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CHAPTER ONE
ASSESSMENT OF PATIENT/FAMILY
Assessment is the first stage of the nursing process. It involves gathering information about
the clients health. The data is collected systematically through interview, observations, and
investigations. Analysis is then made to help identify clients health problems for
intervention.
Patients particulars
Madam H.A is sixty two (62) years old, born on 1 st January, 1949 to the late Opanin K.D and
Madam A. A. She is the first born among eight siblings; three males and five females.
She comes from Atwima- Koforidua in Atwima Nwabiagya District in the Ashanti Region.
She stays at house number KD 16, Koforidua. She speaks only Twi. She is married to Mr. K.
A and has five children with him.
Madam H.A is 165cm (1.65m) in height, 62kg in weight, and fair in complexion. She is an
Asante by tribe. She is a trader (plantain and yam seller). She is a Christian and attends Christ
Apostolic Church. Her next-of-kin is Miss K, a sister, who lives in the same house with her.
She has given birth to five children, three of them are male and the two are female. Madam
H.A possesses National Health Insurance that assists her in paying some of her hospital bills.
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Familys medical Socio-economic history
Family medical history consists of information about disorders from which the direct blood
relatives of the patient have suffered from. This helps identify a predisposition to develop
certain illnesses.
According to the patients sister, Miss K, the family has no history of Asthma and Sickle Cell
Disease but there is a known member who experienced hypertension and Diabetes Mellitus in
the family. Madam H.A is also known to be a hypertensive patient. There are no chronic
infectious diseases as well as mental illness in the family.
Madam H.A lives with two of her children and her sister. She is a trader and uses her income
to support her family. Her son who is also in USA supports the family with some sum of
money. In addition to these, she receives remittances from her husband who is a farmer. She
does neither smokes nor drinks alcohol or any other narcotic.
Patients developmental history
According to clients sister, client was born spontaneously per vagina. The delivery was
conducted by Traditional Birth Attendant (TBA). There were no complications but she could
not state the month and the date on which client was born. However, she stated that client was
born in 1949. All medical records at the hospital have 1st
January as her birthday.
Development is the quantitative change in an individual where there is an increase in skills or
ability to perform a task.
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Client started schooling when she was seven (7) years at Koforidua Elementary School but
stopped in class three for personal reasons known to her. She helped her family in farming
until where she was engaged in plantain selling with support from her late father when she
was in her teens. She has not suffered any serious illness that might have retarded her
development. She is currently married and has given birth to three male and two female
children.
Patients lifestyle and hobbies
Madam H.A usually sleeps at 10pm and wakes up at 5:00am to begin her household chores.
She has her regular bowel movement twice daily and she maintains her personal hygiene
twice daily. She is not used to making friends. She usually has her siesta between 12:00pm
and 1:00pm when she is less busy. She neither takes alcohol nor smokes. She listens to local
music from radio during hours of leisure.
On Saturdays she visits their farm with her husband to harvest food products for the rest of the
weeks. She also attends church services on Sundays.
Madam H.A takes in normal diet with fufu as her favourite food. She likes koko and koose in
the morning and rice and stew in the afternoon whilst fufu and palm-nut soups in the
evenings.
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Patients past medical history
According to clients sister, she is not a known Sickle Cell Disease patient, neither is she a
diabetic nor asthmatic. The sister confirmed that client was a hypertensive and she (client)
does not take salt. Client has been on admission at Nkawie- Toase Government Hospital on
the basis of hypertension. She has not been operated before. She is not on drug for any
chronic disease but was on hypertensive drugs and she has no allergies. She and her family
also take over the counter drugs for minor ailments like headache, abdominal pains, to
mention but a few.
Patient s present medical history
Client was well until 16 th November, 2011 when in an attempt to take her bath suddenly she
experienced inability to walk and collapsed. She was immediately taken to Kwadaso S.D.A
Hospital where she was given Sublingual Nefidipine 10mg stat and Intravenous infusion to
manage hypertension and to correct fluid and electrolyte imbalance respectively. She was
later referred to the Accident and Emergency unit of Komfo Anokye Teaching Hospital for further
management. At Komfo Anokye Teaching Hospital, she was diagnosed of Cerebrovascular
Accident with Right Sided Hemiplegia secondary to hypertension by Dr. A and was given
Tablet Lisinopril 10mg daily and Nifecard 30mg daily.
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Admission of patient
Client was admitted to ward D5 of Komfo Anokye Teaching Hospital on a trolley through
Medical Emergency Unit at Accident and Emergency Center on 16 th November, 2011 at
8:35am. She presented with a history of sudden collapse and inability to talk. She was
diagnosed of Cerebrovascular Accident with right hemiplegia secondary to hypertension. She
was under the care of team C doctors headed by Dr. A. She was admitted onto already
prepared admission bed. Her vital signs were checked and recorded as follows:
Temperature : 37.3 Degree Celsius
Pulse : 62 beats per minutes
Respiratory : 36 cycle per minutes
Blood Pressure : 180/100 millimeters of mercury
Client was put on Tablet Lisinopril 10mg daily for thirty days. The first dose was served at
the Medical Emergency Unit. Blood sample was taken for the following investigations;
haemoglobin level estimation, White blood cell count, blood urea and nitrogen and creatinine
level estimation.
Client and the relatives were reassured of competent staff. The patient was orientated to the
ward and wards protocols were also explained to the patient. Client and the relatives were
educated on the condition and the importance to register for the National Health Insurance
Scheme. In the presence of the client, her relatives were informed of visiting hours.
Appropriate documentations were done in the admission and discharge book, daily ward state,
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and in the nurses notes. Client and her relatives were educated on Stroke with right
hemiplegia (Cerebrovascular Accident).
Patients concept of her illness
Madam H.A and her family did not know the cause of her illness. They were also anxious of
the outcome of the disease and hospitalization.
LITERATURE REVIEW ON CEREBROVASCULAR ACCIDENT
Cerebrovascular Accident (CVA) also known as Stroke or Apoplexy is a condition that
produces sudden neurological signs and symptoms and paralysis as a result of rapture of a
cerebral blood vessel or occlusion by a blood clot leading to disruption of blood supply to the
brain tissue and death of brain cells.
Incidence
It is considered often as disease of the aged because approximately 60-75% of all CVA cases
occur in persons over 65 years of age. Young people occasionally sustain CVA because of
trauma to cerebral blood vessels, inflammatory disorders of arteries of the brain, or congenital
vascular anomalies. CVA is a major public health problem in terms of mortality and
permanent disability. In United States, it is ranked third among all causes of death.
TYPES OF STROKE
1. Ischaemic stroke: It is a sudden loss of function resulting from disruption of blood
supply to a part of the brain. It is caused by either an embolus or a thrombus.
