A PATIENT/FAMILY CARE STUDY

(A NURSING PROCESS APPROACH)

ON

MR. S.O.

A PATIENT WITH

ENTERIC FEVER

PRESENTED BY

ODURO ANGELA

A FINAL YEAR STUDENT OF ST.PATRICK’S NURSING AND MIDWIFERY

TRAINING COLLEGE, MAASE-OFFINSO

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF
REGISTERED GENERAL NURSING CERTIFICATE

NOVEMBER, 2022
 PREFACE

Patient/family care study is a study made on a patient and his or her family with a particular

condition on an account of the nursing care rendered to them. Care study offers the student a

variety of importance such as providing knowledge and understanding of the cases, pathology,

diagnosis, signs and symptoms, treatment and complications of the patient condition.

Enteric fever is an acute illness associated with fever caused salmonella enterica serotype typhi

bacteria. It can also be caused by salmonella paratyphi related bacteria that usually causes a less

severe illness. The bacteria are deposited in water or food by a human carrier and are then

spread to other people in the area.

Modern trend of nursing lays emphasis on individual care which aims at maintenance of patient

physiological, psychological, spiritual and social well -being. It gives the student nurse an

opportunity to learn more and understand the client’s behaviour towards her problems and to

give necessary help and support. It also helps the client and family to understand and learn

more about the disease condition and to participate in the care and treatment of the condition

during hospitalization and after discharge.

The study is one of the requirement by the Nursing and Midwifery Council (NMC) of Ghana,

before awarding a certificate to the student nurse as Registered General Nurse (RGN), to

practice as a qualified nurse. The study is based on nursing process which consist of

assessment, diagnosing, planning, implemention and evaluation.

i
 ACKNOWLEDGEMENT

I have taken efforts in this project. However, it would not have been possible without the kind

support and help of many individuals and institutions. I would like to extend my sincere thanks

to all of them.

I am highly indebted to God for his guidance and support from beginning of this project to the

end of it.

I will like to say thank you to my supervisor for his constant supervision as well as for

providing necessary information regarding the project & also for their support in completing

the project.

I would like to express my gratitude toward Mr. S.O and his family for their kind co-operation

and encouragement which help me in completion of this project.

I would like to express my special gratitude and thanks to the staff of St. Patrick’s hospital for

giving me such attention and time.

My thanks and appreciation also go to my colleague in developing the project and people who

have willingly helped me out with their abilities especially Adjei Solomon, Amoako Isaac and

my parents.

ii
 INTRODUCTION

According to World Health Organization (WHO,1994), health is a state of complete physical,

mental and social wellbeing of an individual and not merely the absence of disease or infirmity.

Family centred care study is a tool that serves as learning experience for student nurses in

giving nursing care to client and families.

Enteric Fever is an acute illness associated with fever caused by the salmonella enterica

serotype Typhi bacteria. The bacteria are deposited in water or food by a human carrier and are

then spread to other people in the area. Typhoid fever is contracted by drinking or eating the

bacteria in contaminated food or water. People with acute illness can contaminate the

surrounding water supply through stool, which contains a high concentration of the bacteria.

The bacteria can survive for weeks in water or dried sewage.

The care study was centred on Mr. S. O a twenty four- year old young man , who was

admitted at the emergency ward of St. Patrick’s Hospital on 3 rd November, 2022 with a

diagnosis of Enteric Fever under the care of Dr. Ntori. The patient health was restored through

nursing process that aimed at identifying the patient’s problems in order to solve them. The

whole script is divided into five (5) chapters and it is organized as follows;

Chapter one (1) deals with assessment of patient and family. This includes patient’s particulars,

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

and hobbies, past and present medical history. Admission of patient, patient’s concept of

illness, literature review and validation of data.

Chapter two (2) involves analysis of data. In which the data collected is compared with

standard in the literature review, table of laboratory investigation /test, treatment given to

iii
patient, aetiology, clinical manifestation, pharmacology of drugs, complications, patient and

family strength, health problems identified and nursing diagnosis made.

Chapter three (3) entails planning for patient and family care. A care plan is drawn and

intervention carried out.

Chapter four (4) comprises of implementing patient and family care, summary of actual nursing

care, preparation of patient and family for discharge and follow-up visit.

Chapter five (5) evaluate care rendered to patient and family. It also involves summary and

conclusion of whole nursing care. Amendment of nursing care, termination of care and

conclusion.

iv
 TABLE OF CONTENTS

CONTENTS PAGE

PREFACE.......................................................................................................................................I

ACKNOWLEDGEMENT............................................................................................................II

INTRODUCTION.......................................................................................................................III

TABLE OF CONTENTS.............................................................................................................V

LIST OF TABLES....................................................................................................................VIII

CHAPTER ONE............................................................................................................................1

ASSESSMENT OF PATIENT AND FAMILY...........................................................................1

PATIENT’S PARTICULARS.....................................................................................................1

PATIENT FAMILY’S MEDICAL AND SOCIO-ECONOMIC HISTORY..............................1

PATIENT'S DEVELOPMENTAL HISTORY............................................................................2

PATIENT'S LIFESTYLE / HOBBIES........................................................................................3

PATIENTS PAST MEDICAL AND SURGICAL HISTORY....................................................3

PATIENT PRESENT MEDICAL HISTORY.............................................................................4

ADMISSION OF MR. S O..........................................................................................................4

PATIENT CONCEPT OF ILLNESS...........................................................................................6

LITERATURE REVIEW OF ENTERIC FEVER..........................................................................7

VALIDATION OF DATA.........................................................................................................17

CHAPTER TWO.........................................................................................................................18

ANALYSIS OF DATA................................................................................................................18

COMPARISON OF DATA WITH STANDARD.....................................................................18

COMPARISON OF CLINICAL FEATURES WITH STANDARD........................................22

v
 COMPLICATIONS...................................................................................................................25

PATIENT'S HEALTH PROBLEM...........................................................................................25

PATIENT/FAMILY STRENGTH.............................................................................................25

NURSING DIAGNOSES..........................................................................................................26

CHAPTER THREE.....................................................................................................................27

PLANNING FOR PATIENT/ FAMILY CARE.......................................................................27

OBJECTIVES AND OUTCOME CRITERIA..........................................................................27

CHAPTER FOUR.......................................................................................................................39

IMPLEMENTATION OF CARE RENDERED TO PATIENT / FAMILY..........................39

SUMMARY OF ACTUAL NURSING CARE RENDERED TO PATIENT / FAMILY........39

PREPARATION OF PATIENT/FAMILY FOR DISCHARGE AND REHABILITATION...45

HOME VISITS OR FOLLOW UP............................................................................................46

CHAPTER FIVE.........................................................................................................................50

EVALUATION OF CARE RENDERED TO PATIENT/FAMILY.......................................50

STATEMENT OF EVALUATION...........................................................................................50

AMENDMENT OF NURSING CARE PLAN FOR PARTIALLY MET OUTCOME

CRITERIA.................................................................................................................................52

TERMINATION OF CARE......................................................................................................52

SUMMARY..................................................................................................................................53

CONCLUSION............................................................................................................................54

BIBLIOGRAPHY........................................................................................................................55

SIGNATORIES............................................................................................................................57

vi
 LIST OF TABLES

TABLE PAGE

TABLE ONE: Comparison of Laboratory Investigations ………………………………………21

TABLE TWO: Comparison of Clinical Features………………………………………………..22

TABLE THREE: Pharmacology of Drugs Administered to Patient…...………………………..24

TABLE FOUR: Nursing Care Plan ………..................................................................................28

 CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

Assessment

Assessment of patient is the first stage of the nursing process that involves the gathering of

formation and data to determine patient’s present health status and to evaluate patient current

and past coping pattern. The data can be collected from the patient, his or her family, the health

care team and the records of the patient. These data helps to identify patient’s problems to give

patient quality nursing care for patient to be able to achieve full recovery.

