendously and expressed the desire to be discharged.

Client however had little knowledge about home care. After client had carried out his

personal hygiene he was served with porridge and bread. During the cause of the day, it was

explained to him that he will be discharged in a few days time. He was educated on the need

to eat nutritious diet which contains all essential nutrients that the body requires for improved

health. He was asked to drink a lot of water to help remove toxins from his body. His wife

who was around was also educated on things to use in preparing food and also how to keep

and observe clean wound.

Finally he was educated on how to keep the wound clean and dry to prevent infection and the

need to attend review after discharge. Catheter care and irrigation was carried out as ordered

by the doctor to prevent blockage of the catheter. The urethral catheter was then removed

afterwards as ordered by the doctor and documented appropriately.

SEVENTH DAY POST-OPERATIVE

NINTH DAY OF ADMISSION (TEUSDAY 19/09/2017)

46
Client had a sound sleep during the night; he appeared healthy and had a cheerful facial

expression. Activities of daily living were performed by him. He was served with breakfast

which he really enjoyed.

Alternate stitches were removed and the rest were to be removed on the ninth day post

operatively. Aseptic technique was used in dressing the wound. Client was encouraged to

exercise his body by walking short distances in order to improve circulation and muscle tone.

He was however advised not to take part in strenuous activities such as lifting up things until

the doctor recommends that it can be done. Prescribed medication was served and charted.

Client’s vital signs were checked and recorded as follows:

Temperature 37.10C

Pulse 74 beats per minute

Respiration 22 cycles per minute and

Blood pressure 130/80mmHg.

EIGHTH DAY POST OPERATIVE.

TENTH DAY OF ADMISSION (WEDESDAY ,20/09/2017 )

On the eighth and ninth day, client was able to get out bed and was able to perform his usual

activities such as brushing his teeth and bathing.

Medications were served, vital signs were checked and recorded and client was served with

high roughage diet to prevent constipation.

Client continued with his prescribed medications with no changes done.

DAY OF DISCHARGE

(THURSDAY, 21/09/2017)

47
Mr. Kassim had a peaceful night as he verbalized. He took his bath and brushed his teeth with

tooth brush and paste. Vital signs were checked and recorded and all prescribed medications

were administered.

On ward rounds patient was discharged and scheduled for review on 30/09/2017. Client was

educated on the importance of adhering strictly to the prescribed treatment and to finish

completely all the drugs given. Since client was a beneficiary of the National Health

Insurance Scheme all necessary paper works were completed at the insurance office, other

bills were paid and they were helped to pack off their belongings and seen them off to board a

taxi after promising another home visit.

PREPARATION OF CLIENT / FAMILY FOR DISCHARGE AND

REHABILITATION

Client’s preparation towards discharge started from the day of admission and the main aim

was to give client and family insight into the client’s condition and how to live a healthy life

thereafter. Mr. Kassim was given series of health education on his condition. They included

complications and preventions of the disease and the need to report any signs of the disease.

Client was educated on the need for early ambulation to restore the normal and proper

functioning of all the body organs. He was also educated on the need to engage in mild to

moderate exercises to improve circulation as his condition improves.

The need for client to take in nutritious diet was not ruled out. Laying emphases in the intake

of protein and vitamins for effective wound healing and repair of worn-out tissues. He was

also encouraged to take in carbohydrate and less fat to supply him with energy in order to

undertake his daily activities. The importance of personal hygiene that is bathing, mouth care

and care of hair, finger nails and toe nails were reinforced.

48
Client and family were enlightened on the need to maintain good environmental hygiene. It

was stressed that client’s wound should be kept clean and dry and the review date was given

to be kept in mind and to prevent defaulting.

Client was again educated on the importance of adhering strictly to the prescribed treatment

and to finish completely all the drugs given. Since client was a beneficiary of the National

Health Insurance Scheme all necessary paper works was completed at the insurance office.

Client’s family was asked to pay for the non-insured drugs that were used. Mr. Kassimwas

finally discharged on 21/09/2017 and was to come for review on 30/09/2017.

Home visits were made and care was terminated after client was handed over to the

community health nurse for continuity of care and follow ups.