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A. Embolic: It has sudden onset and sometimes can be transient
B. Thrombolic: It has gradual onset. It is the most common cause and is
usually due to atherosclerosis.
2. Haemorrhagic stroke: It has a sudden onset. It occurs from ruptured secular
aneurysm or as a result of ruptured cerebral blood vessel secondary to hypertension or
subarachnoid haemorrhage.
SPECIFIC CAUSES OF STROKE
1. Cerebral haemorrhage: Rupture of the blood vessel that produces haemorrhage
into the brain tissue. It is common in cases of hypertension.
2. Cerebral thrombosis: It is most common cause of stroke. The cerebral arteries
are affected by arteriosclerosis; in which the lumen of the arteries becomes
thickened and rough. The flow of blood is obstructed and clotting occurs. This
clot blocks the artery and deprives part of the brain of its blood supply.
3. Cerebral embolism: An embolic or detach clot may lodge in one of the cerebral
arteries to cause obstruction and once there is obstruction, there will be no blood
flow and brain cells die.
Predisposing (risk) factors of stro ke
1. Hypertension
2. Diabetes Mellitus
3. Heart Disease
4. Cigarette Smoking
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5. Excessive Alcohol Intake
6. Obesity
7. Family History of Stroke
8. Ageing
9. Emotional Stress
10. Polycythaemia
11. Use of Oral Contraceptive
Pathophysiology of stroke
When the blood vessel supplying an area of the brain is blocked by an embolus, thrombus, or
ruptures, ischaemia of brain tissue occurs. This leads to hypoxia, anoxia, and hypoglycaemia.
The affected part of the brain produces neurological dysfunction and paralysis. If ischaemia
persists, necrosis of the deprived area follows. The infarcted area eventually liquefies and is
absorbed and neurological defects remain. Since the cerebral hemisphere controls the contra
lateral side of the body, damage to the left hemisphere produces paralysis in the right side of
the body and vice versa.
Clinical features
1. Dysphasia
2. Paraesthesia
3. Diplopia
4. Blurred vision
5. Dizziness
6. Visual field cut
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7. Hostility
8. Forgetfulness
9. Difficulty in comprehension
10. Anxiety
11. Depression
Diagnostic investigations
1. Lumbar puncture reveals bloody cerebrospinal fluid in haemorrhagic stroke.
2. Computed tomography scan of the brain shows ischaemic areas of the brain or
reveals evidence of haemorrhage or isolate structural abnormalities.
3. Magnetic Resonance Imaging helps to identify lesion occupying areas.
4. Angiography outlines blood vessels and pinpoints occlusion or ruptured sites.
5. Electroencephalogram may show low-voltage, slow waves in ischaemic
infarction. If haemorrhage, it may show high-voltage but slow waves.
6. Other investigations may include urinalysis, coagulation studies, complete blood
count, and serum osmolarity, and electrolyte, Creatinine and urea nitrogen level.
Medical treatment
Medical treatment includes dietary management, physical rehabilitation, and drug regimen to
help reduce risk factors. Drugs useful in stroke include;
1. Antihypertensive example Nefidipine to reduce hypertension
2. Analgesics example Paracetamol to control headache
3. Anticoagulant example Heparin to prevent further development of thrombosis and
embolism.
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4. Antiplatelet example Aspirin to prevent clotting and reduce risk of recurrent
stroke after treatment has begun.
5. Corticosteroids example Dexamethasone to minimise associated cerebral oedema.
6. Anticonvulsants example Phenytoin to treat seizures.
7. Stool softeners example Sulfocuccinate to avoid straining which increases
intracranial pressure.
8. Haematinics example Folic Acid to help in red blood cell formation to reverse the
effect of antibiotic therapy in decreasing red blood cell production.
9.
Antibiotic example Capsule Amoxicillin to prevent risk of infection.10. Mild sedatives example diazepam to help reduce restlessness.
Specific surgical treatment
One of the following surgical procedures can be carried out depending on the cause of stroke
Craniotomy to help reduce haematoma.
Endoarterectomy to help remove arteriosclerosis plaques from inner arterial wall
Intracranial bypass to circumvent an artery that is blocked or ventricular shunt may be
done to drain cerebrospinal fluid.
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NURSING MANAGEMENT
1. Psychological care
The goal of psychological care is to gain clients cooperation during procedures. Reassure
client and relatives of competent staff and availability of instrument for her care. Explain
every procedure to client and relatives to allay fears and anxiety. Introduce client to other
client who are doing well with similar condition to build their hope of client recovery. Allow
client to express feelings and clear any misconceptions. Permit client spiritual leader to visit
client, pray and share words of encouragement with her.
2. Rest and sleep
Adequate rest and sleep is of importance in client whose physical mobility is impaired. Ensure
rest and sleep by providing comfortable bed free from creases and cramps. Change soiled
linen to clean ones. Minimize noise by turning down the volume of television and radio set
and staff should communicate in low tone. Open nearby windows to improve ventilation
when weather is warm or close windows when weather is cold. Provide dim light and serve
warm drinks to induce sleep. Avoid painful procedures, such as giving of injection at the time
of sleeping. Restrict stress producing visitors.
3. Position
Put client in a position not contraindicated to her condition. Place patient in semi-lateral
position supported with pillows and the head turned to the affected part to allow client use the
unaffected part for minimal activities. Provide foot board to prevent feet from dropping.
Elevate the head of bed to about 30 degrees after patient has gained consciousness to reduce
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intracranial pressure. Turn patient two hourly and treat pressure areas four hourly to prevent
the development of bed sores.
4. Personal hygiene
Give client bed bath twice with warm water. Care for clients mouth twice daily with paste
and brush. Treat clients pressure areas four hourly to prevent bed sores. Keep finger and toe
nails short and clean to prevent them from harbouring microorganisms and prevent patient
from injuring herself. Clean clients hair every other day to prevent lice infestation.
5. Observation
Monitor vital signs (temperature, pulse, respiration, and blood pressure) every four hours
paying particular attention to blood pressure. If client is on intravenous infusion, check the
flow rate and make sure it is at the prescribed flow rate. Check cannular site for swelling,
blockage by a blood clot. Discontinue intravenous line if any occurs and inform the nurse in
charge. Maintain accurate intake and output chart to know the amount of fluid gain or loss.
Check patients level of consciousness and orientation to time, place, and person by
mentioning her name for response, asking her time of day, where she is, and who the
caregiver is. Observe for desired and side effects of drugs. If serious side effect occur, report
to the doctor and nurse in charge and document in the nurses notes.
