Table 2.1 Diagnostic investigations.



PATIENT / FAMILY CARE STUDY ON A PATIENT WITH HYPERTENSIONAT BAPTIST MEDICAL CENTERWRITTEN BYOFROBO FRANCIS ANANEA FINAL YEAR STUDENT OFNURSING AND MIDWIFERY TRAINING COLLEGE –NALERIGUSUBMITTED TO THE NURSING AND MIDWIFERYCOUNCIL OF GHANA IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF CERTIFICATE IN REGISTERED GENERAL NURSING (DIPLOMA)MAY 2016TABLE OF CONTENTS TOC \o "1-3" \h \z \u LIST OF TABLESiPREFACEiiAKNOWLEDGEMENT …………………………………………………..…………iiiINTRODUCTIONivCHAPTER ONE11.1Patient’s Particulars11.2The Family Medical History 11.3Socio-Economic History21.4The Patient’s Developmental History 21.5The Patient’s Lifestyle And Hobbies Client’s Past Medical History PAGEREF _Toc324049844 \h Error! Bookmark not defined.1.6Patient’s Past Medical And Surgical History 31.7Patient’s Present Medical History……………………………………………..41.8Admission Of.Patient’s 41.9Patient’s Concepts Of Illness 61.10 Literature Review On The Condition Validation Of Data61.11 Validation of Data……………………………………………………………..17CHAPTER TWO………………………………………………..................................182.1 Comparing Of Data With Standards…………………………………………...192.2 Patient And Family Strenths222.3 Patient Health Problems222.4 Nursing Diagnoses……………………………………………………………………………………………………23CHAPTER THREE243.1 Objectives243.2 The Nursing Care Plan……………...………………………………………….25CHAPTER FOUR324.1 Summary of Actual Nursing Care324.2 Preparation of Patient And Family Toward Discharge And Rehabilitation364.3 Follow-Up / Home Visits/ Continuity of Care37CHAPTER FIVE405.1 Statement Of Evaluation405.2 Amendment Of Nursing Care425.3 Termination Of Care426.0 Summary And Conclussions Of Care Rendered To Patient And Family………43BIBLIOGRAPHY45SIGNATORIES46LIST OF TABLES TOC \t "Heading 2" \c Table 2.1 Diagnostic investigations. PAGEREF _Toc451433774 \h 19Table 2.2 comparison of clinical features PAGEREF _Toc451433775 \h 20Table 2.3 pharmacology of drugs administered to Mrs. Verse one. PAGEREF _Toc451433776 \h 21Table 2.4 The Nursing Care Plan for Mrs. Verse one with hypertension PAGEREF _Toc451433777 \h 25Table 2.5 Nursing care plan for Mrs. Verse one with hypertension PAGEREF _Toc451433778 \h 26Table 2.6 Nursing care plan for Mrs. Verse one with hypertension. PAGEREF _Toc451433779 \h 27Table 2.7 Nursing care plan for Mrs. Verse one with hypertension. PAGEREF _Toc451433780 \h 28Table 2.8 Nursing care plan for Mrs. Verse one with hypertension. PAGEREF _Toc451433781 \h 29Table 2.9 The Nursing Care Plan for Mrs. Verse one with hypertension. PAGEREF _Toc451433782 \h 30PREFACEThe patient/family care study is a writing report of the nursing care rendered to a particular patient and his/her family within a particular period of time. Professional nursing today places much emphasis on the use of scientific and holistic approach in caring for patients. The patient and family care study is also an in-depth analysis of how this process was used by a student nurse to care for a particular patient with a specific disease condition. Patient/family care study is helpful as it assesses the practical ability of the final year student by the nursing and midwifery council of Ghana as a partial fulfilment for the award of the registered general nursing (R.G.N.) certificate. It also offers the following benefits to the student nurse; it enhance and promote the student nurse to research, communicate and build interpersonal relationship with the patient, the family and other health care providers. Also, it gives the student nurse the opportunity to transfer the theoretical knowledge into practical field of leaning during the course of training and prepares him/her for the final practical exams. Again, it gives a sense of satisfaction and fulfilment to the student nurse after successfully nursing the patient to gain his/her normal health status. Furthermore, the study serves as a very important document for references and academic purposes from which other students and health personnel can easily obtain detail information about the patient’s condition as well as the health services rendered to him/ her and the family at large.ACKNOWLEDGEMENT I would first and foremost, express my gratitude to the Almighty God for giving me the knowledge and direction to undertake this patient / family care study.Furthermore, my sincere thanks go to my client, Mrs. Verse one and her family for their maximum cooperation towards the successful achievement of this script.Also my heartfelt thanks go to my supervisor Mr. Alhassan Sibdow of Nalerigu College of Nursing and Midwifery who in diverse ways corrected, sorted and directed the writing of this script. My next thanks and appreciation goes to the principal and all the tutors of Nalerigu College of Nursing and Midwifery for taking me through the nursing course.Also my next thanks go to the entire nursing staff of Baptist Medical Centre Nalerigu for allowing me choose a patient case notes to gather most of the data to successfully conduct my study.I cannot forget my parents, Mr. and Mrs. Anane and My brother Desmond Obeng Anane for their support and encouragement both financially and socially throughout my nursing course.Finally, my word of appreciation goes to all my classmates especially Bandim Sakwaka Eric. INTRODUCTIONFor the purpose of confidentiality, Mrs. Verse one was used to represent the name of the patient for this care study. This patient care study is a detailed account of nursing care rendered to Mrs. Verse one who was admitted to the Baptist medical center (B.M.C.) on the 6th October, 2015 with the diagnosis of hypertension and was discharged on the 11th October, 2015. It has been organized in to five chapters; chapter one contains assessment of patient and family, chapter two consists analysis of data, chapter three entails planning for patient / family care, chapter four deals with implementation of patient / family care plan and finally, chapter five which is concerned with evaluation of care rendered to patient /family. The interaction with patient started on the first day of admission (6th October, 2015) as a way of establishing rapport. Consent was seek from the patient and her family to be taken as a patient for this care study which they all agreed. The interaction with the patient whiles on admission lasted for six (6) days and three (3) fellow-up visit was made to patient home for further interaction with her and to give appropriate her education to her. On admission, she was assessed of having the following clinical features; headache, fever, vomiting, dizziness, general bodily weakness and high blood pressure with the dizziness being the chief complain and the main reason for the patient to be brought to the hospital. A systematic and a holistic nursing care was rendered to patient using the nursing care plan with the assistance of the nursing process. Patient and her family cooperated well with the health team throughout hospitalization and was fully recovered on the sixth day of admission and was therefore discharge on the 6th October, 2015 with a blood pressure of 140/90mmgh. CHAPTER ONEASSESSMENT OF PATIENT AND FAMILYThis chapter consists of the assessment of patient and family. The assessment is the continuous process of collecting data about the patient and the family through observation, interviews, physical examination and past medical history to identify specific health problems of the patient so as to make an informed judgment about the patient problem to solve them.1.1 Patient particularsMrs. Verse One, a 53 year old woman who is an Islamic by religion comes from Gambaga in the East Mamprusi district in the northern region of Ghana. She is married to Mr. Dakrugu a retired teacher who lives in Gambaga as well. Mrs. Verse One is a Mamprusi by