FOLLOW UP/ HOME VISIT/ CONTINUITY OF CARE.

Follow up and home visit play an important role in the care of the patient after discharge. It

enables assessment of the client after discharge to know how the client and family are coping

at home.

FIRST HOME VISIT (FRIDAY 19/09/2017)

A visit was made to Mr. Kassim’s house on the 19/09/2017 with his wife to find out the

sanitary conditions in the house in conjugation with the available of basic social amenities

like water, health facilities and good roads that might have influence on his disease. The

purpose was to find out if client’s environment had an influence on his condition. Upon

arrival, other members of the family including grandchildren welcomed me. The house is

situated at the northern part of Techimantia town in the BrongAhafo district.

49
The community though a big one had bad drainage system, no supply of pipe-borne water,

electricity is good, road to the Town is poor. There are good communication system and

educational facilities, there is poor disposable of waste. Client’s house is built with mad

bricks and roofed with corrugated sheets. The nearest health facility is at Duan-kwanta. We

had some discussions on client’s condition and family members were reassured that, it is

improving and as such he will soon join them in good health. Permission was sought to

enable me leave and another home visit promised after discharge.

SECOND HOME VISIT (TUESDAY 26/09/2017)

A second home visit was conducted after client’s discharge to assess his response to good

family care in the home and his general condition and to remind client of the review. The

family welcomed me warmly and offered a seat and water. My mission was explained to

them. His well-being enquired about which he answered to be excellent.

The client and family were reminded on the review date and he was encouraged to take his

prescribed drugs till it is completed. His bowel movement was enquired and he said he moves

it once daily. An opportunity was taken to inspect the site of operation and it was dry and had

healed completely.

The surrounding of the house was observed and it was neat as before since general cleaning

was done every Saturday morning. They were congratulated and encouraged to keep it up.

Client and family were bade goodbye and saw me off to board a lorry and another visit

promised.

50
REVIEW (THURSDAY 30/09/2017)

Client reported for review on the Thursday, 30th September, 2017 with his son. He was

examined after assessment had been made. The doctor confirmed after examination that the

wound had healed completely.

Client was then sent to the for the remaining stitches to be removed. The wound was

aseptically dressed after the stitches were removed. Client was educated on how to care for

the wound at home, good nutrition and personal hygiene.

Client was seen off after that to board a car home after promising them another home visit

THIRD HOME VISIT (SATURDAY, 14 OCTOBER 2017)

Client was visited for the last time on Saturday 14/10/2017 in the company of a community

health nurse. Client was found in a good state of health as he looks cheerful and feels better

and made no complaints. Health educations on personal and environmental hygiene were

emphasized.

Mr. KassimMusah and family expressed their appreciation to me and the entire health team.

After a few discussions and conversations, client was handed over to the community health

nurse for continuity of care and follow ups. Permission was sought to leave for school.

51
CHAPTER FIVE

EVALUATION OF CARE RENDERED TO CLIENT AND FAMILY

Evaluation is the final stage of the nursing process. It focuses on the outcome criteria of the

objectives set in the nursing care plan and the effectiveness of the care given.

STATEMENT OF EVALUATION

On admission, Mr.KassimMusahwas found to be anxious over impending surgery. Goals

were set and fully met as nursing activities were performed and nurse observed relaxed facial

expression from client.

On the same day, client was prone to urinary tract infection as a result of catheter in place.

Goals set were fully met as client showed no signs of urinary tract infection throughout time

of hospitalization.

52
On the 12th September, 2017 client complained of insomnia. Goals set were fully met as

client had an undisturbed sleep of about 6 – 8 hours at night.

On the 13th September, 2017, client complained of incision pain after the surgery in the

afternoon. Goals were set and fully met as client verbalized relieved of pain.

On the 14th September, 2017, client had no knowledge about benign prostatic hypertrophy.

Goals set were met as client was able to answer questions on the causes, signs and symptoms,

and complications of benign prostatic hypertrophy.

On the 15th September, 2017, client could not bath himself. Goals set were fully met as client

appeared neat in bed.

On the 16th September, 2017, client’s wound was prone to infection. Nursing measures were

carried out to ensure that wound appeared clean and dry.

