HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE,

BEREKUM

A PATIENT/ FAMILY CARE STUDY ON GASTRITIS

ADU-ADJEI MISPA FRANCISCA

4120190014

A PATIENT /FAMILY CARE STUDY SUBMITTED TO THE NURSING AND

MIDWIFERY COUNCIL OF GHANA IN PARTIAL FULFILLMENT TOWARDS THE

AWARD OF LICENSE TO PRACTISE AS A PROFESSIONAL REGISTERED

GENERAL NURSE

AUGUST, 2022

i
 TABLE OF CONTENTS

Contents
TABLE OF CONTENTS ................................................................................................................ ii
LIST OF TABLES ......................................................................................................................... iv
PREFACE ....................................................................................................................................... v
ACKNOWLEDGEMENT ............................................................................................................. vi
INTRODUCTION ........................................................................................................................ vii
CHAPTER ONE ............................................................................................................................. 1
ASSESSMENT OF PATIENT AND FAMILY ............................................................................. 1
1.0 Introduction ........................................................................................................................... 1
1.1 Patient’s Particulars ............................................................................................................... 1
1.2 Family Medical History ........................................................................................................ 2
1.3 Family’s Socio-Economic History ........................................................................................ 2
1.4 Patient’s Developmental History. ......................................................................................... 3
1.5 Obstetric History ................................................................................................................... 5
1.6 Patients Lifestyle/Hobbies..................................................................................................... 5
1.7 Patient’s Past Medical/Surgical History................................................................................ 6
1.8 Patient’s Present Medical and Surgical History .................................................................... 7
1.9 Admission of the Patient ....................................................................................................... 7
1.11 Literature Review .............................................................................................................. 10
1.12 Validation Of Data ............................................................................................................ 22
CHAPTER TWO .......................................................................................................................... 24
ANALYSIS OF DATA................................................................................................................. 24
2.0 Introduction ......................................................................................................................... 24
2.1 Comparison of Data with Standards.................................................................................... 24
2.2 Patient Family Strength ....................................................................................................... 33
2.3 Patient’s Health Problems ................................................................................................... 33
2.4 Nursing Diagnosis ............................................................................................................... 34
CHAPTER THREE ...................................................................................................................... 35
PLANNING FOR PATIENT AND FAMILY CARE .................................................................. 35
3.0 Introduction ......................................................................................................................... 35

ii
 3.1 Objective for the Patient and Family Care. ......................................................................... 35
CHAPTER FOUR ......................................................................................................................... 44
IMPLEMENTATION OF PATIENT / FAMILY CARE STUDY............................................... 44
4.0 Introduction ......................................................................................................................... 44
4.1 Summary of the Actual Nursing Care Rendered. ................................................................ 44
4.2 The Preparation of the Patient / Family for Discharge and Rehabilitation ......................... 54
CHAPTER FIVE .......................................................................................................................... 59
EVALUATION OF CARE RENDERED TO PATIENT ............................................................ 60
5.0 Introduction ......................................................................................................................... 60
5.2 Amendment of Nursing Care Plan for Partially met or Unmet Outcome Criteria .............. 64
5.3 Termination of Care ............................................................................................................ 64
CHAPTER SIX ............................................................................................................................. 65
SUMMARY OF CARE RENDERED TO PATIENT AND FAMILY ........................................ 65
6.0 Introduction ......................................................................................................................... 65
6.1 Summary ............................................................................................................................. 65
6.2 Conclusion........................................................................................................................... 67
REFERENCE ................................................................................................................................ 68
SIGNATORIES .............................................................................Error! Bookmark not defined.

iii
 LIST OF TABLES

Table 1: Diagnostic Tests/Investigation In Literature Review Compared With Those Carried Out

On Madam B.E ............................................................................................................................. 26

Table 2: Diagnostic Investigations carried out on Madam B.E .................................................... 27

Table 3: Clinical Features Exhibited by Madam B.E. Compared with those in the Literature

Review .......................................................................................................................................... 28

Table 4: Treatment Outlined in Literature Compared with those given to Patient. ...................... 30

Table 5: Pharmacology of Drugs Given To Madam B.E............................................................. 31

Table 6: Nursing care plan for Madam B.E .................................................................................. 37

Table 7: Vital Signs of Madam B.E throughout admission .......................................................... 69

iv
 PREFACE
Previously, nursing was just caring for the sick on the sick bed. The nursing profession began to

change rapidly under the influence of Florence Nightingale. Nursing has changed from caring for

the sick to include taking of medical history and conducting physical examination which was

previously the duty of the medical doctor. According to Virginia Henderson, nursing is the process

of assisting the individual either sick or well in the performance of those activities which contribute

to health or peaceful death that he would have performed unaided if he had the necessary strength,

will or knowledge and to do this in such a way as to help him gain independence and rapidly as

possible. Due to modernization, nursing has been changed to a holistic and individual nursing care

of a client by means of new techniques employed in the profession. To provide holistic and

efficient nursing care to patient and family, the student nurse employs knowledge and skills in all

areas of discipline, such as; psychology, sociology, surgery, pharmacology, public health and

medicine to meet the needs of the client, family and community as a whole. Patient/Family care

study is a written script on individualized nursing care rendered to a patient in relation to his

disease condition at a specific period of time.

The care is based on the theoretical and practical experienced acquired by the student nurse through

the three-year training. The study forms part of the assessment of the student nurse by the Nursing

and Midwifery Council of Ghana for the award of Professional Diploma Certificate. The patient’s

care was carried out making use of the scientific approach to nursing care which is the nursing

process. The study helps the student to gain knowledge in all areas of medical science to care for

clients as individuals. The patient and family care study starts from the day of admission to the

time of discharge and continue in the community to ensure optimum health through home visit.

For the purpose of confidentiality, the name of my patient and family relatives were stated using

initials throughout the care study.

v
 ACKNOWLEDGEMENT
I extend my outmost gratitude to patient Madam B.E and her family for giving me the opportunity

to use her as the subject for this project and also for their co-operation during our interaction

together.

Moreover, my appreciation goes to Monica Nkrumah, the principal of Holy Family Nursing and

Midwifery Training College, Berekum and the entire tutorial board especially my supervisor Mr

Edward Amponsah, for the guidelines and supervision in the writing of my care study successfully.

I take this opportunity to express my thanks to the General Ward in-charge, Doctors and other staff

of St. Mary’s Hospital, Drobo for the great support in the study.

I also own particular thanks to my dear parents Mr and Mrs.Adu-Adjei for their support spiritually

and financially and to all my friends, especially my roommates. I say God richly bless you all.

Finally, to the authors and publishers of the text books from which information was retrieved to

serve as a guide in writing this Patient/ Family Care Study, I say thank you.

vi
 INTRODUCTION
This is a well documented report of interaction between myself and Madam B.E, a 54 year old

woman who was admitted into the female’s ward of St. Mary’s Hospital, Drobo on the

11/011/2021 at 12pm with the diagnosis of Gastritis after presenting with abdominal pain and

vomiting . On admission patient was weak and looked generally unwell. At the ward, patient was

made comfortable in bed and nursing assessment was done to identify patient’s problem. Vital

signs were then checked and charted. The problems identified throughout period of patient’s

admission included Epigastric pain, Vomiting, Anxiety, loss of appetite, Insomnia and knowledge

deficit. On admission till discharge, routine nursing care such as checking and charting of vital

signs especially blood pressure, administration of medication, laying of patient’s bed, education

of patient on disease condition, applying cold compresses on patient’s forehead and reassurance

etc. were rendered on daily basis to ensure patient was cared for holistically. Patient was managed

on the following medications.

Intravenous Omeprazole 80 mg stat and then 40mg bd x 24 hours, Suspension Nugel 15 mls three

times daily x 5 days, Intravenous Metronidazole 500 mg tds x 2 days, Injection Buscopan 40 mg

stat, Intravenous Metoclopramide 10mg stat, Intravenous DNS 500mls stat, Capsule Omeprazole

20 mg BD X 14 days, Tab Metronidazole 400 mg tds x 5 days and Tab paracetamol 1g tds x 5

days.

The following laboratory investigations were ordered, done and reviewed by the attending

medical officer: Blood for Full blood count, Blood for malaria parasite, Serology testing for H.

Pylori antibody, Stool routine examination and Gastroscopy. Gastroscopy which could not be

done as a result of unavailability of gastroscopy machine in the facility.

vii
During patient’s stay at the hospital, a care plan was drawn with clear objectives, stated time frame

and appropriate nursing interventions instituted to tackle each of the problems identified. All

objectives set were fully met. Patient was discharged on the 15/11/2021 when she was deemed well

and healthy by the medical doctor. Patient was prepared towards discharge from the first day of

admission. Madam B.E. recovered within five days of admission without any complication and was

scheduled.

In all patient was visited on three different occasions. The first home visit was paid while patient was

still on admission to assess patient’s home environment and to validate data given to me. The second

home visit was to ensure patient was adhering to treatment regimen and to remind her of the review

date. The third home visit was to terminate care and to hand over patient to community health nurse

for continuation of care. During the home visits, education on patient’s condition and its

management, personal and environmental hygiene was done. Care was terminated on the 11/11/2021.

For clarity, the care study has been arranged as follows:

Chapter one (assessment) involves the collection of data about the patient and family. Chapter two

(analysis/ Diagnosis) encompasses the organization of data about the patient and his family and

review of literature on the condition. Chapter three (planning) has to do with the setting of specific

objectives based on Identified problems and care plans made to achieve the set objectives. Chapter

four (Implementation) comprises of the action phase of the care plan where a documentation of

the nursing care given is done. Chapter five (Evaluation) covers the assessment of how effective

and holistic the set objectives have been and the various procedures used in rendering nursing care.

Finally chapter six details the summary of care of rendered to patient and family and also

conclusion to the care study.

viii
 CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

1.0 Introduction
According to Weller (2014), assessment is the systematic collection of data to determine the

patient’s health status and any actual or potential health problems. This is the first step of nursing

process and involves the systematic and continuous gathering of information about the patient and

his/her family as well as the community in which he/she resides Assessment is important because

it helps the nurses to identify the patient’s problems. It gives an idea about the patient’s condition,

needs and health problems which enables nurses to render efficient nursing care. The methods

used in collecting the data include interviewing, information from patient’s folder, observation,

literature review, patient’s relatives and medical team. It involves patient’s particulars, patient’s

past medical history, socio-economic history, patient’s developmental history, patient lifestyle and

hobbies and finally patient’s present medical history.

1.1 Patient’s Particulars

Patient‘s particulars refer to factual demographic data about the patient. It include patient‘s name,

address, age, sex, marital status, occupation, religious preference, health care financing, and usual

source of medical care.

Madam B.E, the patient for this care study is a fifty four (54) year old woman born on 1st August,

1967 to Madam A.M and Mr. T.S. She is Bono by tribe and a Ghanaian. She speaks bono fluently.

Patrient is dark in complexion, her height is about 172cm and weighs 68kg on admission. She has

no physical disability or any facial marking. Madam B.E. is the fourth child among seven siblings

of her parents. Madam B.E is married to Mr. H.A and she has three children of which two are girls

and one male, all alive. Patient reside at Komfourkrom, a town within the Jaman South Municipal,

1
where she lives with her husband Mr. H.A and her three children. Her house number is KF 22/JSM.

Her next of kin is Mr. H.A, her husband. According to patient, she was educated up to form 4 but

could not continue her education. Madam B.A is a farmer by occupation. Patient is a Christian

and a member of the Presbyterian Church at Komfourkrom. Madam B.E is registered with the

national health insurance scheme.

1.2 Family Medical History

The Patient/Family’s Medical History provides information about illness in patient’s family which

has a genetic origin (Weller, 2014).

Patient intimated that there are no known history of hereditary, infectious or chronic diseases such

as Asthma, Diabetes mellitus, mental illness, epilepsy, hypertension tuberculosis and leprosy in

the family. There are no known allergy to any food, drug or substance in the family.

However, they sometimes experience minor ailments like common cold, headache and diarrhoea

which they treat by using over the counter drugs and they usually go to the hospital when

symptoms persist for long period. They receive treatment usually at St. Mary’s Hospital, Drobo

using the national health insurance scheme. Patient affirmed that she has never been admitted to

the hospital for any medical illness except when she was hospitalized on three occasions for

delivery. Patient’s parents and siblings are all alive and they do not suffer any chronic or non-

communicable illness. All her grandparents are dead except her paternal grandfather.