6. Nutrition
Assess the ability of client to swallow oral food to determine the convenient way to feed. Plan
diet with client and dietician taking into consideration her likes and dislikes. If client is
unconscious, feed per nasogastric tube. Administer prescribed intravenous fluid to maintain
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fluid and electrolyte balance. When condition improves, give normal diet containing right
proportion of carbohydrate for energy, protein for repair of worn out tissue, vitamin to
improve immunity, minerals to maintain electrolyte balance, roughage for free bowel
movement, and low fats and oil. Diet should be low in salt and cholesterol to prevent oedema
and arteriosclerosis. Prior to feeding, remove nauseating substances from clients vicinity.
Avoid painful procedures. Give fluid juice and serve food in bits to stimulate appetite.
7. Exercise
Initiate exercise based on clients tolerance and ability. Begin passive exercise to promote
circulation, prevent joint stiffness and muscle wasting. Encourage and assist client to exercise
the unaffected extremities to prevent impairment in function. Exercise the affected part
supported by the unaffected part. Invite the physiotherapist to take patient through range of
motion exercises.
8. Protection from injury
Nurse client on a low bed with fracture board under the mattress to maintain body alignment.
Provide bed rails to prevent client from falling. Provide pillows to elevate the affected part.
Place items needed by client within her reach. Remove sharp instruments example blade from
within clients reach to prevent it from in juring the client. Keep floor dry to prevent client
from falling when she begins ambulating. Keep client finger and toe nails short and clean to
prevent client from injuring herself.
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9. Elimination
Provide client with bed pan on request or when needed. In case of constipation, encourage the
client to take copious fluids and high roughage diet. Encourage and engage client in passive
exercise to promote free bowel movement. If there is retention of urine, apply warm
compresses to the supra pubic area, open nearby tap, and serve warm beverage drinks to
stimulate client to urinate. If these measures fail, pass urethral catheter to drain urine.
10. Education
Educate client and relatives on the causes, signs and symptoms, and complications of stroke.
Educate client and relatives on drug regimen and the need to take the full course of drugs.
Explain side effects of drugs and coping mechanism to them. Educate and encourage the
intake of low salt and low cholesterol diet. Advice was given to client on the need to avoid
alcohol intake if she is a drunkard. Inform client to report any signs and symptoms to the
doctor for prompt treatment. Document date of follow up for the client and emphasize the
need for follow up.
COMPLICATIONS
1. Paralysis
2. Seizures
3. Hypostatic pneumonia
4. Contractures
5. Neuropathy
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PREVENTION
1. Avoid smoking and alcohol intake.
2. Ensure regular checkups especially the blood pressure and weight.
3. Avoid or minimize stress.
4. Ensure regular exercise.
5. Control weight by reducing fat intake.
6. Avoid excessive intake of oral contraceptive.
7. Reduce intake of sodium and cholesterol diet.
VALIDATION OF DATA
The literature on the condition was compared with the signs and symptoms exhibited by the
client and doctors findings. Laboratory investigations were also compared with standard.
There are no variations in the data from the sources indicating that information gathered for
this study was accurate, valid and free from errors.
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CHAPTER TWO
DATA ANALYSIS
Data analysis is the second stage of the nursing process. It involves the separation of
information to its constituent parts. Data analysis comprises comparison of data to standard,
clients strength, health problem, and nursing diagnosis. This helps to plan care for client.
COMPARISON OF DATA WITH STANDARD
This deals with comparing information gathered from client to standard to help determine any
deviation from normal. This includes comparison of diagnostic investigations, causes, clinical
features, treatment, and complications.
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TABLE ONE: DIAGNOSTIC INVESTIGATIONS/TESTS
DATE SPECIMEN INVESTIGATION RESULTS REFERENCE
RANGE
INTERPRETATION REMARKS
16/11/11 Blood Haemoglobin level
estimation
14.0g/Dl Male:12.0-
18.0g/dL
Female:11.0-
16.0g/dL
Within normal range.
Client was not
anaemic.
No treatment was
given.
16/11/11 Blood White Blood Cell
Count
6.7x10/Ul 2.6-8.5x10u/L Within normal range.
Client had no
infection.
Antibiotics were given
to prevent infection.
16/11/11 Blood Urea and nitrogen
level
5.02mmol/L 2.50-
8.30mmol/L
Within normal range.
There was no renal
dysfunction.
No treatment given.
16/11/11 Blood Creatinine level 50umol/L 44-106umol/L Within normal range.
No renal dysfunction.
No treatment given
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CAUSES OF CLIENTS CONDITION
With reference to the literature review, the cause of Cerebrovascular Accident (stroke)
includes; embolism, thromboembolism, haemorrhage into the brain and others. The risk
factors also include; hypertension, diabetes mellitus, heart diseases etc. In the case of Madam
H.A, her condition was caused by cerebral thrombosis.
TABLE TWO: CLINICAL FEATURES
CLINICAL FEATURES INDICATED
IN THE LITERATURE
CLINICAL FEATURES EXHIBITED
BY CLIENT
1. Dysphasia Client experienced dysphasia
2. Paraesthesia Client experienced paraesthesia
3. Dizziness Client experienced dizziness
4. Blurred vision Client experienced blurred vision
5. Diplopia Client did not experience diplopia
6. Hemiplegia Client experienced right sided hemiplegia
7. Ataxia Client experienced ataxia
8. Dysphagia Client did not experience dysphagia
9. Forgetfulness Client did not exhibit forgetfulness
10. Anxiety Client was anxious
11. Depression Client was not depressed
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TREATMENT
With particular reference to the literature review, the following specific drugs were prescribed
for the client.
1. Tablet Lisinopril 10mg daily x 30
2. Tablet Methyldopa 250mg tds x 30
3. Tablet Amlodipine 10mg daily x30
4. Tablet Bendrofluazide 2.5mg daily x 30
5. Intravenous Metronidazole 500mg tds x 3
6. Intravenous Cefuroxime 1.5g stat, then 750mg tds x 3
7. Tablet Metronidazole 400mg tds x 5
8. Tablet Cefuroxime 500mg tds x 5
9. Artemeter lumefantrine 35mg bd x 3
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TABLE THREE: PHARMACOLOGY OF DRUGS PRESCRIBED FOR CLIENT
DATE DRUG DOSAGE AND
ROUTE OF
ADMINISTRA-
TION
ACCORDING TO
LITERATURE
DOSAGE AND
ROUTE OF
ADMINISTRA-
TION GIVEN TO
CLIENT
CLASSIFICATION DESIRED EFFECT ACTUAL
ACTION
OBSERVED
SIDE
EFFECTS
AND
REMARK
16/11/11 Tablet
Lisinopril
Dose
Adult: 10mg-40mg
Child: 0.07mg-
5mg /day
Route: Oral
10mg daily x 30
days orally
Antihypertensive
(Angiotensin
Converting Enzyme
Inhibitor)
Reduces peripheral
resistance and
decreases blood
pressure
Clients blood
pressure
reduced
gradually.
