Care Study Chapter 3 (Stella) (Full Work)

CLIENT/FAMILY CENTERED CARE STUDY
ON A CLIENT WITH
PULMONARY TUBERCULOSIS
BY
STELLA AMANKWAA AGYEMANG
UGW 0502211454
A FINAL YEAR STUDENT OF CATHOLIC UNIVERSITY OF GHANA-
FIAPRE, SCHOOL OF PUBLIC HEALTH NURSING
SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF
GHANA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR

THE AWARD OF REGISTERED COMMUNITY NURSING
CERTIFICATE
MAY 2024
i
PREFACE
According to Henderson "the unique function of the nurse is to assist the individual, sick or
well in the performance of those activities contributing to health or it's recovery (or to a
peaceful death) that he or she would perform unaided if he or she had the necessary strength,
will or knowledge and to do this in a way to help him or gain independence as rapidly as
possible" (Henderson,1966) Nightingale also define nursing as" the act of utilizing the
environment of the patient to assist him in his recovery" (Nightingale,1860).Miss Nightingale
focused on the importance of healthy environment for patients. Trends in nursing have
undergone systematic development over the years. Currently, the holistic approach is being
emphasized. The nursing process has therefore become the bedrock of nursing care activities.
The nursing process is systematic rational method of planning and providing nursing care.
The family centered care study is a report of the comprehensive care given to the client and
the interaction that occurred between the client and family within a specific period. It helps to
get more details about the cause, risk factors, incidence, signs and symptoms, diagnostic
investigation, management, prevention of certain conditions. It also enlightens the study nurse
on the general care given to the client being physical, psychological, socioeconomic and
spiritual needs. In order to carry out the care study, a thorough assessment of the client is
done. Through this care, the student nurse derives the opportunity to improve upon his/her
ability to identify individuals with problems, and make necessary interventions as well as
skillfully render care to the client using the knowledge acquired by the student nurse during
his or her training period.
The curriculum for the registered community nursing ensures that student nurses identify a
client with a chronic disease, plan with the client and his or her family and using the nursing
process, render care to the client. The family centered care study is a project work submitted
to the Nursing and Midwifery Council, Ghana in partial fulfillment of the requirement for the
award of registered Public Health Nursing (RPHN) Certificate.
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ACKNOWLEDGEMENT
I thank the almighty God for granting me life, strength, wisdom, and protection to complete
this assignment. Much gratitude and thanks also go to my client, A.E and his family for their
time, support and the needed information they gave me during the study. I also acknowledge
various authors and publishers of textbooks I used in writing this family centered care study. I
also express my sincere gratitude to my DEAN, Dr. Dominic Doglikuu and my supervisor, for
their guidance and support, Prof. Prudence, not forgetting the other tutors on campus for their
assistance. I also acknowledge the advice and motivation from my friends, classmate, for their
financial support and words of encouragement throughout the period of study. I say God bless
you all.
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DECLARATION
I declare that this client/family centered care study was carried out by me under the
supervision of Mr. Dominic Amoah in partial fulfillment of the requirement for the award of
BSc in Public Health Nursing.
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TABLE OF CONTENT
CONTENT PAGES
PREFACE………………………………………………………………………………….i
ACKNOWLEDGEMENT…………………………………………………………………ii
DECLARATION………………………………………………………………………….iii
TABLE OF CONTENT………………………………………………………………......iv
LIST OF TABLES………………………………………………………………………..vi
INTRODUCTION………………………………………………………………………..viii
CHAPTER ONE…………………………………………………………………………1
INTRODUCTION………………………………………………………………………. 1
ASSESSMENT OF THE CLIENT/FAMILY…………………………………………… 3
CLIENT’S PARTICULARS…………………………………………………………….. 3
IDENTIFICATION OF CLIENT………………………………………………………... 4
FAMILY HISTORY…………………………………………………………………….. 4
CLIENT’S MEDICAL/SURGICAL HISTORY………………………………………… 5
CLIENT’S FAMILY SOCIAL-ECONOMIC HISTORY…………………………………5
CLIENT’S DEVELOPMENTAL HISTORY…………………………………………… 5
CLIENT’S HOBBIES AND LIFE STYLE……………………………………………… 6
PAST MEDICAL HISTORY………………………………………………………………6
CLIENT’S PRESENT MEDICAL/SURGICAL HISTORY………………………………6
CLIENT CONCEPT OF ILLNESS………………………………………………………..7
VALIDATIONS OF DATA……………………………………………………………….7
PROBLEM IDENTIFIED…………………………………………………………………7
OBJECTIVES………………………………………………………………………………9
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GENERAL OBJECTIVES…………………………………………………………………9
SPECIFIC OBJECTIVE…………………………………………………………………….9
CHAPTER TWO………………………………………………………………………….10
LITERATURE REVIEW OF THE CONDITION…………………………………………10
INCIDENCE OF TUBERCULOSIS……………………………………………………….10
PUBLICHEALTH IMPORTANCE OF TUBERCLOSIS…………………………………10
CLINICAL MANIFESTATIONS………………………………………………………….11
COMPLICATIONS……………………………………………………………..…………..16
DIAGNOSTIC INVESTIGATIONS……………………………………………..…………16
MEDICAL TREATMENT……………………………………………………………….…..17
DRUGS FOR TB TREATMENT…………………………………………………………..17
PREVENTION OF TUBERCLOSIS…………………………………………….…………19
NURSING MANAGEMENT AND CLIENT EDUCATION……………………………...22
ANALYSIS OF DATA……………………………………………………………………..24
CLINICAL MANIFESTATIONS………………………………………………………….24
DIAGNOSTIC INVESTIGATIONS………………………………………………….……25
TREATMENT REGIMEN…………………………………………………………………25
CHAPTER THREE…………………………………………………………..……………26
HOME VISITS AND NURSING CARE PLANS………………………………..…………26
SPECIAL HOME VISIT……………………………………………………………………..27
AIMS OF HOME VISIT……………………………………………………………….….27
ADVANTAGES OF HOME VISIT ………………………………………………………28
HOME SITUATION………………………………………………………………..………28
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CHAPTER FOUR………………………………………………………………………57
SUMMARY……………………………………………………………………………...57
CONCLUSION…………………………………………………………………………..59
RECOMMENDATION…………………………………………………………………..59
LIST OF TABLES
TABLE PAGES
TABLE1; RECOMMENDED TREATMENT REGIMEN FOR TB………………………18
TABLE 2; THE TABLE BELOW INDICATES A COMPARISON OF SIGNS AND
SYMPTOMS OF TUBERCULOSIS IN LITERATURE AND THOSE MANIFESTED BY
THE
CLIENT……………………………………………………………………………………..24
TABLE 3; THIS TABLE BELOW SHOWS A COMPARISON OF DIAGNOSTIC
INVESTIGATIONS OF TUBERCULOSIS IN LITERATURE AND THOSE CARRIED
OUT ON
PATIENT………………………………………………………………………………25
TABLE 4; THE TABLE BELOW INDICATES DRUGS IN LITERATURE COMPARING
WITH DRUGS USED IN TREATING CLIENT WITH TB………………………….…..25
NURSING CARE PLAN
TABLE 1: NURSING CARE PLAN FOR FIRST HOME VISIT……………………..….31
TABLE 2; NURSING CARE PLAN FOR SECOND HOME VISITON…………………33
TABLE 3; NURSING CARE PLAN FOR THIRD HOME VISIT……………………….34
TABLE 4: NURSING CARE PLAN FOR FOURTH HOME VISIT…………………….38
TABLE 5: NURSING CARE PLAN FOR FIFTH HOME VISIT………………………..41
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TABLE 6: NURSING CARE PLAN FOR SIXTH HOME VISIT……………………….44
TABLE 7: NURSING CARE PLAN FOR SEVENTH HOME VISIT…………………..47
TABLE 8; NURSING CARE PLAN FOR EIGTH HOME VISIT……………………….49
TABLE 9; NURSING CARE PLAN FOR NINETH HOME VISIT……………………..51
TABLE 10: AMENDMENT TABLE……………………………………………………..55
APPENDIX
TABLE 11; PHARMACOLOGY OF DRUGS USED…………………………………….60
REFERENCES……………………………………………………………………………..60
SIGNATORIES…………………………………………………………………………….62
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CHAPTER ONE
INTRODUCTION
According to Henderson "the unique function of the nurse is to assist the individual, sick or
well in the performance of those activities contributing to health or it's recovery (or to a
peaceful death) that he or she would perform unaided if he or she had the necessary strength,
will or knowledge and to do this in a way to help him or gain independence as rapidly as
possible" (Henderson,1966) Nightingale also define nursing as" the act of utilizing the
environment of the patient to assist him in his recovery" (Nightingale,1860).Miss Nightingale
focused on the importance of healthy environment for patients. Trends in nursing have
undergone systematic development over the years. Currently, the holistic approach is being
emphasized. The nursing process has therefore become the bedrock of nursing care activities.
The nursing process is systematic rational method of planning and providing nursing care.
The family centered care study is a method used in rendering nursing care to patient and
family with the involvement of the family members using home available resources. In
rendering this nursing care, the nursing process approach is used. The family centered care
study also gives the student more insight to the condition in which the student writes. This
client and family centered care study is a detailed nursing care rendered to Mr A.E a 36 years
old man who was diagnosed of Tuberculosis.