This care study, assessment was done through interview, physical examination, observation,

diagnostic investigation.

Patient’s Particulars

Mr. S. O is a 24 years old male born on 26 th August, 1998 to Mr. A.O and Madam P.O at

Akomadan Government Hospital. He hails from Akomadan but resides at Dentin. He is single

with one child. He is the third born to his parents. He weighed 54kg on admission and a height

of 170cm. His house number is plot 9, block 8 new Dentin.

Mr. S.O is a Tailor and completed junior high school he is a Ghanaian and speaks Twi,

and English. He is a Christian . His next of king is Mr. R.A

Patient Family’s Medical and Socio-Economic History

The family of Mr. S.O has no known disease of genetic origin. Also there are no known

infectious conditions such as measles, tuberculosis and chicken pox. There is no known allergy

in the family. They sometimes use over the counter drugs when they have general body pains.

According to Mr. S.O his mother is a trader and his father is dead. Their family can be

classified under middle income earners. There is a trusting relationship between the family and

the community at large.

Patient's Developmental History

Development is the qualitative change that occurs in an individual which includes gradual

acquisition of gross and fine motor skills. (Bailliere`s nurses dictionary, 26th edition.)

Growth in other hand is the progressive development of a living thing, especially the process by

which the body reaches its point of complete physical development. (Bailliere’s nurse’s

dictionary, 26th edition)

According to Lowry (1978) defines growth as an increase in the size of the whole organism as

evidence by an increase in height and weight as in bones and organs.

Development is qualitative change in which there is an increase in skills or ability to perform a

particular task. Developmental stages according to various theories provide a guide to assess a

person’s development pattern. The various developmental stages are grouped under

psychosexual (Sigmund Freud), psychosocial (Eric Ericson),and cognitive(Jean Piaget ) stages

of life. He was born to Mr.A.O and Madam P.O. MR. S.O said he does not remember having

any abnormality during his stages of development. According to his mother, she breastfed

Mr .S.O exclusively for 3 months and complementary food like porridge were introduced.
Mr .S.O could not say if he was fully immunized against all the childhood diseases but on

physical assessment, indicated a scar on the right upper arm that indicates she was immunized

with Bacillus Chalmette Guerin (BCG) vaccine.

According to Mr.S.O's mother, Mr.S.O started sitting when she was 4 months old and started

crawling when he was 6 months old. He crawled for 3 to 4 months and started walking on the

10th month. He also started talking fluently when he was 3 years of age.

Whiles engaging Mr .S .O in conversation, he made me aware that he started school as early as

at age four. He said he experienced his secondary sexual characteristics such as growing of

auxiliary and pubic hair as at about 14 years of age. Mr .S .O is sexually active and has one

child. He completed his junior high education.

Patient's Lifestyle / Hobbies

Mr. S. O normally wakes up from bed around 4:30 am in the morning and goes to work around

7:30am in the morning. On Sunday, he goes to church and at his leisure time he listens to news.

His favorite food is rice and stew. He is kind and sociable. Mostly in the morning, Mr .S. O

takes his breakfast sometimes porridge with bread or any other breakfast before going to work.

He also takes fruit such as banana or orange after his lunch at his home . He normally closes

from work at 5pm and gets to home about 5:30 pm and prepares for the following day's work.

He normally moves his bowel every morning before taking his bath.

Patients Past Medical And Surgical History

Information gathered from Mr. S.O revealed that apart from minor fever that subsides after Tab

paracetamol administration; there has not been any major illness that demands hospitalization.
He is not suffering from any childhood illness like measles, whooping cough etc . Mr S.O have

had no surgery or accident and also does not go for medical check-ups.

Patient Present Medical History

Client became sick 4days ago when he had some slight headache and low-grade fever. He

became very weak and worsen on Thursday 3 rd November, 2022 and was sent to St. Patrick’s

Hospital where he was admitted to the emergency ward.

Admission of Mr. S O

Client was admitted to the emergency ward on the 3 rd November at 10:00am on account of

Enteric fever. He was accompanied to the ward in the company of a relative and an outpatient

department nurse. Client and his relative were warmly welcomed into the ward. The relative

was offered a seat and the client was admitted into a warm comfortable bed. He was alert and

conscious but looked ill, his relative looked very anxious on admission. On admission, he

presented some complaints which were fever, vomiting, general body weakness, and abdominal

pains.

The client’s folder was collected and cross checked with the name and condition for

confirmation. Client’s particulars such as name, sex, age, occupation of patient, address and

religion were documented into the admission and discharge book and daily ward state. His vital

signs were checked and recorded as:

Temperature – 38.5°C

Pulse - 100 beats per minute

 Respiration - 83cycles per minute

Weight - 54 kilograms

Blood Pressure − 126/69mmg

Height − 170centimeters

General observation done which revealed that client looked very ill; due to the anxious state of

Mr. S.O, he was reassured that his condition was manageable and will improve with the

presence of competent staff. This was done to establish a good therapeutic relationship between

the relative and staff. He was then introduced to other clients on the ward. He was orientated to

the ward and its environment. Mode of payment of hospital bills was also explained to him and

national health insurance scheme was also explained to the relatives.

The following medications for treatment of Mr. S.O were bought from the pharmacy and were

served as prescribed

1. Tab ciprofloxacin 500mg bd x 7

2.Tab metronidazole 400mg tds x 7

3.IV metronidazole 500mg tds x 24

4.IV ciprofloxacin 400mg bd x 24

5. IV morphine 10g tds x1

6.Tab paracetamol 1g tdx5

7. IV metoclopramide 10mg tds x1

8. Intravenous fluid Ringers Lactate 1 litre x 24 hours

9.Intravenous fluid Dextrose Normal Saline 500mls x 24 hours

Blood sample taken to the laboratory and results recorded as:

White blood cell count

Haemoglobin level estimation

Widal test

BF for MPS

His valuables were collected and kept in the bedside locker. The mother and relatives were

informed of the normal visiting hours which are 4pm to 6pm and 5am to 7am each evening and

morning respectively. Mr. S O was encouraged to eat well balanced diet, drink enough liquid

and fruits. Mr. S O was reassured of quality care and early relieve of symptoms. Family

members were informed on visiting hours. They were again advised to bring the following;

bucket, soap, washing soap, cloths, pale, brush, a pair of sandals etc, to facilitates his

hospitalization.

Patient Concept of Illness

According to Mr. S.O, His illness was not as a result of any spiritual factor but believed that

human beings are bound to fall sick once a life time.

 LITERATURE REVIEW OF ENTERIC FEVER

INTRODUCTION

According to John L.Brusah, MD department of medical school of Harvard, typhoid fever also

known as enteric fever is potentially fatal multisystemic illness caused primarily by the

ingestion of a bacterial known as salmonella enteric sub species of enterica serovar paratyphi

the classical presentation includes ;fever, malaise, constipation ,diffuse abdominal pains and

general bodily pains.

Salmonella typhi has been a major human pathogen for thousands of years ,the name

salmonella typhi has been derived from the Greek word “typhus’’ an enteral freak or cloud that

was believed to cause disease and madness.

Untreated typhoid fever is a gruelling illness that may progress to delirium, obtundation,

intestinal haemorrhage, bowl perforation and psychoses within the first few months of

infection.

Survivors may be carriers and capable of transmitting the infection to others, though antibiotics

have reduced the incidence of enteric fever in developed countries it still remain endemic in

developing countries.

Enteric fever can be transmitted through contaminated food and water, large epidemics related

to faecal contamination of water and food.

Definition of Enteric Fever

According to Bear, (2008), enteric fever is a systemic disease caused by salmonella typhi

characterised with high fever, prostration, abdominal pain, malaise and constipation in some

cases.

According to Brusah, (2006) typhoid fever also known as enteric fever is potentially fatal

multisystemic illness caused primarily by the ingestion of a bacterial known as salmonella

enteric sub species of enterica serovar paratyphi the classical presentation includes; fever,

malaise, constipation, diffuse abdominal pains and general bodily pains.