1.3 Family’s Socio-Economic History

Madam B.E family lives harmoniously with each other as well as other people in the community.

They support each other in times of need. According to Madam B.E, they are all registered

members of National Health Insurance Scheme (NHIS) so they do not have problem whenever

they visit the hospital. Madam B.E. has a family size of four; her husband, and her three children.

2
Madam B.E. is a farmer, who together with her husband cultivate cash crops such as cashew and

cocoa but they are also involved in food crops such yam, plantain and cassava. Produce from their

farm are sold at Drobo during market days. She is supported economically by her husband, and

their eldest son, who is a taxi driver. Because of her occupation, patient is prone to cuts and insect

bites and stinks. The income derived from their economic activities is used for the up keep of the

family. In times of financial crisis patient is supported by members of her external family and

sometimes friends. .

Madam B.E is a Christian and a member of the Presbyterian Church of Ghana. She worships at

the Komfourkrom where she is an active member and the leader of the women group. As a

Christian and a mother, she believes in discipline and hard work. She likes people who are

hardworking and discipline and abhors those who are not.

1.4 Patient’s Developmental History.

Developmental history is an account of how and when a person met developmental milestones suc

as walking and talking (medicinenet.com) Development is growth in function and capabilities,

thus qualitative increase in an individual Weller (2014). Growth is a progressive increase in size

of an individual, quantitative increase of an individual and Maturation is the process of

development in which an individual reaches full functionality (Weller, 2014).

Patient was born at Komfourkrom in the Jaman South Municipal, Bono Region of Ghana.

According to patient her mother told her that she was delivered spontaneously through the vagina

after nine months gestation without any complication by a Traditional Birth Attendant (TBA).

Patient was never immunized against all the vaccine preventable diseases and there was no mark

on her deltoid muscle to show proof of immunization. Madam B.E could not give a detailed

account of her developmental milestone. She was told that she passed through the normal

3
developmental milestone thus sitting, crawling, standing, walking etc. without any setback and by

age 12 months could walk without assistance.

She also said, she started developing secondary sexual characteristics at the age of 15 years with

the development of pubic hair, enlargement of breast, menstruation and others. She started having

menopausal symptoms at the age of forty-five (45) years.

According to patient she was educated up to form 4 but could not continue her education due to

financial constraints. As part of her aspiration and career plan when she was growing up, her

dream was to become a teacher which she couldn’t because of lack of financial support during

that period, currently she is a farmer. She married her husband, when she was 24 years old and

had her first child when she was 25 years old. Currently, she has three children. Patient has few

grey hair which she confirmed started coming when she was around 50years. Patient’s teeth are

all intact and her skin is minimally wrinkled.

According to Eric Erikson’s psychosocial theory of development, there are eight distinct stages

with each possible results, thus either success or failure personality.

1. Trust versus mistrust (birth to 1year)

2. Autonomy versus shame and doubt (2 to 3years)

3. Initiative versus guilt (3 to 5years)

4. Industry versus inferiority (6 to 11years)

5. Identity versus role confusion (12 to 18years)

6. Intimacy versus isolation (19 to 40years)

7. Generativity versus stagnation (40 to 65years)

8. Integrity versus despair (65 to death)

4
Madam B.E is within the seventh stage; generativity versus stagnation (40 to 65years) during

adulthood, we establish our career, settle down within a relationship, begin our own families and

develop a sense of being a part of a bigger picture. We give back to society through raising our

children, being productive at work and becoming involved in community activities and

organizations. By failing to achieve these objectives, we become stagnant and feel unproductive.

Throughout interaction with patient, I found out that, she has achieved generativity because she

has been able to contribute her part to the immediate family’s upkeep and she is a women leader

in her church. Patient is also proud that she and her husband has been able to educate their second

and third born to tertiary institutions.

1.5 Obstetric History

Madam B.E has had 4 pregnancies with which one was spontaneously aborted. She was able to deliver all

her three children per spontaneous vagina delivery without any complications. Currently all three children

are alive. She had her menopause at age 45 and has no history of the use of contraceptives. Patient does

not have history of sexually transmitted disease such as gonorrhea, syphilis, HIV/AIDS, among others.

She does not suffer from breast or cervical cancer.

1.6 Patients Lifestyle/Hobbies

Madam B.E is the outspoken type of person who does not exclude herself from social gatherings.

She has a quite number of friends of which the most from her church. She always put on a smiling

face which always makes people approach her easily. Madam B.E brushes her teeth twice a day,

baths twice daily and keeps short well-kept nails. She wakes up around 5:30am each day except

Sundays and goes to bed around 9:00pm at night after watching television with her family. She

frequently goes to farm from Monday to Friday except on Tuesdays when she comes to Drobo to

sell products from her farm. On Saturdays, she does her house chores such as washing, after which

she attends social gatherings such as funerals, parties, weddings or naming ceremonies. She goes

5
to church on every Sunday unless she is sick and a women group leader she is very energetic in

the activities of her church. She does not experience any difficulties in carrying out activities of

daily living like eating, grooming, dressing and walking. According to Madam B.E, she attends to

nature call whenever she feels the urge and hardly experience constipation. She is a non-smoker,

do not like coffee and does not take illicit or recreational drugs but according to her, whenever she

returns from farm and she is experiencing bodily pains she frequently takes over the counter drugs

such as brufen and bought from a local pharmacy store. She takes normal three regular meals daily

and cooks most of the time and has a great preference for spiced foods. She does not exercise

regularly and likes watching local movies. She does not have any known allergies and her favorite

food is fufu with palm-nut soup and snail. She is caring and uses non-verbal communication to

speak to her children to desist from doing certain things. She worries a lot about her family‘s well-

being and the educational outcome of her children and it is her highest priority that her children

have education to the possible highest level. Personally, I think Madam B.E is an extrovert, caring

and kind.

1.7 Patient’s Past Medical/Surgical History

According to Madam B.E, she has never been so sick to warrant hospitalization, but rarely suffers

minor ailments such as headaches and body pains as a result of her work but she treats them using

over the counter medications such as diclofenac and brufen and seeks outpatient treatments when

such ailments become severe. She said her only periods of hospitalizations are during deliveries

and she has never undergone any surgical procedure. She could not recall any childhood diseases

such as whooping cough or measles. Despite her easy access to healthcare, she does not attend

regular check-ups. Madam B.E has never had an accident and does not have any known allergies.

6
1.8 Patient’s Present Medical and Surgical History
Patient was apparently well until 10th November, 2021 when she started experiencing vague

abdominal (epigastric) pains. The pains were initially intermittent but later became severe. The

pain was associated with vomiting, a loss of appetite and a feeling of nausea which was gradual.

On Friday the 11th of November, 2021, she was rushed to Out patient department of St. Mary‘s

Hospital- Drobo where she was seen by Dr. A.M and diagnosed of gastritis and was then admitted

to the female medical ward for treatment to be continued on the same day.

1.9 Admission of the Patient

On 11th November, 2021 at 12pm, Madam B.E was admitted to the females’ ward of the St

Mary’s’ hospital, Drobo in a wheel chair from out- patient department accompanied by a nurse

from the out patient department and patient’s relative. Patient was conscious and well orientated

to time, place and persons. Patient’s folder was collected from the OPD nurse and her name was

mentioned to ascertain and confirm the identity of the patient. Madam B.E was immediately made

comfortable in an already prepared simple bed in females ward with bed number F6. Upon

assessment patient complain of epigastric pains, headache and vomiting. It was also observed that

patient was very anxious. I introduced myself to the patient and her accompanying relative.

Madam B.E’s. particulars were documented into the admission and discharge book and daily ward

state.

Vital signs was checked and recorded as follows

Temperature - 36.9oc

Pulse - 84bpm

Respiration - 21cpm

Blood Pressure - 110/60mmHg

7
SPO2 - 97%

Laboratory investigations requested on admission were

Blood for Full blood count

Blood for malaria parasite

Stool routine examination

Gastroscopy

Blood sample was taken, sample bottle labelled and sent to the laboratory for the investigations

to be carried out.

The drugs below were prescribed for Madam B.E to treat her condition:

Intravenous Omeprazole 80 mg stat and then 40mg bd x 24 hours

Suspension Nugel 15 mls three times daily x 5 days

Intravenous Metronidazole 500 mg tds x 2 days

Injection Buscopan 40 mg stat

Intravenous Metoclopromide 10mg stat

Intravenous DNS 500mls stat

Drugs were collected from pharmacy. An intravenous cannula was inserted and intravenous

medications commenced. Patient and relative were then informed about daily ward routine such

as medication, ward rounds and visiting hours. Also patient was orientated to the ward and it’s

environ. They were introduced to other patients at the ward, shown the toilet, bathroom and also

to the nurses’ station. Since there was no restroom in the ward, patient was encouraged to eat by

Her bedside. Items to be used at the ward during their stay such as towel, bucket, spoon and bowl

were also mentioned to the colleague who accompanied her to the ward.

8
After these interventions, permission was sought from the ward in-charge to use the patient for

my case study and she agreed. After 30 minutes of admission, patient’s husband Mr.H.A had

come around. I then introduced myself to the patient/family that, I am a final year student nurse

of Holy Family Hospital, Berekum, conducting a study at the hospital. I then made it known to

them my desire to use Madam B.E for the care study. I made them to understand that it case study

was part of the requirement by the nursing and midwifery council of Ghana in partial fulfilment

towards the award of a diploma in general nursing. I further explained to them holistic care will

be rendered to them to ensure speedy recovery. I told them that, as part of my training, final year

students are to take a patient each, nurse him or her from the time of admission till time of

discharge and home visits. The patient and family accepted and promised their cooperation and

readiness to give me any information needed for my study. They were informed that her

hospitalization was temporal and that she will be discharged as soon as her condition gets better.

They were also informed that, as part of care, I would visit their home whiles patient was on

admission and after she has been discharged. I choose to write a care study on gastritis because it

is very common in women due to the risk of excessive use over the counter medication. I wanted

to know more about this condition and to holistically nurse a patient who was suffering from this

ailment and also to apply the lesson from the study to nursing other patient with same condition.

1.10 Patient Concept of Illness

Madam B.E did not attribute her illness to any spiritual cause, though she did not know the specific

cause(s) of the illness. She was anxious because it was the first time she was sick to warrant an

admission . She was looking forward to a speedy recovery once she was receiving treatment so

that she can be discharged home to continue her trade. I took this opportunity to educate her on

gastritis; its causes, signs and symptoms, treatment, prevention and the need for the admission.

9
1.11 Literature Review
Anatomy and Physiology of the Stomach

According to Hinkle and Cheever (2014), the stomach is a muscular, hollow, dilated part of the

digestion system which functions as an important organ of the digestive tract in some animals,

including vertebrates, echinoderms, insects (mid-gut), and molluscs. It is involved in the second

phase of digestion, following mastication (chewing). The stomach is located between the

esophagus and the small intestine. It secretes protein-digesting enzymes and strong acids to aid in

food digestion, (sent to it via oesophageal peristalsis) through smooth muscular contortions (called

segmentation) before sending partially digested food (chyme) to the small intestines.

Role in Digestion

According to Hinkle and Cheever (2014), bolus (masticated food) enters the stomach through the

oesophagus via the oesophageal sphincter. The stomach releases proteases (protein-digesting

enzymes such as pepsin) and hydrochloric acid, which kills or inhibits bacteria and provides the

acidic pH of two for the proteases to work. Food is churned by the stomach through muscular

contractions of the wall called peristalsis – reducing the volume of the fundus, before looping

around the fundus and the body of stomach as the bolus is converted into chyme (partially digested

food). Chyme slowly passes through the pyloric sphincter and into the duodenum, where the

extraction of nutrients begins. Depending on the quantity and contents of the meal, the stomach

will digest the food into chyme anywhere between forty minutes and a few hours.

Anatomy of the Stomach

According to Hinkle and Cheever (2014), the stomach lies between the esophagus and the

duodenum (the first part of the small intestine). It is on the left upper part of the abdominal cavity.

The top of the stomach lies against the diaphragm. Lying behind the stomach is the pancreas. The

greater omentum hangs down from the greater curvature.

10
Greater omentum and stomach; Two sphincters keep the contents of the stomach contained. They

are the esophageal sphincter (found in the cardiac region, not an anatomical sphincter) dividing

the tract above, and the Pyloric sphincter dividing the stomach from the small intestine.