Nursing process is described as the systematic, rational method of planning and providing
nursing care. Its goal is to identify a client health care status, the actual or potential health
problems, in order to establish plan to meet the identified needs and to deliver specific nursing
interventions to address these needs. It consists of five phases that is assessing the client and
family, diagnosing their health needs, planning, implementing and evaluating the
effectiveness of the nursing care based on the assessed status and health concerns of the client
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and family as a whole. It uses basic solving methodology known as nursing care plan
designed to meet the needs of the particular client and the family.
This family centered care study is on Tuberculosis. Tuberculosis is a chronic disease caused
by a Mycobacterium tuberculosis that affects the lungs, other organs and tissues of the body.
This can happen when someone with the untreated, active form of Tuberculosis cough,
speaks, sneezes, spits, laugh or sings, releasing droplets containing the bacteria. The
symptoms of pulmonary Tuberculosis may include a persistent cough up blood or phlegm,
fever, weight loss, night sweats, and difficult breathing.
The study has been grouped in four chapters, chapter one talks about client’s and family data,
client identification, client’s particulars, family health history, client’s lifestyle and hobbies,
family health history, family socio-economic history, client’s developmental history, client’s
past and present health history, problems identified, SWOT Analysis and objectives.
Chapter two, talks about the literature review of tuberculosis disease which includes;
overview of tuberculosis, definition of tuberculosis, causes, mode of transmission,
predisposing factors, Lab investigations, nursing and medical management, public health
importance, prevention and control and complications.
Chapter three talks about the assessment of the home environment and home visits, problem
identification and the use of nursing care plan to solve identified problems.
And the last chapter deals with the continuity of care, summary, conclusion, recommendation
and bibliography.
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CLIENT IDENTIFICATION
Mr. A.E and I met on Thursday January, 2024 during one of my routine home visits at Tepa. In
the course of our discussion, he alleged that she has been coughing since early December.
Again, he has been experiencing left sided chest pain, headache, fever, bloody cough, difficulty
in breathing and loss of appetite.
According to him, the signs and symptoms continue to aggravate until he visited Tepa
Municipal hospital on 17th January, 2024. Later she was diagnosed as having Pulmonary
Tuberculosis and has been put on medication till now.
I then became much interested in her condition, and made a follow-up visit exactly two (2) days
later and inform her that he would be my special client to assist him in the management of his
condition. The family was informed about Family Centered Care study and explained what it
entails to them. They agreed to cooperate. After which we scheduled a day for my first official
home visit. Mr. A.E. was chosen as my special client for the care study because he had little
knowledge on the condition. It was very necessary to assist him and the family to manage his
condition in order to prevent complications and for him to live a normal healthy life.
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ASSESSMENT OF THE CLIENT/FAMILY
Assessment is a plan of care that helps identifies the specific needs of the client and how it
will be addressed. It is the gathering of information about client psychological, physical,
socioeconomic, medical and social needs. This chapter involves the collection of data from
the client, Family, friends, and neighbours through interviews, physical examination,
Observation, and Medical records. The data collected serves as a benchmark for the
identification of client/family health problems. This chapter comprises the client's particulars,
Family Medical and Socio-economic History, Client Developmental History, Client Lifestyle
and Hobbies, Client Past Obstetric History, Client Past Medical/Surgical History and Client
Present Medical/Surgical History. For confidentiality sake the following initials will be used.
CLIENT’S PARTICULARS
Client Name : Mr A E
Date of Birth. : 07/06/1987
Age. : 36years
Occupation. : Farmer
Marital status. : married
Wife. : A.F
Number of children. : 1 (male)
Home Town. : Tepa
House Number. : ward one
Region. : Ashanti
Language spoken. : Twi , English
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Educational Background : BECE
Allergies. : Not known allergies
Weight. : 54 kg
Diagnosis. : Tuberculosis
Date of admission : 02/01/2024
CLIENT’S FAMILY HISTORY
Mr. A.E is a 36years old man who lives in Tepa in the Ashanti Region of Ghana. Mr. A.E.
was born on 7th June, 1987 to Mr. E. M and Mrs. L.E. According to Mr. A.E he is the third
born of five children born to his parents. My client now lives with his nuclear family that is
his son and wife at Tepa.
FAMILY MEDICAL HISTORY
According to Mr. A. E he lives in an extended family where chronic conditions in the family
such as diabetes, leprosy, and sickle cell disease are not known. However, some of the family
members suffered from hypertension, headache, malaria, diarrhea and others. Mr. A.E went to
his farm and came back late. On the following day he had difficulty in breathing and
coughing. He was sent for local treatment for about two weeks with no improvement. One day
he complained of chest pain, cough and he was sent to Tepa Government Hospital where he
was suspected for tuberculosis based on the signs and symptoms presented, the Doctor in-
charge requested lab investigation and was confirmed of having tuberculosis.
2
SOCIO-ECONOMIC HISTORY
Mr. A.E is from a family where the total number of people in the family counts up to fifteen
people. He further went on to say that, most of them were traders and during the raining
season they farm.
According to him, he does not know how much they earn in a year because they do not keep
records. Mr. A.E is a Christian and all of the family members are Christian. The family gets it
source of drinking water from borehole which is not far from the house, they have bathrooms
in the house but there are no toilet facilities in the house, therefore they go for free range.
CLIENT’S DEVELOPMENTAL HISTORY
According to Mr. A.E, he was born to in the village where health facility was a distance from
his house, therefore his parents did not send him for postnatal. He never took (BCG) vaccines
and polio vaccine at birth.
Mr. A.E started school at 6years, completed his junior Secondary School Education.
He developed secondary sexual characteristics such as deep voice, growth of pubic hair at the
age of Fourteen (14) years.
After completing Junior School, Mr. A.E started working as a farmer and married at age
twenty-eight (28) years. He has one son with his wife, is also working as a farmer at Tepa.
According to my client age and in respect to Erickson’s stage of development, Mr. A.E falls
within generativity verses stagnation which starts from 35 to 55years. At this stage the person
contributes to his or her family, work, and society. This is demonstrated in the raising and
caring for their children, getting involved in productive jobs and also helping the society.
Those who fail to establish this becomes pre-occupied with their own personal needs other
than others such people are said to have acquired a sense of self-absorption. Therefore Mr.
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A.E has succeeded at this stage because he involves himself in the society and also contributes
to his family.
LIFE STYLE AND HOBBIES
During the interaction with Mr. A.E, he wakes up early in the morning around 5:00am, wash
his face with water and clean his mouth with chewing stick and performs his daily activities,
he baths twice in a day thus morning and evening before he goes to bed. What he does most
during his leisure time is his business. He likes banku with groundnut soup. According to him,
he takes banku in the morning and does not smoke nor drinks. However, he uses key soap, or
“azumah blow” depending on which soap is available.
PAST MEDICAL HISTORY
According to Mr. A.E he does not fall sick frequently. He is always active and healthy.
However, there was a time he complaint of fever, headache and general bodily weakness
which was confirmed to be simple malaria when he was taken to the hospital. The appropriate
treatment was given (Artesuanate Amodiquine) and analgesics such as paracetamol to relieve
pain and fever.
PRESENT MEDICAL HISTORY
It all started when there was a climate change in the community where there was cold in the
morning, warmth in the afternoon and cold at night that he started having difficulty in
breathing and cough. It was on 2nd January, 2024 that he started feeling weakness, loss of
appetite, loss of weight and persistent cough. He visited Tepa Government Hospital and he
was asked to undergo laboratory investigation such as blood for full count and sputum for
Acid Fast Bacilli upon which he was diagnosed with tuberculosis. He was put on initial phase
treatment for two months and continuous phase treatment four months under my supervision.
4
CLIENT CONCEPT OF ILLNESS
According to Mr. A. E he has knowledge about his condition. However, he said one of his
grandmothers had such sickness and died of it. He was anxious and thought he was going to
die due to how severe the condition was. The family/client were educated on the cause, signs
and symptoms and preventive measures of the tuberculosis. They were reassured that, T.B can
be cured if only they comply with the treatment.
VALIDATIONS OF DATA
The care study on Mr. A.E went on successfully and this is because information gathered from
family members corresponded with information client gave as he had experienced and as a
matter of fact literature review and information from the hospital on the condition were valid.