tribe, Ghanaian by nationality and have five children of which four are males and a female. She had a little formal education and completed junior high school at Gambaga.She speaks Mamprusi and English Language and has a height of 1.6 meters, weighs 68.7kg on admission and 68.3kg on discharge. The house number of the patient is A 127. According to the patient, the husband Mr. Dakrugu is her next of kin and they have no family doctor.1.2 The Family medical historyThe knowledge about family medical history helps in the diagnosis of certain disease that are inherited from the family. Health is a dynamic concept of life which can change at any period of time. Mrs. Verse One believes that hypertension is not a hereditary in the family. According to her, there are no other hereditary disease like diabetes mellitus, sickle cell disease, mental illness, heart disease and cancer. Moreover, she said there is no communicable disease such as tuberculosis and leprosy in the family. She stated that most often, some of the family members complain of minor ailment like headache, abdominal discomfort, common cold, fever and minor injuries which are usually treated at home using over the counter drugs and even local preparations. However, they report to the hospital for assistance when it gets serious.1.3 Socio-economic historyAccording to Mrs. Verse One, she lives with her husband and the children in their own house (nuclear family). She is a trader and the husband being a retired teacher. She sells plastic products like water containers, bowls, buckets etc. at Gambaga and sometimes goes to Nalerigu during market days to sell. The income she earns from her sales are used for the upkeep of the family. Also her elderly son is a head teacher at Lamgbinisi a sub-district under East Mamprusi who also support the family financially. She does not belong to any social group but usually attends public gatherings like naming ceremonies, weddings and funerals.1.4 Patient developmental historyAccording to Mrs. Verse One, her mother said she was safely delivered at home with the help of a traditional birth attendant without any complications. She was breastfed and brought out by her biological mother. After being breastfed for a period of time which she could not tell, she was then introduce to supplementary foods like tuo -zaafi and porridge as it was a common practice among the people of the community. According to her, the mother said she begun to sit with support at the age of seven months and by the age of ten months she could sit without support. She begun to crawl at the age of ten months, walked with support at the age of eighteen months and at the age of two years she was able to walk on her own without any assistance. She admitted that, the mother said she had no serious ailment during childhood development. Also she had no knowledge about immunization during childhood. She passed through normal developmental stages according to her mother. She got married at the age of 21yeras. Currently she is still married.1.5 The patient lifestyle and hobbiesAccording to the patient, she wakes up around 4:30am - 5:00am every day to go for her morning prayers. She prays five times daily as a Muslim. She practice oral hygiene once daily but sometimes twice a day; morning and evening by using toothpaste(close-up) and brush and sometimes chewing stick. She baths twice daily with cold and warm water in the hot weather and cold weather respectively. She takes tea or porridge with bread as her breakfast, rice and stew as her launch and tuo-zaafi with ground nut soup as her supper as the later her favorite. At her leisure times she visits her family and friends and also plays Ludo with her husband. She empties her bowel twice a day. 1.6 Past medical / surgical historyAccording to Mrs. Verse one, she was once hospitalized at Baptist medical center in Nalerigu with the diagnosis of malaria. She was improved upon within three days and was then discharged home by the doctor. She also said she has ever had an accident on her way from Gambaga to Tamale but sustained no injury and for that matter she never bothered to go to hospital. She admitted the fact that, she has never undergone any surgical procedure in any hospital before. She however stated that, she do occasionally suffers from minor ailments like common cold, headache and fever which she usually manage with over the counter drugs and also with local herbs.1.7 Present medical historyMrs. Verse one had been well until 1st October, 2015 when she started experiencing general bodily weakness, severe headache, dizziness and palpitation. As her usual practice, she bought some drugs from a nearby chemical shop to treat the symptoms. The symptoms subsided after she took the drugs but 3 days later, the presenting symptoms started and became more severe that she could not do anything and was then brought to the Baptist medical Centre on the 6th October, 2015 for proper medical care. On examination by the doctor on duty, she was diagnosed of suffering from hypertension and was admitted the female ward. 1.8 Admission of the patientMrs. verse one, 53 year old woman was admitted on the 6th October, 2015 around 10;15am into the female ward at Baptist medical center through the out - patient department with the diagnosis on hypertension. Client arrived at the ward ambulant and accompanied by her son and an accompanied nurse. They were warmly welcomed offered a seat at the nurse’s station. The necessary documents were collected from the accompanied nurse and the patient particulars were identified and confirmed by the client. Client particulars were written into admission and discharge book and also the daily ward state. Assessment of the patient general condition revealed general bodily weakness, dizziness, profuse sweating and severe headache. A comfortable bed was made for patient. Her vital signs were then checked and recorded as follows;Temperature - 38.90cPulse - 76 bpmRespiration - 20 cpmBlood pressure - 180/110 mmHgWeight - 68.7 kgAll her medications were collected and started as orderedTablet bendrofluzide 2.5 mg daily x 10 days Tablet nifedipine 20 mg x 10 daysTablet lisinopril 5 mg daily x 10 daysTablet acetaminophen 1g x 3 daysPromethazine 25mg stat.Normal saline 1.5 liters x 24 hours.Patient was kept on 4 hour blood pressure chart for monitoring as ordered.When the patient condition improved slightly, about two hours later, she was introduced to other patients recovering from hypertension. She was then orientated to the ward; the toilet and the bathroom. Ward and hospital rules and routines such as visiting hours, medication time, time for taking vital signs and time ward rounds were explained to her and her son. She was then reassured of competent staff and safe handling of her condition. The following laboratory investigation were requested:Urine sample for urinalysisWhite blood cell countBlood hemoglobin level estimatedFour hourly blood pressure checking for left and right arms. 1.9 The patient concept of illnessClient did not attribute her condition to any spiritual background or super natural powers. She did not also believed that her condition was inherited since no one has ever suffers hypertension from their family. However, she thinks that there is a lot of stress in her trading and that might have contributed in a way to her condition currently.1.10 Literature Review on HypertensionDefinition of hypertensionHypertension is defined by the seventh report of the joint national committee on prevention, detection, evaluation and treatment high blood pressure (JNC7) as a systolic blood pressure greater than 140mmgh and a diastolic blood pressure greater than 90mmgh based on the average of two or more accurate blood pressure measurement taken