Enteric fever can also be defined as faeco-oral infection of the gastrointestinal tract caused by

the bacteria called salmonella typhi with the clinical manifestations of fever, abdominal, pains,

malaise and nausea.

Enteric fever is an acute, generalised enteric disease belonging to the group of enteric fevers

(typhoid and paratyphoid) caused by a bacterial called salmonella typhi. (Offei, V. 2014)

Incidence/Epidemiology of Enteric Fever

According to John L. Brusah 2006, Typhoid/enteric fever infects roughly 21.6 million people

that is incidence of 3.6 per 1000 population and kills an estimated 200,000 people every year

Enteric fever affects all age groups but more in children and young adults.
Between 1999 and 2006, 79% of typhoid fever cases occurred in patients who had been outside

of the country within the preceding 30 days.

The three known outbreaks of enteric fever within the United States were traced to imported

food or to a food handler from an endemic area. Whilst remarkably, 17% of cases acquired

were traced to a carrier.

Enteric fever occurs worldwide primarily in developing nations whose sanitary conditions are

poor. Enteric fever is endemic in Asia, Africa, Latin America.80% cases come from

Bangladesh, china, India and Indonesia.

In the United States, most cases of enteric fever arise in international travellers. The average

yearly incidence of typhoid fever per million travellers from 1999 -2006 by country or region

of departure was as follows; United States is 1.3,Africa is7.6,Asia10.5,India 89(122 in 2006).

Enteric Fever Infection Rate in Africa and Ghana

According to facts and figures of the Ghana statistical service 2007, enteric fever has been

ranked the 16th cause of illness and the 9th mortality cause.

11,407 cases of enteric fever cases were recorded in the year 2000 representing 0.3 percent of

the total population of Ghana. The number increased in the year 2001 to 23,594 representing

0.4 percent of the population. The number increased to 31,791 in the year 2002 and 53,825 in

the year 2003 representing 0.7 percent.

Enteric fever according to the statistics is the 7th cause of under morbid.

Aetiology Of Enteric Fever.

According to Beer (2008), about 400 to 500 cases of typhoid fever are reported annually in the

United State.

Typhoid bacilli are shed in stool of asymptomatic carriers or in the stool or urine of those with

active disease.

Inadequate hygiene after defecation may spread S. Typhi to community food or water supplies.

In endemic areas where sanitary measures are generally inadequate S. Typhi is transmitted

more frequently by water than by food.

In developed countries, transmission is chiefly by food that has been contaminated during

preparation by healthy carries .Flies may spread the organism from faeces to food.

Occasionally transmission by direct contact (Faecal-oral route) may occur in children during

play and in adults during sexual practices.

Rarely, hospital personnel who have not taken adequate enteric precautions have acquired the

disease when changing soiled bed clothes.

Pathophysiology Enteric Fever

The organism enters the body via the gastrointestinal tract and gains access to the bloodstream

via the lymphatic channels. Ulceration, haemorrhage and intestinal perforation may occur in

severe cases. About 3% of untreated patients, referred to as chronic enteric carriers harbour

organisms in their gallbladder and shed them in stool for more than one year. Some carriers

have no history of clinical illness. Most of the estimated 2000 carriers in the US are elderly

women with chronic biliary disease. Obstructive uropathy related to schistosomiasis may

predispose certain typhoid patients to developing urinary carrier state.

All pathogenic salmonella species, when pressed in the gut are engulfed by phagocytic cells

and transport them through the mucosa and presents them to the macrophages in the lamina

propriae.

Macrophages recognise pathogen associated molecular patterns (PAMPS) such as lipopoly

saccharides. Macrophages and intestinal epithelia cells then attracts T cells and neutrophils with

interleukins 8(IL8) causing inflammation and suppression the infections.

Salmonella typhi and paratyphi enter the host through the distal illume. They have specialised

fimbriae that adhere to the epithelium over clusters of lymphoid tissues in the ileum.

Typhoidal salmonella co-opt the macrophages cellular machinery for their reproduction as they

are carried through the mesenteric lymph nodes to the thoracic duct and the lymphatics and

then to the reticulo-endothelia tissues of the liver, spleen ,bone marrow and lymph nodes.

Once the bacteria reaches there it pause and multiply until some critical density is

reached .afterward the bacteria induce macrophage apoptosis breaking out into the blood stream

to invade the rest of the body. The bacteria then infect the gall bladder through either

bacteraemia or direct extension of infected bile.

The result is that the organism re-enters the gastro intestinal tract through the bile and re-infects

the peyer patches. The salmonella bacteria that do not re-infect the host are typically shed in the

stool and are then available to infect other host.

The bacteria excreted by a carrier may have multiple genotypes making it difficult to trace an

outbreak to its origin.

Mode of Transmission
Oral transmission via food or beverages handled by an often asymptomatic individual. A carrier

chronically sheds the bacterial in the stool but less commonly in urine.

Hand to mouth transmission after using a contaminated toilet and neglecting hand hygiene.

Risk Factors of Enteric Fever

Typhoidal salmonella have no non-human vectors, an inoculum as small as 100,000 organisms

of typhi causes infection in more than 50% of healthy volunteers. Paratyphoid requires a much

higher inoculum to infect and it is less endemic in rural areas.

Typhoid fever affects mostly school age children and young adults, it is higher in very young

children and infant (Beer, 2008)

Types of Enteric/Typhoid Fever

Non Typhoidal Salmonella Infections

Nontyphoidal salmonella mainly salmonella enteriditis, are common and remain significant

public health problem in the US.

Many sero types of salmonella enteriditis have been given names as if they were separate

species but they are not.

Sources of this type of infection includes infected animals, milk and meat products.

Signs and symptoms include:

Primarily produce gastroenteritis, bacteraemia and focal infections. Symptoms may include

high fever, prostration,

Clinical Manifestation of Typhoid Fever

7 to 14 days (days after ingestion of typhi in food or drink)

 Step wise fever

 Diffuse abdominal pain

 Constipation

 Dry cough

 Dull frontal headache

 Delirium

 Malaise

Second Week

Fever 39oC

Rose spot develops

Distended abdomen

Third Week

 Anorexia

 Wight loss

 Diarrhoea

Later Stage

 Apathy

 Confusion

 Psychosis
  Intestinal perforation.

Diagnostic Investigation

Physical examination is one of the methods used in diagnosing enteric fever, during physical

examination, the skin is assessed for rose spot rashes,

The abdomen is also assessed for distension and tenderness.

Laboratory Studies

 Full Blood Count - This may indicate an elevated white blood cell (WBC) count.

 Culture and Sensitivity (Widal test) – To determine the causative organism and the

right treatment to be given. Samples that can be cultured include blood and stool. Blood

or stool culture may reveal the salmonella typhi bacterial in the stool or the blood.

Differential Diagnosis

 Abdominal abscess

 Amoebic hepatic abscess

 Appendicitis

 Brucellosis

 Typhus

 Toxoplasmosis

 Malaria

Medical Management

The treatment of enteric fever is considered under the various classes.

Class I: Patients can usually be managed with oral antibiotics on an outpatient basis.

Class II: Patients are suitable for short-term (up to 48 hours) hospitalization and discharge on

outpatient parenteral antibiotic therapy where this service is available.

Class III and Class IV: Patients require hospitalization until the infection is clinically

improved, systemic signs of infection are resolved and any co-morbidity is stabilized. Patients

with suspected intestinal perforation require urgent surgical assessment and possible

laparotomy.

SUITABLE DRUG THERAPY FOR ENTERIC FEVER

First line Second line

Class I Tablet ciprofloxacin 500mg 12 hourly for 14days Tablet azithromycin 500mg-1g
daily for 7days

Class II Intravenous ciprofloxacin 400mg 12 hourly for 1 Intravenous ceftriaxone 80mg

day per kilogram body weight

Class III Intravenous ciprofloxacin 400mg 12 hourly 48 hours

Intravenous ceftriaxone 80mg per kilogram body
weight.