PROBLEM IDENTIFIED
 Client had insomnia
 Client complained of loss of appetite
 Client had diarrhea
 Client had general bodily pains
 Client had fever
 Client complained of anxiety
 Client complained of constipation
 Client complained of body weakness
 Client also complaint of productive cough
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ANALYSIS (Strength, weakness, Opportunities and Threat)
STRENGTH WEAKNESS OPPORTUNITIES THREATS
1. Client can sleep well in low noise 1. Client had insomnia  Client is financially 1. Mr. A.E was at risk of
environment 2. Client complained of loss of stable. re-infection and infecting
2. Client can feed himself appetite.  Client had his own other family members due
3. Client had knowledge of managing 3. Client had diarrhoea room to the persistent cough.
diarrhea 4. Client had general bodly pains  Client was not 2. Mr. A.E was exposed to
4. Client is able to walk around to prevent 5. Client had fever stigmatised. Malaria because he was not
complications of immobility 6. Client complained of anxiety  Client has NHIS card. sleeping under the Long-
5. Client had items for tepidsponge 7. Client complained of Lasting Insecticide Treated
6. Client can verbalize the level of constipation Mosquito Net.
anxious 8. Client complained of body 3. Mr A.E was at risk of
7. Client had fruits to relieve constipation weakness developing multi-drug
8. Client has NHIS 9. Client also complained of resistance if he did not take
9. Client can tolerate with cough mixture productive cough. his drugs as prescribed.
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OBJECTIVES
Objectives are expected outcome or results after the Nurse have rendered all the nursing care
to the client. This may be a long or short term objectives. They are in two categories
1. General objectives
2. Specific objectives
GENERAL OBJECTIVES
 To provide effective nursing care to client and family and prevent the spread of the
disease among members in the family and to manage the condition for my client to
gain full recovery.
SPECIFIC OBJECTIVES
By the end of the care, client will be able;
 To familiarized myself with client and family for effective interaction.
 To ensure that client takes his medication
 To educate my client and family on the condition
 To assess the side effects of Mr. A.E ’s medication
 To gain support of the family to cope with Mr. A.E’s condition.
 To prepare my client ahead for follow up
 To educate treatment supporter in assisting Mr. A.E in his medication.
 To hand over client and family to a senior colleague public health nurse for continuity
of care.
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CHAPTER TWO
LITERATURE REVIEW OF THE CONDITION
Pulmonary Tuberculosis is a chronic infectious disease that primarily affects the lung
parenchyma. (Brunner and Saddarth’s Textbook of Medical -Surgical Nursing, 12th
edition) Tuberculosis is an infectious disease that primarily affects the lungs parenchyma.
According to (Nursing Time Servers of Respiratory Disorders): “Tuberculosis is a chronic
infection characterized by pulmonary infiltrations, formation of granulomas (tubercles)
with caseation, fibrosis and calcification. It’s a communicable disease caused by
Mycobacterium tuberculosis. It affects mostly the lungs and other structures of the body
called Extra Pulmonary Tuberculosis. This type of tuberculosis affects any other organ
apart from the lungs. It can affect organs such as lymph nodes (lymphadenitis), the nervous
system (meningitis), bone (osteomyelitis), joint (arthritis), the skin, kidney, and other parts
of the body.
The Mycobacterium bacterium is an acid –fast aerobic rod shaped bacillus that grows
slowly and is sensitive to heat and ultraviolent light. Mycobacterium bovis and
Mycobacterium avium have been rarely associated with the development of a TB infection.
It accounts for more than 80% of all TB cases whiles extra pulmonary TB accounts for
20% of all TB cases
It also may be transmitted to other parts of the body, including the meninges, kidneys,
bones, and lymph nodes.
Incidence of Tuberculosis
Tuberculosis is a worldwide public health problem that is closely associated with poverty,
malnutrition, overcrowding, and inadequate health care. Tuberculosis infects an estimated
one third of the world's population and remains the leading cause of death from infectious
disease in the world. According to the WHO, an estimated 1.6 million death resulted from
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Tuberculosis in 2005(WHO,2007).In the United States, almost 15,000 cases of
Tuberculosis are reported annually to the CDC(2005).
PUBLICHEALTH IMPORTANCE OF TUBERCLOSIS
Tuberculosis (TB) is a potentially serious infectious disease primarily affecting the lungs,
though it can spread to other organs. It is caused by the bacterium Mycobacterium
tuberculosis. TB spreads through airborne droplets when an infected person coughs,
sneezes, or speaks.
Epidemiology
 Global Burden: TB is one of the top 10 causes of death worldwide. According to the
World Health Organization (WHO), in 2020, an estimated 10 million people fell ill with
TB, and 1.5 million died from the disease.
 Geographic Distribution: TB is present in all countries, but over 95% of cases and deaths
occur in developing countries. India, China, Indonesia, the Philippines, Pakistan, Nigeria,
Bangladesh, and South Africa account for two-thirds of the global total.
 High-Risk Populations: TB disproportionately affects vulnerable populations such as
those with HIV/AIDS, malnutrition, diabetes, and those living in crowded conditions like
prisons and refugee camps.
Transmission and Pathophysiology
 Transmission: TB is spread through airborne particles. When a person with active
pulmonary TB coughs, sneezes, or talks, the bacteria are expelled into the air and can be
inhaled by others.
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 Pathogenesis: After inhalation, TB bacteria can remain dormant in the body, leading to
latent TB infection (LTBI). If the immune system fails to control the bacteria, they can
multiply and cause active TB disease.
Clinical Manifestations
 Pulmonary TB: The most common form, with symptoms including a persistent cough,
chest pain, hemoptysis (coughing up blood), fever, night sweats, and weight loss.
 Extrapulmonary TB: TB can affect other organs, causing symptoms specific to the site of
infection (e.g., lymph nodes, bones and joints, meninges, kidneys).
Diagnosis
 Screening and Detection: Diagnostic tools include the tuberculin skin test (TST),
interferon-gamma release assays (IGRAs), chest X-rays, and microbiological examination
of sputum samples (smear microscopy, culture, and molecular tests like GeneXpert).
 Challenges: Diagnosing TB can be challenging in resource-limited settings due to the lack
of laboratory infrastructure and trained personnel.
Treatment
 Drug-Susceptible TB: Standard treatment involves a 6-month course of four antimicrobial
drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) in the initial phase, followed
by two drugs (isoniazid and rifampicin) in the continuation phase.
 Multidrug-Resistant TB (MDR-TB): MDR-TB, resistant to at least isoniazid and
rifampicin, requires longer and more complex treatment regimens with second-line drugs,
which are more toxic and less effective.
 Drug-Resistant TB: Extensively drug-resistant TB (XDR-TB) and totally drug-resistant
TB pose significant challenges and require individualized treatment plans.
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Public Health Interventions
 Surveillance and Monitoring: Accurate reporting and monitoring systems are crucial for
tracking TB incidence, prevalence, and treatment outcomes.
 Prevention: Key measures include:
o Vaccination: The Bacillus Calmette-Guérin (BCG) vaccine, although not fully
protective, is used in many countries to prevent severe forms of TB in children.
o Infection Control: Implementing airborne infection control measures in healthcare
settings and high-risk congregate settings.
o LTBI Management: Identifying and treating latent TB infections in high-risk
groups to prevent progression to active TB.
Social and Economic Impact
 Economic Burden: TB primarily affects adults in their most productive years, causing
significant economic loss due to illness, long treatment periods, and reduced productivity.
 Stigma and Discrimination: TB patients often face social stigma and discrimination,
impacting their mental health and willingness to seek care.
Research and Development
 Diagnostics: Development of rapid, accurate, and affordable diagnostic tests is crucial for
early detection and treatment.
 Treatment: Research into new TB drugs and shorter, more effective treatment regimens is
ongoing to combat drug-resistant TB.
 Vaccines: Development of new, more effective TB vaccines is a priority to enhance
protection against the disease.
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Global Strategies and Partnerships
 WHO End TB Strategy: Aims to reduce TB incidence by 90% and TB deaths by 95% by
2035 compared to 2015 levels.
 Global Fund: Provides funding and resources to countries heavily burdened by TB to
strengthen their TB control programs.
 Collaborative Efforts: International collaborations and partnerships are essential to
advance research, improve access to diagnostics and treatment, and implement effective
public health interventions.
Challenges and Future Directions
 Health System Strengthening: Ensuring robust healthcare systems capable of providing
comprehensive TB care and control.
 Equity: Addressing social determinants of health, such as poverty and malnutrition, which
contribute to TB vulnerability.
 Innovation: Continued investment in research and innovation for new tools and strategies
to combat TB.
 Policy and Advocacy: Strong political commitment and advocacy at the global and
national levels to prioritize TB control and ensure sustained funding.
Conclusion TB remains a major public health challenge, requiring a multifaceted approach
involving prevention, early detection, effective treatment, and addressing social
determinants of health. Coordinated global efforts and innovative solutions are crucial to
achieving the ultimate goal of TB elimination.
Causes of Tuberculosis (www.mayoclinic.org.com)
Tuberculosis (TB) is caused by bacterial (mycobacterium Tuberculosis) that spread from
person to person through microscopic droplets release into the air.This can happen when
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someone with the untreated, active form of Tuberculosis cough, speaks, sneezes, spits,
laugh, or sings affect the lungs.
Predisposing Factors of Tuberculosis
According to (Brunner and Saddarth’s Textbook of Medical -Surgical Nursing,12th
edition) some of predisposing factors of Tuberculosis include:
1. Close contact with someone who has active Tuberculosis.
2. Lmmunocompromised status (eg, those with HIV infection, cancer, transplanted organs
and prolonged high dose corticosteroid therapy)
3. Substance abuse (IV/injection during users and alcoholics)
4. Living in overcrowded, substandard housing
5. Any person without adequate health care
6. Preexisting medical conditions or special treatment (eg, Diabetes, chronic renal failure,
malnutrition, hemodialysis, transplanted organ.)
