CHAPTER FOUR

IMPLEMENATING PATIENT/FAMILY CARE PLAN

This is the fourth step in the nursing process and it involves the summary of the

actual nursing care rendered to the patient and family from time of admission to the

time of discharge. The care rendered to the family was in accordance with the nursing

care plan. This chapter involves the following;

1. Summary of the total nursing care rendered

2. Preparation of the patient and family toward discharge, rehabilitation, follow

up/home visit and continuity of care.

A SUMMARY OF THE ACTUAL CARE RENDERED TO MRS. J.N

Nursing care for Mrs J . N. was rendered on daily basis according to patient’s needs. It

was initiated on the day of admission to the day of discharge.

Day of Admission (24th August, 2023 )

Admission of Patient (24TH AUGUST, 2023)

Mrs. J. N. a 34 years old woman was admitted into the female ward of Kumasi South

Hospital through the Accident and Emergency Unit on 24th August 2023 at

4:00pm.She was weak, came into the ward in a wheel chair, in conscious state and

was accompanied by a nurse and her relatives. The relatives were made comfortable

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in a seat and reassured of competent care and speedy recovery. She was admitted into

an already prepared admission bed comfortably and all information needed was

collected from the accompanying nurse and patient and relatives were oriented.

Particulars were collected and filled in the admission and discharge book.

Vital signs was checked and recorded as;

Temperature -36.30 c,

Blood pressure-110/90mmHg,

Pulse- 80b/m

Respiration-22c/m

The following medications were prescribed;

1.Intravenous infusion Ciprofloxacin 400mg bd ×24hours

2.Intramuscular diclofenac 75mg stat

3. Intravenous Infusion Ringers Lactate 2 Litres

4. Intravenous Infusion Normal Saline × 24hours

She was examined by Dr.Forson with history easily fatigue, severe abdominal pain,

vomiting, distended abdomen and constipation. She was finally diagnosed of

Intestinal Obstruction and was booked for Expiratory Laparotomy. They were again

reassured that she will go through the surgery successfully just like other patients and

will be discharge home after she had fully recovered.. Doctor’s instructions were read

through and followed. At 2:00pm patient complains of pain and I reassure that pain

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will subside, patient was put in supine position, and encouraged to have enough rest.

Patient was observed of distended abdomen at 3:00pm and naso-gastric tube was

passed to decompress the gastric content and was attached to drainage bag and hang

to the bed side.

At 3:30pm it was realized that patient was anxious about the impending surgery.

She reassured of the competency of the surgical team and the importance of the

surgery explained to her and how pain wouldl be managed with intra and post

operative drugs. She was encouraged to ask question and also to verbalize her fears.

Her questions were answered tactfully and misconceptions were cleared and she

was introduced to other patients on the ward who have undergone similar surgery and

are recovering well,

All prescribed medication was served and infusion rate was observed and infusion

site also observed for infiltration.

Sample for laboratory investigation requested were collected and sent to the

laboratory were as follows;

1. Full blood count to reveal red blood cell and hemoglobin level estimation

2. Plain abdominal x-ray Erect and Supine to reveal the organs of the abdomen

3.Blood for platelet level estimation

4. Random blood sugar to reveal the glucose level in the blood

5. Blood for Red blood cell count

6. Blood for white blood cell count

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All information was later recorded in the admission and discharge book and also into

the daily ward state. She was prepared physically, physiologically and psychologically

for the surgery.

. I then introduced myself as a final year student nurse at Cape Coast Nurses and

Midwifery Training College who will offer help and also would like to use Mrs. J.

N. for my patient/family care study. It was explain to them that the patient/family care

study forms part of the final assessment for the award of a professional Certificate in

General nursing and therefore needed their cooperation. It was explained to relatives

that this relationship will not last forever but will one day be terminated during the

last home visit. Mrs J. N. agreed and assured me of a maximum cooperation. Mrs. J.

N. brought all items needed for her surgery including head gear, sponge towel tooth

brush, tooth paste and deposited an amount for extra blood, if needed after the

surgery.

she was prepared physically, psychologically and physiologically.

PREOPERATIVE PREPARATION

Psychological Preparation

Mrs. J. N. was reassured of the competency of the surgical team. The need for the

surgery was explained to her. She was introduced to other patients on the ward who

have gone through the similar surgery and other surgeries and are recovering well. It

was explained to Mrs. J. N. that she will be given an anesthetic agent which she

will not feel pain during the surgery and after the surgery, analgesics will be used to

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control the pain. She was encouraged to verbalize her fears and expectations and all

fears were allayed by giving him tactful and honest answers.