during two or more contacts with the health care provider. (Susanne, C.S., Brenda, G. B., Janice, L.H $ Kerry, H.C., 2010).Types of hypertensionHypertension can be classified into two:Primary hypertension and secondary hypertension 1. Primary hypertensionPrimary hypertension is also known as idiopathic (unknown cause) or essential hypertension. This type of hypertension accounts for 90-95% of all cases of hypertension and it may either be benign or malignant according to the rate at which the disease progresses.2. Benign hypertensionWith this type, there is moderate rise in blood pressure which continues to rise over years. Cardiovascular disease, heart failure and stroke may be the first indication of hypertension.Malignant hypertensionIn this, blood pressure is already elevated and there is continues rise over a few months or time. The diastolic pressure may exceed 120mmHg. Complication may include; encephalopathy, edema around the optic nerve etc.Secondary hypertensionSecondary hypertension accounts for 10-15% of all cases of hypertension, Cushing syndrome, diabetes mellitus, primary hyperaldosteronism, coarctation of the aorta and some drugs.Incidence of hypertensionMore than 50 million people in the United States of America have high blood pressure. Internationally, about one out of five persons have high blood pressure. In United States 38% of African American have high blood pressure and 29% of Caucasians have high blood pressure. The incidence of hypertension in children is low, but it is been detected in adolescents and it may occur in neonate, infant and in young children in secondary causes. In Africa hypertension affects more women than men whiles in Europe it rather affect men than women. Generally hypertension is more prevalent in Africa than any other part of the world.The incidence of hypertension however increases with age thus common in adult who are 40 years and above. Hypertension also tends to be more common among people living in urban area than those living in rural areas. It is also common among people whose job involves a lot of stress, overweight people, and family history with hypertension, cigarette smoking, sedentary lifestyle and diabetes mellitus. (Phipps’ 2007, Ross and Wilson, 2006, Clinical Watson’s, 2007).Classification of blood pressure for adult age 18 and aboveBP classificationSystolic BP (mmhg)Diastolic BP (mmhg)Normal <120<80prehypertension120 – 13980 – 89Stage 1 hypertension140 – 15990 – 99State 2 hypertension.>160>100 People with BP in the prehypertension category should begin lifestyle modifications such as nutritional changes and exercise. Also people with stage 1 hypertension should be treated with drugs and be seen by the health care provider about every month until their BP goal is reached and subsequently about every 3 to 6 months. Again people with stage 2 hypertension or with order complicating condition needs to be seen more frequently. (Susanne et al, 2010). Etiology of hypertensionThere are several factors leading to the causes of hypertension but this depends on the type of hypertension. In the majority of people (90-95%) hypertension is known to be idiopathic, primary or essential. The following are believe to be some of the factors underlying the etiology of hypertension.Essential / primary / idiopathic hypertensionEven though the causes of these types are not known, usually it begins as an intermittent process in Person in the late 30s to the late 50s. Primary hypertension is however believe to be associated with the following predisposing factorsHereditary: this condition usually runs through families and it is transmitted from parents Age to offeringsGender: In Africa it affect more females than males : the condition normally affect people in the middle age and olderRace: hypertension is more common in blacks than in whites Emotional stress: persistent stress predisposes an individual to hypertension Diet: high sodium and cholesterol diet predispose an individual to hypertension Lifestyle: this involve excessive intake of alcohol, smoking and lack of exercise and sedentary lifestyleObesity: over-weight put a lot of strain on the heart leading to over activity or hyper activity of the heartSecondary / non- essential hypertensionThis type of hypertension has an underlying causes which may be systemic disorder, endocrine over activity or under activity, renal disorders etc. Below are elaborations on the causes.Cardiovascular disorders: this includes arteriosclerosis, systemic sclerosis and poly arteritis etc. 2. Endocrine disorders: example are hyperthyroidism, acromegaly, and cushion syndrome 3. Renal disorders: renal artery stenosis, chronic pyelonephritis, glomerulonephritis, hydro nephrosis and poly cystic kidney disease 4. Drugs: oral contraceptive pills and steroids can cause hypertension 5. Pregnancy: pregnancy can induce hypertension in some women.Pathophysiology of hypertensionAlthough no precise cause can be identified for most causes of hypertension, it is understood that, hypertension is a multifactorial condition. Because hypertension is a sign, it is most likely have many causes. For hypertension to occur, there must be a change in one or more factors affecting peripheral resistance or cardiac output. In addition, there must also be a problem with the body’s control system that monitors or regulate pressure. Single gene mutation have been identified for a few rare types of hypertension, but most types of high blood pressure are thought to be polygenic(mutation in more than one gene) (Dominiczak,Negrin, clerk, etal.,2000). Many factors have been implicated as causes of hypertension;1. Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system.2. Increased renal reabsorption of sodium (Na+), chloride (Cl-) and water related to a genetic variation in the pathways by which the kidneys handles sodium (Na+).3. Increased activity of the renin- angiotensin aldosterone system resulting in expansion of extracellular fluid volume and increased systemic vascular resistance.4. Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium.5. Resistance to insulin action which may be common factor linking hypertension, type two (2) diabetes mellitus, hypertriglyceridemia, edema, obesity and glucose intolerance. (Susanne et al, 2010). Clinical features of hypertensionThe clinical features of hypertension include:Occipital headacheDizzinessPalpitation EpistasisDyspneaRestlessnessChest pain IrritabilityLeft ventricular hypertrophyFatigueHigh blood pressureLight headednessInsomniaGeneral body painNausea and vomitingIntermittent claudication (decrease blood supply to the legs)Diagnostic investigationsMeasuring blood pressure HistoryChest x- rayFull blood count Blood glucoseSerum uric acidBlood urea electrolytes and creatinine estimationElectrocardiogramUrinalysis Renal arteriographyIntravenous pyelogramMedical managementThere are various kinds of anti-hypertensive agents that can be used to reduce high blood pressure. The categories of anti-hypertensive drugs are: Beta adrenergic blockers: these groups of drugs tend to lower cardiac output by their effect on the heart rate and contractility example propranolol, nadolol, atenolol etc.Angiotensin converting enzyme (ACE) inhibiters, ACE inhibiters block ACE in the lungs from converting angiotensin 1, activated when renin is released from the kidney to angiotensin 1, which a potent vasoconstrictor. Blocking this conversion leads to decreased blood pressure, decreased aldosterone secretion, increase in serum potassium level and fluid and sodium loss. Examples are captopril, enalapril, lisinopril etc. Calcium channel blockers: these drugs inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells for example nifedipine, verapamil etc.Thiazide diuretic: an example is