Types/Classification of Tuberculosis
According to www.healthline.com,we have two types of Tuberculosis
1. Pulmonary Tuberculosis (when it affects the lungs)
2. Extra pulmonary Tuberculosis (T.B outside the lungs)
Active Tuberculosis is contagious and cause symptoms. Latent Tuberculosis on the other
hand, does not cause symptoms and is not contagious.
PATHOPHYSIOLOGY
When a susceptible person inhales mycobacterium and gets infected, the bacterium moves
through the airways to the alveoli, where they are deposited and multiply. The bacilli are
transported via the lymph system and blood stream to others parts of the body (kidney,
bones etc) and areas of the lungs (lungs lobes). The body responds by initiating an
15
inflammatory reaction. Phagocytes (neutrophils and macrophages) engulf many of the
bacterial and tuberculosis specific lymphocytes lyses (destroy) the bacilli and normal
tissue. This reaction accumulates exudates in the alveoli, causing bronchopneumonia. This
initial infection occurs two to ten weeks after exposure. Granulomas (new tissues masses)
of live and dead bacilli are surrounded by macrophages which form a protective wall. They
transform to fibrous tissues mass, the central parts called Ghon tubercle. The bacterial and
macrophages become necrotic, forming cheesy mass. These masses become calcified and
form a collagenous scar. At this time, the bacterial become dormant; there is no
progression of active disease. Active disease may develop because of compromised
system response or occur with re-infection and activation of dormant bacteria.
In this case, the Ghon tubercle ulcerates releasing the cheesy mass into the bronchi. Then
the ulcerated tubercle heals and scars inflamed resulting in further development of
bronchopneumonia and tubercle formation. If not arrested, it spreads to the hilum of the
lungs and later extends to adjacent lobes.
CLINICAL MANIFESTATIONS OF TUBERCULOSIS (Brunner and Saddarth’s
Textbook of medical Surgical Nursing, 12th Edition)
 Couth (the couth maybe nonproductive or mucopurulent sputum maybe expected (
 Weight loss
 Fatique
 Chest pains
 Hemoptysis
 persistent cough with mucus
 Night sweats
16
COMPLICATIONS (www. Uptodate.com)
 Hemoptysis
 Pneumothorax
 Bronchiectasis
 Chronic pulmonary aspergillosis
DIAGNOSTIC INVESTIGATIONS (Brunner and Saddarth’s Textbook of medical
Surgical Nursing, 12th Edition)
 History taking
 Physical examination
 Chest X-ray reveals lungs cavitations
 Tuberculin Skin Test. This involves IM (intra muscular) injection of purified
protein Derivatives (PPD) 0.lm
 Acid-fast bacillus smear
 Signs and symptoms
 Sputum culture
MEDICAL TREATMENT (Brunner and Saddarth’s Textbook of medical
Surgical Nursing, 12th Edition)
Pulmonary TB is treated primary with antituberculosis agents for 6 to 12 months.
Antituberculosis agents commonly used include: isoniazid (INH), Rifampin (Rifadin),
Rifabutin (Mycobutin), Rifapentine (Priftin), Ethambutol (Myambutol), Pyrazinamide.
Recommended treatment quidlines for newly diagnosed case of pulmonary TB (CDC,
2003) have two parts:
1. Initial treatment phase
17
2. Continuation phase
The initial phase consists of a multiple medication regimen of INH, rifampin,
pyrazinamide and ethambutol. The initial intensive treatment regimen is administered daily
for eight weeks. The continuation regimen last for an additional four to seven months.
DRUGS FOR TB TREATMENT
 Isoniazid (H)
 Rifampicin (R)
 Pyrazinamide (Z)
 Ethambutol (E)
 Streptomycin (S)
18
TABLE1; RECOMMENDED TREATMENT REGIMEN FOR TB
PATIENT DEFINITION INITIAL TREATMENT. DAILY CONTINUATION PHASE
CATEGORY (28 DOSES / MONTH) TREATMENT DAILY (28
DOSES /MONTH)
All new cases. New Smear Negative PTB-
concomitant HIV disease EPTB HRZE HR
Previous treated sputum-positive PTB
Relapse treatment after interruption. HRZE+S HRE
Treatment failure.
Children under twelve years
HR2 HR
19
PREVENTION OF TUBERCLOSIS
Prevention of Tuberculosis: Comprehensive Notes
Tuberculosis (TB) is a potentially serious infectious disease that primarily affects the
lungs, caused by the bacterium Mycobacterium tuberculosis. Effective prevention
strategies are crucial in controlling and eventually eliminating TB. This comprehensive
note on TB prevention includes insights from medical books and specialist
recommendations.
 Vaccination: BCG Vaccine
The Bacillus Calmette-Guérin (BCG) vaccine is the primary vaccine for TB prevention.
 Efficacy: BCG is most effective in preventing severe forms of TB in children, such as TB
meningitis and miliary TB.
 Administration: Typically given at birth in countries with a high prevalence of TB.
 Limitations: The vaccine’s efficacy in preventing pulmonary TB in adults is variable,
ranging from 0% to 80% in different studies.
 Early Detection and Treatment
 Screening: Regular screening in high-risk populations, such as healthcare workers, people
with HIV, and those in close contact with TB patients.
 Latent TB Infection (LTBI): Identifying and treating LTBI to prevent progression to
active TB. Common treatments include isoniazid for 6-9 months or rifampin for 4 months .
 DOTS Strategy: Directly Observed Treatment, Short-course (DOTS) ensures adherence to
TB treatment regimens, which is critical in preventing the development of drug-resistant
TB.
20
 Infection Control Measures
 Airborne Precautions: Implementing proper ventilation in healthcare and communal
settings to reduce the transmission of TB bacteria.
 Use of Respirators: Healthcare workers should use N95 respirators when attending to TB
patients.
 Isolation of Active TB Cases: Patients with active TB should be isolated until they are no
longer infectious.
 Public Health Interventions
 Education and Awareness: Public health campaigns to raise awareness about TB
transmission, symptoms, and the importance of completing treatment courses.
 Community Health Programs: Implementing community-based programs to support TB
patients, ensuring they adhere to treatment and reduce the risk of spreading the disease.
 Reducing Stigma: Addressing stigma associated with TB to encourage individuals to seek
timely medical attention.
 Nutritional Support and General Health
 Improved Nutrition: Proper nutrition strengthens the immune system, making individuals
less susceptible to TB.
 General Health: Addressing co-morbid conditions like diabetes, HIV, and malnutrition
that can exacerbate TB.
 Chemoprophylaxis
 Preventive Therapy: In high-risk individuals (e.g., those with HIV or recent contacts of
TB patients), preventive therapy can significantly reduce the risk of developing TB.
Common regimens include:
21
o Isoniazid for 6-9 months
o Rifapentine and isoniazid weekly for 12 weeks.
 Improving Living Conditions
 Housing Improvements: Reducing overcrowding and improving ventilation in homes can
significantly lower the risk of TB transmission.
 Sanitation and Hygiene: Ensuring access to clean water and sanitation facilities to prevent
the spread of TB and other infectious diseases.
 Global and National Policies
 National TB Programs: Governments should implement and strengthen national TB
control programs in line with the World Health Organization (WHO) guidelines.
 Global Cooperation: International collaboration and funding are essential for TB research,
vaccine development, and implementing large-scale prevention programs.
These references provide a comprehensive overview of current strategies and
recommendations for TB prevention from various reputable medical and public health
sources.
NURSING MANAGEMENT AND CLIENT EDUCATION
With reference to Brunner and Saddarth’s textbook of medical - surgical nursing, 12th
edition, the nursing management of tuberculosis can be carried out under the following
headings:
A. Promoting Airway Clearance
 The nurse instructs the patient about correct positioning to facilitate airway
drainage
22
 Increasing the fluid intake promotes systemic hydration and serve as an effective
expectorant.
B. Advocating Adherence to Treatment Regimen
 The nurse teaches the patient that TB is a communicable disease and taking
medication is the most effective means of preventing transmission.
 The nurse instructs the patient to take medication either on an empty stomach or at
least an hour before meals because food interferes with medication absorption
(although taking medication on an empty stomach results in gastrointestinal upset).
 The nurse instructs the patient on the risk of drug resistance if the medication
regimen is not strictly or continuously followed.
C. Observation
 The nurse carefully monitors the vital signs and observes for spikes in temperature
or changes in the patients clinical status.
 The nurse monitors for other side effects of anti-TB medications, including
Hepatitis, Neurologic changes (hearing loss or Neuritis) and rash.
D. Promoting Activity And Adequate Nutrition
 The nurses plan a progressive activity schedule that focuses on increasing activity
tolerance and muscle strength.
 A nutritional plan that allows for small, frequent meals may be required.
 Liquid nutritional supplements may assist in meeting basic caloric requirements.
E. Preventing Spreading Of Tuberculosis Infection
In an effort to prevent transmission of TB to others, the nurse carefully instructs the patient
about the importance of hygiene measures including:
 Mouth care
 Covering the mouth and nose when coughing and sneezing
23
 Proper disposal of tissues
 Propper handwashing
ANALYSIS OF DATA
It describes as the process of comparing or dismantling of data into constituent elements in
order to study the nature or function.
CLINICAL MANIFESTATIONS
TABLE 2; the table below indicates a comparison of signs and symptoms of tuberculosis
in literature and those manifested by the client.