AMENDMENT OF NURSING CARE PLAN FOR PARTIALLY MET OR UNMET

OUTCOME CRITERIA

The objectives set for Mr. Kassim’s problems were fully met due to proper nursing

interventions employed. Nurses’ with client and family co-operation made is possible that

none of the objectives was unmet or partially met.

TERMINATION OF CARE

53
After every nurse-client relationship, there will be termination. Termination is a very difficult

step to take after a good rapport has been established. For this reason, the reality of separation

was started from the day of admission till discharge.

Termination of care started on 11th September, 2017, the first day of admission. Client and

family were made aware that client was being chosen for a care study. Thorough explanation

was made to client on his care in the hospital and after discharge which will eventually be

terminated.

The client and family showed appreciation for services and asked me to keep the relationship

established.

Termination of care therefore did not have any ill effect on client and his family since they

were educated from the beginning.

SUMMARY AND CONCLUSION

SUMMARY

Mr. KassimMusah a 65 year old man was admitted to the ward Bed NM13, Urology ward of

Methodist Hospital Wenchi after he was diagnosed of benign prostatic hypertrophy on the

11th of September, 2017.

Transurethral Resection of the Prostate by Dr. BB and assisted by Dr. Bernardon 12th

September, 2017.

Routine care such as bathing, mouth care, serving of bedpan, treatment of pressure areas and

monitoring of vital signs were carried out satisfactorily. Drugs treatment given included

54
antibiotics, analgesics, and intravenous fluids to flush system off toxins and replace loss fluid

and provide fluid and electrolyte balance.

Nursing problems were identified during admission, nursing diagnosis made, objectives set,

nursing orders carried out and ultimate goals fully met within the expected time. Client was

discharged on 21th September, 20187 after having stitches removed. Home visits were made

to see how client was doing at home; he was seen to be healthy and strong. Care was

terminated after client was handed over to the community health nurse for continuity of care

and follow ups.

CONCLUSION

This case study has enlightened me on what it means to give comprehensive care to an

individual. It has enabled me to put the knowledge acquired in the three year training into

practice. It has enabled me to establish a good rapport with client and family on the other

hand.

Finally the study has also broadened my knowledge on benign prostatic hypertrophy, its signs

and symptoms. The care has therefore prepared me to help and give a better education to

clients with similar condition. It has enabled me to practice individualized nursing.

55
BIBLIOGRAPHY

Amy M. Karch (2003) Lippincott’s Nursing Drug Guide Lippincott Williams & Wilkins,

Bethlehem pike, Springhouse.

Bare GB and Smeltzer CS (2007) Brunner and Suddarth Text Book of Medical and

Surgical Nursing 11th edition. Philadelphia, JB Lippincott Company.

Betty J.A and Gail B.L (2004). Nursing diagnosis Handbook, 6th edition Elsevier Mosby

U.S.A.

56
Phipps W.J., Sands K.J., Marek J.F., 1999, Medical-Surgical Nursing; Concepts and

Clinical Practice, 6th edition, 1737-1757, Mosby Inc., St. Louis.

Sparks & Taylor C (1998) Nursing Diagnosis Reference Manual, 4th edition, Pennsylvania,

Springhouse.

Weller BF et al (2001) Belliere’s Nurses Dictionary 23rd edition, London, RCN Publishing

Company.

Client’s Folder Number

APPENDIX

FLUID INTAKE AND OUTPUT CHART

POST OPERATIVE (14/09/2017)

DATE/TIME INTAKE OUTPUT

14/09/2017 KIND OF AMOUNT OF KIND OF AMOUNT OF

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 FLUID FLUID (MLS) FLUID FLUID (MLS)

7:00am Normal Saline 500 Urine passed 700

1:30pm Dextrose Saline 500

3:00pm Ringers Lactate 500 Urine passed 1000

4:00pm Normal Saline 500

5:30pm Ringers Lactate 500 Urine passed 900

8:30pm Dextrose Saline 500

16/1/2010 Total Intake 3000 Total Output 2600

7:00am

Balance = Intake-Output

3000-2600 = 400mls

58