bendrofluzide thiazide (bendrofluzide). This category of drugs promote the secretion of sodium and water by the kidney tubules, thus results in reduction in the blood volume and venous returns with subsequent reduction in cardiac output and blood pressure.Alpha adrenergic blockers: they lower blood pressure by inhibiting peripheral vascular resistance principally by inhibiting norepinephrine induced vasoconstrictionAngiotensin II receptor blockers (ARBs): this selectively blocks the binding of angiotensin II to specific tissue receptors found in the vasculature of smooth muscles and adrenal glands. This action blocks the vasoconstriction effect of renin- angiotensin system as well as the release of aldosterone leading to decreased blood pressure. Nursing managementThe main aim of nursing care for hypertensive patients is to control blood pressure. Psychological carePatient and relative relatives should be reassured of competent nursing care to alley anxietyProvide enough information to patient about condition.Encourage patient to express feeling about fears and ask questions and answer them clearly.Encourage patient to identify stresses, plan strategies with her to reduced them Encourage on relaxation techniques including reading books, listening to music or watching television. Rest and sleepMaximum rest can achieve by providing comfortable bed devoid of crease and crumpsVisitors should restricted and surrounding environment should free from noise Nursing procedures must by scheduled in other not to interfere patient sleep Patient should be positioned according to her comfort.ObservationMonitoring and recording of vital signs especially blood pressure every 30 minute or one hourly depending on the severity of the condition.Institute fluid intake and output chart to monitor the amount of fluid retained in the body.Monitor patient for signs and symptoms of complication example stroke, renal failure etc.Observe for the side effects of the drugs administered like blurred vision, dizziness, nausea and vomiting, dry mouth etc.,MedicationsMake sure that right drugs are given at the right time, the right dosage, the right route and to the right patient.Monitor vital signs before administration of drugs and also educate patient and family on adverse side effects of drugsDietEncourage low sodium diet since sodium in the body expand intravascular volume and aggravates hypertensionDiscourage the intake of fatty foodsDiscourage patient to stop the use of tobacco and alcohol consumption Encourage patient to take foods containing calcium as it increases dietary potassium, this can decrease the effect of sodium and act on the kidney to reduced blood pressure.Health educationEducate patient on hypertension, its predisposing factors, signs and symptoms, treatment, complication and preventionEducate patient on lifestyle modification that is reducing alcohol and tobacco useEducate patient on the need to exercise regularlyEducate patient to check the blood pressure frequently Educate patient to express feeling of daily stress and identify ways to reduce them. Educate patient on intake of low salt, low fat and cholesterol dietEducate patient on the need to take medications as prescribed Stress on the need for follow-up and continuity of care Educate patient on the effect of involving in strenuous activities.Educate patient on therapeutic and side effects of drugs especially anti-hypertensive agentsComplication of HypertensionSome complications of hypertension include:Heart attackHeart failureStrokeMyocardial infarction Cerebrovascular accident EncephalopathyRenal failureHypertensive retinopathyGlaucomaPulmonary edemaCoronary artery diseasePrognosis of hypertensionThere is no known cure for hypertension. However, it can be well control and manage with proper treatment. Antihypertensive drugs with combination of lifestyle modification usually can manage high blood pressure. Prevention of hypertensionEliminating known risk factors helps reduce the risk of developing hypertensionExercising regularly Managing stress and anxietyAvoiding or limiting alcohol consumption and quitting cigarette smoking Reducing weight if over- weight.Additional dietary changes beneficial to reducing blood pressure include the DASH (Dietary Approaches to Stop Hypertension), which is rich in fruits and vegetables and low fats or fat free diet.1.11 Validation of dataTo ensure that the data at hand is free from errors, misinterpretation, biases, a series of special attention and activities were carried out during client’s admission until discharge by frequent interaction with client. These include: interviewing some of client’s visitors especially family at the hospital and their responses confirm my data obtained earlier. Data that were gathered by measuring with accurate equipment such as temperature, respiration, pulse and blood pressure were confirmed as they were checked by other competent staffs in the ward and finally both subjective and objective data were compared and there was no difference and hence the data was valid.CHAPTER TWOANALYSIS OF DATAIntroductionThis is the second stage of the nursing process and involves the act of making judgment on the client’s data to identify data that indicate actual or potential health problems. Also, this chapter involves the sorting of data obtained from diagnostic investigations, interviews, clinical features and comparisons with literature review in order to identify client/family strengths, actual and potential problems.Table 2.1 Diagnostic investigations. Date SpecimenInvestigation Result Normal values Interpretation Remarks 6/10/2015Urine Urinalysis No abnorm-alitiesUrine should be free from abnormalitiesNo renal involvement No action needed 6/10/2015 Blood Hemoglobin level estimation 12.8g/dlMale=12-18g/dl Female=11-16g/dlHemoglobin level is within normal range meaning no anemia She was not anemic therefore no treatment was given for anemia6/10/2015 BloodWhite blood cell count 5.3x1000?l500-900?lNo infection detectedRequires no treatmentCauses of patient condition With reference to the literature review on hypertension, patient condition can be attributed to old age, psychological stress as a result of pressure from her work and also other family problems.Table 2.2 comparison of clinical featuresClinical features in literature Clinical features exhibited by patient Severe headacheSevere headache was presentDizzinessDizziness was presentPalpitation Palpitation was absentRestlessnessRestlessness was presentEpistaxis Epistaxis was absentDyspnea Dyspnea was absentChest pain Chest pain was absentIrritability Irritability was absentFatigue Fatigue was presentHigh blood pressureHigh blood pressure was presentLight headednessLight headedness was absentInsomnia Insomnia was presentGeneral body weaknessGeneral body weakness was presentConvulsion Convulsion was absentPolyuria Polyuria was absentNausea Nausea was present Vomiting Vomiting was present Medical treatment of Mrs Verse oneIn relations to the treatments outlined in the literature review. Mrs. Verse one was put on the following medications:Tablet Bendroflumethazide 2.5mg daily x 10 daysTablet Nefedipine 20mg bid x 10 daysTablet lisinopril 5mg daily x 10 daysTablet Acetaminophen 1gm tds x 5 dayIM Promethazine 25mg stat1.5 litres of normal saline x 24 hoursTable 2.3 pharmacology of drugs administered to Mrs. Verse one.Date Drugs Standard dosage Dosages/route of administration Classifications of drugsDesired effects of drugsActual actions observedSide effects/ remedies6/10/15Tablet Bendrofluzide2.5 – 5mg tablet daily.2.5mg daily x 10 days orallyThiazide-(diuretic)To inhibit reabsorption of sodium and water and to decrease blood volume.Blood pressure was reduced from 180/110 to 140/90mmHg Postural hypotension, impotence and dehydration6/10/15Tablet Nifedipine 20 - 60mg tablet daily. 