Class IV +Intravenous Ciprofloxacin 400mg bd for 3 days

+Intravenous ceftriaxone 80mg per body weight
Intravenous metronidazole 500mg 3 times daily for 3 days.

 Analgesics (Ibuprofen, Diclofenac) are prescribed to relieve pain.

 Antipyretic (Paracetamol) is prescribed to reduce temperature.

  Intravenous infusions (Normal saline, Ringers Lactate) are also prescribed to hydrate

and maintain fluid electrolyte balance.

Surgical Management Of Enteric Fever.

According to Beer, (2008),Laparotomy is done to for diagnosis purposes.

The advance form of enteric fever with intestinal perforation requires urgent surgical

management. Bowel resection is done and if the gallbladder is affected gallbladder resection is

done.

Nursing Managements

 Patient was reassured with words of encouragement and quality care.

 Patient was given enough bed rest and sleep to promote early recovery.

 Patient vital signs was monitored especially temperature four hourly.

 Patient was tepid sponge with tepid water to reduce temperature.

 Menu was discussed with patient and was fed with diets rich in nutrients.

 Patient hands and nails was cared.

 Patient was served with diet rich in protein and vitamin C to enhance a strong

immunity.

 Patient was educated on preventive measures to reduce the reoccurrence.

 Prescribed medications was administered and observed for desire and side effects and

manage accordingly.

 Patient was educated on personal hygiene to prevent reoccurrences of condition.

Complications
 According to Beer, (2008), untreated enteric fever may progress to the following

complications;

 Intestinal perforation

 Typhoid psychosis

 Peritonitis

 Septicaemia and bacteraemia.

Prevention of Enteric Fever

Prevention of enteric fever according to Beer (2008), is more of behavioural change and strict

adherence to personal hygiene.

 Patient is educated on the need to practice good personal hygiene; proper hand washing,

keeping the nails shot,

 Food must be well cooked before eaten.

 Food must be well covered from flies.

 Proper disposal of human excreta

 Vegetables and fruits should be well washed before eaten

 Milk and shell fish consumption should be avoided or reduced.

Validation of Data

This strategy determines the validity of the data collected or how true it is from the patient,

relatives and other health workers about the patient’s condition. After collecting the data on Mr.

S.O, the data was cross-checked again and it was confirmed through the laboratory investigations

ordered as well as the other medical health documents that Mr. S.O truly had enteric fever.
I therefore have no doubt to conclude that the data I have gathered is free from errors, bias and

misinterpretations

CHAPTER TWO

ANALYSIS OF DATA

Using the nursing process, analysis of data is next to assessment and it attempts to judge and

analyze the data collected about Mr. S.O condition and compares it to the various information

in text books and other reliable sources.

Analysis as an essential component of the nursing process which helps in the organization and

presentation of the nursing diagnosis in accordance with the patient’s prioritized needs after the

data is collected

Comparison of Data with Standard

TEST is a procedure that involves testing a sample of blood, urine or other substance from the

body. INVESTIGATION is a process of examining a part of the human body or body fluids

including blood and urine.

This serves as a guide to measure and compare the cause of Mr. S.O condition, the clinical

features presented, laboratory investigations done, treatment given as well as any complications

developed with those found in the textbooks and other school of thoughts.

Causes Of Patient’s Condition

With reference to the literature review, enteric fever usually occurs after the invasion of

salmonella bacteria into the gastrointestinal tract through a portal of entry (faeco-oral route).It

occur when the bacteria is ingested in food or drink. According to Mr. S.O, he buys food from
the street food venders, he eats food with some colleagues in which they sometimes do not

wash their hands and has been diagnosed of the typhoid fever infection earlier.

Mr. S.O also confirms eating fruits sometimes without washing them. These facts made it

possibly true that Mr. S. O acquired the infection from drink or food.

DIAGNOSTIC TEST LITERATURE DIAGNOSIC TEST CARRIED OUT ON MY

REVIEW PATIENT

Full Blood Count Done for my patient

Culture and Sensitivity test Not done for my patient

Widal test Done for my patient

 Table 1: Comparison of Laboratory Investigations

Date Specimen Investigations Result Normal Values Interpretation Remarks

03/11/22 Blood FBC:

White Blood Cell 7.78×109g/ l 4.0-10.0×109 g/l Normal No treatment was given

Red Blood Cell 6.53×109g/ l 3.9-6.5×109 g/ l Normal No hematinic was ordered

Hemoglobin 13g/ dl 13.2 to 16 .6g / dl Normal No hematinic was ordered

Platelet 17.2×109 g/ l 150-400×109 g/ dl Normal No treatment was given

Lymphocyte 17.5×109 g/ l 20-40×109 g/ l Normal

No treatment was given
Neutrophils 17.2×109 g/ l 50.0-70.5×109 g/ l Normal

BF for mps Malaria parasite No parasite present Patient is not No treatment was given

absent suffering from

malaria No treatment was given

03/11/22 Blood Total protein 83.7g/ dl 60-80g/ dl High

 Albumin 28.2g/ dl 30-50g/ dl Low Patient was encouraged to

Globulin 55.5g/ l 20-40g/ l High eat high protein foods

03/11/22 Blood Widal Test S/TO1/320 S/TH1/I6O High Patient will be rehydrated.
Comparison Of Clinical Features With Standard

Below is a table showing the clinical manifestations according to the literature review compared

to those of my patient, Mr. S.O

Table 2: Comparison of Clinical Features

LITERATURE PATIENT

Fever Patient presented with fever of 38.5oC.

Abdominal pains Patient complained of severe abdominal pain.

Initial constipation Mr. S.O had constipation few days before

admission.

Headache Patient experienced headache on admission.

Abdominal distension (advanced No abdominal distension observed.

stage)

Anorexia Patient alleged loss of appetite.

Nausea Nausea was present

Abdominal discomfort. Abdominal discomfort.

Statement of Comparison

Mr. S.O experienced most of the clinical features indicated in the literature review.

TABLE 2.4 COMPARION OF SPECIFIC TREATMENT GIVEN TO MY PATIENT

Intravenous Fluids Intravenous fluid Ringers Lactate 1 litre x

24hours

Intravenous fluid Dextrose Normal saline 2

Litres x24hours

Antibiotic Tab Ciprofloxacin 500mg bd x7

IV Ciprofloxacin 400mg bd x24

IV Metronidazole 500mg tds x1

Tab Metronidazole 400mg tds x7

Anti- Emetic
IV Metoclopramide 10mg tds x1

Analgesics IV morphine 10 mg tds x1

Tab paracetamol 1g td x5
 Table 3: Pharmacology of Drugs Administered

Date Drugs Dosage/ Route Of Classification Desired Effect And Actual Action Side Effects/remarks

Administration Action Observed

03/11/22 IV 400mg bd for 24hours Antibiotics To kill susceptible Abdominal Dizziness, insomnia, nausea.

Ciprofloxacin intravenously bacteria. discomfort relieved. None was observed.

03/11/22 IV 500mg tds for 24 Antibiotic To kill susceptible Abdominal Dizziness, fluid retention,

Metronidazole hours, intravenously bacterial discomfort relieved. blurred vision. None

observed.

03/11/22 Iv Morphine 10 mg tds for 24 hours Opioid / To subside pain Pain reliever Drowsiness ,

Analgesic

03/11/22 Intravenous 500mls in 24 hours Isotonic To prevent Patient was Fluid over load (Enema).

infusion intravenously. solution. dehydration and Hydrated throughout None was observed.

Dextrose in increase sugar level. Admission

Normal Saline

03/11/22 Intravenous 1 Litre in 24 hours Isotonic To prevent Patient was Fluid over load (Enema).

infusion Solution dehydration and Hydrated throughout None was observed.