Headache
Dizziness,
postural
hypotensio
None
observed i
client.
17/11/11 Tablet
Methyldo
pa
Dose
Adult: 0.5-3g/day
Child: 10-
65mg/kg/day
Route: Oral
250mg tds x 30days
orally
Antihypertensive
(Centrally acting
Alpha-agonist)
Stimulates alpha-
adrenergic receptor in
the cardiovascular
centers in the central
nervous system
Clients blood
pressure
reduced
gradually.
Impaired
memory,
Depressio
nasal
congestion
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reducing blood
pressure.
None was
exhibited
client.
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DATE DRUG DOSAGE AND ROUTE
OF
ADMINISTRATION
ACCORDING TO
LITERATURE
DOSAGE AND
ROUTE OF
ADMINISTRA-
TION GIVEN
TO CLIENT
CLASSIFICATION DESIRED
EFFECT
ACTUAL
ACTION
OBSERVED
SIDE
EFFECTS
AND
REMARK
17/11/11 Tablet
Amlodipi
ne
Dose
Adult: 2.5mg,5mg,
10mg/day
Child: 2.5mg-5mg/day
Route: Oral
10mg daily x 30
days orally
Antihypertensive
(Calcium Channel
Blocker)
Dilates coronal
arteries,
peripheral
arteries/arteriole
reducing blood
pressure.
Clients blood
pressure reduced
gradually.
Peripheral
oedema,
Headache
Flushing.
Client did
not
experience
any of the
17/11/11 TabletBendroflu
azide
DoseAdult:
2.5mg,5mg,10mg/day
Child: 50 micrograms -
100 micrograms/kg/day
Route: Oral
2.5mg daily x 30days orally
Thiazides diuretics Reduces bloodpressure with
very little
biochemical
disturbance.
Clients bloodpressure reduced
gradually.
Posturalhypotensio
Hypokalae
mia. N
observed
client.
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DATE DRUG DOSAGE AND ROUTE
OF
ADMINISTRATION
ACCORDING TO
LITERATURE
DOSAGE AND
ROUTE OF
ADMINISTRA-
TION GIVEN
TO CLIENT
CLASSIFICATION DESIRED
EFFECT
ACTUAL
ACTION
OBSERVED
SIDE
EFFECTS
AND
REMARK
18/11/11
and
20/11/11
Metronid
azole
Dose
Adult: 400mg, 500mg
Child: 7.5mg/kg
Route:
Oral, Intravenous (IV)
Intravenous
500mg tds x3
days
Oral
400mg tds x 5
days
Antibiotic Disrupts DNA,
inhibiting
nucleic acid
synthesis by the
bacterial
Client was
infected
throughout
admission.
Anorexia,
nausea, dr
mouth,
metallic
taste,
anaemia.
None was
experience
by client.18/11/11
and
20/11/11
Cefuroxi
me
Dose
Adult: 750mg-2g
Child: 60mg/kg
Route:
Oral, Intravenous.
Intravenous
1.5g stat, then
750mg tds x
3days
Oral
Antibiotic Binds to bacteria
cell membranes,
inhibiting cell
wall synthesis to
prevent
infection.
Client was
infected
throughout
hospitalization.
Nausea
vomiting,
headache,
dizziness.
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Tablet 500mg
tds x3days
None
observed
client
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DATE DRUG DOSAGE AND ROUTE
OF
ADMINISTRATION
ACCORDING TO
LITERATURE
DOSAGE AND
ROUTE OF
ADMINISTRA-
TION GIVEN
TO CLIENT
CLASSIFICATION DESIRED
EFFECT
ACTUAL
ACTION
OBSERVED
SIDE
EFFECTS
AND
REMARK
18/11/11 Tablet
Artemeter
lumefan-
trine
Artemeter 20mg +
Lumefantrine 120mg
Recommended Dosing
Regimen
5-14kg 20/120bd x 3 days
15-24kg 40/240mg bd x 3
days
25-34kg 60/360mg bd x 3
days35 and above 80/480mg
bd x 3 days
600/480mg bd x
3 days
Antimalaria Inhibits nucleic-
acid and protein
synthesis within
the malaria
parasite.
Client did not get
malaria
throughout
hospital.
Anorexia,
headache,
fatigue,
dizziness.
Client
experience
none of
them.
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COMPLICATIONS
Client did not develop any of the complications outlined in the literature. This is due to well
coordinated and executed medical and nursing interventions and clients compliance with
treatment.
PATIENT/FAMILY STRENGTHS
This explains the ability of client and her family members to help in the achievement of goals set
for quick recovery.
Client and the relatives were cooperative with the health team in rendering care to her. They
visited client twice daily; morning and evening as per protocol of the hospital. They do bring
food and other items that might be needed by client. They also pray and share words of
encouragement with her.
Client was a National Health Insurance Scheme (NHIS) beneficiary, so they were able to pay her
hospital bill on discharge.
The son who is in abroad also assisted the care of client by providing financial support which
enables her pay her bills and other necessities.
In addition, client receives support from family members which enables her in the entire stay in
the hospital for treatment.
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HEALTH PROBLEMS
From the data collected from the client, the following health problems were identified.
16/11/2011
1. Client and her relatives were anxious
17/11/2011
2. Client could not perform personal hygiene.
17/11/2011
3. Client could not feed herself.
18/11/2011
4. Client was constipated.
19/11/2011
5. Client was prone to bed sore.
22/11/2011
6. Client could not sleep.
22/11/2011
7. They had little knowledge about stroke.
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NURSING DIAGNOSIS
Nursing diagnosis is actual or potential health problem identified by the nurse which can be
managed by nursing intervention.
1. Anxiety related to unknown outcome of disease condition.
2. Self care deficit related (bathing, grooming, hair care, nail care) related to right sided
hemiplegia.
3. High risk for nutritional deficit related to weakness.
4. Altered bowel movement (constipation) related to change of environment.
5. High risk for impaired skin integrity (bed sore) related to confinement to bed.
6. Sleep pattern disturbances (insomnia) related to change of environment.
7. Knowledge deficit on Cerebrovascular Accident related to lack of information.
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CHAPTER THREE
PLANNING FOR PATIENT/ FAMILY CARE
Planning, the third stage of the nursing process involves objectives and outcome criteria and
outlined nursing strategies that will be instituted to aid speedy recovery of client. It also means
putting in place measures to deal with clients health problem s.