20mg bid x 10 days orallyCalcium channel blockerDecrease cardiac output and Reduced blood pressure through vasodilationChest pain and Blood pressure were reducedNausea, headaches, muscle cramps, joint stiffness, postural hypotension.7/10/15Tablet acetaminophen1000mg (1g) tablet x 8 hourly.1g tds x 5 days orallyNon- narcotic analgesic and antipyretic.Reduce pain and fever.Patient headache was relieved Damage of the liver and kidney, skin rashes.7/10/15Lisinopril5-40mg tablet daily5mg daily x 10days orallyAngiotensin converting enzyme (ACE) inhibitorPrevent conversion of Angiotensin I to angiotensin IIBlood pressure loweredConstipation, flatulence, rash, nasal congestion muscle cramps8/10/15Promethazine12.5 - 25mgIM/IV stat. 25mg stat intramuscularAntiemetic Prevent nausea and vomitingClient was relief of vomiting Dizziness, headache 8/10/15Normal saline500 – 1000 Milliliters x 24 hours.1.5 liters Isotonic solution To correct dehydrationpatient remained hydratedCirculatory overload, Edema. ComplicationsWith reference to the complication in the literature review, Mrs. Verse one did not experience any of them because she reported early to the hospital and also she responded well to treatment throughout the period of hospitalization and after discharge.2.2 The patient / family strengths.Specific strengths.Patient can described the location of pain and degree of discomfort.Patient was able to perform her activities (ADL) with assistance.Patient can described her normal sleep pattern. Patient drinks copious amount of fluids Patient had the desire or wiliness to eat.General strengths1. Patient was able to interact with other patients and the staffs on the ward.2. Patient was willing to be educated on her condition (hypertension)2.3 Health problems.After several interactions and assessment of Mrs. Verse one during the period of hospitalization, her actual and potential health problems were notice as:Specific problems.Bodily discomfort (headache)Inability to tolerate activity (dizziness).Patient cannot sleep well (insomnia)Patient experienced nausea and vomiting.Patient does not have appetite for foodGeneral problem1. Patient was anxious2. Patient lack knowledge on hypertension.2.4 Nursing diagnoses.1. Alteration in body comfort related to high body temperature (fever = 38.90C).2. Activity intolerance related dizziness.3. Sleep pattern disturbance related to change of environment4. Risk for fluid imbalance related to excessive fluid loss (vomiting)5. Risk for imbalanced nutrition (less than body requirement) related to loss of appetite.CHAPTER THREEPLANNING FOR PATIENT / FAMILY CARE.IntroductionThis is the third stage of the nursing process and it requires the designation of comprehensive plan of care for the patient and family to solve or reduced identified problems. Here the nurse outlines a plan of action to help the client in the achievement of wellness with reference to the client’s needs. This phase terminate with the nursing care plan which provides guide lines for implementation of the plan of care and offers a platform for evaluation.3.1 Objectives.In other to ensure comprehensive care, Mrs. Verse one nursing care objectives were based on her problems and needs for health care. These were then group into short and long term goals based on the duration.Short term objectives.To help reduced or normalized patient’s body temperature by 1oC within 30 minutes.To help improve patient’s tolerance to activities within 48 hours.To help patient regain her normal sleep pattern within 48 hours. Long term objectives.To help patient maintain normal fluid volume and good skin turgor throughout hospitalization.To help patient maintain optimal nutritional status throughout hospitalization.Table 2.4 The Nursing Care Plan for Mrs. Verse one with hypertensionDate/ timeNursing diagnosisObjective/outcome criteria Nursing ordersNursing intervention Date/timeEvaluation Sign 6/10/15 @ 11:45amAlteration in body comfort related high body temperature (fever 38.9oC)Patient will regain and maintain her normal body temperature within 30 minutes evidenced by; 1.Reduction of body temperature by 10C.2.Patient’s temperature within normal range(36.2 – 37.3) 1. Monitor patient temperature 2.Tepid sponge patient3. Ensure adequate ventilation in patient room. 4. Loose tight clothing from patient.5. Administer prescribed antipyretics.1. Patient temperature was monitored.2. Patient was tepid sponged.3. Fans and windows were opened for ventilation.4. Tight clothing were loosed from patient5. 1g of acetaminophen was administered as ordered.6/10/15@12:15pmGoal partially met evidence by 1. Patient’s body temperature reduced by 10C2. Patient temperature not within normal range (36.2 – 37.3).Table 2.5 Nursing care plan for Mrs. Verse one with hypertensionDate/ timeNursing diagnosisObjective/outcome criteria Nursing ordersNursing intervention Date/timeEvaluation Sign 6/10/15@1:30pmActivity(ADL) intolerance related dizzinessPatient will demonstrate tolerance to activity within 48hours as evidenced by 1. Patient performing her activities (ADL) without assistance.2. Patient verbalizes that dizziness has reduced.1. Asses patient state of dizziness.2. Ensure complete bed rest.3. Assist patient to perform her activities (ADL).4. Encourage patient to perform activity she can tolerate.5. Instruct patient to stop activities whenever she feels dizzy.1. Patient was asked whether she has double vision or not to assess her state of dizziness.2. Visitors were restricted to ensure complete bed rest.3. Patient was assisted to perform her activities of daily living like bathing.4. Patient was encourage to performed activities she can tolerate e.g. bathing.5. Patient was instructed to stop activities whenever she feels dizzy.8/10/15 @ 1:25pmGoals fully met as evidence by1. Patient performed her activities without assistance.2. Patient verbalizes absence of dizziness.Table 2.6 Nursing care plan for Mrs. Verse one with hypertension.Date/ timeNursing diagnosisObjective/outcome criteria Nursing ordersNursing intervention Date/timeEvaluationSign 7/10/15 @ 10:30am Sleep pattern disturbance (insomnia) related to change of environment. Patient will regain her normal sleep pattern within 48 hours as evidenced by 1. Verbalization of uninterrupted sleep by patient.2. Report from night nurses indicating that patient has sound sleep.1. Assess patient’s sleep pattern.2. Nurse patient in a quite environment.3. Restrict visitors.4. Assist patient to bath before going to bed.5. Schedule nursing activities to avoid unnecessary interruption of patient.1. Patient was asked about the time she normally goes to bed and the time she wakes up.2. Patient was nurse in a noise free environment.3. All visitors were restricted from patient room.4. Patient was assisted to have warm bath before going to bed.5. All nursing activities were scheduled to prevent interrupting with patient sleep.9/10/15@10:20amGoal was fully met as evidenced by 1. Patient verbalizes that she had interrupted sleep.2. Report from night nurses indicating that patient has sound sleepTable 2.7 Nursing care plan for Mrs. Verse one with hypertension.Date/ timeNursing diagnosisObjective/out-come criteria Nursing ordersNursing intervention Date/timeEvaluationSign 8/10/15@10:00amRisk for fluid and electrolyte imbalance related to excessive fluid loss(vomiting) Patient will maintain adequate fluid and electrolyte balance throughout hospitalization as evidenced by 1. Observation of good skin turgor.2. Verbalization by patient that vomiting has stopped.1. Assess patient hydration status.2. Monitor patient’s vital signs.3. Encourage oral fluid intake.4. Monitor fluid intake and output.5. Administer all prescribed intravenous fluids.1. Patient hydration status was assessed by checking the skin turgor and oral fluids intake.2. Patient’s vital signs were monitored.3. Patient was encouraged to take oral fluids liberally.4. Patient was kept on fluid intake and output chart.5. 