The stomach is surrounded by parasympathetic (stimulant) and orthosympathetic (inhibitor)

plexuses (networks of blood vessels and nerves in the anterior gastric, posterior, superior and

inferior, celiac and myenteric), which regulate both the secretions activity and the motor (motion)

activity of its muscles. In adult humans, the stomach has a relaxed, near empty volume of about

45 ml. Because it is a distensible organ, it normally expands to hold about one litre of food, but

can hold as much as two to three liters. The stomach of a newborn human baby will only be able

to retain about 30 ml.

Diagram of the Stomach

(Scalon and Sanders, 2010)

Sections of the Stomach

According to Hinkle and Cheever (2014), the sections of the stomach include;

11
Cardia - The cardia is the anatomical term for the part of the stomach attached to the esophagus.

The cardia begins immediately distal to the z-line of the gastroesophageal junction, where the

squamous epithelium of the esophagus gives way to the columnar epithelium of the gastrointestinal

tract.

Fundus - The fundus of the stomach is the left portion of the stomach's body, and is marked off

from the remainder of the body by a plane passing horizontally through the cardiac orifice. As the

rounded part of the upper stomach, it allows for an accumulation of stomach gases produced by

chemical digestion. It will also store undigested food for up to 1 hour.It will also store undigested

food for up to 1 hour.

Body or Corpus - The Body of the Stomach (Lat. corpus gastricum) often just called the body or

corpus is an anatomical region of the stomach in humans. The boundaries of the body of the

stomach are shown in the diagram to the right, with the dotted line stemming from the cardiac

notch separating the body from the fundus, while the lower boundary is defined by a line

perpendicular to the lesser curvature of the stomach from the angular notch. The line drawn from

the angular notch thus divides the body of the stomach to yield an antrum section, which goes on

to drain into the duodenum via the pyloric sphincter.

Pylorus - The pylorus; from the Greek, "gate guard" is the region of the stomach that connects to

the duodenum (the beginning of the small intestines). It is divided into two parts:

A) The pyloric antrum, which connects to the body of the stomach.

B) The pyloric canal, which connects to the duodenum.

The pyloric sphincter, or valve, is a strong ring of smooth muscle at the end of the pyloric canal

which lets food pass from the stomach to the duodenum. It receives sympathetic innervation from

the celiac ganglion.

12
GASTRITIS

Hinkle & Cheever (0214) describes gastritis as the inflammation of the gastric or stomach mucosa.

It is a common gastrointestinal problem. It may be acute or chronic. The inflammation may be

contained within one region or be patchy in many areas. Gastric structure and function are altered

in either the epithelial or the glandular components of the gastric mucosa. The inflammation is

usually limited to the mucosa but some forms involve the deeper layers of the gastric wall.

EPIDEMIOLOGY

According to the Scalon & sanders (2014), acute gastritis occurs in men more than women.

Chronic gastritis occurs more frequently in women than in men. About 35% of adults are

infected with H. Pylori.

TYPES

Inkle & Cheever (2014), classifies gastritis into two major types:

1. Acute gastritis

2. Chronic gastritis

Acute gastritis: It is a term covering a broad spectrum of entities that induce inflammatory

changes in the gastric mucosa. The inflammation may involve the entire stomach (e.g. pan

gastritis) or a region of the stomach (e.g. antral gastritis). Acute gastritis can be sub-divided into

2 categories: erosive (e.g. superficial erosions, deep erosions, haemorrhagic erosions) and non-

erosive, generally caused by Helicobacter pylori.

Causes

The cause of true gastritis as discussed by Marilyn, Mary. & Alice (2012), are

1. H. pylori infection and is indicated in an average of 90% of gastritis cases

13
2. Chronic ingestion of (or an allergic reaction to) irritating foods or beverages, such as hot peppers

or alcohol.

3. Drugs, such aspirin and other non-steroidal anti-inflammatory agents (in large doses), cytotoxic

agents, corticosteroids, antimetabolites, phenylbutazone, and indomethacin. .

4. Ingestion of poisons, especially DDT, ammonia, mercury, carbon tetrachloride, and corrosive

substances

5. Endotoxins released from infecting bacteria such as staphylococci, Escherichia coli, or

Salmonella.

Chronic gastritis: According to Hinkle & Cheever (2014), it results from repeated exposure to

irritating agents or recurring episodes of acute gastritis. Prolonged inflammation of the stomach

may be caused either by benign or malignant ulcers of the stomach or by the bacteria

Helicobacter pylori, may be associated with peptic ulcer disease or gastrostomy, both of which

cause chronic reflux of pancreatic secretions, bile, and bile acids from the duodenum into the

stomach. Recurring exposure to irritating substances, such as drugs, alcohol, cigarette smoke, or

environmental agents, may also lead to chronic gastritis. Chronic gastritis may occur with

pernicious anaemia, renal disease, or diabetes mellitus. Pernicious anaemia is commonly

associated with atrophic gastritis, a chronic inflammation of the stomach resulting from

degeneration of the gastric mucosa.

Risk Factors of gastritis

The risk factors of gastritis are described by Hinkle & Cheever (2014) to include;

1. Infection with Helicobacter Pylori, AIDS, Herpes simplex virus or cytomegalovirus

2. Excessive use of NSAIDS

3. Alcoholism

14
4. Cigarette smoking

5. Inflammatory bowel disease

6. Stress

Pathophysiology

The pathology as described by Hinkle & Cheever (2014) is that; normally, the gastrointestinal

mucosa is protected by several distinct mechanisms:

(1) Mucosal production of mucus and bicarbonate (HCO3) which creates a pH gradient from the

gastric lumen (low pH) to the mucosa (neutral pH) with the mucus serving as a barrier to the

diffusion of acid and pepsin

(2) Epithelial cells remove excess hydrogen ions (H+) via membrane transport systems and have

tight junctions, which prevent back diffusion of H+ ions.

(3) Mucosal blood flow removes excess acid that has diffused across the epithelial layer.

In the presence of factors like stress, chemical substances, like drugs and alcohol, spicy foods, hot

or sour foods, etc., there is sympathetic nerve stimulation, particularly that of the valgus nerve.

The stimulation leads to increased production of hydrochloric acid in the stomach causing nausea,

vomiting and anorexia. There is gastric mucosal cell exfoliation leading to erosion causing the

gastric mucosa to lose its protective property. There is invasion of gastric mucosa and

inflammatory reaction occurs. Mucosal cell loss cause bleeding. With constant irritation, tissues

become inflamed. The gastric mucous membrane becomes oedematous and hyperaemic

(congested with fluid and blood) and begin to undergo superficial erosion. It secretes scanty

amount of gastric juice with very little acid but much mucous.

15
SIGNS AND SYMPTOMS

According to the GHS (2014), symptoms include;

1. Epigastric pain

2. Headache

3. Nausea

4. Anorexia

5. Vomiting

6. Hiccupping, which can last from a few hours to a few days

Assessment and Diagnostic Findings

According to Hinkle & Cheever (2014),Diagnosis can be determined by;

1. Clinical manifestation/ history taking

2. Upper gastro-intestinal radiography

3. Endoscopy of the gastric mucosa (Gastroscopy)

4. Histologic examination of a tissue specimen obtained by biopsy.

5. Serum vitamin B12 assessment

6. Serologic testing for antibodies to helicobacter Pylor

TREATMENT/MANAGEMENT

AIMS:

Waugh and Grant (2014) describes the aims of treating gastritis to include;

1. Reduce the amount of acid in the stomach and allow the stomach lining to heal

2. To relieve symptoms such as abdominal pains and reduce complications

3. To treat the underlying cause of the condition

16
4. To promote comfort

MEDICAL MANAGEMENT

1 .Proton pump inhibitors such as omeprazole, Esomeprazole, lansoprazole

2. Antibiotics to treat helicobacter pylori infection eg Amoksiclav, metronidazole

3. Intravenous fluids Dextrose Normal Saline (DNS) to correct electrolyte imbalance

4. Analgesics to relief pain. Eg. tramadol, paracetamol to relieve pain

5. Antacids to neutralize stomach acid content. Eg Aluminium hydroxide, Magnesium hydroxide

6. Histamine 2 (H2) Blockers which reduce gastric acid secretion. Eg Cimetidine, Ranitidine

7. Prostaglandin E1 Analogue e.g. Sulcrafate, Misoprostol (Cytotec) protects gastric mucosa

against actions of gastric juice by acting as a barrier) may need to be administered.

8. Anti- emetics e.g. Phenergan to reduce vomiting.

NURSING MANAGEMENT

Nursing management of gastritis is described by Hinkle & Cheever (2014) to include the following

interventions;

Reassuring the patient

There is the need for continuous reassurance of patient and family about readiness of health care

team to aid in treatment and the effectiveness of available medications and other supportive

treatment modalities in bringing about speedy recovery and remission.

Reducing Anxiety

If the patient has ingested acids or alkalis, emergency measures may be necessary. The nurse

offers supportive therapy to the patient and family during treatment and after the ingested acid or

alkali has been neutralized or diluted. In some cases, the nurse may need to prepare the patient

17
for additional diagnostic studies (endoscopies) or surgery. The patient may be anxious because of

pain and planned treatment modalities. The nurse uses a calm approach to assess the patient and

to answer all questions as completely as possible. It is important to explain all procedures and

treatments based on the patient‘s level of understanding.

Ensuring rest and sleep

The following measures should be implemented to ensure good rest and comfortable sleep to

promote recovery;

1. Restrict or limit visitors when necessary and explain to the patient the need for rest and sleep

in aiding speedy recovery

2. The environment should be properly ventilated and noise minimized to promote rest and sleep.

3. Put patient in well prepared, comfortable bed and make sure bed is free from creases and cramps

4. Carry out bulk nursing when applicable

5. Encourage patient to take warm bath after meals and warm drinks before bed 6. If patient has

pain-related insomnia, serve prescribed analgesics to relieve pain. Also serve prescribed

hypnotics and sleep inducers and monitor for therapeutic and adverse effects.

Ensuring elimination

Elimination needs in the patient with gastritis is equally important as is medications in recovery

and remission of signs and symptoms. Assess patients‘elimination pattern and monitor intake

and output of patient. Monitor vomiting and observe vomitus for colour, consistency and

content of the vomitus. If vomiting is persistent, prevent dehydration of patient by rehydrating

with prescribed intravenous infusions. Administer prescribed anti-emetics and monitor for

therapeutic and adverse effects. To prevent infection from elimination, ensure emesis basins,

bed pans and commodes served patient to meet elimination needs, contain disinfectants and

18
 such products of elimination are properly discarded.

Ensuring personal hygiene

Ensure patients hygienic needs are equally met as other medical needs of the patient are

established. The following measures can be followed;

1. Ensure patient takes his/her bath twice a day. Assist or carry out bed bath when necessary

2. Encourage patient to maintain adequate mouth care by brushing his/her teeth at least twice in

a day

3. Teach and encourage patient and relatives to observe hand washing techniques after visiting

the toilet or coming into contact with patient fluids such as vomitus to prevent spread of

Helicobacter pylori bacteria.

4. Ensure patient keeps a short and well-kept nails. Carry out hand and feet care when necessary.

Observation and monitoring

1. Continuously monitor vital signs including temperature, pulse, respiration and blood pressure

and intervene when appropriate

2. Monitor strict intake and output especially when vomiting persists

3. Monitor patient for therapeutic and adverse effects of administered medications

4. Assess and monitor patient for signs and symptoms of dehydration including, loss of skin

turgor, dry mouth and persistent complains of thirst.

Relieving Pain

Measures to help relieve pain include instructing the patient to avoid foods and beverages that may

be irritating to the gastric mucosa and instructing the patient about the correct use of medications

to relieve chronic gastritis. The nurse must regularly assess the patient‘s level of pain and the extent

19
of comfort achieved through the use of medications and avoidance of irritating substances.

Promoting Fluid Balance

Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid

intake of 1.5 L/day, minimal output of 30 mL/h). If food and oral fluids are withheld, IV fluids (3

L/day) usually are prescribed and a record of fluid intake plus caloric value (1 L of 5% dextrose

in water 170 calories of carbohydrate) needs to be maintained. Electrolyte values (sodium,

potassium, chloride) are assessed every 24 hours to detect any imbalance. The nurse must always

be alert for any indicators of haemorrhagic gastritis, which include hematemesis (vomiting of

blood), tachycardia, and hypotension. If these occur, the physician is notified and the patient‘s

vital signs are monitored as the patient‘s condition warrants.