She was once again reassured that effective care will be given to her to ensure full

recovery. Patient was assured that his relatives will be allowed to visit him during

visiting hours.

The importance of a concent form was explained to her. She understood and signed

under supervision.

Physical Preparation

Mrs. J. N. was prepared by shaving from the xiphisternum to the mid-thigh, washed

and dried the area using mild soap and water, afterwards an anti-septic lotion

(savlon) was used to clean the area and covered with a sterile towel. She was

informed not take any thing by mouth. An identification band was placed on her hand

with the name, type of surgery, the ward, age and the condition. Patient’s necklace and

ring was removed and kept under lock and key. She was assumed into a hospital

gown. A catheter was passed to empty the bladder. she was encourage to empty the

bowel as well.

Physiological Preparation

Laboratory investigations were carried out to assess Mrs. J. N’s health status and to

rule out any abnormality. These include;Hemoglobin level estimation, blood for

platelet, blood for red blood cell count, blood white cell count, random blood sugar

and abdominal x-ray.

Mrs. J. N’s vital signs was checked and recorded as

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Temperature –37.7oc

Pulse -108b/m

Respiration-24c/m

Blood pressure-124/83mmHg

She was taught how to perform deep breathing and coughing exercises after

surgery to avoid pressure and exertions on the suture lines. He was informed of early

ambulation and its importance. Her naso-gastric drainage bag was emptied of its

content of 450mls and urine bag containing 500mls of concentrated urine were both

emptied and recorded in the nurse’s note.

First day of admission and day of surgery (25th august, 2023).

Patient slept well throughout the night and lodged no complaints, She woke up at

5:30am. She was assisted to maintain her personal hygiene (bathing, brushing of the

teeth etc) and was encourage to move her bowel. 75mls of Greenish fluid was emptied

from the drainage bag and 500mls of urine was also emptied from the urine bag. It

was all recorded in the intake and output chart.

At 6am, the patient vital signs reads;

Temperature 36.7oc

Blood Pressure 120/80mmHg

Pulse 94b/m

Respiration 19c/m

Due medications were all administered. Patient was instructed to take nothing by

mouth. Intravenous normal saline was set up and was dripping well. Pre-operative

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preparation continued as patient was shaved from the xiphiod sternum to the mid-

thigh, it was washed and cleaned with antiseptic lotion and covered with a sterile

towel. All laboratory investigation was attached to the folder, an arm band was put on

patient wrist indicating: name, age, sex, type of operation, ward and diagnosis. Patient

was put into a theatre gown and hair covered with a cap. She was reassured of the

competency of the surgical team, the consent form was explained to the patient and

she was assisted to sign. Patient was reviewed at 9am and she was to continue

treatment and be prepared and sent to the theatre at 9:30am. At 9:30am, the surgical

team called for the patient to be brought to the theatre. She was put on a stretcher and

sent to the theatre. Mrs J. N. accepted that her relatives and I prays with her before the

surgery.

Intra operative care

On 25th August 2023 at 9:30am the surgical suit called female ward for Mrs. J. N. to

be taken for her surgery to be done. She was put on stretcher with all her intra and

post medication checked together with IV fluid and was sent to the theater for the

surgery. At the theatre Dr. Forson and anesthetist assessed the patient physically,

psychologically and physiologically and the intra and post-operative medication were

checked and compared with the orders in the folder. Patient was declared fit for the

surgery. She was placed on the theatre table and was draped by the assistant surgeon.

She was given spinal anesthesia by Mr. Nyantekyi with the scrub nurse assisting in

the procedure, 500mls of Ringers lactate was in situ which was dripping well and a

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catheter was also in situ to help drain urine from the bladder. The surgeon firstly

cleaned the skin of abdomen with antiseptic solution. An incision was made through

the skin of the abdomen and the affected intestine was identified. Another incision

was made through the intestine to get rid of the adhessions causing the

obstruction.The intestine was sutured with an absorbable suture and the abdomen was

also sutured. An estimated amount of 150ml of blood was lost during the surgery. The

incised wound was then covered with sterile gauze and secured with adhesive

tapes. Surgery was completed at 11:45am and patient was sent Female ward.