1.5 liters of normal saline was administered to patient as prescribed.11/10/15 @9:45amGoal fully met as evidenced by 1. Observation of good skin turgor. 2. Verbalization by patient that vomiting has stopped.Table 2.8 Nursing care plan for Mrs. Verse one with hypertension.Date/ timeNursing diagnosisObjective/out-come criteria Nursing ordersNursing intervention Date/timeEvaluationSign 9/10/2015@11:30amRisk for imbalanced nutrition (less than body requirement) related to loss of appetite.Patient will maintain optimal nutritional status throughout the period of hospitalization as evidenced by 1. Patient is willing to eat. 2.patient eaten one third (1/3) of meal Served.1. Assess the nutritional status of patient.2. Perform oral care.3. Plan diet with patient.4. Encourage patient to eat.5. Serve meal in bit and in attractive manner.1. Patient nutritional status was assessed.2. Patient was assisted to perform mouth care before and after meal. 3. Patient was involved in planning of her diet.4. Patient was encourage to eat by praising her for the effort after meal.5. Food was served in small quantity and in an attractive manner.11/10/2o15@9:45amGoal fully met as evidenced 1. Patient has the willingness to eat.2. Patient eaten two third (2/3) of meal served.THE AMENDED CARE PLAN.Table 2.9 The Nursing Care Plan for Mrs. Verse one with hypertension.Date/ timeNursing diagnosisObjective/outcome criteria Nursing ordersNursing intervention Date/timeEvaluation Sign 6/10/15 @ 11:45amAlteration in body comfort related high body temperature (fever 38.9oC)Patient will regain and maintain her normal body temperature within 45 minutes evidenced by; 1.Reduction of body temperature by 10C.2.Patient’s temperature within normal range(36.2 – 37.3) 1.Monitor patient temperature 2.Tepid sponge patient3. Ensure adequate ventilation in patient room.4. serve cold drink if necessary5. Administer prescribed antipyretics.1. Patient temperature was monitored.2. Patient was tepid sponged.3. Fans and windows were opened for ventilation.4. About 330mls of chilled fluid juice was served5. 1g of acetaminophen was administered as ordered.6/10/15@12:30pmGoal partially met evidence by 1. Patient’s body temperature reduced by 10C2. Patient temperature not within normal range (36.2 – 37.3).CHAPTER FOURIMPLEMENTATION OF PATIENT/FAMILY CAREIntroductionThis is the fourth stage of the nursing process and it entails the actual nursing care that was rendered to patient and family from the time of admission to the time of discharge. It is composed of the following: summary of actual nursing care, Preparation of patient and family towards discharge, Rehabilitation and Follow up visit / continuity of care. 5.1 Summary of actual nursing careMrs. Verse one was admitted to the female ward of Baptist medical center on the 6/10/2015through the Outpatient Department (OPD) with the diagnosis of hypertension. She was nursed as an individual with a unique problems taking into consideration her physical, social, cultural and psychological not forgotten her religious background before planning her care. The comprehensive nursing care rendered to her started on the very day of admission at around 10:15am till the day of discharge on 11/10/ 2015 and the subsequent follow up visits and home care carried out.On admission she complained of headache, fever, vomiting, dizziness and general bodily pains. Considering the problems presented a comprehensive nursing care plan was drawn for her and implemented appropriately. Below are the actual nursing care rendered to Mrs. Verse one.First day of admission (6/10/2015) Upon thorough assessment of patient on admission, it was realized that she has bodily discomfort related to high body temperature (38.9oC). Patient was tepid sponged, 1g of acetaminophen was administered as ordered and other nursing care were carry out to reduce the high body temperature. At about 30 minutes later, patient’s body temperature was taken and the value obtained indicated a reduction by 10C (37.90C).Also there was activity intolerance related to dizziness. In handling this, patient was ensured a complete bed rest, she was monitored during movement to prevent her from falling and also assisted in performing her activities of daily living like bathing. Her vital signs were monitored and documented as; temperature =38.9 0C, pulse=76bpm, respiration=20 cpm, blood pressure =180/110 mmHg and weight=68.7 kg.All her medications were collected and started as ordered including Tablet bendrofluzide 2.5 mg daily x 10 days, Tablet nifedipine 20 mg bid x 10 days.The following laboratory investigations were requested; Hemoglobin level estimation, white blood cells count and urinalysis. The specimens were quickly taken and sent to the laboratory.Patient and her relative were also taken round the ward on orientation. The relative was also advised on the items she should bring especial things that are necessary for her use while on admission. Second day of admission (7/10/15)On the second day of admission, patient’s condition improved slightly. It was detected that, patient has disturbed sleep pattern related to change of environment. This problem was handled by restricting all visitors and other relatives from interrupting with patient’s sleep. Also all nursing activities were grouped and performed together to prevent interrupting in patient’s sleep. Patient’s vital signs were monitored and documented as; Temperature=36.60C, Pulse=74 bpm Respiration=22 cpm, Blood pressure=150/100 mmHgThird day of admission (8/10/2015)Following interaction with patient the next day, she verbalized improvement in her sleep pattern. She was assessed again and it was detected that, she has risk for fluid imbalance related to excessive fluid loss (vomiting). In tackling this, all nauseating items were taken away from her sight. She was also given water to rinse her mouth any time she vomited and prescribed intravenous fluid (normal saline 1.5 liters) was set up on her.Her vital signs were monitored and documented as: Temperature=36.8oc, Pulse=72 bpm, Respiration=22 cpm, and Blood pressure=140/85 mmHg. The following medications were prescribed for patient; IM promethazine 25mg stat, Normal saline 1.5 liters x 24 hours.Fourth day of admission (9/10/2015) During interaction with Patient as usual, she verbalizes absence of vomiting and feels better than the previous days. However, it was identified that she had risk for nutritional imbalance (less than body requirement) related to loss of appetite. In addressing this problem, meal was served in bit, at regular interval and in an attractive manner. Her prescribed medications were administered as ordered. Vital signs were then monitored including; Temperature=36.4oc, Pulse=82bpm, Respiration=24 cpm, Blood pressure=140/90 mmHg.Fifth day of admission (10/10/2015)On the fifth day of admission, patient woke up in the morning looking very cheerful with no complain but later complain of having a slit headache and restlessness probably because her daughters came to the hospital and quarrel there in her presence.Patient’s vital sign were monitored and documented; Temperature=37.1oC, Pulse=74 bpm, Respiration=24 cpm, Blood pressure=130/100 mmHg Patient was educated not to let the quarrel disturb her because it will make her condition worse. Her due medications were administered as prescribed.Sixth day of admission (11/10/2015) The 11th October, 2015 marked her sixth day on admission. On this day, patient was reviewed by the doctor on ward