SIGNS AND SYMPTOMS OF SIGNS AND SYMPTOMS
TUBERCULOSIS IN LITERATURE MANIFESTED BY CLIENT
Weight loss Client experienced weight loss
Insomnia Client experienced insomnia
Chest pain Client had chest pain
Persistent cough Client had cough persistently
Night sweats Client had sweats in the night
Fatigue Client had fatigue
Fever Client experienced fever
Anorexia Client had nausea
Head ache Client had headache
24
DIAGNOSTIC INVESTIGATIONS
TABLE 3; This table below shows a comparison of diagnostic investigations of
tuberculosis in literature and those carried out on patient
DIAGNOSTIC INVESTIGATIONS IN DIAGNOSTIC INVESTIGATIONS
LITERATURE DONE WITH CLIENT
Tuberculin Skin Test Client was not tested on this
Three sputum smears for Acid Fast Bacilli test Sputum test was carried out
Chest X-ray Chest X-ray was done
Blood for full blood count It was done
TREATMENT REGIMEN
TABLE 4; the table below indicates drugs in literature comparing with drugs used in
treating client with TB.
DRUGS IN LITERATURE DRUGS USED IN TREATING PATIENT
Isoniazid (H) Present
Rifampicin(R) Present
Pyrazinamide (Z) Present
Ethambutol (E) Present
Streptomycin (S) Absent
25
CHAPTER THREE
HOME VISITS AND NURSING CARE PLANS
According to Offei (2014), home visit is the classic and traditional preserve of the public
nurse. It remains an excellent and most often the only way for the nurse to observe home
situations, family interactions and the various positive and negative forces that operate on
the client. Home visit therefore is the art of making health visit to the home of clients and
families to teach them health living and promoting their confidence in caring for clients at
home, and also assist them in their effort to achieve a higher level of well-being as possible
with the use of home available resources. It is the core of preventive nursing and is carried
out by a public health nurse, community health nurse and other health personnel with
varying objectives.
The objectives of home visit are: it promotes nursing services that the family needs but
cannot provide for itself, help educate the family on current health issues and also for
continuity of care.
Home visit is important because it helps teach the family basic direct nursing care and
make them own their own care in the absence of the nurse. It also serves as a teaching
situation or review of teaching done at the hospital and also it ensures continuity of care
and follow up of discharged patients.
There are two types of home visit
i. Routine home visit
ii. Special home visit
ROUTINE HOME VISIT
It is a type of home visit that is carried out by the health worker to individuals in their
homes to assess their health needs and to render services according to needs identified.
26
During routine home visit, the Nurse goes from house to house to render health services to
his or her clients.
SPECIAL HOME VISIT
It is a type of home visit that is carried out to a person with special disease condition which
is known to the health worker.
In the case of special home visit, the nurse reads the particulars and records and prepares
for that house, so that when he sets out for home visiting, he goes straight to that house to
render specific services.
The type of visit made to my client is a special visit.
AIMS OF HOME VISIT
1. Assessing the living conditions and safety of the home environment: Home visits
allow professionals to evaluate the safety and cleanliness of the home, identifying
potential hazards or risks that could affect the health and well-being of the
occupants. This assessment can help in preventing accidents and ensuring a safe
living environment.
2. Identifying and addressing health and safety concernerns: During a home visit,
professionals can identify any health and safety concerns, such as inadequate
ventilation, exposure to toxins, or poor sanitation. They can then work with the
occupants to address these concerns and safety of the home.
3. Providing education and support: Home visit offer an opportunity for professionals
to educate occupants about health living practices, safety protocols, and ways to
maintain their homes. They can also provide support and resources to help
occupants make informed decisions about their living conditions.
27
ADVANTAGES OF HOME VISIT
1. Home visit improve client outcomes: Home visit allow healthcare professionals to
provide care and support to patients in the comfort and safety of their own homes.
This can lead to better health outcomes, reduced hospitalizations, and improved
quality of life for patients.
2. Reduced healthcare costs: By providing care in the home, healthcare providers can
reduce the need for hospitalizations and other costly healthcare services. This can
help reduce healthcare costs for both patients and healthcare providers.
3. Increased patient satisfaction: Home visit allow patients to receive care and support
in the convenience of their own homes, which can improve patient satisfaction and
reduce the stress associated with receiving healthcare services.
DISADVANTAGES OF HOME VISIT
1. It increased risk of infections: Home visit can increase the risk of infection for both
healthcare professionals and clients, particularly if proper infection control
measures are not followed.
2. It limits access to medical equipment and supplies: Home visit may limit healthcare
professionals’ access to medical equipment and supplies, which can make it more
difficult to provide comprehensive care and support to patients.
3. It increased risk of falls and other accidents: Home visits can increase the risk of
falls and other accidents for both healthcare professionals and patients, particularly
if proper safety measures are not followed.
28
HOME SITUATION
Mr. A.E lives in Tepa in the Ahafo Ano North Municipal of Ashanti Region with his
family members. It is an extended family with about four households. The house is roofed
with aluminum sheets and others are roofed with elephant grasses. He has a kitchen, the
toilet facility in the house is a pit latrine, situated 20 meters away from the building and
bathroom 5 miters from the toilet. Their source of water is from a pipe, The refuse dump is
not far from the house surrounding, therefore rubbish spread around the environment, but
they do sweep every morning. There is no electricity at that area so they use solar.
29
FIRST HOME VISIT 4TH January, 2024
OBJECTIVES
 To familiarize myself with my client and his family
 To assess the health status of Mr. A.E and family
I made my first visit to Mr. A.E and his family on the 4th January, 2024 few days ago after
I had met him at Tepa Government Hospital. I arrived in his house at 8:45am. On entering,
I saw water accumulated at a particular area that is from the bath room. On knocking and
entering the house, that early morning, a good number of them were sitting in the yard.
They offered me a seat and after greeting, I introduced myself as a final year student of the
CUG, PHN and my mission was to provide nursing care, to promote and maintain health
to anyone in the family but particularly to Mr. A.E throughout the period of our interaction.
Mr. A.E was called upon and was told of my mission, they expressed their gratitude and
promised to co-operate fully in all issues concerning Mr. A.E’s condition and I reassured
the family members to allay anxiety and emphasized their role in support Mr. A.Eto get
well. They were educated to keep their environment clean, always to prevent illnesses or
diseases. Mr. A.E encouraged to take his medications regularly to reduce the risk of
passing the disease to others. The family was also encouraged to should avoid
stigmatization and to support Mr. A.E
I checked Mr. A.E.’s vital signs and recorded as follows:
Blood Pressure - 120/80mmHg
Temperature - 37.20c
Pulse - 80b/m and
Respiration - 24c/m.
30
I discussed the results with him and assured him that he will be well. I made it known to
them that, I will be visiting them to check on Mr. A.E until he is through with his treatment
and I promised to come back on the 7th of January, 2024. I thanked them for their time and
cooperation.
PROBLEMS IDENTIFIED
1. Poor drainage of water in the home surrounding
31
TABLE 1: NURSING CARE PLAN FOR FIRST HOME VISIT, 4th January,2024
DATE/ NURSING NURSING NURSING ORDERS NURSING /FAMILY EVALU SIG

TIME DIAGNOSIS OBJECTIVES/ ACTIONS ATION N
OUTCOME
CRITERIA
04/01/2024 Risk for infection Client will remain  Assess client/family  Client/family knowledge on Goal was
8:45am (malaria) related to from infection knowledge level on environment hygiene was fully met
stagnant water in throughout the environment hygiene assessed as
the environment period of  Educate client and family on  Client and family were educated members
interaction. as the importance of keeping the on the importance of keeping remained
evidenced by environment clean. the environment clean. free from
client/family  Encourage client and family to  Client and family were infection
recording no construct a gutter to aid encouraged to construct a gutter and
incidence of drainage. for proper drainage. practiced
infection and  Encourage client and family to  Client and family were adequate
clearing all avoid pouring water in places encouraged to avoid pouring environm
stagnant waters that cannot be properly water on poor drainage grounds. ental
within their home drained.  Client and family were educated cleanline
environment to  Educate client and family not not to throw rubbish into gutters ss.
keep it tidy. to throw rubbish into gutters. to prevent choking of the
gutters.
32
SECOND HOME VISIT 7th January, 2024
OBJECTIVES
 To educate client and family on his condition.
 To assess client and family’s health status.
I made my second visit to Mr. A.E’s house on the 7th January, 2024 as scheduled with the
family the last time I went. I got to the house around 9:00am. Before I entered, I knocked
and with echoing of a response, I entered and greeted them and they offered me a seat and
then called Mr. A.E from the room to come out. From the look of things, they were happy
to see me being there. As usual, I introduced myself and my mission which was for us to
understand the condition, the causes, mode of spread, signs and symptoms, importance of
taking the medications and prevention of the condition.
According to client and family, they had knowledge on the condition. During the
discussion a member asked if he fails to take his medication for a day, what will be the
consequences.I made them to understand that, they are supposed to support and encourage
him to take his medications regularly. It should be the care taker’s responsibility to also
give the drugs and indicate on the yellow card. But in a case where the client defaults, he
will relapse which will be very serious. Mr. A.E was educated that, when coughing, the
mouth should be covered with handkerchief and should wash hands after handling the
sputum. Before the discussion, client complained of not having appetite for food. There
were no more questions so I summarized all that we discussed and thanked them for their
efforts and cooperation. My next visit was communicated to the family which was set for
10th January,2024.