Immediate Post-Operative care

At 11:45am Mrs. J. N. was brought from theater to the ward in a conscious state after

exploratory laparotomy was done Dr. Forson under Spinal anesthesia

given by Mr. Nyantakyi. On the ward, Mrs. J. N. was put on an already prepared

operation bed in the dorsal position. She came back with intravenous fluid;300mls of

5% dextrose saline and was dripping well, an indwelling catheter connected to urinary

bag with about 200mls of concentrated urine

No bleeding was observed at the incisional site. She was on nil per os and to

monitor intake and output strictly. Her vital signs were monitored every 15minute for

the first one hour, 30 minutes for the next two hours, one hour for 2 hours, then later

four hourly, when condition has improved.

She was put on the following post-operative treatment;

1. Injection metronidazole 500mg×72hrs

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 2. Infusion 5% Dextrose 2litres×48hrs

3. Infusion normal saline 1litre×24hrs

4. Infusion Ringers Lactate 2litre x24 hrs

5. Suppository paracetamol 1g

6. injection morphine 5mg qid x 48hrs

7.Injection ceftriazone 2g bd x 72hrs

She was given water to rinse her mouth and was provided with sputum mug to

expel secretions from the mouth. Mrs. J. N’s drugs were collected from the pharmacy.

At 2:00pm Mrs. J. N. complained of pain at the wound site. She was

reassured that her pain will be reduced within 48hours where level of pain was

assessed using the pain rating scale of 0-10, patient was put in dorsal position without

pillow with the head turn to one side and I encouraged her to watch television.

The incisional site was reassessed for bleeding and tightness. Re-enforcement of

dressing was not done since there was no bleeding. The dressing tightness was also

left as it was since it was not too tight. She was assisted into the supine position to

prevent pressure on the incision site.

Patient was encouraged to exert pressure on wound site when coughing, vomiting and

sneezing to prevent gaping. Prescribed suppository paracetamol 1g was

administered.Patency of drainage tube was maintained.

At 4:00pm Mrs. J. N. was reassured that skin will be intact as the wound heals by

first intention and was educated to keep wound site clean and dry. She was informed

that wound will be dressed aseptically to prevent infection.

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Complete bed rest was ensured and was helped to assume dorsal position to reduce

pressure on wound site. Incisional site was observed for swelling and was encouraged

to do deep breathing exercise to enhance in circulation to promote healing.

Mrs. J. N’s vital signs was checked and recorded at 10:00pm as

Temperature 37.0oc

Blood pressure 120/80mmHg

Pulse 89b/m

Respiration 18c/m

Due medication was given at 10:00pm

1. Injection metronidazole 500mg

2. Infusion 5% Dextrose 1 liter

3. Infision normal saline 1litre

4. Suppository paracetamol 1g

5. Injection morphine 5mg

6. Injection ceftriazone 2g

She was kept warm in bed and was observed to be sleeping, she was provided

with a pillow.

First Day Post – Operative Care, (26/8/2023).

Mrs. J. N. slept well throughout the night and woke up at 5:30am. She was

assisted to take her bath and brush her teeth. At 6am patient vomited 4 times with

estimated volume of 400mls. Patient was assured that measures will be put in place

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for her fluid volume to be restored within 48hours. Her skin and mucous membrane

was assessed for moist and prescribed IV fluid was administered. Her intake and

output was strictly monitored. She was encouraged to sit up in bed and her catheter

been cared for. Her vital signs was checked and recorded as;

Temperature – 37.1o c

Blood pressure –120/90mmHg

Pulse – 94b/m

Respiration – 20c/m

Due medications for 6:00am; IV Metronidazole 500mg, IV Ringers lactate 1litre

and Suppository Paracetamol 1g administered and documented.

During ward round at 8:30am the incision site was observed for bleeding and

signs of infection , but none of these was observed. Mrs. J. N. was assisted into a

comfortable position, her complaints was made to doctor that she vomited in the

morning. Dr. Forson ordered for strict monitoring of her intake and output. She was

advised to keep the wound site dry always and avoid touching the incisional site. The

intake and output was recorded in the intake and output chart. Patient was seen

interacting with other patient in the cubicle. At 10am her vital signs recorded;

Temperature 370c

Blood pressure 120/80mmHg

Pulse 80b/m

Respiration 18c/m

She was made comfortable in bed. At 12:00pm, she was infused with 500mls

Normal Saline and at 2:00pm Injection Metronidazole 500mg was also administered
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.Her vital signs was checked and recorded as follows;

Temperature - 36.9oc

Blood pressure-130/90mmHg

Pulse - 96b/m

Respiration – 22 c/m

At 2:10pm, 200mls of amber urine emptied and recorded in the intake and output

chat.