 Ringers increase sugar level. Admission

Lactate

03/11/22 Tab 500mg bid for 7 days Antibiotic To kill susceptible Improved abdominal No reaction

Ciprofloxacin Orally bacteria Discomfort Observed.

03/11/22 Tab 1g tds for 5days, Analgesic To reduce pain Pain relieved No reaction observed

Paracetamol orally

03/11/22 Tab 400 mg for 7days Antibiotic To kill susceptible Improved abdominal No reaction

Metronidazole bacteria Discomfort Observed.

Complications

Patient did not develop any complication stated in the literature review.

Patient's Health Problem

Health problems are conditions that are present in the patient that hinders him from being

psychologically, physically, socially and spiritually sound and prevents her from the

performance of her daily activities unaided.

The following were the health problems identified in Mr. S O

1. Patient complained of pain in the abdomen. 03 / 11/ 22

2. Patient had elevated body temperature (38.5o C) 03 / 11/ 22

3. Patient complained of general body weakness 03 / 11/ 22

4. Patient was anxious. 03/ 11/ 22

5. Patient complained of vomiting. 04 / 11/ 22

6. Patient was unable to sleep at night. 05 / 11/ 22

Patient/Family Strength

The patient and family strength refers to the things the patient as well as the family can do to

assist the health care team to carry out their duties effectively without difficulties.

Patient is on the National health Insurance Scheme and was fully conscious.

1. Patient was able to verbalize pain and adopt a comfortable position

2. Patient was able to swallow oral antipyretics.

 3. Patient was able to walk to the bath room unaided

4. Patient was able to ask questions about her condition.

5. Patient was able to tolerate liberal fluid

6. Patient can assume a comfortable position that can induce sleep.

Nursing Diagnoses

1. Acute Pain (abdomen) related to semolina typhi infection.

2. Hyperthermia (38.5 degree Celsius) related to infectious process

3. Decrease activity tolerance (partial) related to body weakness.

4. Anxiety related to unknown outcome of disease condition.

5. Risk for deficient fluid Volume related to vomiting.

6. Insomnia related to change of environment (hospitalization).

 CHAPTER THREE

PLANNING FOR PATIENT/ FAMILY CARE

This involves drawing of care plan for the patient / family out of the objectives set for the

patient / family, their strengths and health problems. This plan enables the care giver to

render comprehensive and individualized care to the patient / family.

Objectives and Outcome Criteria

1. Patient comfort will be restored within 24 hours as evidenced by:

 Patient verbalizing the absence of pain.

 Patient looking cheerful in bed.

2. Patient's body temperature will be restored to normal within 1hour as evidenced by:

 Patient’s body temperature range 36.2 to 37.2 degree Celsius.

 Patient being calm and relaxed in bed

3. Patient`s activity level will be restored within 48 hours as evidenced by:

 Patient performing her activities of daily living such as bathing, oral hygiene with no

Assistance.

4. Patient`s anxiety level will be allayed within 24 hours as evidenced by:

 Patient looking comfortable in bed.

 Patient verbalizing absence of anxiety

5. Patient`s will be relieved from vomiting within 24 hours as evidenced by:

 Patient verbalizing that he is no longer vomiting.

 Nurse observing the patient skin turgidity.

6. Patient sleep pattern will be restored to normal within 24hours as evidenced by:

 Patient was able to sleep 6 hours without interruption.

 Table 4: Nursing Care Plan

Date/ Nursing Outcome Nursing Orders Nursing Intervention Evaluation/Sign

Time Diagnosis Criteria
03/11/22 Acute Pain Patient`s 1. Assess the level of pain, location, 1. The level, the location, the quality, intensity Goal fully met as

@ (abdomen) comfort will be quality, intensity and relieving factors. and relieving factors of the pain was patient verbalized

10:00am related to restored within 2. Explain to patient the cause of the pain assessed to help manage pain effectively. absence of pain and

semolina 24hrs as to clear any misconception about the 2. The cause of the pain was explained to the looking cheerful in

typhi evidence by disease condition. patient to gain his cooperation during bed.

infection. patient treatment. 04/11/22 @ 10:00am

verbalizing 3. Assist patient to assume a comfortable 3. Patient was assisted to assume comfortable O.A

absence of pain position that would minimize the pain. position.

and looking 4. Serve prescribed analgesics at the

cheerful in right time. 4. Prescribed analgesics were served at the

bed. 5. Check vital signs such as temperature, right time.

pulse, respiration and blood pressure 5. Vital signs were checked and recorded 4

and recorded every 4 hours. hourly to detect any deviation from normal.
 Nursing Care Plan

Date/ Nursing Outcome Nursing Nursing Evaluation/Sign

Time Diagnosis Criteria Orders Interventions
03/11/22 Hyperthermi Patient 's body 1. Check and record patient body 1. Patient body temperature was checked and Goal fully met as

@ a (38.5 temperature temperature. recorded as 38.5 degree Celsius. patient's body

10:00am degree will be restored 2. Reassure patient that with care and 2. Patient was reassured that with care and temperature reduced

Celsius) within 1 hour treatment, his body temperature will treatment, her body temperature will reduce. to 37.1 degree

related as evidence by: subside. Celsius. And patient

systemic Patient body 3. Explain procedure to patient and tepid 3. Procedure was explained to patient and he was calm and

infection temperature sponge her. agree to wash down himself in the bath relaxed in bed.

ranging room. 03/11/22@ 11:00am

between 36.2 4. Open nearby windows and raise 4. Nearby windows and curtains were raised O.A

to 37.2 degree curtains for good air. for good ventilation.

Celsius and 5. Bed cover clothes were removed to expose

5. Remove bed cover cloth to expose
patient being patient's body for fresh air.
patient's body to fresh air.
calm and. 6. Prescribed antipyretic drug e.g. suppository
6. Administer prescribed antipyretic

29
 drugs e.g. suppository diclofenac diclofenac 100mg was given.

100mg

7. Recheck patient`s body temperature 7. Patient's body temperature was rechecked

after 15 to 30 minutes. after 15min and recorded as 37.1 degree

8. Document all procedures. Celsius.

8. All procedures were documented.

Nursing Care Plan

Date/ Nursing Outcome Nursing Nursing Evaluation/Sign

Time Diagnosis Criteria Orders Interventions
03/11/22 Decrease Patient activity 1. Assess the patient's activity level. 1. Patient activity level was assessed. Goals were fully met

@ activity level will be 2. Reassure patient that he is in the hands 2. Patient was reassured that he is in the hand as evidence by:

30
12:10pm tolerance restored within of competent nurses'. of competent nurses' and he will regain her Patient performing

related to 24 hours as activity level within shortest possible time. her activities of daily

body evidence by: 3. Assist patient in planning his care. 3. Patient was assisted to plan his care for living such as

weakness. Patient daily activities such as bathing. bathing and

performing his 4. Schedule care and hygiene activities 4. Care and hygiene activities such as bathing, maintaining oral

activities of as desired by the patient. oral hygiene were scheduled with patient at hygiene with little

daily living 6:30am every day. assistance.04/11/22

(such as 5. Assist and encourage patient to 5. Patient was assisted and encouraged to @ 12:10pm

bathing, oral perform activities of daily living as perform activities of daily living. O.A

hygiene) with tolerated.

no assistance. 6. Supervise patient as he gradually 6. Patient was supervised as he goes through

regains ability to perform all daily daily living activities gradually.

living activities.
7. All procedures were documented in the
7. Document all procedures carried on
nurses' note.
the patient.