Promoting Optimal Nutrition

For acute gastritis, the nurse provides physical and emotional support and helps the patient

manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The patient

should take no foods or fluids by mouth (possibly for a few days) until the acute symptoms

subside if possible, thus allowing the gastric mucosa to heal. If intravenous therapy is necessary,

the nurse monitors fluid intake and output along with serum electrolyte values. After the

symptoms subside, the nurse may offer the patient ice chips followed by clear liquids.

Introducing solid food as soon as possible may provide adequate oral nutrition, decrease the need

for intravenous therapy, and minimize irritation to the gastric mucosa. As food is introduced, the

nurse evaluates and reports any symptoms that suggest a repeat episode of gastritis. The nurse

discourages the intake of caffeinated beverages, because caffeine is a central nervous system

stimulant that increases gastric activity and pepsin secretion. It also is important to discourage

20
alcohol use. Discouraging cigarette smoking is important because nicotine reduces the secretion

of pancreatic bicarbonate, which inhibits the neutralization of gastric acid in the duodenum.

When appropriate, the nurse initiates and refers the patient for alcohol counseling and smoking

cessation programs. Also ensure patient takes in a bland diet and serve small meals at frequent

intervals.

Nutrition and dietary Supplements

Following these nutritional tips may help reduce symptoms:

1. Eating antioxidant foods, including fruits (such as blueberries, cherries and tomatoes), and

vegetables (such as garden eggs and cucumber)

2. Intake of foods high in B vitamins and calcium, such as almonds, beans, whole grains (if non-

allergic), dark leafy greens (such as spinach and kale) and sea vegetables

3. Avoid refined foods such as white breads, pastas, and sugar

4. Use healthy oils, such as olive oil

5. Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies,

crackers, cakes, onion rings, donuts and margarine.

6. Avoid beverages that may irritate the stomach lining or increase acid production including

coffee (with or without caffeine), alcohol and carbonated beverages.

7. Drink 6 to 8 glasses of filtered water daily

Education

1. Educate patient/family about the condition

2. Educate patient/family on the need to take prescribed medications

3. Educate patient/family on the restriction of offending agents like alcohol or highly seasoned

foods

21
 4. Educate patient on the need to ensure rest 5. Educate patient/family on the need for follow-up

Prevention

According to Ferris (2012), prevention of gastritis include

1. Wash your hands with soap and water regularly and before meals. This can reduce the risk of

being infected with helicobacter pylori

2. Cook foods thoroughly. This also reduces the risk of infection

3. Avoid alcohol or limit your alcohol intake

4. Avoid NSAIDs or only use them infrequently. Consume NSAIDs with food and water to avoid

symptoms.

Complications

The complications of gastritis were described by Hinkle & Cheever (2014) to include;

1. Stomach Ulcer mostly from chronic gastritis

2. Anaemia (Vitamin B12 deficiency anaemia): This occurs as a result of destruction of intrinsic

factors.

3. Pyloric stenosis mostly occurs from malignant changes of gastric mucosa

4. Malignant changes of gastric mucosa

5. Haemorrhage or bleeding from an erosion or ulcer

6. Gastric Outlet Obstruction due oedema limiting the adequate transfer of food from the stomach

to the small intestine

7. Dehydration from vomiting

1.12 Validation of Data

This is the act of confirming data collected from patient, family members and significant others.

The data collected was cross checked with that from the literature review, medical records, nurses

22
note and signs and symptoms presented by the patient. It was found out that all the information

gathered correspond with each other. For example, patient exhibited most of the signs and

symptoms of the condition in the literature review. It is therefore clear that there is no error or

misinterpretation of information.

Hence the data is valid.

23
 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction
This is the second step based on the nursing process. It is a detailed examination of the data

collected from patient and family. Information gathered during the assessment phase is digested

to enable the nurse identify the patient’s actual and potential health problems.

This helps the nurse to priorities the patient’s health problems; formulate appropriate nursing

interventions as well as health education with respect to the existing problems.

The components of analysis of data are

1. Comparison of data with standards

2. Health problems

3. Patient/family strengths

4. Nursing diagnoses

2.1 Comparison of Data with Standards

This is where the data collected on the health of the patient is compared with those in the

Literature review. These include

a. Diagnostic investigation

b. Causes

c. Signs and symptoms (clinical features).

d. Treatment

e. Complications.

24
A.Diagnostic Investigations/Tests

A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of

disease, injury or any other medical condition, to monitor a person’s health, disease or the

effectiveness of treatment.

The following investigations were ordered to be carried on patient to aid in the diagnosis and

treatment;

Blood for Full blood count

Blood for malaria parasite

Serology testing for H. Pylori antibody

Stool routine examination

Gastroscopy

Table 1 below shows the Comparism of diagnostic tests carried out on Madam B.E with those

listed in literature review

25
Table 1: Diagnostic Tests/Investigation In Literature Review Compared With Those

Carried Out On Madam B.E

DIAGNOSTIC TESTS OUTLINED IN DIAGNOSTIC TESTS CARRIED OUT

LITERATURE REVIEW ON PATIENT

Upper gastro-intestinal radiography Investigation was not requested for patient

Stool for routine examination Test was requested and done

Histologic examination of a biopsy tissue Test was not requested for patient

specimen

Serology testing (H. pylori antigen) Test was ordered for patient

Endoscopy of the gastric mucosa Investigation was ordered for patient

(Gastroscopy)

Serum vitamin B12 assessment Test was not requested for patient

On the day of admission, blood sample was taken and sent to the laboratory for full blood count

and serology testing to identify any infection and infection with H. Pylori respectively. Stool

specimen for routine examination was also taken to identify any infection and occult bleeding.

Although gastroscopy was ordered, due to unavailability of gastroscopy test machine and the cost

of doing it Sunyani patient could not afford it for test to be carried out.

Details of the test carried out on patient have been presented in table 2.

26
 Table 2: Diagnostic Investigations carried out on Madam B.E

DATE SPECIMEN INVESTIGATION RESULTS NORMAL VALUES INTERPRETATION REMARKS

11/11/2021 Blood. Haemoglobin level 12.6g/dl Female:12.0-16.0g /dl Haemoglobin level was No treatment was given
estimation (HB) Male:13-18g/dl within the normal range

11/11/2021 White blood cell count 5.9×109/ul Males: 4.00-11.00 Within the normal range No treatment was given
(WBC) ×109/ul indicating no infection
Females: 4.00-11.00
×109/ul
11/11/2021 Red blood cell count 5.05×106/ul Male: 4.35-5.65 x 106/ul Result is within normal No treatment was given
(RBC) Female: 3.92-5.13 x
106/ul
11/11/2021 Blood Malaria Parasite No parasite was No Malaria parasite No malaria infection No treatment was given
seen (Negative) should be seen
11/11/2021 Stool Stool for routine Macroscopic: Stool should be formed Normal stool No treatment was given
examination (RE) Formed and no intestinal
specimen flagellate must be seen
Microscopic: no
Intestinal spiral
flagellates seen
11/11/2021 Blood Serology Test for Negative Negative Absence of infection of No treatment given
H.Pylori H. Pylori antigen

All laboratory investigations ordered were carried out except gastroscopy due to financial problems on the patient’s part.

27
 a. Causes

With reference to the literature review, the risk factors of gastritis are excessive smoking,

excessive intake of alcohol, NSAIDS, inflammatory bowel disease and bfection with

H.Pylori.

In the case of Madam B.E it can be suggested that her indiscriminate use of NSAID any time

she experiences bodily pain predisposed her to gastritis.

b. Clinical features/ signs and symptoms

Comparison of clinical features exhibited by patient s with those listed in the literature

review.

Table 3 below shows the comparison of clinical features outlined in literature and those

exhibited by patient.

Table 3: Clinical Features Exhibited by Madam B.E. Compared with those in the

Literature Review

CLINICAL FEATURES OUTLINED IN CLINICAL FEATURES EXHIBITED

LITERATURE REVIEW BY PATIENT

There is anorexia(loss of appetite) and Patient complained of anorexia(loss of

nausea appetite)

Epigastric pain Patient complained of epigastric pain

occurring 1-2 hours after going to bed

Vomiting (normally undigested food) Vomiting complained of vomiting

Hiccupping Hiccupping was absent

Headache Patient complained of headache

28
The table indicates that the patient exhibited most of the clinical manifestations stated in the

literature review and did not exhibit some. The patient did not exhibit some of the signs and

symptoms because she reported early and the condition was managed promptly.

c. Treatment Of Patient

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

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

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

to relieve symptoms without affecting a cure. The drugs below were prescribed for Madam B.E

to treat her condition.

Intravenous Omeprazole 80 mg stat and then 40mg bd x 24 hours

Suspension Nugel 15 mls three times daily x 5 days

Intravenous Metronidazole 500 mg tds x 2 days

Injection Buscopan 40 mg stat

Intravenous Metoclopramide 10mg stat

Intravenous DNS 500mls stat

Capsule Omeprazole 20 mg BD X 14 days

Tab Metronidazole 400 mg tds X 5 days

Tab paracetamol 1g tds X 5 days

Table 4 shows the treatment given to patient compared with those in literature review.

29
Table 4: Treatment Outlined in Literature Compared with those given to Patient.

Treatment outlined in the literature Treatment given to patient

review

Proton Pump Inhibitors (PPI): example; Intravenous and Capsule Omeprazole was

Omeprazle, Esomeprazol, Rabeprazole. given to patient.

Antacids: example; Aluminum Suspension Nugel was given to patient.

Hydroxide, Magnesium Tricilicate,

Nugel.

Antispasmotic eg Buscopam IM Buscopam was prescribed

Anti-biotics: example; Metronidazole, Intravenous and tab Metronidazole were all

Amoxicillin, Amosiklav. prescribed

Histamine 2 (H2) Receptors Antagonists: No Anti Histamine drug was given

example; Ranitine, Cimetidine.

Analgesices: example; Paracetamol. Tablet Paracetamol was given

Prostaglandin E1 Analogue e.g. Prostaglandin analogues were not prescribed

Sulcrafate, Misoprostol (Cytotec)

Intravenous fluid eg Dextrose Normal IV DNS 500 ml stat was administered

Saline

Table 4 above shows that the treatment that was given to patient was found in the literature

review which confirmed patient was given the right treatment.

30
 Table 5: Pharmacology of Drugs Given To Madam B.E.
Drug Standard Dosage and Dosage/ Classification Desire action Actual action Side effect Remarks
Route Route of administration Observed
Omeprazole Adult 80mg stat Proton pump Reduces Patient ’s Headache, None of
Dose: 20mg daily for 4 Intravenous, then 40mg bd inhibiter anti- hydrochloric acid condition constipation, the side
weeks in duodenal x2 secretary agent secretion improved due diarrhea, nausea and effects
ulcer and for 8 weeks to reduction in vomiting. was
in gastric ulcer. 20mg twice daily x 14 her abdominal observed
Route: Orally days, orally pains

40 mg 12 hourly for up
to 5 days
Route: Intravenous
Suspension Adult: 15mls three times daily for Antacid Provides a Help to Constipation, None of
Nugel Dose: 15 ml 8 hourly 7 days suspension protective coating reduce acid diarrhea. these was
daily Orally on the stomach content in the observed
Route: Orally lining and stomach and
lowering acid relieved
level. patient of pain
Dosage: 400-800mg 500mg tds 24 hours Antimicrobial To fight and kill Patient was Vomiting, insomnia, None of
Metronidazol three times daily. Route: Intravenous bacteria free from dark urine. these was
e (Flagyl) Route: oral and IV infection or observed
400mg tds x 5 days bacteria
Route : orally
Metoclopram Metoclopramide, IM or 10mg stat Antiemetic Inhibits Vomiting Restlessness, None was
ide IV, Route: Intravenous presynaptic and subsided dizziness, tiredness, observed
5-10 mg 8 hourly postsynaptic headache and
receptors on confusion
gastric muscles
thereby
preventing
vomiting.