I encouraged patient to walk around the ward to improve circulations. During visiting

time, patient received visitors from the house and had interaction with them, I had the

chance to interact with some of the family members and asked Mrs. J. N. how she was

recovering from the surgery. She was assisted to perform her personal hygiene at

5:30pm.

In the evening at 6:00pm, she was reassured about competent staffs and her vital

signs were checked and recorded as follows;

Temperature - 37oc

Blood pressure -120/90mmHg

Pulse-96b/m

Respiration-20c/m

Due medications for 6:00am; IV Metronidazole 500mg, IV Ringers lactate 2litres, IV

ceftriazone 2g and Suppository Paracetamol 1g administered and documented.

450mls of urine was observed and recorded, and urine bag was emptied.She was

assisted to maintain her personal hygiene. She watched television and she fell asleep

around 10:30pm and I covered her with top sheet.

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 Second Day Post-Operative Care, (27/08/2023)

Mrs. J. N. had uninterrupted sleep at night, She woke up around 5:00am and

was assisted to maintain her personal hygiene. In the morning at 6:00am, I reassured

and encouraged patient that her skin will be intact as the wound heals by first

intention and educated her to keep wound site clean and dry. She was informed that

wound will be dressed aseptically to prevent infection and to maintain her skin

integrity.

Her 6:00am vital signs checked and recorded as;

Temperature- 36.80c

Blood pressure-120/90mmHg

Pulse - 94b/m

Respiration -20c/m

Her medication at 6:00am; IV Ceftriazone 2g, IV Metronidazole 500mg,

suppository paracetamol 1g and infusion 5% Dextrose 500mls were

served and recorded in the nurse’s note. At 7:30am, her catheter was cared for and

750mls of urine was emptied and recorded in the nurse notes, she interacted with the

other patient on the ward. She said that pain has subsided a little

Dr. Forson reviewed patient in the morning at 9:30am and infusion 5% dextrose

Saline and 1litre Nor mal Saline were added to her medication and ordered to dress

wound the next day. After the ward rounds, I reminded her not to take nothing by

mouth, she was put in comfortable position and was made comfortable in bed.

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 At 10:00am, I had a chat with her for about 2hours during which I educated her

on her condition and also assessed patient’s knowledge, patient was also allowed to

ask question and was answered appropriately. She also had a chart with other patient

at ward and walk around the ward.

At 2:00pm, IV Metronidazole 500mg, suppository paracetamol 1g and Infusion 5%

Dextrose 500mls was served.

Vital signs was checked and recorded as follows;

Temperature - 36.7Oc

Blood pressure-130/90mmHg

Pulse – 88b/m

Respiration -19c/m

At 2:00pm an evaluation on acute pain related to surgical incision was done and goal

was partially met as patient verbalized that pain has subsided, this is because the set

time to achieve goal was too short. The care plan was amended by increasing the

duration set for outcome criteria.

At 3:30pm, Mrs. J. N. wanted to take her bath before visiting hours, I assisted her to

bath and groom nicely and went to stay outside for fresh air. During visiting hours her

friends came of which she was happy to see them and had good interactions with

them. They brought her some provision which she shown it to me.

In the evening at 6:00pm, she was reassured, vitals was checked and

recorded and medications was served. Mrs. J. N. had a chat with other patients in the

ward and also watched television.

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 Medication at 10:00pm was served that is suppository paracetamol 1g was

served and vital signs was checked and recorded. She was made comfortable in bed

and patient slept off.

Third Day Post-Operative, (28/08/2023).

Mrs. J. N. slept well at night and woke up at 5:45am, she was assisted to bath and

brush her teeth. Catheter was cared for and 450mls of urine was emptied and recorded

in the nurse’s note

Vital signs checked and recorded as at 6:00am

Temperature - 370 c

Pulse - 94b/m

Blood pressure -120/80mmHg

Respiration - 19c/m

Due medication serve and recorded in the nurse’s note.

At 7:00am, patient was at risk for wound infection as a result of the incisional

wound. She was reassured that wound will be free from infections. Wound will

be dressed aseptically using methylated spirit. Adequate food rich in protein and

vitamins would be served to help in wound healing and wound was observed for

discharges. Her vital signs was checked and recorded and assisted into her

comfortable position in bed and observations was documented in the nurse’s

note.