31
 Nursing Care Plan

Date/ Nursing Outcome Nursing Nursing Evaluation/Sign

Time Diagnosis Criteria Orders Interventions
03/11/22 Anxiety Patient level of 1. .Assess patients level of anxiety. 1. Patient level of anxiety was assessed by Goal fully met as
evidence by:
@ related to anxiety will be using numerical scale (1-10) where 1 is less
 Patient looking
10:00am unknown allayed within and 10 is maximum and it was 7.
comfortable in
outcome of 24 hours as 2. Identify the cause of anxiety in the 2. The cause of anxiety was identified as the bed.

disease evidence by: patient. unknown outcome of the condition.  Patient

verbalizing
condition a. Patient 3. Patient was educated on his disease
absence of
and class looking 3. Explain condition to patient and condition and she was allowed to ask anxiety.

test. comfortable allow patient to ask questions. questions for clarification. 04/11/22 @
10:00am
in bed. 4. Patient was introduced to other patients that
O.A

32
b. Patient 4. Show patient to other patients that recovered from same condition.

verbalizing have gone through same condition

absence of and recovered.

anxiety. 5. Relatives were encouraged to visit and

5. Encouraged relatives to spend much spend much time with client,

time with client.

6. Provide diversional therapy. 6. Television was put on for patient to

entertain him.

7. Document all procedures 7. All procedure carried on the patient we

documented.

33
Date/ Nursing Outcome Nursing Orders Nursing Intervention Evaluation/Sign

Time Diagnosis Criteria

04 /11/22 Risk for Patient will be 1. Reassure patient not to worry, she 1. Patient was reassured that she was in Goal fully met

@ deficient relieved from will develop appetite for food. competent hands, so she would regain his as evidence by:

12:25pm fluid volume vomiting within appetite very soon. Patient

related to the 24 hours as 2. Remove any nauseated objects 2. All nauseated objects have been removed verbalizing

vomiting evidenced by: from the patient bed side. from patient bed side to avoid stimulation relieve of

a. Patient was of vomiting. vomiting

verbalizing that 3. Assess patient skin for possible 3. Patient skin was assessed to see if patient 05/11/22 @

he is no longer signs of dehydration. is being relieved from vomiting and 7:20am

vomiting. possible dehydration. O.A

4. Ensure intake and output chart for 4. Intake and output chart was ensured to

b. Nurse the patient. know the amount of fluid taking or

observing the excreted for the day

patient skin 5. Encourage patient to drink enough 5. Patient was encouraged to drink enough

turgidity. water. water to restore fluid loss.

6. Check and monitor patient vital 6. Patient vital signs were checked every 4

signs hours.

7. Serve all prescribed medications at 7. Patient diet was planned with his and the

the right time. 34 reasons for the choice of some meals

were explained to him.

35
Date/ Nursing Outcome Nursing Orders Nursing Intervention Evaluation/Sign

Time Diagnosis Criteria

05/11/22 Insomnia Patient sleep 1. Assess the sleep pattern level of 1. Patient`s sleep pattern was assessed to Goal fully met

@ related to pattern will be the patient. help manage his sleep well. as patient

8:00am change of restored within verbalize the

environment 24 hours as 2. Reassure patient that he is in the 2. Patient was reassured that he was in the ability to sleep

(hospitalization) evidence by hands of competent nurses. hands of competent nurses and soon he well throughout

patient able to will be fine. the night without

sleep 6 hours 3. Provide a quiet and dim light 3. A quiet dim light room was provided to interruption for

without environment to induce sleep. patient to induce enough sleep and rest. more than 6

interruption. 4. Assist patient to assume a 4. Patient was assisted to assume a hours. 19/03/22

comfortable position that can comfortable position that can help his to @ 8:00am

induce sleep. sleep well. O.A

5. Provide comfortable bed that is 5. Bed free from creases and cramps was

free from creases and cramps. provided to patient to make his

comfortable in bed.

6. Educate patient relatives about 6. Patient relatives were educated about

visiting time in order to allow visiting time to prevent them from

patient to have more time for sleep disturbing the patient while sleeping.

and rest. 36

7. Document all procedures carried 7. All procedures performed were

37
 CHAPTER FOUR

IMPLEMENTATION OF CARE RENDERED TO PATIENT / FAMILY.

According to Yura and Walsh (1983) implementation is the initiation and completion of

actions necessary to accomplish the define goals of optimal fulfilment of human needs.

Implementation is the fourth step in the process. It involves the use of nursing actions to

render care and solve patient's problems. This chapter includes:

1. Summary of actual nursing care rendered to Mr. S O and his family from the time of

admission to the time he was discharged and left the ward.

2. Preparation of patient / family for discharge and rehabilitation.

3. Follow- up or home visit.

Summary of Actual Nursing Care Rendered to Patient / Family

Day of Admission Of Mr. S O (03/11/2022)

Client was admitted to the emergency ward on the 13rd November at 10:00am on account of

Enteric fever. He was accompanied to the ward a relative and an outpatient department

nurse. Client and his relative were warmly welcomed into the ward. The relative was offered

a seat and the client was admitted into a warm comfortable bed. He was alert and

conscious but looked ill, his relative looked very anxious on admission. On admission, he

presented some complaints which were fever, vomiting, general body weakness, and

abdominal pains.

The client’s folder was collected and cross checked with the name and condition for

confirmation. Client’s particulars such as name, sex, age, occupation of patient, address and

38
religion were documented into the admission and discharge book and daily ward state. His

vital signs were checked and recorded as:

Temperature – 38.5°C

Pulse - 100 beats per minute

Respiration - 83cycles per minute

Weight - 54 kilograms

Blood Pressure − 126/69mmg

Height − 170centimeters

Due to the pyrexia an objective was set to restore and maintain patient’s temperature to the

normal range. The following interventions were put in place; patient body temperature was

checked and recorded as 38.5 degree Celsius, was reassured that with care and treatment, her

body temperature will reduce, procedure was explained to patient and he agree to wash down

himself in the bath room, nearby windows and curtains were raised for good ventilation, bed

cover clothes were removed to expose patient's body for fresh air, prescribed antipyretic drug

e.g. suppository diclofenac 100mg was given, patient's body temperature was rechecked after

15min and recorded as 37.1 degree Celsius. At 11:00am the goal was fully met.

An objective was set to relieved patient of the abdominal pain and restore comfort. The

following interventions were put in place: the level, the location, the quality, intensity and

relieving factors of the pain was assessed to help manage pain effectively, the cause of the

pain was explained to the patient to gain his cooperation during treatment, patient was

assisted to assume comfortable position, prescribed analgesics were served at the right time,

vital signs were checked and recorded 4 hourly to detect any deviation from normal

39
Another objective was set to help restore patient’s activity level within 24hours. The

following nursing interventions were put in place : Patient activity level was assessed, Patient

was reassured that he is in the hand of competent nurses' and he will regain her activity level

within shortest possible time, Patient was assisted to plan his care for daily activities such as

bathing, Care and hygiene activities such as bathing, oral hygiene were scheduled with

patient at 6:30am every day, Patient was assisted and encouraged to perform activities of

daily living, Patient was supervised as he goes through daily living activities gradually and all

procedures were documented in the nurses' note.

General observation done which revealed that client looked very ill; due to the anxious state

of Mr. S.O, he was reassured that his condition was manageable and will improve with the

presence of competent staff. This was done to establish a good therapeutic relationship

between the relative and staff. He was then introduced to other clients on the ward. He was

orientated to the ward and its environment. Mode of payment of hospital bills was also

explained to him and national health insurance scheme was also explained to the relatives.

The following medications for treatment of Mr. S.O were bought from the pharmacy and

were served as prescribed

1. Tab ciprofloxacin 500mg bd x 7

2.Tab metronidazole 400mg tds x 7

3.IV metronidazole 500mg tds x 24

4.IV ciprofloxacin 400mg bd x 24

5. IV morphine 10g tds x1

6.Tab paracetamol 1g tdx5

40
7. IV metoclopramide 10mg tds x1

8. Intravenous fluid Ringers Lactate 1 litre x 24 hours

9.Intravenous fluid Dextrose Normal Saline 500mls x 24 hours

Blood sample taken to the laboratory and results recorded as:

White blood cell count

Haemoglobin level

Widal test

BF for MPS

His valuables were collected and kept in the bedside locker. The mother and relatives were

informed of the normal visiting hours which are 4pm to 6pm and 5am to 7am each evening

and morning respectively. Mr.S O was encouraged to eat well balanced diet, drink enough

liquid and fruits. Mr.S O was reassured of quality care and early relieve of symptoms. Family

members were informed on visiting hours. They were again advised to bring the following;

bucket, soap, washing soap, cloths, pale, brush, a pair of sandals etc, to facilitates his

hospitalization.