31
 Table 5: Pharmacology Of Drugs Given To Madam B.E continued

Drug Standard Dosage Dosage/ Classification Desire action Actual action Side effect Remarks
and Route of Route of Observed
Administration administration
Buscopam Dosage available 40mg bd for 24 Antispasmodics It helps relieve one Gastrointestinal Constipation, dry None of these
was observed
intramuscularly hours from gastro-intestinal disorders was mouth, palpitation
20mg, repeated disorder characterized minimize and arrhythmias.
after half an hour. by smooth muscle
It is given orally spasm.
Dextrose in Adults 500mls for 24 Isotonic To correct dehydration Patient fluid and Circulatory None
Sodium overload, observed
Dose:70 ml/kg hours solution and maintain electrolyte balance
Chloride pulmonary
body weight; electrolyte balance was maintained
oedema.
Route: Intravenous
Paracetamol Adult: 1g three times Analgesics, To relieve headache, Patient responded Hypoglycemic None of the
bodily pains and to treatment coma, liver side effects
500 mg–1 g tid daily x 5 days, antipyretic
reduce high body damage, and was observed
daily orally temperature erythematous skin
reaction,
Route :Orally
leucopoenia.

32
 d. Complications

With reference to the complications stated under the literature review, patient did not develop

any of the complications as stated in the literature review because she reported to the hospital

early, rightly diagnosed and received the right treatment and holistic care from the hospital

staff.

2.2. Patient Family Strength

According to Harvey (2014), this involves activities the patient can perform and those the

family can also perform in helping the patient recover. The under mentioned strengths were

observed on patient and her family.

1. Patient epigastric pain reduced when she assumes lateral position.

2. Patient could take in fluid diet

3. Patient could eat about 50mls of porridge served.

4. Patient/family could express the level of anxiety and participate in patient care.

5. Patient could sleep for about 4 hours at night.

6. Patient and family were willing to learn about disease condition

2.3. Patient’s Health Problems

According to Harvey (2014), a health problem is an unmet health need to which the patient

responds in a variety of ways. The following problems were identified in patient and family.

1. Patient had epigastric pain

2. Patient complained of vomiting

3. Patient had loss of appetite

4. Patient and family were anxious

5. Patient had insomnia

6. Patient and family had inadequate knowledge on the disease condition

33
2.4. Nursing Diagnosis

According to Hinkle and Cheever (2014), nursing diagnosis is the organization, analysis,

synthesis and summarization of data collected and determined the patient need for care.

Nursing diagnosis for Madam B.E.is as follows;

1. Acute pain (epigastric)related to ulceration of the stomach mucosa

2. Risk for fluid volume deficit related to vomiting

3. Imbalance nutritional pattern (less than body requirement) related to loss of

appetite.

4. Anxiety related to unknown outcome of disease condition.

5. Sleeping pattern disturbance (insomnia) related to abdominal pain.

6. Deficient Knowledge related to inadequate information on the disease condition

34
 CHAPTER THREE

PLANNING FOR PATIENT AND FAMILY CARE

3.0 Introduction

According to Hinkle and Cheever (2014), planning is the development of goals and outcomes

as well as a plan of care designed to assist the patient in resolving the diagnosed problems and

achieving the identified goals and desired outcomes.

It involves setting of objectives into short and long term in order of priority which is part of the

nursing care process and if they are not met after implementation, then it means the care

rendered had to be reassigned and new plan of action has to be taken to help meet the problems

that were not met.

3.1 Objective for the Patient and Family Care.

The following objectives were set for the patient and family care during the period of

hospitalization to help solve their health problems identified.

1. Patient will be relieved of epigastric pain within 48 hours as evidenced by;

a. Patient verbalizing that she no longer feels the pain

b. Nurse observing that patient has a relaxed facial expression

2. Patient will be relieved of vomiting within 24 hours as evidenced by;

a. Patient verbalizing that nausea and vomiting has ceased.

b. Patient having normal skin turgor

3. Patient will regain her normal eating pattern within 48 hours as evidenced by;

a. Patient verbalizing she has regained her normal appetite.

b. Nurse observing patient eat more than half of the food served

4. Patient will be relieved of anxiety within 24 hours as evidenced by;

a. Patient verbalizing that she is relieved of anxiety

b. Nurse observing a relaxed facial expression.

35
5. Patient will regain her normal sleep pattern within the period of hospitalization as evidenced

by;

a. Nurse observing patient sleep for about 6-8 hours without interruption

b. Patient telling the nurse she was able to have uninterrupted sleep throughout the night.

6. Patient and family will gain adequate knowledge on the disease condition within 24 hours

as evidenced by;

a. Nurse observing Patient / family being able to answer some questions on gastritis

correctly

b .Patient/family verbalizing understanding on the information given them.

Table 6 below shows the nursing care plan for Madam B.E

36
 Table 6: Nursing care plan for Madam B.E
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTIONS DATE/ EVALUATION SIGN
TIME DIAGNOSES OUTCOME TIME
CRITERIA
11/11 Acute Pain Patient will be 1. Reassure patient 1.Patient was reassured that she will be 13/11/20 Goal fully met as;

/2021 (epigastric) relieved of relieved of abdominal pain with 21 1.Nurse observed

12:30 related to epigastric pain holistic care been rendered. 12:30P that patient is

pm ulceration of the within 48 hours as 2. Put patient in a 2.Patient was put in lateral position as m relaxed, looked

stomach mucosa evidenced by; comfortable position she felt comfortable and relieved from comfortable and

1. Patient abdominal pain in that position has cheerful facial

verbalizing that 3. Assess patient level of 3.Patient’s level of pain was assessed expression in bed

she no longer pain with a pain rating scale and it recorded without

feels the pain 7 showing a severe pain complains of

2. Nurse observing 4. Identify food that 4.Food that worsens patient’s condition epigastric pain

that patient has a exacerbate patient’s such as pepper, spicy food were 2. Patient

relaxed facial condition. identified and patient was discourage verbalized that

expression form taking it. she does not feel

the pain anymore.

37
5. Reduce noise and 5.Noiseless environment was provided

improve ventilation at by lowering the volume of the ward

the ward television

6. Administer prescribed 6.Prescribed drugs such as IM

medications Buscopam 40mg and Suspension

Nugel were administered to relieve

patient of pain.

38
 Table 6: Nursing care plan for Madam B.E Cont’d
Date / Nursing Objectives/Outcome Nursing orders Nursing interventions Date Evaluation Sign
Time diagnosis criteria /Time
11/11 Risk for Patient will retain a 1. Reassure patient/family. 1. Patient/family were reassured that she is 12/11/ Goal fully
/2021
fluid normal fluid volume in the hands of health team and that all met as
12:35pm 2021
volume within 24 hours as measures will be put in place to reduce patient take
12:35Pm
deficit evidenced by; vomiting in copious
related to 1. Patient verbalizing 2. Observe patient for signs of 2. Patient was observed for signs of liberal
vomiting. that nausea and dehydration. dehydration such as skin turgor and the fluids to
vomiting has appearance of the skin. regain lost
ceased. 3. Maintain and keep strict 3. Patient’s intake and output was fluids.
intake and output. maintained in the chart and it was Patient
2. Patient having balanced at the end of each 24 hours. showed no
normal skin turgor. 4. Encourage patient to drink 4. Patient was encourage to drink about 2-3 sign of
about 2-3 litres of fluid per litres of fluid per day to replace fluid dehydration
day. loss. .
5. Provide frequent oral care 5. Frequent oral care was provided for
for patient. patient to replace fluid loss.
6. Encourage patient to take 6. Fluid diet such as porridge was served to
fluid diet patient in small bit frequently.

39
 Table 6: Nursing care plan for Madam B.E Cont’d
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTIONS DATE/ EVALUATION SIGN
TIME DIAGNOSES OUTCOME TIME
CRITERIA
11/11 Imbalance Patient will regain 1. Reassure patient that she will 1. Patient was reassured that she 13/11 Goal fully met as;
/2021
12:40 nutritional her normal eating gain back her appetite will gain back her appetite /2021 1.Patient verbalized
pm
pattern (less than pattern within 48 2. Maintain patient’s oral 2. Patient’s oral hygiene was 12:40 she can eat more

body hour as evidenced hygiene maintained pm than half of the

requirement) by; 3. Remove all items that are 3. Items that are unpleasant were bowl served

related to nausea 1. Patient verbalizing unpleasant before meal. removed before meal 2.Nurse observed

she has regained 4. Serve liquid easily digestible 4. Liquid digestible foods like patient eat more

her normal foods like juice, milo and juice, milo and porridge were than half of food

appetite. porridge. served served.

2. Nurse observing 5. Serve food according to 5. Food was served according to

patient eat more patient’s preference. patient’s preference

than half of the 6. Assess patient nutritional 6. Patient nutritional status was
status. assessed.’
food served.

40
 Table 6: Nursing care plan for Madam B.E Cont’d
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTIONS DATE/ EVALUATION SIGN
TIME DIAGNOSES OUTCOME TIME
CRITERIA
11/11 Anxiety Patient will be 1.Reassure patient 1.Patient was reassured of the 12/11 Goal fully met
/2021 competent nurses
relieved of anxiety
1:00pm related to /2021 as;
within 24hours as 2.Allow patient to express her 2. Patient was allowed to express
unknown feelings her fears about outcome of 1:00pm 1.Patient told the
evidenced by;
condition
outcome of 1. Patient nurse that she
3.Explain every process to patient 3. Every procedure was explained
verbalizing that to patient to ensure her
condition had no fears
she is relieved of cooperation.
4.Provide divertional therapy 4. Divertional therapy was 2.The nurse
anxiety
2.Nurse observing provided such as watching observed that
television
a relaxed facial
5.Allow patient to ask questions 5. Patient was allowed to ask patient has
expression.
and answer them in simple terms questions and was answered in relaxed facial
simple terms for her to
understand. expression
6.Educate patient and relatives on 6. Patient and relatives were
the condition educated on the condition
7.Check vital signs and record 7. Vital signs was checked and
recorded to identify any
physiological indicators of
anxiety such as high pulse rate.

41
 Table 6: Nursing care plan for Madam B.E Cont’d
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING DATE/ EVALUATION SIGN
TIME DIAGNOSES OUTCOME INTERVENTIONS TIME
CRITERIA
12/11/ Sleeping Patient will regain her 1. Reassure patient. 1.Patient was reassured of 15/11/ Goal fully met as;
2021 pattern normal sleep pattern recovering peacefully 2021 1.Nurse observed
08:00am disturbances
(Insomnia) throughout the period of 2. Serve warm beverages like 2.Warm beverages like milo was 08:00am patient sleeping
related to hospitalization as milo drink to induce sleep served to induce sleep throughout the
abdominal
pain. evidenced by; 3. Ensure adequate ventilation 3.Adequate ventilation was night
1. Nurse observing patient ensured during sleeping hours uninterrupted
sleep for about 6-8 hours and switching on fan to induce 2.Patient verbalized
without interruption sleep she had
2. Patient telling the nurse 4. Reduce noise at the ward 4.Noise was reduced by uninterrupted
she was able to have minimizing television volumes sleep.
uninterrupted sleep 5. Plan nursing activities to be 5.Nursing activities were
throughout the night. performed on the patient planned together to avoid
together disturbing the patient
6. Ensure warm bath before 6.Warm bath was ensured to
sleep enable good sleep.
7. Reduce the number of 7.The number of visitors were
visitors during sleep hours reduced during sleep hours

42
 Table 6: Nursing care plan for Madam B.E Cont’d
Date/ Nursing diagnosis Objectives/Outcome Nursing orders Nursing interventions Date/ Evaluation Sign
Time criteria Time

13/11/2021 Knowledge deficit Patient will gain 1. Reassure patient /family that 1. Patient /family were reassured that 14/11/21 Goal fully met
with detailed information detailed information on Gastritis as patient and
adequate knowledge
10am related to lack of they will have understanding will be given for better 10am family gave
on the disease correct answers
of Gastritis understanding.
inadequate to questions
condition within 2. Schedule time with patient 2. Time was scheduled with patient
and relatives to educate them and relatives to educate them on asked on
information on causes, 24hours as evidenced Gastritis and
on Gastritis. Gastritis.
by; patient/ family
signs and symptoms 3. Make patient comfortable by 3. Patient was made comfortable by
verbalizing
1. Nurse observing lying in bed whiles relatives lying in bed whiles relatives and
and prevention of understanding
Patient / family being and the nurse sit by bedside. the nurse sit by bedside. on the
4. Assess patient and family 4. Patient and family knowledge on information
disease condition able to answer some
knowledge level on Gastritis Gastritis was assessed. given them
questions on Gastritis 5. Correct any misconception 5. Accurate information on the
(Gastritis).
correctly and and provide accurate predisposing causes, signs and
2.Patient/family information on the symptoms, prevention, drug
predisposing causes, signs management and lifestyle
verbalizing and symptoms, prevention, modification were provided to
understanding on the drug management and correct misconceptions
information given lifestyle modification
6. Invite questions and answer 6. Questions were invited and
them. tactfully answered.
them tactfully.
7. Give patient pamphlets on 7. Pamphlets on Gastritis were given
Gastritis to read to patient

43
 CHAPTER FOUR

IMPLEMENTATION OF PATIENT / FAMILY CARE STUDY

4.0 Introduction

Implementation is the fourt phase of the nursing process signifying the giving of care in relation

to defined nursing interventions and goals .During implementation the nursing care plan is

tested for effectiveness and accuracy .Data gathering continues and plans may change on the

basis of new information obtained .The implementation phase concludes with recording of the

activities performed and the response of the patient. (Weller, 2014)

4.1 Summary of the Actual Nursing Care Rendered.

The actual nursing care rendered to Madam B.E started from her first day of admission which

was 11/11/2021 during hospitalization, visit to her home whiles on admission and after

discharged home, day of discharged and review day has been summarized.