rounds and was discharged base on the absence of no complain and blood pressure readings also lowered. All nursing diagnosis whose objectives were expected to meet at the time of discharge evaluated and found to be fully met. Patient look much healthier on that day and her vital signs were normal as it was recorded as; Temperature=36.4oC Pulse=72 bpm, Respiration=20 cpm, Blood pressure=130/80mmHg.Patient has no significant problem to complain of. She was encouraged to continue taking her medications at home. She was also advised to report back to the hospital when she experiences any of the signs and symptoms of hypertension. She was again educated on how to avoid on predisposing factors of hypertension such as stress. Patient particulars were recorded in to the admission and discharge book and in diary ward state. Her bills were calculated and taken care of by the national health insurance scheme. Patient’s belongings were packed, her bed dismantled and simple laid in preparation for incoming patients. Finally, Mrs. Verse one left the ward very happy in the company of her daughter and the student nurse.4.2 Preparation of patient/family towards discharge and rehabilitationPreparation for discharge of patient and her family commenced on the day of admission until the day of discharge. On admission, patient was informed that her stay in the hospital was not permanent and that she will be discharged to go home when her condition improves better. Patient and relatives were educated on hypertension, its causes, clinical features, diagnosis, management, possible complications and preventive measures. Patient and relatives were encouraged to ask questions about anything that borders their mind for clarification. She was also educated on how to avoid the predisposing factors of hypertension like stress. Her family was advised to support in her care at home especially encouraging her to take the medications as prescribed. The patient and her relatives were reminded on the date of review which was on the 11th November, 2015. She was also reminded to come to the hospital as soon as possible when she experiences signs and symptoms like severe headache, palpitation, dizziness and fatigue among others. Patient was discharged on 11thOctober, 2015 by the medical doctor on duty during the usual ward rounds after which she and her family were informed. She was very happy to hear that she will be going home to join her family on that day. She was assured that she will be visited at home and given the necessary support. All her bills were settled by the National Health Insurance Scheme. Her particulars were written into the admission and discharge book and in the daily ward state. They were assisted to pack their belongings. Finally patient thanked the health team for the care rendered to her and they were accompanied to the road side. They were wished fare ware and informed that they will be visited in their home.4.3 Follow-up visit/ Home Visit/Continuity of Care.This involves care given to a patient and family after discharge from the hospital. This is about visiting the patients home to enable the health worker monitor the continuity of care until patient is fully recovered and so they were educated on the importance of follow up visit to their place of residence.Pre- Home Visit (9/10/2015)The first home visit was done at the time the patient was still on admission. The main objective was to assess the home situation in other to gather information for health education on actual and potential problems seen. It was also meant to prepare the home for continuity of care after discharge.When patient was on admission, an arrangement was made with her including her daughter and on the 9th of October, 2015, visitation was made to her home. Patient residence at Gagbeni in Gambaga. The house is just opposite to the junction of Gambaga College of education. Patient gave a direction to her house. Pre-information was made with patient relatives of the visit a day before the visit. Patient home was visited and on arrival at the junction of Gambaga College education, her son Mr. Kadri was called to provide an accurate direction to the house since it would have been difficult to locate because the road to the house was not straight. On arrival at the house, good reception was made by Patient’s relatives. Other family members who were present, were introduced. They were informed about the purpose of the visit. It was observed that they lived in a block house which has 10rooms, it was a compound house. The compound was neatly swept that day.Upon going in and around the house, the following problems were identified; there was improper disposal of refuse, they use the public toilet since there was no toilet in the house.Their source of drinking water was a pipe born water. They were advice to find a proper way of disposing off their refuse by putting them into a dustbin with a well fitted lid or sending them to the main refuse dump and disposed them there since this refuse can cause other health related problems cholera, malaria and others. The date of the next visit was communicated to them. They were thanked for their warmth reception and bid them good bye.Second Home Visit (18/10/2015)The second home visit was done one week after patient was discharged. On arrival, patient was met with one of her daughters on the compound. Patient was very happy for the visit and she offered a warmly welcomed into her room. She was then made known the reason for the visit and it was to see how she was coping at home and whether she was responding to treatment or not. There was no problem according to patient and a check on her drugs revealed that she was taking medications as prescribed. Her blood pressure was checked and it was 130/70mmhg. Health talk was centered on environmental hygiene, home accidents, they need to continue with the treatment regimen and the need to abide by recommended diet. Also patient was reminded about the need for reporting to the hospital for review after this. The need for a third home visits was discussed with patient which she agreed and the specific date was known to her.Third Home Visit (18/11/2015)The third home visit was on 18th November, 2015. On arrival, patient and family were all fine with no health problem. Health education was given to re-echoes previous discussion and also asks some questions so that she could recap what was discussed. Patient was so glad and said she will call any time she comes around the hospital. She was much better and going about her normal daily activities. Furthermore, patient had adjusted to low salt and low fat diet. Added to the above, the whole family seems to be happy and leaving peacefully. They were encouraged to always support her with regards to health and physiological care. They were reminded on the need to always ensure that Mrs. Verse one sticks to recommended diet, continuity of treatment and the need to avoid stress by having enough rest. Patient was introduced to community health nurse in charge of the area and also advice to always consult her when the need arises. In conclusion patient and family were thanked for their cooperation and the lovely manner they handled all the health team members. CHAPTER FIVEEVALUATION OF CARE RENDERED TO PATIENT/FAMILYIntroductionThis is the fifth and the final stage of the nursing process. The primary purpose of this chapter is to evaluate the care rendered to patient and family. This is done through review of the goals set in the nursing care plan and to elicit whether they have been achieved within specified time frame or otherwise.5.1 Statement of EvaluationIn other to assess the effectiveness of the individualized and holistic nursing care rendered to patient and family, various