First Day Post Admission (04/11/2022).

Mr. S 0 slept well throughout the night and woke up at 5:20am. Abdominal pain and general

body weakness has subsided as well as the body temperature. Patient took his bath and

brushed his teeth. His bed linen was straightened. His medications were served at 6:00am and

recorded. Patient was served with porridge and bread for breakfast at 7:30am. He was

reviewed by Dr.Ntori on routine ward rounds at 9:00am and was put on additional treatment

of drugs, that is; tablet ciprofloxacin 500mg bid for 7 days.

41
At 12:25pm client complains of vomiting and an objective was set to relieve patient of

vomiting. The following intervention were implemented: patient was reassured that she was

in competent hands, so she would regain his appetite very soon, all nauseated objects have

been removed from patient bed side to avoid stimulation of vomiting, patient skin was

assessed to see if patient is being relieved from vomiting and possible dehydration, intake and

output chart was ensured to know the amount of fluid taking or excreted for the day, patient

was encouraged to drink enough water to restore fluid loss, patient vital signs were checked

every 4 hours, patient diet was planned with his and the reasons for the choice of some meals

were explained to him and all procedures were correctly documented.

Mr. S O was served with kenkey and stew with fried fish as lunch at 1:20pm and tolerated

about 70% of it. His prescribed drugs were served and recorded as well as vital signs checked

and recorded at 2pm.

Mr. S O was served with his prescribed medications and his vital signs were checked and

recorded at 6pm. Mr. S O's vital signs for the whole day ranged as follows:

Temperature : 36.5 to 37.2 degree Celsius.

Pulse : 76 to 88 bpm.

Respiration : 22 to 24cpm.

Blood Pressure : 130/70mmHg

Patient Second Day Post Admission (05/11/2022)

Mr. S O slept on and off during night. He woke up at 5:40am and his personal hygiene was

maintained. Nursing interventions were put in place to help patient sleep at night. His bed

linen was changed and he was made comfortable in bed. His medications were served as well

42
as his vital signs checked and recorded at 6am. He was served with spiced porridge with

bread which was not well tolerated. Dr.Ntori came to review his condition at 9am and he

ordered to continue treatment. Patient was encouraged to keep and maintain good personal

hygiene and also to drink a lot of fluid.

Problem of the day was general bodily weakness and loss of appetite. Patient relatives were

encouraged to support patient in activities of daily living. A relaxed and enabling

environment was ensured and privacy was also maintained. Patient was then educated on the

cause, predisposing factors, treatment and prevention of enteric fever in simple language that

he understood. Patient was allowed to ask questions of concern which were addressed

appropriately. Patient knowledge about disease condition was reassessed and he was able to

answer some questions and able to mention some predisposing factors and causes. His due

medications were served and recorded as well as his vital signs were checked and recorded at

2pm in which his temperature was 36.5 degree Celsius.

Mr. S O took beans with fried ripe plantain as lunch and rested for an hour and was taught

about the management of enteric fever. After the teaching, Mr. S O had boiled rice with egg

stew for supper. His due medications were served and his vital signs were checked and

recorded as it ranges as follows in the whole day:

Temperature: 36.3 to 36.8 degree Celsius.

Pulse 62 to 86 bpm.

Respiration: 20 to 24 bpm.

Blood Pressure: 100/60 to 130/80 mmHg.

43
He took his bath without assistance and maintained his oral hygiene. He was made

comfortable in bed whilst enjoying good music from his mobile phone. He slept at 10:45pm

after taking his 10pm medications.

Patient’s Third Day Post Admission (06/11/2022)

Mr. S O slept well with no complaint lodged, he was strong and able to do all activities of

daily living, and he woke up around 5am and ensured all his personal hygiene needs were

met.6am vital signs checked and recorded as temperature 36.3 degrees Celsius, pulse 71bpm,

Respiration 21bpm and Blood pressure 110/60mmHg.Medications served and documented.

Client was reviewed by Dr.Ntori at 9:15am and patient made no complain to doctor on.

Patient was fine.

Preparation of Patient/Family for Discharge and Rehabilitation

Preparation of patient and family for discharge and rehabilitation entails assembling all the

necessary tools and elements and other resources to ensure effective discharge of patient from

hospital to the house. It is essential for every patient and family to be prepared prior to

discharge because the nurse has to ensure that the education and cares rendered to the patient

will help the patient to live a perfect life at home after discharge.

Preparation of Mr. S.O towards discharge started from the day of admission. On the day of

admission, I congratulated him for being a member of the national health insurance scheme.

He was reassured that, his condition can be managed to every good state. Emphasis was laid

on the fact that he could manage his condition if he complies positively with treatment and

medication.

Exercise personal and environmental hygiene was stressed was stressed on. He was also

educated on enteric fever, its causes, predisposing factors, signs and symptoms, treatment and

44
prevention. He and his family were also educated on eating well cooked vegetables, drinking

clean water, fruits (orange, banana and pineapple) and protein (beans, fish and meat) to

enhance her immunity.

A day before discharge, patient and relatives were informed about discharge the next day so

that the family can prepare and put the house in order to receive the patient. Good personal

hygiene such as bathing at least twice daily, oral care, proper hand washing with soap and

water were also stressed.

Finally, on the day of discharge, the need for review was reinforced that it helps assess his

condition to know if he is responding to treatment.

They were also informed to report at the hospital if he experiences any abnormality earlier

before the review date (17/11/22).

He was educated on the medications given to him, which were tablet ciprofloxacin 500 mg bd

for 7 days and Tab paracetamol 1g tds for 5 days; the dosage, therapeutic effects and side

effects such as nausea and dizziness.

They were also reminded of the follow-up visit in his home for continuity of care.

The relatives arranged for a car and he was accompanied to the car and they departed home

and the discharge was entered into the necessary books.

Home Visits or Follow Up

Home visit refers to the follow up visit to the patient's and family in their own environment

so as to see and assess family or resources which were available in the home to ensure

continuity of care. It also gives the nurse the opportunity to educate the patient and family on

behaviours, habits or lifestyles which will expose them to health hazards.

45
First Home Visit (3rd November, 2022)

The first home visit to the patient's place of residence was done while he was in the ward.

The visit was made to Mr. S O`s house at Dentin near Beco Guest House where he lives. The

younger sister met me at the road side and sent me to the house.

My purpose of visiting their home was made known to his as part of the continuity of care of

Mr. S O and the family.

When I got to the house I interacted with the mother and explained to her that my purpose of

visit was to identify any health problem and help in finding solutions to problems identified

using available resources to ensure safe environment before patient is discharged from the

hospital and on permission, I went round the house and realized it was clean.

The patient's house is built with cement block and roofed with aluminium sheets. The house

is four bedroom chamber and hall. The rooms have adequate windows fitted with wire gauze

and net. The occupants of the house are Madam P. O, Mr. S O’s younger sister and two other

rooms reserved for the owner of the house. The compound is covered with gravel, bathroom

and the toilet are at the right side of the house and the kitchen is in front of the house. Their

source of water is only pipe-borne which is used for cooking, drinking, washing and bathing.

Their source of light is electricity aside the use of lantern when there is power outage. The

entire house was neat and tidy. They normally dump their refuse at a mass disposal point but

store refuse temporally refuse in a bucket without cover.