4.1.1 Day of Admission: 11/11/2021

On 11th November, 2021 at 12pm, Madam B.E was admitted to the females’ ward of the St

Mary’s’ Hospital, Drobo in a wheel chair from out- patient department accompanied by a

nurse from the out patient department and patient’s relative. Patient was conscious and well

orientated to time, place and persons. Patient’s folder was collected from the OPD nurse and

her name was mentioned to ascertain and confirm the identity of the patient. Madam B.E was

immediately made comfortable in an already prepared simple bed in females ward with bed

number F6. Upon assessment patient complain of epigastric pains, headache and vomiting. It

was also observed that patient was very anxious. I introduced myself to the patient and her

accompanying relative. Madam B.E’s. particulars were documented into the admission and

discharge book and daily ward state.

Vital signs was checked and recorded as follows

44
Temperature - 36.9oc

Pulse - 84bpm

Respiration - 21cpm

Blood Pressure - 110/60mmHg

SPO2 - 97%

Laboratory investigations requested on admission were

Blood for Full blood count

Blood for malaria parasite

Stool routine examination

Gastroscopy

Blood sample was taken, sample bottle labelled and sent to the laboratory for the

investigations to be carried out.

The drugs below were prescribed for Madam B.E to treat her condition:

Intravenous Omeprazole 80 mg stat and then 40mg bd x 24 hours

Suspension Nugel 15 mls three times daily x 5 days

Intravenous Metronidazole 500 mg tds x 2 days

Injection Buscopan 40 mg stat

Intravenous Metoclopromide 10mg stat

Intravenous DNS 500mls stat

Drugs were collected from pharmacy. An intravenous cannula was inserted and intravenous

medications commenced. Patient and relative were then informed about daily ward routine

such as medication, ward rounds and visiting hours. Also patient was orientated to the ward

and it’s environ. They were introduced to other patients at the ward, shown the toilet, bathroom

and also to the nurses’ station. Since there was no restroom in the ward, patient was

encouraged to eat by her bedside. Items to be used at the ward during their stay such as towel,

45
bucket, spoon and bowl were also mentioned to the colleague who accompanied her to the

ward.

After these interventions, permission was sought from the ward in-charge to use the patient

for my case study and she agreed. After 30 minutes of admission, patient’s husband Mr. H.A

had come around. I then introduced myself to the patient/family that, I am a final student of

Holy Family Nursing and Midwifery Training Collage Berekum, conducting a study at the

hospital. I then made it known to them my desire to use Madam B.E for the care study. I

explained to them holistic care will be rendered to them to ensure speedy recovery. I told them

that, as part of my training, final year students are to take a patient each, nurse him or her from

the time of admission till time of discharge and home visits. The patient and family accepted

and promised their cooperation and readiness to give me any information needed for the study.

They were informed that her hospitalization was temporal and that she will be discharged as

soon as her condition gets better. They were also informed that, as part of the care, I would

visit their home whiles patient was on admission and after she has been discharged. A care

plan was then made to manage holistically patient’s identified actual and potential problems.

On the day of admission at 12:30pm due to patient’s complaint of abdominal pain, a nursing

diagnosis of Acute Pain (epigastric) related to ulceration of the stomach mucosa was

formulated. A goal was set to help relieve patient’s epigastric pain within 48 hours and the

following nursing interventions were carried out. Patient was reassured that she will be relieved

of abdominal pain with holistic care been rendered. Patient was put in lateral position as she

felt comfortable and relieved from abdominal pain in that position Patient’s level of pain was

assessed with a pain rating scale and it recorded 7 showing a severe pain

Food that worsens patient’s condition such as pepper, spicy food were identified and patient

was discourage form taking it. Noiseless environment was provided by lowering the volume

46
of the ward television. Prescribed drug such as IM Buscopam 40mg and Injection was

administered to relieve patient of pain.

At 12:35pm Madam B.E complain of vomiting. A nursing diagnosis of risk for fluid volume

deficit related to vomiting was formulated. A goal was set to ensure patent was relieved of

vomiting within 24 hours and the following nursing interventions were carried out.

Patient/family were reassured that she is in the hands of health team and that all measures will

be put in place to reduce vomiting. Patient was observed for signs of dehydration such as skin

turgor and the appearance of the skin. Patient’s intake and output was maintained in the chart

and it was balanced at the end of each 24 hours. Patient was encourage to drink about 2-3 litres

of fluid per day to replace fluid loss. Frequent oral care was provided for patient to replace

fluid loss. Fluid diet such as porridge was served to patient in small bit frequently.

At 12:40pm, patient complain of loss of appetite. A nursing diagnosis of Imbalance nutritional

pattern (less than body requirement) related to loss of appetite was ten formulated. A goal was

set to ensure that patient regained her eating pattern within 48 hours. The interventions carried

out included patient was reassured that she will gain back her appetite. Patient’s oral hygiene

was maintained. Items that are unpleasant were removed before meal. Liquid digestible foods

like juice, milo and porridge were served

Food was served according to patient’s preference.

At 1:00 pm, through interaction with patient she was verbalised feelings of anxiousness. A

nursing diagnosis of Anxiety related to unknown outcome of condition was formulated. An

objective was set to ensure Madam B.E was relieved of anxiety within 24 hours. Nursing

interventions put in place to ensure goal set to relieve patient of anxiety were; patient was

reassured of the competent nursing care. Patient was allowed to express her fears about

outcome of condition. Every procedure was explained to patient to ensure her cooperation..

Divertional therapy was provided such as watching television. Patient was allowed to ask

47
questions and was answered in simple terms for her to understand. Patient and relatives were

educated on the condition. Vital signs was checked and recorded to identify any physiological

indicators of anxiety such as high pulse rate.

All nursing activities were carried out to ensure speedy recovery of patient. Routine nursing

care such administration of medication, monitoring of vital signs, continuous monitoring and

assessing of patient, etc were all done.

At 5pm, patient was encouraged to have yam and kontomire stew but she could not eat enough

of the food. Madam B.E was reassured that all nursing interventions will be carried out to

ensure she regained her appetite. At 8:00pm, patient performed her personal hygiene, due

medication suspension Nugel 15ml and IV metronidazole were served and recorded. Her vital

sign was checked and recorded as

Temperature 36.3 oC,

Pulse 80bpm,

Respiration 22cpm

Blood pressure 110/75 mmHg.

Adequate ventilation and conducive environment were also provided to induce sleep. Madam

B.E slept around 9:30pm.

4.1.2 Second day of Admission (12/11/2021)

Madam B.E was up from bed by 5:30am. She took her bath and performed oral hygiene

unassisted. Patient complained of interrupted sleep throughout the night and this was confirmed

by the nurses’ notes.

Her vital signs were checked at 6:00am and recorded as

Blood Pressure: 110/ 70 mmHg

Respiration : 22cpm

48
Pulse rate : 60 bpm

Temperature : 36.7 °C

Patient took rice porridge with bread for breakfast at 6:30am. Due medication Intravenous

Omeprazole 40mg, Suspension Nugel 15 mls and Intravenous Metronidazole 500 mg were

served and documented. At 8am, due to patient’s complain and night nurses report of patient

having interrupted sleep throughout the night, a nursing diagnosis of sleeping pattern

disturbances (Insomnia) related to abdominal pain was written and a goal was set to ensure

Madam B.E was relieved of insomnia throughout period of admission. The following nursing

orders were carried out; Patient was reassured of recovering peacefully. Warm beverages like

milo was served to induce sleep. Adequate ventilation was ensured during sleeping hours and

switching on fan to induce sleep. Noise was reduced by minimizing television volumes and

Nursing activities were planned and carried out together to avoid disturbing the patient Warm

bath was ensured in the evening to enable good sleep. The number of visitors were reduced

during sleep hours to avoid disturbing patient while sleeping.

Ward rounds was conducted at 8:30am by the medical doctor on duty and patient complain of

abdominal pain and sleeplessness. Patient’s laboratory results were then reviewed and results

were within normal range. Due to financial difficulties patient could not afford to do the

Gastroscopy test which she was supposed to do in Sunyani. No new treatment regimen was

added to patient’s drugs as she was to continue with the old drugs. Patient was monitored

throughout the day and nursing care rendered.

At 12:35pm goal set on the day of admission to ensure patient was free from vomiting was

evaluated. Goal was fully met as she was took in copious fluid and also showed no sign of

dehydration. Moreover at 1pm, goal set to ensure patient was relieved of anxiety was evaluated.

Goal was fully met as patient told the nurse that she has no fears and she was observed to have

relaxed facial expression. At 1:30pm, patient took fufu with light soup for lunch. Vital signs

49
were checked and recorded. Patient was encouraged to rest and have a nap in the afternoon.

Due medications Intravenous Metronidazole 500 mg and Suspension Nugel 15 mls were served

at 2pm. The therapeutic and side effects of the drugs were then observed. At 5:30 pm, Madam

B.E took rice and groundnut soup for supper and performed her personal hygiene activities.

Her vital signs were checked and recorded in the evening and recorded as

Temperature 36.3 oC,

Pulse 77bpm,

Respiration 19cpm

Blood pressure 120/75 mmHg.

Patient was encouraged to watch the ward television with other patient’s at the ward. Patient

went to bed around 10:00pm.

4.1.3 Third day of admission (13/11/2021)

Madam B.E woke from bed at 5:30am. She emptied her bowel, took her bath and performed

oral hygiene unassisted. According to the nursing notes patient was able to sleep well

throughout the night. Patient complain of coughing intermittently and she was reassured of

speedy recovery.

Her vital signs was checked at 6:00am and recorded as

Temperature 37.0 degree Celsius

Pulse 68 beat per minute

Respiration 21 cycle per minute

Blood Pressure 130/70mmHg

She took “tom brown” with milk as breakfast. At 6:30am patients due medication served were

Suspension Nugel 15mls and IV Metronidazole 500mg, Documentation of the drugs

administered were then done.

50
During ward rounds the medical officer on duty was notified that patients IV omeprazole, IV

metronidazole were completed. He prescribed oral Metronidazole 400mg tds x 5days, Capsule

Omeprazole 20mg BD x 14 days and Tablet paracetamol 1g tds x 5 days. Prescribed medication

was collected from the hospital pharmacy and served.

At 10am, patient’s knowledge on the disease condition was assessed and it was found to be

inadequate. A nursing diagnosis of Knowledge deficit related to lack of inadequate information

on causes, signs and symptoms and prevention of disease condition (Gastritis) was formulated

and a goal was set to ensure patient had adequate knowledge within 24 hours. Nursing

interventions carried out included patient /family were reassured that detailed information on

Gastritis will be given for better understanding. Time was scheduled with patient and relatives

to educate them on Gastritis. Patient was made comfortable by lying in bed whiles relatives

and the nurse sit by bedside. Patient and family knowledge on Gastritis was assessed. Accurate

information on the predisposing causes, signs and symptoms, prevention, drug management

and lifestyle modification were provided to correct misconceptions. Questions were invited and

tactfully answered. Pamphlets on Gastritis were given to patient.