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 She complained of her first flatus after surgery and I reassured her bowel sound

has returned. Her medications were served and recorded in the treatment

sheet. Her medications; IV Ceftriazone 2g, IV Metronidazole 500mg,IV Morphine

5mg and Infusion 5% Dextrose 500mls were served and recorded in the nurses

note. Her wound was dressed with methylated sprit.

During ward rounds at 9:30 the doctor was informed that the patient

has passed first flatus and was reassured that her bowel sound has returned. She can

take liquid diet and doctor ordered to remove catheter and also placed her on

additional medication; tablet metronidazole 500mg tds x 5 and tablet

ciprofloxacin 500mg bd x 7. After ward rounds catheter was removed and was

documented in the nurse’s note.

Patient was assumed into her comfortable position, and was given water to drink, she

again took plain tea and had conversation with another patient in the ward. Patient’s

folder was sent to the dispensary to collect the drugs. She was happy because of her

progression in her condition, Infusion 5% Dextrose Saline 500mls was served at

12:00pm. She went outside for fresh air.

At 2:00pm vital signs was checked and recorded as follows;

Temperature -37.00c

Blood pressure -130/90mmHg

Pulse -96b/m

Respiration - 19c/m

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She called her relatives to bring her food and relatives brought porridge which she

took small portion of the food, whiles relative were going home I asked permission

from the nurses in charge and relatives to go with them to their home to familiarize

myself to their environment.

She maintained her personal hygiene and groom well and was in hurry to watch

television.

In the evening at 6:00pm, her vital signs were checked and recorded in the nurse’s

note and patient watched television with other patients.

10:00pm medication was given and recorded in nurse’s note and vital signs was

checked and recorded as well

Temperature – 36.90c

Blood pressure -120/90mmHg

Pulse -96b/m

Respiration - 20c/m

She was able sleep after the checking of vital signs at 10pm.

Fourth Day Post- Operative, ( 29/08/2023)

Mrs. J. N. slept well during the night. She woke up at 5:30am

and maintained her personal hygiene assisted. Mrs. J. N. was served with one

cup of tom brown of which she was able to eat quarter of it. Her 6:00am

medications reads; tablet Metronidazole 500mg and tablet Ciprofloxacin

500mg was served. Her vital signs were checked and recorded at 6:00am and

were found within normal ranges.

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 Mrs. J. N. complained of not being able to care for herself at 7:30am. She was

assured that measures will be put in place for her to perform self-care activities.

She was educated on how to perform self-care (bathing, oral care and grooming)

without causing any general body weakness and I also ensured enough bed rest

and muscle strength was assessed.

At 9:30am, Dr. Forson reviewed patient. Her incision site was observed and

was to continue with treatment.

At 2:00pm, patient was served with tablet Metronidazole 500mg. Her vital

signs for 2:00pm were checked and recorded and were found within normal

range.

I had a chat with patient and I educated her to eat balance diet which will help in

wound healing. Visitors came around at visiting hours whom they were those

she do business with, they engaged her in some conversation. She bid them

goodbye and took her bath after they had left.

Patient maintained her personal hygiene with assistance and was served with

300mls of white porridge and banana of which she was able eat all the meal

served at 5:30pm.

At 6:00pm vital signs were checked and recorded and were found within normal

range. Due medication, tablet Ciprofloxacin 500mg was served and recorded.

Patient was served with tablet Metronidazole 500mg at 10pm and recorded in

treatment sheet.

She was able to sleep around 10:30pm.

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 During the day, patient’s vital signs were checked and have been group as

follows;

Temperature 36.6 - 36.70c

Blood Pressure 120/80mmHg

Pulse 84b/m-86b/m

Respiration 18c/m – 19c/m

Fifth Day Post-Operative, (30/08/2023)

Mrs. J. N. slept well during the night and woke up around 5:30am, she was

fully conscious and oriented. She performed her personal hygiene and was well

groomed in bed, she looks cheerful and happy. At 6:00am vitals was checked

and recorded and was found within normal range.She was served with a cup full

of rice porridge,wheat bread at 6:30 and she was able to eat all. Due

medications were administered that is tablet metronidazole 500mg and

ciprofloxacin 500mg and was recorded in patients treatment sheet.