goals were formulated. The objectives of the nursing care plan were evaluated after the nursing orders were implemented. The goals set for Mrs. Verse one and the statements made are respectively indicated below:6th October, 2015Goal set at 11:45am was to regain and maintain patient’s normal body temperature within 30 minutes. Patient has bodily discomfort related to high body temperature (38.90C). Some nursing interventions were as follows; patient vital signs were monitored and documented, patient was tepid sponged, prescribed medications were administered. Goal was partially met at 12:15pm as Patient’s body temperature reduced by 1 0 C but was still outside the normal range (36.2 – 37.3).At 1:30pm on the stated date; goal set was to enable patient demonstrate tolerance to activities within 48hours. Patient has intolerance to activities due to dizziness. Patient tolerance to activities was assessed, patient was assisted in performing her activities of daily living such as bathing. Goal was fully met at 1:25pm on 8/10/2015 as patient performed her activities without assistance and also she verbalizes the absence of dizziness.7th October, 2015At 10:30am on the stated date; goal set was to help Patient regain her normal sleep pattern within 48 hours. Patient has sleep pattern disturbance related to change of environment. All the nursing activities were scheduled carry out at a time and visitors were restricted to prevent interrupting with patient sleep. Goal was fully met at 10:20am on 9/10/2015 as patient verbalizes that she had uninterrupted sleep and also report from night nurses indicating that patient had sound night sleep.8th October, 2015Goal set at 10:00am was to maintain adequate fluid balance within 72 hours. Patient has risk for fluid imbalance related to excess fluid loss (vomiting). Patient hydration status was assessed, prescribed intravenous infusion was administered. Goal was fully met at 9:50am on 11th October, 2015 as observation of good skin turgor and also patient verbalized that vomiting has stopped.9th October, 2015Goal set at 11:30am was to maintain optimal nutritional status throughout hospitalization. Patient has risk for nutritional imbalance (less than body requirement) related to loss of appetite. Patient nutritional status was assessed, mouth care was performed to stimulate appetite, and meal was served in bit and in an attracted manner. Goal was fully met at 9:45am on 11/10/2015 as patient was able to eat all meal served and her normal body weight restored 5.2 Amendments of nursing careGoal for high body temperature was partially met due to short time frame and inappropriate orders stated. In order to achieve this, the time frame was extended by 15 minutes and some nursing orders were changed.5.3 Termination of care.This is the last aspect of nursing care but start on the day of patient admission. It is a gradual process of breaking the therapeutic relationship between the patient/family and the nurse. .On the day of admission, patient and relatives were made to understand that the hospital was not a permanent but rather a temporal place for them and for that matter, patient will be discharged when she gets well. As days went on and patient condition gets improved, nursing of patient was not frequent as compared to the early days of admission prior to the discharge. She was prepared psychologically towards it. Patient and her family were visited once whiles on admission and twice after discharged with the last visit on the 18th November, 2015. It was established that patient had fully recovered, so they were informed that the therapeutic relationship between us has ended.The need for continuity of care necessitated my introduction of Mrs. Verse one and her family to a community health nurse who resides the same community for help whenever the need arose.Patient and family members thanked the health team for the services rendered and the same gesture was given to them for their understanding and co-operation.6.0 SUMMARY AND CONCLUSIONS.Summary Mrs. Verse one, a 53 years old woman was admitted to the female ward of Baptist Medical Center on 6thOctober, 2015 with the complain of headache, fever, vomiting, dizziness and general body weakness and was diagnosed as having hypertension.The health problems identified during admission included; vomiting, fever, insomnia, anxiety, dizziness and lack of knowledge about condition. However, with the appropriate nursing interventions carried out, client was much better and there was improvement in her health status at the time of discharge.Family and relatives of patient participated actively throughout the period of patient stay in the hospital and they provided psychological support to patient. They also gave out valuable information that helped in the nursing and management of patient. Patient was given adequate health education to prevent future occurrence of hypertension. Three home visit were made to the patient and her family and the interactions with the patient and her relatives were finally terminated on the last home visit (18th October, 2015).CONCLUSIONThe study has been successful and beneficial to me as well as my patient and her family. This care study has helped widen my knowledge on hypertension, how to identify and solve patient and family health problems as well as how to evaluate nursing interventions.Throughout the study, I have been able to correlate my theoretical knowledge with practical experience. This has also given me an understanding of research work and how to connect the hospital with community care there by promoting continuity of care.The experience acquired, will be useful in nursing other patients to achieve optimum health and also impact knowledge to others in the profession.BIBLIOGRAPHY1. Alexander, M.G, Fawcett, J.N. And Runciman, P.J. (2001). Nursing Practice, Hospital and Home 2nd Edition, Churchill Livingstone, Edinburgh, Pp_44-46.2. Boon, A.N., Colldge, N.R. And Walker, B.R. (2006), Davidson’s Principle and Practice of Medicine 20th Edition, Churchill Livingstone, Edinburgh, Pp_ 551-552.3. Cook, G.C.Zumla, I. A. (2009). Manson’s Tropical Diseases 22nd Edition, Saunders, Edinburgh, Pp_ 669-683.4. Greenstein, B. (2009). Trounce’s Clinical Pharmacology For Nurses 18th Edition, Churchill Livingstone, Edinburgh, Pp_75-87.5. Kasper, D.L. Fauci, A.S., Longo, D.L., Braunwald. Hauser, S.L. And Jameson, J.L. (2005). Harrison’s Principles of Internal Medicine 16th Edition, McGraw-Hill, New York, Pp_ 1462-1480.6. Kumar, P. And Clark, C. (2009). Kumar and Clark’s Clinical Medicine 17th Edition, Saunders, Edinburgh, Pp_ 798-805.7. Ministry Of Health- Ghana (2010). Standard Treatment Guidelines 6th Edition, Ghana National Drugs Programme (Gndp), Accra, Pp_ 97-104.8. Stead, L. (2000). Emergency Medicine, Lippincott Williams and Wilkins, Philadelphia, Pp_ 41-44.9. Susanne, C.S., Brenda, G.B., Janice, L.H and Kerry, H.C., (2010). Brunner And Saddarth’s Textbook Of Medical – Surgical Nursing, 12th Edition, Volume 2, Lippincott Williams And Wilkins, Philadelphia, Pp_ 890-901.10. Waugh, A. And Grant, A. (2010). Ross and Wilson Anatomy and Physiology in Health and Illness 11th Edition Churchill Livingstone, Edinburgh, Pp_124-125.11. Weller, B.F. (2014). Bailliere’s Nurses’ Dictionary for Nurses and Health Care Workers 26th Edition, Bailliere Tindall, Edinburgh, Pp_ 203. SIGNATORIESNAME OF CANDIDATEOFROBO FRANCIS ANANESIGNATURE …………………………………………DATE…………………………………………NAME OF CLINICAL SUPERVISOR…………………………………………SIGNATURE…………………………………………DATE…………………………………………NAME OF SUPERVISORY TUTOR………………………………………..SIGNATURE…………………………………………DATE…………………………………………NAME OF PRINCIPAL…………………………………………SIGNATURE…………………………………………DATE………………………………………… ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download