PROBLEM IDENTIFIED
1. Mr. A.E had loss of appetite
33
TABLE 2; NURSING CARE PLAN FOR SECOND HOME VISITON 7th January, 2024
DATE/ NURSING NURSING NURSING NURSING EVALUATION SIGN
TIME DIAGNOSIS OBJECTIVE ORDER /FAMILY ACTIONS
07/01/2024 Risk for Client will maintain a  Assess causes of anorexia  Causes of client’s loss of Goal was fully met as
9:00am nutritional normal nutritional from the client. appetite were assessed evidence by client
imbalance: (less status within 24  Explain to client on proper  Client was encouraged to brush being able to eat half
body hours as evidenced mouth care before and teeth with Pepsodent tooth paste plate of rice.
requirement) by; after meals. and brush before and after
related to loss of Client maintain his  Give fluids diets e.g. light meals. 07/01/24 at 1;30pm
appetite body weight and soup rich in nutrients.  Client was served with fluid
having his normal  Serve food in a clean diet eg. Frutelli juices.
appetite restored. environment  Client was served food. in clean
 Serve prescribed drugs and appetizing environment
such as multivitamin  Client was educated on nutrient
 Educate client on nutrient 4-star diet.
4-star diet.
34
THIRD HOME VISIT ON 10TH January, 2024
OBJECTIVES
 To educate the care taker to ensure Mr. A.E does not default.
On 10th January, 2024, I visited Mr. A.E as scheduled with the family the last time I went
there. I arrived to the house around 9:30am. As usual, I knocked and entered on response.
They offered me a seat after which I greeted them and asked of their health status both my
client and the family. I assessed Mr. A E.’s health status. B/P was 110/60mmHhg,
Temperature 37.4oc, pulse 80bpm and respiration 26cpm. During the assessment, Mr. A.E
complained of insomnia due to persistent cough. He said he coughed throughout the night.
I called for the caregiver from a nearby house, who was educated up to the tertiary level
and could understand certain things about the condition. I educated the caretaker on the
importance of the client taking his medication all the time. This is to prevent relapse of the
disease. As said earlier in the clinic, he confirmed after giving the medication, should tick
on the card. Also, he should wash his hands when giving medication and also to make sure
he gives the drugs into client’s palms without handling it. He was educated on the mode of
transmission, signs and symptoms and how to prevent contracting the condition. I thanked
them for their cooperation and concentration during the discussion and I promised to visit
them on 14th January, 2024.
PROBLEM IDENTIFIED
1. Client had insomnia
35
TABLE 3; NURSING CARE PLAN FOR THIRD HOME VISIT 10TH January, 2024
DATE/ NURSING NURSING NURSING NURSING /FAMILY EVALUATION SIGN
TIME DIAGNOSIS OBJECTIVES/OUTC ORDER ACTIONS
OME CRITERIA
10/01/24 Insomnia related Patient will regain  Reassure client of good  Client was reassured of 11/01/2024 at 9:30 am
9:30am to persistent normal sleep pattern (6- nursing care and that good nursing care that Goal partially met as
cough 8 hours) within 24 hrs his symptoms are will relieve his client verbalized he
as evidenced by temporal and treatable symptoms. only slept for 4 hours
a. client  Serve prescribed  Client was served with continuously.
verbalizing that medication example his prescribed antibiotics
he slept for at antibiotics and and encouraged to
least 6 hours antitussives continue taking them.
and that cough  Assist client to make a
had subsided comfortable bed.  Client was assisted to
b. family members  Encourage client to take prepare a comfortable
verbalizing that a warm bath in the night bed.
client slept to induce sleep.  Client was encouraged
soundly  Encourage family to to take a warm bath in
provide a conducive the night to induce sleep.
environment by opening  Client’s family was
windows and doors for encouraged to provide a
36
fresh air. conducive environment
 Assist client and family by opening windows and
to identify irritants in doors for fresh air.
their home surroundings  Client and family were
and to get rid of or avoid assisted to identify
them. irritants such as smoke,
perfumes, deodorants,
dust etc. and advised to
avoid them to minimize
GIT irritation and cough.
37
FOURTH HOME VISIT ON 14TH January, 2024.
OBJECTIVES
1. To assess the health status of Mr. A.E and family.
I made another visit to my client on 14thJanuary, 2024, around 8:00am. I met Mr. A.E and
his family members in the house. As usual, I asked of their condition of health and they
responded positively. He complained of not having the appetite to take his drugs again
because he is tired with the drugs. I advised him to take them with fruit drinks to reduce the
irritation and bitterness. For example, I advised him to take it with fruits like banana,
orange, or water melon to boost his appetite and he promised to do that.
I congratulated him for his effort and he promised to continue with his drugs for the rest of
his treatment schedule. After all was said and done, the next visit was scheduled on 17 th
January, 2024.
His blood pressure read 120/80mmHg and the temperature was 36.5°C.
PROBLEM IDENTIFIED
Difficulty coping with prescribed drugs
38
TABLE 4 ; NURSING CARE PLAN FOR THE FOUTH HOME VISIT ON 14th January 2024.
DATE/ NURSING NURSING OBJECTIVE/ NURSING NURSING EVALUATION SIGN
TIME DIAGNOSIS OUTCOME CRITERIA ORDERS /FAMILY ACTIONS
14/01/24 Ineffective Client will effective coping  Reassure client about  Client was reassured 15/01/2024 at
08:00am coping with TB medication the condition being that his treatable with 08:00 am Goal
(emotional schedule within 48 hours treatable and temporal. good nursing care. fully met as Mr.
stress) related to as evidence by:  Educate client on the  Client was educated on A.E verbalized
prolonged TB a. Client verbalizing, importance of the importance of that he feels
treatment he feels motivated continuing with the continuing all his motivated to
schedule (intake to continue with his medication. medications. continue his
of medications) medications  Reinforce client and  Side effects of medications and
b. client being family teachings on medication was was assessed to be
optimistic and side effects of TB reinforced in the form positive minded
positive about his medications. of teaching of client about overcoming
condition and  Encourage client to eat and family. his condition while
recovery adequate nutritious diet  Client was encouraged emotionally stable.
39
before taking his drugs. to eat food before
 Reinforce caretaker/ taking his medication.
family teaching on  Effective supervision
effective supervision an monitoring of client
and monitoring client and intake of
taking his medication medication was
reinforced
40
FIFTH HOME VISIT ON 17TH January, 2024
OBJECTIVES
1. To assess the side effects of Mr. A. E’s medications.
2. To assess the health status of Mr. A.E and family.
As scheduled earlier with the client and the family on my next visit on 17th January, 2024, I
got to the house at 9:00am and fortunately on my part, almost every member was present
except a young man that was not at home. They welcomed me on responding to my
greetings, they offered me seat. I told them my mission for that day, which was to assess
the side effects of Mr. A.E.’s medications and to also assess the health status of the family.
During the assessment, everyone was well except Mr. A.E, who complained that, because
of the cough, he feels chest pain and difficulty in breathing. The family was educated on
keeping personal and environmental cleanliness which include keeping their nails short,
bathing, washing their clothing and sweeping the environment to prevent diseases. I was
very happy because they gave me their maximum cooperation.
However, as part of the objectives set for that day, I asked my client as to whether he gets
any reactions to the drugs of which he said there were no reactions. I then monitored his
vital signs and recorded as;
Blood Pressure - 110/80mmHg
Temperature - 37.50c.
They expressed their gratitude for my time and I also thanked them for their cooperation. I
told them my next visit will be on 19th January, 2024.
PROBLEM IDENTIFIED
1. Mr. A.E had difficulty in breathing
41
TABLE 5; NURSING CARE PLAN FOR FIFTH HOME VISIT 17TH January, 2024
TIME DIAGNOSIS OBJECTIVE/OUTCOME ORDERS ACTIONS
CRITERIA
17/01/24 Difficulty in Client will regain comfort Reassure client of good  Client was reassured of 18/01/2024 at
9:00am breathing (dyspnea) within 24 hrs as evidenced nursing care to allay his good nursing care to 10am
related to chest by anxiety allay anxiety Goal was fully
pain a. Nurse checking and Put client in sitting up  Client was put in a achieved as
normal respiration position to aid easy sitting up position to respiration
cycle of Mr. A.E breathing ease breathing. recorded was
b. Client verbalizing Encourage client to have  Client was encouraged 23cpm and client
absence of chest enough rest and sleep. to have enough sleep verbalized that
pain. Encourage client of the and rest. he was relieved
c. Observing client effectiveness and efficacy  Client was reassured of of chest pain and
looking cheerful and of the medications in the effectiveness of looking cheerful
relaxed treating his condition drugs and efficacy of and relaxed as
42
Serve prescribe analgesic the medication in well.
medications such as treating his condition.