At 12:30pm, goal set on the day of admission (11/11/2021), to ensure patient was relieve of

epigastric pain was evaluated. Goal fully met as it was observed that patient was relaxed,

looked comfortable and had cheerful facial expression in bed without complains of epigastric

pain. Patient verbalized that she does not feel the pain anymore. Moreover at 12:40pm, goal

set on the day of admission ((11/11/2021) to ensure patient regained her normal eating pattern

was evaluated. Goal was fully met as patient verbalized she can eat more than half of the bowl

serve. Patient was informed that of my intention to visit her home the following day to assess

her environment. She agreed and promised to give me direction to her house the following day.

51
Madam B.E had T.Z in the afternoon. During the visiting hours in the evening, Madam B.E

was visited by members from her church who mostly belonged to the women group in the

church.

At 2pm while patient was still on admission the first home visit was made to her house to assess

her home environment. During the visit to patient’s home at Komfourkrom, I found patient’s

house at about 200m from the road and I was met by her husband. Upon inspection of the

house, the place was found to be hygienic except bushes that had grown around the house. He

was advised to weed to prevent mosquitoes breeding and also reptiles such as snake from

lodging there and biting people. Mr.H.A was educated on Madam B.E’ condition and advised

to assist her in the home chores when she is discharged to ensure complete recovery. I returned

from patient’s home at 5:50pm and informed her of my findings.

At 6pm she was served with fufu and light soup for supper, due medication i.e Tab

Metronidazole 400mg, Capsule Omeprazole 20mg and Tablet paracetamol 1g were served and

recorded as prescribed. At 8:00pm patients vital signs were checked and recorded. She slept

around 9:00pm.

4.1.4 Fourth day of admission (14/11/2021)

On the fourth day of admission, Patient waked up from bed at 5:30am, after emptying her

bowel. She took care of her personal hygiene without assistance. Madam B.E was served with

rice porridge with milk and bread for breakfast.

At 6:00am patients vital signs was checked and recorded as

Temperature 36.6 Degree Celsius

Pulse 68 cycle per minute

Respiration 20 cycle per minute

Blood Pressure 120/70mmHg

52
Her due medications served and documented were Capsule Omeprazole 20mg, Suspension

Nugel 15mls, Tablet Paracetamol 1g and Tab Metronidazole 400mg,

During ward rounds at 7:00am, Madam B.E’s condition was stable and she had no new

complains, which the medical officer ordered to continue treatment. Patient was informed by

medical doctor that she may be discharged the following day if her condition remained stable

throughout the day.

At 10am goal set on the previous day to ensure patient had adequate knowledge was evaluated.

Goal set was fully met as patient and family gave correct answers to questions asked on

Gastritis and patient/ family verbalizing understanding on the information given them.

At 5:00pm, Madam B.E was served with yam and ‘kontomire’ for supper. At 8:00pm, patient’s

due medications Tablet Metronidazole 400mg, Suspension Nugel 15ml and Tablet paracetamol

1g were served. All interventions done on patient were document and patient was handed over

to the afternoon night nurses. Madam B.E. slept at 9:30pm.

4.1.5 Day of discharge (Fifth day of admission) (15/11/2021)

Patient woke up from bed at 6:00am. Madam B.E looked cheerful and had relaxed facial

expression. She took care of her personal hygiene, after which her vital signs were checked and

recorded as

Temperature 37.0 degree Celsius

Pulse 78 beat per minute

Respiration 21 cycle per minute

Blood Pressure 120/70mmHg

At 7:00am she was served with tom brown and bread for breakfast. Her due medication was

served and recorded as prescribed.

53
At 08:00am goal set on the day of admission to ensure patient regained her normal sleep pattern

was evaluated. Goal was fully met as patient was observed to have uninterrupted sleep.

During ward rounds she was reviewed by the medical officer. Madam B.E ’s condition was

found to be satisfactory. She was subsequently discharged. Patient was to continue with her

drugs and report for review 29/11/2021. She was to continue her medications in the house. She

called her husband who was waiting outside the ward to inform him. Her folder together with

her insurance card was taken to the accounts department for billing. I helped them pack her

belongings and discharged her in the admission and discharge book.

I educated patient and husband on how to take her medications as well as the importance of

taking medications on time and the side effects as well. They were informed that I will be

visiting them in their house and also the need for review was stressed. Patient bid farewell to

the staff around and they were helped to pack her belongings into an awaiting car, and bid them

good bye.

I finally came back, removed the bed linens and went ahead to carbolized the bed. It was

remade for subsequent admission.

4.2 The Preparation of the Patient / Family for Discharge and Rehabilitation

Preparation towards discharge started on the day of admission until the day of discharge.

Patient and family were reassured that patient will be discharged home once her condition

has resolved. The primary aim was to enable her to take active role in her care for speedy

recovery and also to give her insight of her condition. Emphasis was made on the need to

visit hospital immediately with any illness that may occur, so as to promote early detection

and treatment in order to avoid complication. They were educated on the following:

Dietary instructions take into account the patient’s daily caloric needs, food preferences, and

pattern of eating. Foods and other substances that are to be avoided (e.g., spicy, irritating, or

highly seasoned foods; caffeine; nicotine; alcohol) were reviewed with patient and family.

54
Patient was also encouraged to take in a bland diet and take small meals at frequent intervals

when possible. Eating antioxidant foods, including fruits( such as blueberries, cherries and

tomatoes), and vegetables (such as garden eggs and cucumber), avoiding refined foods such as

white breads, pastas, and sugar, use of healthy oils, such as olive oil, reducing or eliminating

trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, onion

rings, donuts and margarine and drinking 6 to 8 glasses of filtered water daily was encouraged.

Patient was encouraged to chew food served very well before swallowing and to eat in bits.

Information was provided about prescribed antibiotics, bismuth salts, medications to decrease

gastric secretion, and medications to protect mucosal cells from gastric secretions can help the

patient recover and prevent recurrence. Patient was taught to avoid over the counter pain killers

such as Diclofenac, EFPAC, and other analgesics which are NSAIDS e.g. brufen. She was

taught that taking those drugs may aggravate her ailment. Finally, emphasis was made on the

importance of keeping follow-up appointments with health care providers.

The patient and family were educated to maintain good personal and environmental hygiene,

she was advised to wash clothes frequently, proper disposal of refuse, weeding around the

environment; she should ensure good drainage systems because chocked and stagnant water

can result in breeding of mosquitoes. Patient was encouraged to bath and brushed her teeth

twice daily and to keep finger nails short, in order not to harbour micro-organisms. Patient

and family were encouraged to adhere to the various education in order to maintain and

promote a good environment and health in the house respectively.

First Home Visit (13/11/2021)

The first home visit was made on 13/11/2021 whiles the patient was still in the ward at about

2:00pm. Patient was pre-informed of my intention to visit her home on the 12/11/2021 and

details of the directions to her house was given by patient to me. This visit was to know the

55
patient’s residence, her environment and how it contributed to patient health status. It was also

to enable me to know patient’s nearest health facility for possible referral and handing over of

patient to community health nurse after terminating care.

At 2 pm, I took a car from Drobo station towards Komfourkrom where patient and her family

reside. The journey took about 30 minutes from the station to patient’s house. As per the

directions given by Madam B.E., I got down at the first before entering the town. Patient’s

house is about 200 meters from the road side and opposite a drinking a bar. I met a man and I

asked him about patient’s house and he took me directly to the house. The house is a 10 room

closed quarters. I was warmly welcomed by Mr. H.A, seat and water were then offered to me.

I thanked him and explained the reason for the visit. His permission was sought to inspect the

house and its environment. The house is built with blocks and it is made up of ten rooms with

two kitchens and two bathrooms. They had toilet facility which is outside the house. Even

though they have a well in the house, their source of drinking water is a pipe borne stand in the

next house. It was explained to me that water from the well is used for house chores. Their

household refuse is damp in a shallow dugout at the back of the house which they burn

frequently. The only unhygienic condition found was bushes found around the house. Mr. H.A

was advised to weed around the house because the bushes could be breeding ground for reptiles

such as snakes or even be a breeding ground for insects such as mosquitos. I asked about their

usage of mosquito nets and Mr. H.A said they all use it. I congratulated them for using it. I then

educated Mr. H.A. on Madam B.E’s condition. He was encouraged to assist her in her daily

work when she returns home. He was made to understand that stress may aggravate patient’s

condition and also to ensure she avoids the use of OTC drugs as it may exacerbate her

condition. . After the education, permission was sought to leave the house. Mr. H.A. thanked

me and accompanied me to the roadside. He was made aware that, extra home visit will be

56
made when patient is discharged home. He promised to carry out the changes that I had

educated them on. I got a motor that was travelling to Drobo and joined the rider.

Second Home Visit 20/11/2021

On 20/11/2021, five days after patient had been discharged from the hospital, the second home

visit was paid to patient and her family. The aim of the visit was to assess the state of health of

patient at home, to ensure patient was adhering to treatment regimen, to remind them of the

review date, to inform them about handing them over to community nurse on the next visit and

to ensure the family had implemented the recommendations made on the first home visit.

I was welcomed by Madam B.E. and one of her siblings who had come to visit her. They

offered me seat and water. The aim of the visit was explained to them. According to Madam

B.E, her husband had gone to the farm, that’s why he was not at home at that particular time. I

also asked Madam B.E to verify if she was following her treatment regimen and also to remind

her the review date which was 23//11/2021. Upon assessment, Madam B.E was well and was

not in pains any more. I inspected her drugs and it was known she takes her drugs accordingly.

I took this opportunity to encourage and congratulated her for adhering to the treatment

regimen. She was then educated to avoid intake over the counter pain medications and spicy

food and to rest enough. She was also encouraged to visit the hospital anytime she was sick

and to abhor taking unprescribed over the counter drugs. I informed and explained to the patient

and relatives that she would be handed over to the Public Health Nurse of their community on

the next visit which will be my last visit. Madam B.E thanked me for the care I was rendering

to her and her family and promised to come for review on the scheduled date. She also promised

to complete the drugs she was being managed on as prescribed.

57
I took permission to leave after scheduling to visit them again on the 10/11/2021. The family

thanked me for the visit and I was seen off by them at 2:15pm on the same day.

Review 23/11/2021

On the review date 23/11/2021, Patient arrived at the outpatient department at 8:30am. Madam

B.E looked cheerful. She came alone. She was assisted to raise claims at the records

department. Her vitals was checked and recorded at the OPD as

Temperature 36.7oC,

Pulse 74pm

Respiration 23cpm

Blood pressure 120/70mmHg.

Patient was accompanied to the consulting room. Patient was reviewed by medical doctor on

duty. Madam B.E lodged no complains. No new drugs were prescribed for patient.

Patient was advised to continue with the remaining of her drugs and adhere to the dietary

management advice given to her. Patient was reminded of the last home visit and she was

informed that I will be terminating care with her and she would be handed over to a community

health nurse who would ensure continuity of care. Patient was escorted to the roadside where

she picked a car and I bid her good bye.

Third Home Visit (10/11/2021)

Patient and family were visited as promised on this day. I arrived at the house around 2pm and

patient and family were happy to see me. The patient appeared healthy. The purpose of this

visit was to terminate care. Patient and her family were congratulated for sticking to medical

advice given them and other education they had while on admission.

58
The patient made no complains when I inquired. The family also demonstrated their

preparedness to care for patient by been supportive and encouraging him to take his drugs often.

Patient and family were thanked for their support and cooperation during the care. The family

and patient also expressed their profound gratitude to me. Since there was no CHPS or health

center or any hospital in the community, she was not handed over to a community health

personnel rather she was advised to report to the Drobo St. Mary’s Hospital any time she was

sick. I then informed them that care was finally terminated.

After spending some time with them, I sought for permission to leave and this ended the care

I rendered to Madam B.E and her family

59
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT

5.0 Introduction

Evaluation is the structural interpretation and giving of meaning to predicted or actual impacts

of proposals or results. It looks at original objectives and at what are either predicted or what

was accomplished and how it was accomplished. It is the final phase of the nursing process

which allows the nurse to determine the extent of progress made by the patient and family with

comparison to the specific goals and objectives set. It helps to judge patient and family’s

response to the nursing interventions and the effectiveness of the nursing process. This chapter

is categorized into;

a. Statement of evaluation

b. Amendment of patient/family care for partially met and unmet outcome criteria

c. Termination of care

5.1 Statement of Evaluation

Throughout the period of admission six health problems were identified and objectives were

set to solve the identified problem. Below are the various problem presented by patient.