46
Madam.P. O and other members of the house were congratulated for keeping the house neat

and encouraged to keep it up. They were educated on the dangers of leaving food items

without covering them such as contamination of food with germs causing cholera, typhoid as

a result of flies getting in contact with food items. The importance of hand washing after

work, after visiting the toilet and even before and after eating was stressed. They were also

educated on good ventilation by opening of windows and raising of curtains to enhance free

flow of air in the room. They were encouraged to sleep under treated mosquito net to prevent

mosquito bite leading to malaria.

The house hold was encouraged to ask questions which were answered appropriately. I

thanked them for their cooperation and support and bade them good bye and left.

Second Home Visit (12th November, 2022)

The second home visit was done on Saturday 12th November, 2022, after the discharged of

Mr. S. O. It was made to enquire and assess patient's progress as far as his condition and

health care are concern. The visit was also made to ascertain whether learning has taken place

as far as education given to them during hospitalization and first home visit was concern and

to remind them of the review date (17/11/2022).

On observation and assessment, learning has taken place since the patient and family has

practice all the things I taught them during hospitalization and first home visit. The house was

kept clean, all utensils were washed and packed and their food items were all covered. Patient

and relatives were congratulated for their cooperation. It was also observed that, patient was

responding to treatment since he no more complain of the abdominal pain and also

improvement in appetite. Patient’s medications were checked and he was congratulated for

keeping to the medication schedule. It was left with two doses; he was encouraged to

continue his medication as prescribed. The importance of exercise, rest and sleep, hand

47
washing and the need to cover food and wash fruits well before consumption was emphasized

and he should continue eating nutritious food.

My next visit was scheduled and I informed them that, it will be the last official visit and

would be to the gentleman on school campus since Mr. S. O would be in school by then. I

thanked them and made them good bye and returned home.

Day of Review (17th November, 2022)

On the review day, I met Mr. S. O at the outpatient department after she called to inform me

of her arrival.

I helped her, to take her folder from the records and accompanied her to consulting room.

After examination, the doctor said Mr S.O has recovered remarkably and asked her if she has

any complain, to which she said no; therefore, the doctor asked her to go home and to report

to the hospital if she encounters any problem. I accompanied her to board a taxi and told her I

will visit her again.

Third Home Visit (19th November, 2022)

The third and last home visit to my client’s house was on the 19 th November 2022 at

11:00am with the aim of terminating care. The entire family expressed their gratitude for the

visit. His general condition had improved as they adhered to all treatment regimen and

education given to them.I expressed my gratitude for their maximum cooperation and time

during the study and they also thanked me for all my efforts in helping their loved one. The

care was finally terminated and they bid me farewell.

48
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT/FAMILY

Evaluation is the last phase of nursing process which is used to determine the client’s reaction

to nursing interventions and judge whether the goals of the plan have been successful. It

enables the nurse to assess the interventions rendered and change the plan of action for those

which were not fully met. This chapter covers;

 Statement of Evaluation

 Amendment of nursing care plan for partially met or unmet outcome criteria

 Termination of care as well as summary and conclusion

Statement of Evaluation

Mr. S .O was admitted to emergency ward of the St Patrick’s Hospital, Offinso, with the

history of severe abdominal pain, fever, malaise and vomiting. He was diagnosed of Enteric

fever which was managed medically. Patient was nursed using the nursing process; health

problems were identified and nursing care plan drawn to their management. All goals set

were met as expected.

1. patient comfort was restored.

On 3rd November,2022 at 10:00am, an objective was set for patient to restore comfort within

24hours. Goals was fully met as patient verbalized absence of pain and looks cheerful in bed

on 4th November,2022 at 10:00am.

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2. patient’s body temperature was restored.

On 3rd November,2022 at 10:00am, an objective was set for patient that patient temperature

will be restored within 1 hour (36.2-37.2 oC). On 3rd November,2022 at 11:00am, goal was

fully met as patient’s body temperature was reduced to 37.1 oC and patient was calm and

relaxed in bed.

3. patient activity level was restored.

On 3rd November,2022 at 12:10pm, an objective was set for patient to restore patient activity

level within 24 hours. Goals was fully met as patient can perform her activities of daily living

such as bathing and maintaining oral hygiene with little assistance on 4 th November,2022 at

12:10pm.

4. patient’s anxiety level was allayed.

On 3rd of November,2022 at 10:00am, an objective was set that patient level of anxiety will

be allayed within 24hours. On 4th November,2022 at 9:00am, goal fully met as patient

looking comfortable in bed and patient verbalizing absence of anxiety.

5. patient was relieved from vomiting.

On 4th November,2022 at 12;25pm, an objective was set for patient that patient will be

relieved from vomiting within 24hours. On 5th November,2022 at 7:30am, goal fully met as

patient verbalized relieve of vomiting.

6. patient’s sleep pattern was restored.

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On 5th November,2022 at 8:00am, an objective was set for patient that patient sleep pattern

will be restored within 24hours. On 6th November,2022 at 8:00am, goal fully met as patient

verbalize the ability to sleep well throughout the night without interruption for 6 hours.

Amendment of Nursing Care Plan for Partially Met Outcome Criteria

With maximum cooperation and help from Mr. S.O and health staff, the set goals were fully

met thus no amendment was made

Termination of Care

My interactions with Mr. S.O and his family started on the day of admission, thus 3 rdof

November 2022. On admission, Mr. S. O was informed that our interaction was for a short

period and as soon as his health improves, he would be discharged home and our interaction

will continue during home visits. On the 6th of November, 2022, patient was discharged

home and was informed that our daily interactions have ended but he will be visited at home

to continue the care and see how he is coping with treatment after discharge.

During my second home visit, patient and family were told my last official interaction with

them will end on my next visit. Consequently, on my third home visit which was on the 17 th

of

November, 2022 I met Mr. S. O at his residence at around 10:45am which Mr. S. O

expressed his appreciation for the care he received, I also thanked him for his acceptance and

cooperation. I informed him that our meeting and care has officially come to an end. I

encouraged him to go to the hospital if they encounter any problem.

Patient was educated on personal hygiene and the need to eat nutritious diet. We say bye to

each other and I departed.

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 SUMMARY.

Mr. S. O a 24year old gentleman walked into the emergency ward on the 3 rd November, 2022

at 11am accompanied by the mother (Madam P. O). Mr. S .O was seen and admitted on the

orders of Dr Ntori with the diagnosis of enteric fever. Mr. S. O’s history includes; fever,

severe abdominal pains, vomiting (vomit three times every day), which all started for the past

4days.Using the nursing process approach, health problems were identified and a care plan

drawn to provide holistic care for the patient. Patient was managed on the following

medications; IV fluids, analgesia, antibiotics and other treatment. Patient responded well to

treatment and his condition improved satisfactorily. He was discharged home on the 4 th day

of admission. Health problems were identified and nursing process approach was used to

manage these health problems.

Patient and family were visited at home on three occasions for continuity of care. During the

home visits, health education was given on personal and environmental hygiene, good

nutrition, rest and sleep and seeking early treatment in times of sickness.

Finally care was terminated on the third home visit which was on 19 th November, 2022 after

patient’s condition had fully improved. They were congratulated for their cooperation

throughout the care. Our interaction lasted for almost four weeks

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 CONCLUSION

The study of patient and family care has been very challenging, interesting and refreshing

learning experience that offered me the medium to actually put into practice the knowledge

and skills both theoretically and practically acquired during the course of my training. It has

improved my level of knowledge on enteric fever and interpersonal relationship with patient

and family. It also enabled me to nurse the patient to attain the optimum level of wellness

using the nursing process approach.

With the knowledge and skills I have gained, I hope to nurse any patient who would be under

my charge satisfactorily with similar and any other type of disease condition anytime in the

future.

RECOMMENDATION

The patient/family care study has helped me in gaining confidence in rendering selfless and

professional care to clients with same disease condition with little or no supervision

I therefore recommended the idea of patient/family care study as part of the Registered

General Nursing programme to enhance quality assurance of patient care and also to help

nurses to gain confidence when caring for their patient.

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