Ibuprofen  Prescribed analgesic,
Provide sufficient eg. Tablet ibuprofen
ventilation to aid breathing 400mg tds was served
Administer prescribed  Sufficient room
antitussives eg. ventilation was
Diphenhydramine syrup. provided to aid
Refer him to the hospital breathing
for further assessment and  Prescribe antitussive.
management Eg. Diphenhydramine
syrup 10mls was
served.
 Mr. A.E was not

referred to the hospital
as his condition
improve sooner
43
SIXTH HOME VISIT 19TH January, 2024
OBJECTIVES
1. To assess Mr. A.E and family health status
2. To ensure my client takes his medication and goes for follow ups.
I made my sixth home visit to the family on 19th January, 2024 at 8:00am. I got to the
house, knocked and entered on response. The family members welcomed me and gave me
a seat. I asked of their health and they answered they were doing well. However, I saw Mr.
A.E lying on the floor and looking weak and tired. I greeted him and asked of his health.
He complained of general body pain and that during the previous night he had headache. I
asked if he had taken any medications e.g. paracetamol or Ibuprofen for the headache and
pains? According to him, he took paracetamol which was given to him from the Hospital.
I educated him on how to take the analgesics, this is because, some people are in the habit
of not completing their medications, I advised him that when the headache subsides at
once, and he stops taking the medication he will not get the desired effects.
I checked the vital signs and the Temperature was 38.30c. I asked him to take his bath and
to prepare and go to clinic for checkup. On the part of his medications, Mr. A.E said he
took it regularly. The caregiver, when asked, confirmed it and with the card, he showed it
to me. I congratulated them for doing well. I thanked him and the family and scheduled
my next visit on 21stJanuary, 2024.
PROBLEM IDENTIFIED
1. Mr. A.E complained of general body pains.
44
TABLE 6; NURSING CARE PLAN FOR SIXTH HOME VISIT 19TH January, 2024
TIME DIAGNOSIS OBJECTIVE/ ORDERS ACTIONS
OUTCOME
CRITERIA
19/01/24 Altered body Client will regain  Reassure client that he will  Client was reassured 20/01/2024 at
8:00am comfort (pain and bodily comfort within be well since he is in the competent nursing care 8:00am Goals
fatigue) related to 24 hours as evidence hands of a competent nurse. leading to speedy recovery was fully met as
disease process (TB by client verbalizing  Teach client to assume a  Client was taught to client verbalized
infection) absence of body pains comfortable position in bed. assume a comfortable absence of body
and weakness and  Educate client to eat position in bed. weakness and
nurse observing that nutritious diet to replenish  Client was educated to eat pain and looked
client is calm and energy and repair worn out nutritious diet to aid calm and
cheerful tissues. recovery from condition. cheerful.
 Encourage client to have  Enough rest and sleep was
enough bed rest and ensured for patient.
45
tolerable exercises  Prescribed medications
 Serve prescribed analgesic were served.
e.g. paracetamol or
Ibuprofen and TB drugs
46
SEVENTH HOME VISIT ON 21stJanuary, 2024
OBJECTIVES
1. To assess the health condition of Mr. A.E and family
I went to Mr. A.E’s house on 21 January 2024, my seventh home visit. I arrived around
9:40am. I knocked and entered on response. They offered me a seat and just at that time, a
mother rushed out from her room with a two-year-old girl vomiting. According to the
mother, she said the child had diarrhea the previous night and she gave the child oral
rehydration salt (ORS). Upon assessing the child to be very weak. I rushed the mother and
child to the nearest clinic immediately. After I came back from the clinic, I then greeted
my client and asked of his health specially the last time he complained of general body
pains but he said he was well. I encouraged the family to continue to serve him with
adequate nutritious diets. After the discussion, I thanked them and promised to come back
on 24th January, 2024.
PROBLEM IDENTIFIED
1. Child had diarrhea and vomiting.
47
TABLE 6; NURSING CARE PLAN FOR SEVENTH HOME VISIT 21January,2024
TIME DIAGNOSIS OBJECTIVES/ ORDERS ACTIONS
OUTCOME CRITETIA
21/01/24 Risk for fluid Child will maintain her  Reassure mother of good nursing care  Client was reassured of good 21/01/2024 at
9:40am volume deficit normal fluid volume leading to quick recovery. nursing care leading to speedy 8:50am Goal
related to throughout period of care  Encourage mother to serve child with recovery of her daughter. fully met as
vomiting and evidenced by: light diet and plenty fluids  Client was given nutritious diet. nurse assessed
diarrhea 1. Child having normal  Educate mother on good hygiene  Mother was educated on good child to have
skin turgor and with practices, both personal and personal and environmental normal skin
normal weight environment. hygiene practices turgor with
2. Mother verbalizing child  Serve child with prescribed  Prescribed drugs were given at weight of and
is well without any medication or fluid replacement the clinic whiles ORS therapy mother
episodes of diarrhea and therapy e.g. ORS continue at home verbalized that
vomiting.  Teach mother how to mix and  Mother was educated on how to child was well
administer ORS in hygienically prepare ORS for the child. without any
 Educate mother on malaria prevention  All family members were episodes of
and emphasis sleeping on all educated on the importance of diarrhea or
household members sleeping under sleeping under insecticide vomiting
treated net. treated net encouraged to

practice same.
48
EIGTH HOME VISIT 24TH January, 2024
OBJECTIVES
1. To assess health status of Mr. A.E and family
2. To ensure family members live a healthy life
I made another visit to Mr. A.E’s house on 24th January 2024 around 9:05am. I entered on
response and they welcomed me. On greeting them, a seat was offered to me. I followed
the formality by introducing myself and telling them my mission for that day. I asked of
Mr. A.E’s health, but he complained that, he could not pass stool and also felt pains in the
abdomen. This could possibly be constipation, I told him.
I encouraged him to always take fruits such as oranges, vegetables and other fruits and also
take plenty fluids especially water. I encouraged family members on healthy living habits
by educating to wash hands after visiting the toilet with soap. Keeping the surrounding
clean, and washing bowls and covering it to prevent flies from settling on it.
Also, educate them to take their bath and wash their clothing regularly. I took a look at the
two-year-old girl’s health record book, and her mother did not default in any of her
immunization schedule, I therefore encouraged her to continue till the child attains five
years. I educated her on the importance of that health record book, and how immunizations
prevent diseases in the child as she grows. They expressed their gratitude and happiness.
I checked every one’s vital signs and were within the normal ranges. Mr. A.E.’s blood
pressure was 110/70mmHg, Temperature 36. 50c.I thanked them and promised to come
back on 26TH January, 2024.
PROBLEM IDENTIFIED
1. Client had constipation
49
TABLE 8; NURSING CARE PLAN FOR EIGTH HOME VISIT 24TH January, 2024
DATE/ NURSING NURSING NURSING NURSING / FAMILY EVALUATION SIGN
OUTCOME CRITERIA
24/01/24 Impaired bowel Client’s normal bowel  Reassure client to allay his  Client was reassured to allay 25/01/2024 at
9:05am movement movement will be restored anxiety. his anxiety. 9:05am
(constipation) within 24hrs as evidenced  Encourage client to take  Client was encouraged to take Goals fully met as
related to by: plenty fluids of about plenty fluids and fruits. client verbalized
inadequate 10. Client verbalizing 2.5L/day.  Client was encouraged to take return of normal
intake of fluids that his normal bowel  Encourage client to take light diet and with fruits. bowel movement
and fruits movement is restored light diet and with fruits e.g.  Client was encouraged to without pain and
and that the constipation oranges. walk around after eating or nurse observed
and pain are absent  Encourage and teach client squeeze a ball or sit up for a patient looking calm
11. Client looking to undertake some mild to while after meals. and cheerful
calm and cheerful moderate exercises.  Client was encouraged to take
 Encourage client to continue his medications seriously.
with his medications.
50
NINETH HOME VISIT 26TH January, 2024
OBJECTIVES
3. To prepare Mr. A.E and family for handing over
On the 26TH January 2024, I made second but last visit to Mr. A.E’s house. I got to the
house around 9:40am. I met some members in the house. I knocked and entered upon
hearing a response. They welcomed and offered me a seat. I asked of their health which
they said they were all well.
I told them my mission on that day, which was to prepare Mr. A.E and family for handing
over to another health caregiver. Looking at Mr. A.E facial expression, he was not happy at
all and asked of who this “another care giver was. I explained that, the study was just for a
period of time as I told him months earlier. I assured them of competent nursing care. I
also told them I have already informed him the other care giver by name Mr. D.A and that
she will be coming with me on the next visit. He is a public health nurse who is in-charge
of Tepa Government Hospital .
I was very happy with their cooperation and support for helping me through my study. I
thanked them and promised to come back on 28th January, 20214 which will be the last day
of handing them over to the public health nurse, Mr..D.A But before then, I checked his
vital signs; and recorded them as blood pressure 110/70mmHg, Temperature 37.0c and
respirations.