She was engaged in a conversation with the ward staffs, she looks cheerful

and complain of no pain. She was reviewed around 8:30am by Dr. Forson during

ward rounds and she was to continue her medication. Her 10:00am vitals were

checked and recorded and was found within normal range.

At 10:00am she complained of nausea and did not have appetite for food and I

reassured patient that with competent nursing care, she will be able to maintain

normal nutritional balance within 24hours. She was encouraged to sit up in bed
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when eating, rinse her mouth before and after eating and all nauseating items (bed

pan) were removed, food was planned with patient and patient meal was served

with food rich in calories (boiled rice and kontomire stew)

In the afternoon at 12:00pm she was served with a bowl full of rice and soup with

banana and orange of which she was able to eat half of the meal served. She was

engaged in conversation and later took a nap.

She woke up from bed at 1:30pm and was served with rice ball and soup with

two oranges of which she was able to eat all.

At 2:00pm, patient’s vital signs were checked and recorded and were

found within normal range. Due medication were also served and

documented. She watched television after which I had a chat with her and I

educated her on the need to maintain personal hygiene and nutritional balance at

2:30pm. Mrs. J. N. was asked of what she will take for supper and she preferred

taking light soup and rice. She was served with what was planned with her. She

had her bath and her relatives came to visit her at visiting hours, she was glad to

see them.

At 6:00pm, her vital signs was checked and recorded and was found within

normal value. Due medication for 6am was also served and

documented. She watched television and slept around 9:00pm.

Patient’s vital signs recorded throughout the day had been arranged and grouped

as follow;

Temperature

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 36.80C – 37.00C

Blood Pressure 120/80mmHg – 130/90mmHg

Pulse 82b/m – 86b/m

Respiration 18c/m – 20c/m

Sixth Day Post-Operative, (31/08/2023)

Patient woke up at 6:20am; she looked cheerful and comfortable in bed. She said

she had a sound sleep with no interruptions and she felt much better. She performed

her personal hygiene unassisted and had no complaints. She informed the nurses on

duty that she passed semi solid stool in the morning. Her wound was dressed

aseptically, wound look clean and dry. Her vital signs were checked and it recorded

within normal range, and medication was given and recorded in the treatment

sheet. After which I also educated on the need to take well nourishing diet which will

promote wound healing such as protein diet, vegetables and fruits and advice not to

eat from outside

During ward rounds, Dr. Forson ordered for her temperature chart and he

observed patient’s vital signs to be normal. Temperature – 37.0 0c, blood pressure -

120/80mmHg, pulse -89b/m, respiration 20c/m. Questions were asked by patient and

she tactfully answered. The doctor later examined the patient’s general condition and

discharged her after a short education on her condition and also she was advised to

avoid strenous activities and to splint the incision site when coughing to prevent the

incisional site from gapping. She was advised to continue her treatment. I helped Mrs.

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J. N. to pack her belongings and she called her brother to come and pick her home.

Necessary arrangement was done to enable them to leave to the house. She had

already maintained her personal hygiene.

Her vital signs were checked and recorded

Temperature – 370c

Blood pressure – 120/80mmHg

Pulse – 82b/m

Respiration – 18c/m

Her medication; tablet ciprofloxacin 500mg and tablet metronidazole 500mg

were served.

Mrs. D.Y’s discharge papers were duly signed by the doctor. Her diagnosis and

date of discharge was entered in the admission and discharge book. Her National

Health Insurance scheme papers were cross-checked and all necessary corrections

made. Her drugs to be taken home were given to her and the necessary education as to

how she will take the drug was given to her and the importance of completing the

doses of all medications were also taught.

She was reminded of review date which is 07/08/2023 and its importance. She

expressed her sincere gratitude to all patients and staffs on the ward. I promised to

visit her and the family one day which will be my second visit to them and also

thanked her for her cooperation with me, they left the ward around 12:40pm and I

escorted them to where they would pick a car and said goodbye and left to the ward. I

discarded her bed linen and disinfected the bed.

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 Preparation of Patient and Family for Discharge and Rehabilitation

Preparation of my patient for discharge and rehabilitation started on

her first day on the ward till discharge. This was aimed at restoring and maintaining

good health,prevent reoccurrence of the condition and to prevent complications. The

patient and her family were educated on the causes, predisposing factors, signs and

symptoms, complications and the prevention and rationale behind all nursing and

medical management of her condition.The need to seek prompt medical attention if

any family member begins to show such signs and symptoms. Education was also

given on the importance of eating a well-balanced diet to help boosting up

her immune system. They were once again educated on the treatment regimen and the

need to continue the treatment at home and the need to honour the review

date 07/08/2023.