OBJECTIVES / OUTCOME CRITERIA
1. Client and the relatives will be relieved of anxiety within 24 hours as evidenced by client
and the relatives interacting freely with other clients and staff on the ward and verbalizes
that they are no more anxious.
2. Client personal hygiene will be maintained throughout the period of hospitalization as
evidenced by:
a. Client looking neat and well groomed in bed everyday
b. The nurse observing that clients finger and toe nails are kept short and neat.
3. Client will maintain her nutritional status throughout the period of hospitalization as
evidenced by:
a. The nurse observing that client is able to eat.
b. Client maintaining her weight when weighed
4. Client will be able to empty her bowel freely within 24 hours as evidenced by:
a. The nurse observing that client is able to empty her bowel after she was served with
bedpan.
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b. Client verbalizes of her ability to empty her bowels.
5. Client will not develop bedsore throughout the period of hospitalization as evidenced by
client having intact skin on the day of discharge observed by the nurse.
6. Client will be able to sleep at least 5-8 hours within 24 hours as evidenced by:
a. Night nurses report confirming that client slept well without disturbance
b. Client verbalizes that she is able to sleep.
7. Client and her relatives will have insight into Cerebrovascular Accident within 24 hours
as evidenced by client and the relatives being able to give adequate feedback to questionsasked after education.
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and her relatives to
wards
environment.
5. Engage client in
diversional
therapy.
4. Ward staffs were introduced
to client and the relatives.
They were also shown places
of convenience and wards
protocols were explained to
them.
5. Client was made to watch
television and listen to radio to
allay anxiety.
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DATE/
TIME
NURSING
DIAGNOSIS
OBJECTIVE/
OUTCOME
CRITERIA
NURSING
ORDERS
NURSING
INTERVENTIONS
DATE/
TIME
EVALUA
TION
SIGNA
TURE
17/11/11
8:00am
Self care
deficit
(bathing,
grooming, hair
care, nail care)
related to
weakness.
Clients
personal
hygiene will be
maintain
throughout the
period of
hospitalization
as evidenced by
a. Client
looking neat
and well
groomed in bed
everydayb. The nurse
observing that
clients finger
and toe nails are
kept short and
neat.
1. Reassure client.
2. Do skin
assessment.
3. Bath client with
warm water.
4.Care for clients
mouth
1. Client was reassured that
measures would be put in
place to help her maintain her
personal hygiene.
2. Clients skin was assessed to
rule out skin abnormalities and
things needed for the bed bath.
3. Client was bathed twice
daily with warm water
preferred by her. Client was
groomed to enhance neatnessand comfort.
4. Clients mouth was cared
for twice daily with paste and
brush to prevent mouth
abnormalities and other
23/11/11
4:00pm
Goal fully
met as
client
looked
neat each
day on
admission.
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5.Keep clients
finger and toe nails
short and clean
6. Wash clients
hair.
infections.
5. Clients finger and toe nails
were kept short and neat to
prevent client from injuring
herself and to prevent
harbouring microorganisms.
6. Client s hair was washed
and covered with a cap to
prevent harbouring
microorganisms.
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DATE/
TIME
NURSING
DIAGNOSIS
OBJECTIVE/
OUTCOME
CRITERIA
NURSING
ORDERS
NURSING INTERVENTIONS DATE/
TIME
EVALUATION SIGNA-
TURE
17/11/11
8:00am
High risk for
nutritional
deficit related
to inability to
feed herself
due to
weakness.
Client will
maintain her
nutritional
status
throughout the
period of
hospitalization
as evidenced
by
a. The nurse
observing that
client is ableto eat.
b. Client
maintaining
her weight
when weighed.
1. Reassure client
and the family
members.
2. Plan diet with
client and the
dietitian
3. Give client
oral care.
4. Give client
fruit juice.
5. Serve food
attractively.
1. Client and the relatives were
reassured that measures will be
instituted to help client maintain
her nutritional status.
2. Diet was planned with client
and dietitian taking her
preferences into consideration.
3. Client was given oral care to
stimulate appetite.
4. Client was given orange juice
prior to feeding to stimulate
appetite.
5. A tray was set a flower vase to
make the food attractive to the
22/11/11
8:00am
Goal fully met as
client maintained
her weight on
discharge.
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6. Give food to
client a little at a
time.
client.
6. Client was allowed time for
chewing for easy swallowing and
digestion. Water was given
whenever client desired.
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DATE/
TIME
NURSING
DIAGNOSIS
OBJECTIVE/
OUTCOME
CRITERIA
NURSING
ORDERS
NURSING
INTERVENTIONS
DATE/
TIME
EVALUATION SIGNA-
TURE
18/11/11
10:00am
Altered bowel
movement(constipation)
related to
change of
environment.
Client will be
able to empty her
bowel freely
within 24 hours
as evidenced by:
a. the nurse
observing that
client is able to
empty her bowel
after she was
served with bed
panb. Client
verbalizes of her
ability to empty
her bowels.
1. Reassure client.
2. Encourage client
to take copious fluid.
3. Encourage intake
of roughage diet.
4. Encourage and
assist client to
1. Client was reassured that
measures would be put in
place to enable her empty her
bowel.
2. Client was encouraged to
take a lot of water, mashed
kenkey, porridge, and orange
juice to help soften the stool.
3. Client was given orange to
eat and was encouraged totake the inner portion for the
stool to form bulky and
facilitate its movement.
4. Client was encouraged and
assisted to perform kegel
18/11/11
6:00pm
Goal fully met as
client was able to
move her bowel
freely when
served with bed
pan.
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perform passive
exercises in bed.
5. Serve bed pan on
request.
exercises to enhance
peristaltic movement.
5. A warm bed pan was
served to client on request to
empty her bowel. She was
able to empty her bowels.
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DATE/
TIME
NURSING
DIAGNOSIS
OBJECTIVE/
OUTCOME
CRITERIA
NURSING ORDERS NURSING
INTERVENTIONS
DATE/
TIME
EVALUATION SIGNA
-TUR
19/11/11
9:00am
High risk for
impaired skin
integrity (bed
sore) related to
confinement to
bed.
Client will not
develop bed sore
throughout the
period of
hospitalization as
evidenced by
client having
intact skin on the
day of discharge
observed by the
nurse.
1. Prepare a
comfortable bed.
2. Do skin assessment.
3. Change clients
position two hourly.
4. Treat pressure areas
four hourly.
1. A comfortable bed was
prepared free from creases
and cramps to prevent
pressure on bony
prominences.
2. The skin was assessed to
determine areas which are
prone to bed sore for
immediate intervention.