1. Patient was relieved of abdominal pain within 48 hours.

On the day of admission at 12:30pm due to patient’s complaint of abdominal pain, a nursing

diagnosis of Acute Pain (epigastric) related to ulceration of the stomach mucosa was

formulated. A goal was set to help relieve patient’s epigastric pain within 48 hours and the

60
following nursing interventions were carried out. Patient was reassured that she will be relieved

of abdominal pain with holistic care been rendered. Patient was put in lateral position as she

felt comfortable and relieved from abdominal pain in that position Patient’s level of pain was

assessed with a pain rating scale and it recorded 7 showing a severe pain

Food that worsens patient’s condition such as pepper, spicy food were identified and patient

was discourage form taking it. Noiseless environment was provided by lowering the volume of

the ward television. Prescribed drugs such as IM Buscopam 40mg and Suspension Nugel were

administered to relieve patient of pain.

On the 13/11/2021, at 12:30pm, goal set on the day of admission to ensure patient was relieve

of epigastric pain was evaluated. Goal fully met as it was observed that patient was relaxed,

looked comfortable and had cheerful facial expression in bed without complains of epigastric

pain. Patient verbalized that she does not feel the pain anymore.

2. Patient maintained her normal fluid pattern within 24 hours

On the 11/11/2021 at 10:15am Madam B.E complain of vomiting. A nursing diagnosis of Risk

for fluid volume deficit related to vomiting was formulated. A goal was set to ensure patent

was relieved of vomiting within 24 hours and the following nursing interventions were carried

out. Patient/family were reassured that she is in the hands of health team and that all measures

will be put in place to reduce vomiting. Patient was observed for signs of dehydration such as

skin turgor and the appearance of the skin. Patient’s intake and output was maintained in the

chart and it was balanced at the end of each 24 hours. Patient was encourage to drink about 2-

3 litres of fluid per day to replace fluid loss. Frequent oral care was provided for patient to

replace fluid loss. Fluid diet such as porridge was served to patient in small bit frequently.

On the 12/11/2021 at 12:35pm goal set on the 11//11/2021 was evaluated. Goal was fully met

as she was took in copious fluid and also showed no sign of dehydration.

61
 3. Patient regained her normal eating pattern within 48 hours.

At 12:40pm on 11/11/2021 patient complain of loss of appetite. A nursing diagnosis of

Imbalance nutritional pattern (less than body requirement) related to loss of appetite was ten

formulated. A goal was set to ensure that patient regained her eating pattern within 48 hours.

The interventions carried out included Patient was reassured that she will gain back her

appetite. Patient’s oral hygiene was maintained. Items that are unpleasant were removed before

meal. Liquid digestible foods like juice, milo and porridge were served

Food was served according to patient’s preference.

On the 13/11/2021 at 12:45pm, goal set on the day of admission to ensure patient regained her

normal eating pattern was evaluated. Goal was fully met as patient verbalized she can eat more

than half of the bowl serve.

4. Patient was relieved of anxiety within 24 hours.

At 1:00pm on the day of admission, through interaction with patient she was verbalised feelings

of anxiousness. A nursing diagnosis of Anxiety related to unknown outcome of condition was

formulated. Nursing interventions put in place to ensure goal set to relieve patient of anxiety

were Patient was reassured of the competent nurses. Patient was allowed to express her fears

about outcome of condition. Every procedure was explained to patient to ensure her

cooperation. Divertional therapy was provided such as watching television. Patient was

allowed to ask questions and was answered in simple terms for her to understand. Patient and

relatives were educated on the condition. Vital signs was checked and recorded to identify any

physiological indicators of anxiety such as high pulse rate.

62
On the 12/11/2021 at 1:00pm, goal set on the 11/11/2021 was evaluated. Goal was fully met

as patient told the nurse that she has no fears and she was observed to have relaxed facial

expression.

5. Patient regained her normal sleep pattern

On the 12/11/2021 at 8am, due to patient’s complain and night nurses report of patient having

interrupted sleep throughout the night, a nursing diagnosis of Sleeping pattern disturbances

(Insomnia) related to abdominal pain was written and a goal was set to ensure Madam B.E was

relieved of insomnia throughout period of admission. The following nursing orders were

carried out; Patient was reassured of recovering peacefully. Warm beverages like milo was

served to induce sleep. Adequate ventilation was ensured during sleeping hours and switching

on fan to induce sleep. Noise was reduced by minimizing television volumes and Nursing

activities were planned and carried out together to avoid disturbing the patient Warm bath was

ensured in the evening to enable good sleep. The number of visitors were reduced during sleep

hours to avoid disturbing patient while sleeping.

On the 15/11/2021 at 08:00am goal set on the day of admission to ensure patient regained her

normal sleep pattern was evaluated. Goal was fully met as patient was observed to have

uninterrupted sleep.

6. Patient gained adequate knowledge on the disease condition

At 11am on the 13/11/2021, patient’s knowledge on the disease condition was assessed and it

was found to be inadequate. A nursing diagnosis of Knowledge deficit related to lack of

inadequate information on causes, signs and symptoms and prevention of disease condition

(Gastritis) was formulated and a goal was set to ensure patient had adequate knowledge within

24 hours. Nursing interventions carried out included Patient /family were reassured that

detailed information on Gastritis will be given for better understanding. Time was scheduled

63
with patient and relatives to educate them on Gastritis. Patient was made comfortable by lying

in bed whiles relatives and the nurse sit by bedside. Patient and family knowledge on Gastritis

was assessed. Accurate information on the predisposing causes, signs and symptoms,

prevention, drug management and lifestyle modification were provided to correct

misconceptions. Questions were invited and tactfully answered. Pamphlets on Gastritis were

given to patient.

On the 14/11/2021 at 10am goal set on the 13/11/2021 to ensure patient had adequate

knowledge was evaluated. Goal set was fully met as patient and family gave correct answers

to questions asked on Gastritis and patient/ family verbalizing understanding on the

information given them.

5.2 Amendment of Nursing Care Plan for Partially met or Unmet Outcome Criteria

Upon careful implementation of orders and evaluation of the nursing care rendered Madam

B.E and her family, there were no partially met or unmet objectives. Hence, there was no need

for amendment of the care plan.

5.3 Termination of Care

Termination of care is a gradual process and it starts from the day of admission till the 3rd home

visit. This is done to enable patient and relatives realize that they were temporary in the hospital

and the disease condition that was taking its course would soon end.

On the day of review, the doctor revealed that Madam B.E was fully recovered and very fit.

Following this, the last home visit was made to patient’s house on 10/11/2021. The reason of

the visit was to determine whether patient was healthy after her review and to finally terminate

care. . Care was terminated and she was encouraged to visit the hospital anytime she was sick.

64
 CHAPTER SIX

SUMMARY OF CARE RENDERED TO PATIENT AND FAMILY

6.0 Introduction

According to Weller,(2014), summary is a brief account giving the main point to a health

problem. This is the last step of the patient/family care study which entails the student’s

personal appreciation of the therapeutic relationship with the patient as well as the use of

nursing process. This is the last step of the patient/family care study which entails the student’s

personal appreciation of the therapeutic relationship with the patient as well as the use of the

nursing process.

6.1 Summary
This is a well documented report of interaction between myself and Madam B.E, a 54 year

old woman who was admitted into the female’s ward of St. Mary’s Hospital, Drobo on the

11/011/2021 at 12pm with the diagnosis of Gastritis after presenting with abdominal pain and

vomiting . She was attended to by Dr. A.M. Overall, drugs prescribed during patient’s stay at

the hospital were

Intravenous Omeprazole 80 mg stat and then 40mg bd x 24 hours

Suspension Nugel 15 mls three times daily x 5 days

Intravenous Metronidazole 500 mg tds x 2 days

65
Injection Buscopan 40 mg stat

Intravenous Metoclopramide 10mg stat

Intravenous DNS 500mls stat

Capsule Omeprazole 20 mg BD X 14 days

Tab Metronidazole 400 mg tds x 5 days

Tab paracetamol 1g tds x 5 days

Investigations carried out on patient were;

Blood for Full blood count

Blood for malaria parasite

Serology testing for H. Pylori antibody

Stool routine examination

Gastroscopy

All laboratory investigations were carried out and reviewed with appropriate intervention

except gastroscopy which could not be done as a result of unavailability of gastroscopy

machine in the facility.

During her period of hospitalization the seven health problems that were identified includes:

Epigastric pain, Vomiting, Anxiety, loss of appetite, Insomnia and knowledge deficit. Nursing

care plan for the identified problems were drawn and implemented. Some of the interventions

given include; Patient was reassured of speedy recovery since she is in the hands of competent

nurses and medical team, the level of pain was assessed, Patient was put in a comfortable

position, patient was educated and assisted to carry out the exercise. Prescribed antacids and

analgesic were served. This led to the speedy recovery and discharging of patient on

15/11/2021.

Three home visits were made to the patient’s home during the period of care.

66
The first one was during her hospitalization to confirm information provided by the patient,

assess patient’s home environment and to create a conducive home environment for receiving

her after discharge. The second was after discharge to remind patient of review date and to

assess patient’s compliance with treatment and education given and the last visit was to hand

patient over to a community nurse to ensure continuity of patient’s care. During the home visits,

education on patient’s condition and its management, personal and environmental hygiene,

good nutrition and the adverse effects of continuous use of over the counter drugs were given

and reinforced. The care was terminated on 11/11/2021 during the third home visit.

6.2 Conclusion

In conclusion, there is no doubt that a successful patient/family care depends on the cooperation

of the patient and family with the nurse and other members of the health team. This care study

has helped me gain much insight into the management and education of gastritis and other

gastrointestinal-related disorders and has also broadened my knowledge in rendering

comprehensive care to patient and family. I have being able to put the knowledge acquired at

lectures into practice and has also led to my development of therapeutic relationship between

patient and their family and improved my interaction with colleagues and senior staff.

As copy of this work is kept at the school’s library as a reference for students who embark on

similar study and helps the profession as a whole as a reference point in managing similar

conditions, it is therefore my recommendation that nursing process concept should be adhered

to in all clinical areas to help nurses continue delivering quality and holistic care to patients.

67
 REFERENCE

Ferris, F. Fred. (2012). Ferri’s Netter Patient Advisor. (2nd Ed). China. Elsevier Science Ltd

Joint Formulary Committee (2015), British National Formula (75th ed.), London; BMJ Group

and pharmaceuticals press, London

Harvey, M. (2014), Black Medical Dictionary, (41st ed.), A&C Black publication, London.

Hinkle, J.L., & Cheever, K.H. (2014). Brunner and Saddarth's Textbook of Medical –

Surgical Nursing.(12th ed. ). London: Wolter's Kluwer Health/ Lippincott

Marilyn E., Mary F.M., & Alice C.M., (2012), Nursing Care Plans Guidelines for

individualizing Patient Care Across the Life Span, (8th ed.), F.A Davis Company.

Philadelphia

Ministry of health /Ghana health service. (2014). Standard treatment guidelines 10th edition,

Accra, Ghana.

Scalon, V.C. & Sanders, T. (2014), Essentials of anatomy and physiology, (5th ed.), F.A

Davis Company, Philadelphia

Waugh, A. and Grant, A. (2014). Ross and Wilson Anatomy and Physiology in Health and

illness. (11th ed.) Elsevier limited

Weller, F.B. (2014). Bailliere’s Nurses’ Dictionary for Nurses and Health Workers. (25th ed.)

68
 New York: Bailliere Tindal Elsevier

APPENDIX: VITAL SIGNS OF MADAM B.E

Table 7: Vital Signs of Madam B.E throughout admission

Date Time Temperature (oC) Pulse Respiration Blood

(bpm) (cpm) pressure

11/11/2021 12pm 36.9 84 21 110/60

2pm 36.1 72 18 120/70

10pm 36.3 80 22 110/75

12/11/2021 6:00 am 36.7 80 22 110/70

2:00 pm 36.1 86 22 120/80

10:00 pm 36.3 77 19 120/75

13/11/2021 6:00 am 37.0 68 21 130/70

2:00 pm 36.3 86 20 120/70

10:00 pm 36.3 74 18 110/70

14/11/2021 6:00 am 36.6 68 20 120/70

2:00 pm 35.8 73 16 115/80

10:00 pm 36.6 67 18 115/70

15/11/2021 6:00 am 37.0 78 21 120/70

69
70