Four days prior to her discharged, I made a home visit to familiarized myself with

the family and community members. I assessed the home and the environment and

provided the needed health education was given.

On Thursday 31st August 2023, Mrs. J. N was discharged by Dr. Forson, she was

asked to come back in a week time for review. I informed them that two home visits

would be made to ensure continuity of care. I also informed Mrs. J. N. I will

hand over to the community nurse at Agogo

I helped in packing her belongings. They expressed their gratitude towards the care

given and I also thanked them of their co-operation. Mrs. J. N. was discharged from

the admission and discharge book and the daily ward state.

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 Follow Up/Home Visit/ Continuity of Care

Home visiting is done to familiarize one’s self with the patient in her home and

environment and get acquainted with the health needs of both the patient and

family. It also helps to identify any health problem that may interfere with the health

of the patient after discharge. This creates a chance for counseling and educating the

family and others on health issues.

First Home Visit, (28/08/2023).

My first home visit was made on Monday, 28th August 2023 at

1:30pm whiles my patient was still on admission. I went home with Mrs. J. N’s

relatives after visiting hours. I was welcomed by the family on arrival and I was

offered a seat. There was a brief introduction and they were informed about the

purpose of my visit; thus to familiarize myself with the home environment and the

community, to identify some health problems and help them solve them, to prepare

the house for the discharge of my client and also to confirm validity of data collected

from Mrs. J. N. She lives with her family at New Edubiase. They live in a two bed

room house built with cement blocks and roofed with aluminum sheet. They have

their kitchen built separately, they have toilet and bath built separated from

house. They were advised to get a big basket with a cover where they can keep their

food stuffs to avoid rodent’s infestation. They were commended for keeping their

surroundings neat. There is also a hole dug behind the bath room that conveys the

water into the gutter. They were advised to ensure the free flow of the water from the

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bathhouse to prevent the breeding of mosquitoes. They were also advised not to

allow Mrs. J. N. to lift any heavy object and also they are to ensure that paths to the

rooms and outside should be clear and free from any obstruction.

The family was educated on the causes, signs and symptoms, management,

preventions and complications of Intestinal obstruction. They were allowed to ask

questions which were answered tactfully and honestly. At 3:45pm, I asked permission

to leave and promised to be back when Mrs. J. N. is discharged. I thanked them for

their warm reception and said goodbye to them.

Second Home Visit, (03/09/2023)

The second home visit was made a week after the firsthome visit and 3 days

after the discharge of Mrs. J. N. The purpose of this visit was to remind them of the

review date and also to assess my client’s response to the medications.

I arrived at 10:25am and I was received into the house by patient’s daughter, I was

welcomed and we engaged in a conversation on how she was faring after the

surgery. I sought permission from her and examined her wound site, and there were

no signs of infection, it was very neat and she had no complains. Her medications was

inspected and it was found that she was complying. Again the importance to maintain

good hygiene and to eat nutritious diet was emphasized. The need for her to visit the

ward for dressing of the wound and the date of review was stressed on. She was

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informed that my next visit would terminate the care and will hand over to a

community nurse to continue with the care.

Third Home Visit, (10/09/2023)

My third home visit was made on 10th September 2023 around 3.00pm which was

sunday. The purpose of this visit was to thank them for their cooperation and to hand

her over to the community health nurse who will continue with the care.

On arrival she was eating supper in the kitchen with her

children . They offered us a seat beside her and they were very happy to see us. We

were warmly welcomed and I asked about how she is faring. Wound was inspected, it

was healed with a very little scar and had no drugs left with. I told her to report any

detection of abnormalities to the hospital immediately. I encouraged the family to give

assistant to Mrs J. N. until she fully recovers. I still encouraged her to eat a balanced

diet. I handed over Mrs J. N. to the community health nurse who lived in their area

and she assured her of continuity of care. I thanked her and the family for

their cooperation for granting me the opportunity to use them for my study. They also

thanked me to show their appreciation, she was advised to report any kind of sickness

to the hospital for immediate intervention, avoid over the counter drugs and to avoid

the use of herbal medicine. We sought their permission to leave, they saw us off and

bade us goodbye

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