3. Clients position was
change 2 hourly to maintaincomfort and prevent bony
prominences from pressing on
bed linen for long period.
4. Clients pressure areas
were washed, rinsed, and
23/11/11
4:00pm
Goal fully met as
client had intact
skin without any
sign of bed sore.
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5. change bed linen at
regular intervals
6. Massage the
pressure areas.
dried with care and Vaseline
applied to maintain skin
integrity.
5. Bed linens were changed
each morning to enhance
clients comfort.
6. Pressure areas were
massaged to improve blood
circulation to the area in order
to prevent skin breakdown.
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DATE/
TIME
NURSING
DIAGNOSIS
OBJECTIVE/
OUTCOME
CRITERIA
NURSING ORDERS NURSING
INTERVENTIONS
DATE/
TIME
EVALUATION SIGNA
TUR
19/11/11
10:00pm
Sleep pattern
disturbances
(insomnia)
related to
change of
environment
Client will be
able to sleep for
at least 5-8 hours
within 24 hours
as evidenced by
a. night nurses
report
confirming that
client slept well
without
disturbance
b. Clientverbalizes that
she is able to
sleep.
1. Reassure client.
2. Prepare a
comfortable bed.
3. Give client a warm
bath.
4. Provide a conducive
environment.
1. Client was reassured that
she would be able to sleep
with good nursing measures.
2. A comfortable bed was
prepared with clean linen free
from creases and cramps to
ensure her comfort and
promote sleep.
3. Client was bathed with
warm water to induce sleep.
4. Volume of television and
radio sets was turned down
and staff communicated in
low tone to reduce noise.
20/11/11
6:00am
Goal fully met as
client slept for 6
hours indicated by
night nurses
report.
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5. Provide client with
a warm beverage.
6. Ensure adequate
ventilation.
5. Warm Milo was given to
client to reduce blood supply
to the brain and induce sleep.
6. Nearby windows were
opened to allow fresh air
inside to induce sleep.
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DATE/
TIME
NURSING
DIAGNOSIS
OBJECTIVE/
OUTCOME
CRITERIA
NURSING ORDERS NURSING
INTERVENTIONS
DATE/
TIME
EVALUATION SIGNA
-TUR
22/11/11
5:30pm
Knowledge
deficit related
to lack of
information on
Cerebrovascula
r Accident.
Client and the
relatives will
have insight into
the literature of
Cerebrovascular
Accident within
24 hours as
evidenced by
client and the
relatives being
able to give
adequatefeedback to
questions asked
after education.
1. Establish good
nurse-client
relationship.
2. Assess client and
the relatives
knowledge.
3. Educate client and
the relatives about
CerebrovascularAccident.
1. Nurse interacted with client
and the relatives to gain their
cooperation.
2. Nurse explored from the
client and the relatives what
they know about
Cerebrovascular accident.
3. The causes, signs and
symptoms, and prevention of
Cerebrovascular Accidentwere explained to client and
the relatives.
23/12/09
4:30pm
Goal fully met as
client and the
relatives were able
to give correct
answers to
questions asked
them after
education.
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4. Allow them to ask
questions on areas
they did not get
explanation well.
5. Ask client and the
relatives questions
4. Client and the relatives
asked about the causes of
Cerebrovascular Accident and
they were answered in simple
terms.
5. Series of questions were
asked for feedback to evaluate
their level of understanding.
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CHAPTER FOUR
IMPLEMENTING PATIENT/ FAMILY CARE
Implementation, the fourth stage of the nursing process, is the act of carrying out the plan of
care. Nursing care was aimed at relieving client of the condition to prevent complications so that
patient recovers fully.
SUMMARY OF ACTUAL NURSING CARE RENDERED TO PATIENT
DAY OF ADMISSION (16 TH NOVEMBER, 2011).
Madam H. A was admitted to ward D5 of Komfo Anokye Teaching Hospital on 16 th November,
2011, at 8:35am. She was brought in on a trolley accompanied by her sister, Miss K, and two
members of the admission team. She was received onto an already prepared admission bed. After
cross checking information from her folder, admission team members were asked to leave. Her
sister was offered a seat.
Particulars of the client which included her name, age, religion, occupation, marital status, next-
of-kin hometown, and address were taken and cross checked from that of her folder. The
information was recorded in the admission and discharged book and daily ward state.
Her vital signs were taken and recorded as follows;
Temperature : 37.3 degree Celsius
Pulse : 62 beats per minute
Respiration : 36 cycles per minute
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Blood Pressure : 180/ 100 millimeters of mercury
Blood sample was taken for full blood count at the Accident and Emergency Unit. Tablet
Lisinopril 10mg daily x 30 was prescribed and the first dose administered at the Accident and
Emergency Unit. Only this drug was prescribed this. All other drugs were prescribed the
subsequent days.
Client and her sister were educated on the disease condition, thus Cerebrovascular Accident.
They were also educated on the importance of registering with the National Health Insurance
Scheme (NHIS).
Client and her sister were informed of visiting hours and the policies and protocols of the ward.
They were reassured of competent staff and appropriate measures to help her recover fully. They
were orientate d to the wards environment. They were informed that the staffs care for them.
The sister of client was asked to go home and come the next day with items client will need for
her stay at the ward. Client was made to sleep in the evening.
SECOND DAY ON ADMISSION (17 TH NOVEMBER, 2011).
According to the night nurses report, client slept well throughout the night. She woke up at
5:30am and was assisted to perform personal hygiene. During visiting hours, her relatives came
with Milo and bread which she was served with. She ate almost everything. Vital signs were
taken and prescribed medication was administered.
During ward rounds, the team of doctors prescribed the following drugs; Tablet Methyldopa
250mg tds x 30; Tablet Amlodipine 10mg daily x 30; Tablet Bendrofluazide 2.5mg daily x 30.
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These drugs were taken from the pharmacy and the first doses were administered at 10:00am.
Four hourly vital signs monitoring continued. Client was served with rice and stew in the
afternoon and kenkey with fish in the evening. After she was assisted to perform her personal
hygiene in the evening, she was made to sleep.
THIRD DAY ON ADMISSION (18 TH NOVEMBER, 2011).
Client woke up at 5:30am. She was assisted to perform personal hygiene. She was served with
porridge and bread for breakfast. Vital signs were monitored and prescribed drugs were
administered.
On ward rounds, team of doctors prescribed Intravenous Metronidazole 500mg tds x 3;
Intravenous Cefuroxime 1.5g stat, then 750mg tds x 3; and Tablet Artemeter lumefantrine
600/480mg bd x 3 days. These drugs were given to prevent the occurrence of infection. The
drugs were collected from the pharmacy and the first doses served at 10:30am.
Client was unable to empty her bowels. She was encouraged to drink water. She was given
orange juice and mashed kenkey to help her empty her bowels freely. After two hours, she was
served with bed pan and she was able to pass stool. She was served with banku and okro stew for
lunch.
In the evening, she was served with rice and beans stew. She was assisted to perform personal
hygiene and was made comfortable to sleep.
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FOURTH DAY ON ADMISSION (19 TH NOVEMBER, 2011).
Client woke up as usual at 5:30am. She was assisted to perform her personal hygiene. She was
served with tom brown for breakfast. Vital signs were monitored and prescribed medications
were administered.
She was turned in bed every two hours and pressure areas were cared for every four hours to
maintain skin integrity. In the afternoon, she was served with yam and kontomire stew. Four
hourly vital signs monitoring and medications continued.
In the evening, she was given rice and stew. She was assisted to perform her personal hygiene.
During sleep hours client was having difficulty in sleeping as indicated by night nurses report
the previous night. She was given warm beverage, nearby windows were opened to provide
ventilation, and a quiet environment was ensured to enable her to sleep.
FIFTH DAY ON ADMISSION (20 TH NOVEMBER, 2011).
A report on client indicated that she slept well during the night. She woke up as usual. She was
assisted to perform personal hygiene. She ate porridge and bread for breakfast. Vital signs were
monitored and recorded. Prescribed medications were administered.
During ward rounds, she was reviewed by team of doctors and they prescribed the following
drugs; Tablet Metronidazole 400mg tid x 5and Tablet Cefuroxime 500mg bid x 5. The drugs
were collected from the pharmacy and administered as ordered. The doctors also requested for
service of physiotherapist. She ate banku with soup.
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In the evening, she was assisted to maintain personal hygiene. She ate rice water after which she
was made to sleep.
SIXTH DAY ON ADMISSION (21 ST NOVEMBER, 2011).
Client woke up at 5:30am as usual. She was assisted to perform her personal hygiene. Vitals
were monitored and recorded. She ate almost all her breakfast thus tom brown and bread.
Prescribed drugs were administered.
Two members from the physiotherapy department of the hospital attended to her and took her
through range of motion exercises. She was served with rice ball with soup during lunch.
In the evening, she was served with fufu with soup prepared from the house. She was assisted to
maintain personal hygiene. Vital signs were monitored and recorded. Prescribed drugs were
administered. She was made comfortable in bed to sleep.
SEVENTH DAY ON ADMISSION (22 ND NOVEMBER, 2011).
Client slept well with no complains based on night nurses report. She woke up at her usual time.
Her personal hygiene was maintained with the help of the nurse. Routine nursing care was
rendered to her. On general ward rounds, clients condition was noticed to be improving. She
was booked for discharge the next day if the condition does not change. The physiotherapists
once again took her through range of motion exercises.
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In the evening, client and her relatives were educated on the causes, common signs and
symptoms, and preventive measures of Cerebrovascular accident. After nursing care had been
rendered to her, she was made comfortable to sleep in bed.
EIGHTH DAY ON ADMISSION (23 RD NOVEMBER, 2011).
Client woke up in the morning looking cheerful with improved condition. Routine nursing care
was rendered to her. The team of doctors discharged her upon improvement in condition. The
relatives were informed on a phone call.
Her hospital bill was assessed and paid for with a receipt issued at the revenue department. The
original copy of the receipt was given to client and her relatives and the duplicate kept at the
ward. She was assisted to pack her belongings.
Client and relatives were educated on disease condition. They were also educated on medication
schedule and the need for client to complete the drug regimen. Adverse effects of drugs and how
to manage minor side effects were explained to them.
Date for review was documented for client and her relatives. They were advised to report to the
hospital for review as stated. They were further informed to report any abnormality in case any
occurs before the review date. They were advised on good personal and environmental hygienic
practices.
Madam H.A and her relatives were educated on dietary modifications; low sodium, low fat but
well balanced diet. They were congratulated for their cooperation throughout the period of
hospitalization. They also expressed their gratitude to the staff at the ward.
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The discharge information was entered in the admission and discharged book, daily ward state,
nurses report book, and the nurses notes. Client and her relatives were seen off at the car park.
After they had left, the bed linens were removed and the mattress decontaminated with parazone
1:10. The linens were sent to the sluice room for washing and subsequent washing and
sterilization at Central Sterilization and Supply Department (CSSD) for reuse.
PREPARATION OF PATIENT AND FAMILY TOWARDS DISCHARGE AND
REHABILITATION
Preparation of client and family towards discharge started on the day of admission. They were
reassured of competency of staff and achievement of the hospital in relation to the condition of
the client. During ward rounds on 23 rd November, 2011, her condition was found to have
improved and she was discharged as such. Her folder was sent to the revenue department for
assessment and subsequent payment of bill.
Client was assisted to pack her belongings. She and her family members were educated on the
causes, common signs and symptoms, complications and preventive measures of
Cerebrovascular Accident. They were also educated on dietary restrictions, thus low sodium, low
fat diet. They were also educated on the need for client to complete the full course of
medications. They were also educated on the importance to register with the National Health
Insurance Scheme to have access to quality health care at a low cost.
Client and relatives were told the date to come for review. The need for review was emphasized.
They were also advised to report abnormality if any occurs before the date of review. They were
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congratulated for their cooperation throughout the care of client. They also expressed their
gratitude to the staff of the ward. They were seen off at 5:00pm.
Rehabilitation is a programme that helps a person who is recovering from an injury or sickness to
regain as much function as possible. It can also be termed as a restoration to fullest the physical,
mental, and social capability of an individual.
Client rehabilitation started whiles she was on admission and continued after she was discharged.
She was attending out-patient rehabilitation programme at the physiotherapy department of the
hospital. She was taken through exercise ranging from passive to active to help her gain normal
function as possible. This continued for two weeks after she was discharged.
FOLLOW UP/ HOME VISIT/ CONTINUITY OF CARE
FIRST HOME VISIT
My first follow up visit was embarked on the 22 nd of November, 2011 while client was still on
admission with the family after visiting hours in the evening. She stays at house number KD 16,
Koforidua with her sister, other siblings, and her daughter. They live in a compound house with
other tenants.
They have a single kitchen and a bath which serve all the tenants in the house. They get water
supply from a commercial source, about 300 meters from the house. Toilet facility is also
commercial, a stone throw from the house. They dispose refuse into big bins near the toilet.
Family members were reassured that client would get well soon so they should put in their
maximum support. A second visit was promised after which I was seen off at 6:30pm.
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SECOND HOME VISIT
The second home was undertaken on 28 th November, 2011, after client was discharged home.
Client and her relatives welcomed me and offered a seat. Her condition had improved. Emphasis
was placed on the review date. They were also advised to continue sending client for
rehabilitation. I interacted with other inhabitants of the house. After about an hour of interaction,
I sought permission to leave and was granted. A third visit was promised.
THIRD HOME VISIT
The care was terminated on the third home visit on 9 th December, 2011 after she came for
review. She had responded to treatment and was doing well. Emphasis was placed on already
health education given. The need for good nutrition and dietary restrictions were further
explained. They were also educated on the need for client to complete the full course of
medications. Client and her relatives were encouraged to register with the National Health
Insurance Scheme to have access to quality health care at a low cost. Permission to leave was
granted.
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CHAPTER FIVE
EVALUATION OF CARE RENDERED TO PATIENT/ FAMILY
Evaluation is the stage of the nursing process which measures the effectiveness of care rendered
to client. It also helps to determine the clients progress to meet specific objectives and goals set.
STATEMENT OF EVALUATION
During clients stay at the hospital, many goals were set with their specific outcome criteria.
They were aimed at providing client with a comprehensive holistic nursing care to enhance
speedy recovery
On 16 th November, 2011, client and her relatives were noticed to be anxious. Objective set to
relieve them of anxiety was fully met. Client and relatives said they were no more anxious.
On 17th
November 2011, client could not perform personal hygiene as well as feed herself. Goalsset to help client maintain her personal hygiene and to feed her were fully met.
On 18 th November, 2011, client was constipated. Objective set that client will be able to empty
her bowel freely was fully met. Client was able to empty her bowels.
On 19 th November, 2011, client was noticed to stand the risk of developing bed sore and could
not sleep. Objectives set to help client maintain intact skin and that she will be able to sleep were
fully met as client was relieved of insomnia and was able to sleep.
On 20 th-22 nd November, 2011, routine nursing care was rendered to client.
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On 23 rd November, 2011, client and her relatives were noticed to have less knowledge on
Cerebrovascular Accident. Objective set to educate client and her relatives was fully met. They
were able to answer questions put to them on Right Sided Hemiplegia.
AMENDMENT OF NURSING CARE PLAN FOR PATIALLY MET AND UNMET
OUTCOME CRITERIA
Due to high compliance of client and her relatives, all objectives set were fully met. No
amendment of nursing care plan on objective and outcome criteria was done.
TERMINATION OF CARE
Termination of care was initially difficult since a strong therapeutic relationship was established.
Client and the relatives were made aware that therapeutic interaction would come to an end after
the review.
In order to prepare the client and her family members for termination of care, education was
given on good personal and environmental hygiene, completion of drug regimen, observation of
side effects of drugs and management of minor side effects. The importance of dietary
modification thus low sodium, low fat, adequate vitamin and roughage was emphasized.
Client and her relatives were congratulated for their support and co-operation during the
implementation of the care. The care was terminated on 23 rd November, 2011.
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SUMMARY
Madam H. A, a 62-year old woman was admitted to ward D5 of Komfo Anokye Teaching
Hospital on 16 th November, 2011 at 8:35am. She was diagnosed of Cerebrovascular Accident
with right sided hemiplegia. Her particulars, thus name, age, occupation, religion, marital status,
hometown, address, and next-of-kin were taken and recorded.
Client exhibited the following manifestations aphasia, paraesthesia, dizziness, blurred vision, and
ataxia, to mention but a few. Her problems were identified through thorough assessment and all
objectives/goals set to address her problems were fully met.
Routine nursing cares were rendered to towards her recovery and to avoid complications.
Medications prescribed and administered during the period of hospitalization were;
Apparently, client was well and was discharged on 23 rdNovember, 2011 after spending eight
days on admission. Three separate visits were paid to her and her relatives.
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CONCLUSION
The Patient/ Family Care Study has helped me gain in-depth knowledge into Cerebrovascular
Accident. The study has also helped me to know how to give holistic nursing care to clients
using the nursing process as well to acquire good interpersonal relationship skills with client and
family. The study has once again helped me to put what I have learnt into practice.
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British Medical Association and Royal Pharmaceutical Society of Britain ,, 2004, British National Formulary, 48 th edition, UK.
Ignatavicius D.D., Workman M.L., Mishler M.A., 1999, Medical-Surgical Across the Health
Care Continuum, 3rd edition, 1107-1125, W.B. Saunders Company, Philadelphia.
Phipps W.J., Sands K.J., Marek J.F., 1999, Medical-Surgical Nursing; Concepts and Clinical
Practice, 6th edition, 1737-1757, Mosby Inc., St. Louis.
Suzanne C.S., Brenda G.B., Janice L.H., Kerry H.C., Brunner and Suddarths Textbook of
Medical- Surgical Nursing, 11 th edition, Volume 2, 2206-2231, Lippincott Williams and
Wilkins, Philadelphia.
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APPENDIX
BLOOD PRESSURE CHART
DATE TIME BLOOD PRESSURE
16/11/11 12: 35 pm
4 : 35 pm
8 : 30 pm
170/100 millimeters of mercury
160/110 millimeters of mercury
160/100 millimeters of mercury
17/11/11 6: 00 am
10: 05 am
2: 10 pm
6: 00 pm
150/100 millimeters of mercury
140/100 millimeters of mercury
150/90 millimeters of mercury
140/90 millimeters of mercury
18/11/11 6: 08 am
10: 10 am
2: 00 pm
6: 15 pm
150/90 millimeters of mercury
140/80 millimeters of mercury
130/90 millimeters of mercury
140/90 millimeters of mercury
19/11/11 6: 20 am
10: 15 am
2: 20 pm
6: 25 pm
140/80 millimeters of mercury
140/90 millimeters of mercury
130/90 millimeters of mercury
140/80 millimeters of mercury20/11/11 6: 00 am
10: 10 am
2: 15 pm
6: 05 pm
130/80 millimeters of mercury
120/80 millimeters of mercury
130/90 millimeters of mercury
130/80 millimeters of mercury
21/11/11 6: 00 am
10: 05 am
2: 15 pm
6: 15 pm
140/90 millimeters of mercury
130/80 millimeters of mercury
130/70 millimeters of mercury
120/80 millimeters of mercury
22/11/11 6: 15 am
2: 00 pm
6: 20 pm
120/80 millimeters of mercury
120/70 millimeters of mercury
120/70 millimeters of mercury
23/11/11 6: 00 am 120/70 millimeters of mercury
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SIGNATORIES
Name of Candidate: .................................................
Signature
Date:
Name of Nurse In-Charge: .
Signature:
Date:
Name of Supervisor: ................................................
Signature
Date:
Name of Principal: .
Signature: .