PROBLEM IDENTIFIED
1. Client had anxiety due to change of caregiver.
51
TABLE 9; NURSING CARE PLAN FOR NINETH HOME VISIT 26TH January, 2026
DATE/ NURSING NURSING NURSING ORDERS NURSING /FAMILY EVALUATION SIGN
TIME DIAGNOSIS OBJECTIVES/OUTCO ACTIONS
ME CRITETIA
26/01/24 Anxiety related to Client will be relieved of  Reassure client and family  Client was reassured of 27/01/2024 at
9:40am change of caregiver anxiety within 24hrs as of continuity of competent continuity of a competent 9:40am Goal
evidenced by client nursing care from taking nursing care. fully met as
verbalizing absence if over officer.  Client and family were client verbalized
anxiety and looking  Encourage client to be co- encouraged to be co- absence of
cheerful and co-operating. operative with incoming operate with new caregiver. anxiety and
nurse.  Client was encouraged to looked cheerful
 Encourage client to ask open up and ask any and cooperative
questions bordering him question bordering him to
about the handing over of the taking over nurse.
care process.  Contact details of new
 Provide contact example caregiver including phone
52
phone number to client. number to client to help
him reach out to caregiver
where necessary.
 Taking over caregiver was
encouraged to create a
rapport and establish
confidentiality with client
to gain her trust
 Client was encouraged to
feel free to keep in touch
with outgoing nurse where
necessary
 Client and family were
educated on importance of
continuity of care
53
TENTH HOME VISIT 28TH January 2024
OBJECTIVES
1. To hand over client and family to Miss C.D the nurse in-charge of Tepa
Government Hospital.
I made my last visit to Mr. A.E’s house on 28TH January, 2024. On arrival with the public
Health Nurse, we knocked and entered on response at 8:00am. They offered us seats, then
we asked of their health and they were all well. I introduced the public Health Nurse to Mr.
A.E and family and vice versa. They welcomed us and exchanged greetings as custom
demands. Earlier, I had told Mr. C.D everything about Mr. A.E and family. He encouraged
him to continue with the medication and promised to visit them regularly. Also, she
encouraged them to feel free to tell him anything bordering them.
I then expressed my sincere gratitude to the entire family, especially Mr. A.E for giving
me the opportunity to use him for my Family Centred study. They also expressed their
gratitude for the time and services rendered to them. I told them, I promised to come once
in a while or call via phone to say hello to them. We all bid each other bye and I left him.
54
AMENDMENT OF CARE FOR PARTIALLY MET GOAL
This occurred in the third home visit on 10TH January, 2024. In the evaluation table goal
was partially met but was finally amended and the goal was partially achieved tuberculosis
comes with cough that persists for weeks and therefore the expected time framed for the
objective was too short for the patient to be able to sleep well without interruptions. For the
benefit of hindsight, the care was amended in the table below.
55
TABLE 10: AMENDMENT TABLE

OUTCOME
CRITERIA
28/01/24 Insomnia related to Patient will regain Reassure client of good  Client was reassured of 29/01/2024 at
8:10am persisted cough normal sleep pattern ( nursing care and his good nursing care that will 9:30am
6 – 8 hours) within 2 symptoms are temporal and relieve his symptoms Goal fully met as
weeks as evidence by treatable  Client was served with his client verbalized
a. Client o Serve prescribed prescribed drug such as he slept
verbalizing that he medication example isoniazid and encouraged uninterruptedly
slept for at least 6 antibiotics and to continue taking them for 6 hours
hours and that cough antitussives.  Client was assisted to continuously and
had subsided o Assist client to make a prepare a comfortable bed family members
b. Family comfortable bed.  Client was encouraged to corroborated
members verbalizing o Encourage client to take a take warm bath in the same proposition
that client slept warm bath in the night to night a warm bath in the of client
soundly induce sleep. night to induce sleep.
o Encourage family to  Client’s family was
provide a conductive encouraged to provide a
environment by opening conductive environment
windows and doors for by opening windows and
56
fresh air. doors for fresh air.
o Assist client and family to  Client and family ware
identify irritants in their assisted to identify
home surrounding and to irritants such as smoke,
get rid of or avoid them. perfumes. Deodorants,
dust etc. and advised to
avoid them to minimize
GIT irritation and cough
57
CHAPTER FOUR
SUMMARY
The client/family centered care study is health care rendered to a client/family based on the
client’s need. This study was conducted on Mr. A E a thirty six year-old man at Tepa in
the Ahafo Ano North District. He was diagnosed of pulmonary tuberculosis. The
objectives of the care study were to guide my client and family to ensure a complete
prevention of the disease “tuberculosis” Some signs and symptoms exhibited by Mr. A.E
were; Weight loss, Persistent cough, sweat at night, Fever, General body weakness,
Insomnia, Fatigue, Chest pains, Nausea.
The study took about One months (4th January, 2024 to 28thJanuary, 2024). The
medication for tuberculosis includes Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and
Streptomycin. I also reviewed literature on the definition, types, incidence. Etiology,
pathophysiology, clinical manifestation, complications, diagnostic investigation, specific
medical treatment, prevention and nursing management of tuberculosis infection. During
my study, ten home visits were made.
My first home visit was on 4th January 2024, with the objective, to familiarize myself with
my client and family and to assess the health status of Mr. A.E and family.
For that visit, the following problems, were identified, poor drainage of water in the
surrounding and anxiety of contracting the disease. They were educated on how to keep
their surrounding clean and prevent the disease.
On the 2nd home visit, it was to educate client and family on the condition, tuberculosis
infection. On that visit, client complained of loss appetite and nausea Mr. A.E was
educated on how to regain his appetite and maintain his normal nutritional status her diet.
On my 3rd visit to Mr. A E’s house I was to educate the family caregiver to ensure that Mr.
A.E does not default. He was taught how to give and tick on the card. Amendment of care
58
was done in the third home visit due to a partially met goal on insomnia. During the fourth
visit, it was to assess the side effects of Mr. A.E medications and to assess the health status
of Mr. A.E. and family. Client did not have any side effect however, she complained of
difficulty in breathing which was managed well. During the fifth visit in 17 January, 2024
the objectives to ensure my client take his medications and goes for follow up visits at the
hospital. He was taking medications regularly. He had general bodily pains. It was
intervened to ensure the pain was relieved.
In the sixth visit on the 19th January, 2024 the objective was to assess the health condition
of Mr. A.E and family. A problem identified was a child who had diarrhea.
On the seventh visit, this was on 21st January, 2024, with the aim to ensure family
members live healthy lives. The child with diarrhea was managed appropriately with Oral
Rehydration Salt (ORS) and other medications. On the eighth visit, client’s problem
identified was constipation. He was encouraged to take plenty fluid and fruits.
On the 24th January, 2024, thus, on the eighth visit, was carried out to plan to prepare Mr.
A.E and family for handing over. They were educated on how it will be done. However,
Mr. A.E and family had anxiety due to change of caretaker; they were reassured of the
competency of the community health nurse to take over his care. During the last visit,
which was on the 28th January ,2024 my client and family were handed over to the public
Health Nurse for the continuity of care who also assured them of his commitment.
59
CONCLUSION
In conclusion, the client/family centered case study has offered me an opportunity to put
into practice the knowledge and skills acquired in my training. It also offered me that
chance to communicate with people and know problems confronting their health and to
give that support to help them recover.
It helped me to blend the theoretical knowledge and field experience in carrying out my
study. With few challenges that occurred sometime in the study and with prudent support
and cooperation of the client and family coupled with the assistance of my theoretical and
field supervisors, every goal or objective that was set was fully met.
RECOMMENDATION
I want to use this opportunity to thank the authorities of Catholic University of Ghana -
Fiapre.
I therefore recommend that the family centered care be encouraged among students of
nursing in the final year to equip them for the eventual job environment.
In addition, management of Public health unit should help their satellite centers to provide
learning materials that can help students to do their studies well.
60
APPENDIX
TABLE 11; PHARMACOLOGY OF DRUGS USED
DRUGS DOSAGE/ROUTE CLASSIFICATION MECHANISM OF SIDE REMARK

OF ADMINISTRATION ACTION EFFECTS
Tab isoniazid Orally,5mg/kg (300mg Antibacterial It inhibits the synthesis of Rashes, Anaemia Client had fever
maximum daily ) mycolic acid required for hypersensitivity, Fever and loss of appetite
mycobacterial cell wall Loss of appetite
Tab rifampicin Orally,10mg/kg(600mg Anti-bacteria It inhibits the gene transcription Nausea, vomiting, Client had nausea,
maximum daily) of mycobacteria by blocking the Pruritus, Fatigue fatigue and
DNA dependent RNA Headache,hepatitis headache
polymerase
which prevent the bacillus from
synthesis messenger RNA and
protein causing cell death
Pyrazinamide Orally,15-30mg/kg (2.0g Anti-bacteria Pyrazinamide enters the bacillus Nausea Client had nausea
maximum daily and convert into pyrazinoic acid Hepatotoxicity,
Vomiting
Ethambutol Orally, 15-25mg/kg (no Anti-bacteria Inhibits the arabinosyltransferase Optic neuritis, skin rash, No side effect was
maximum daily) Abdominal pain present
Tab Orally,500mg tid for days Analgesic Inhibit prostaglandin synthesis Overdose cause liver No side effect
paracetamol damage and renal failure observed
61
REFERENCES
Brunner and Suddarth’s (2010) Medical and Surgical Medical Nursing (12th Ed) Handbook of
Anti-Tuberculosis Agents. TB (Edinb) 2008.
Ministry of Health (2010), Essential Medicines List.6th Edition. Ghana
Mosby (2003). Medical-Surgical Nursing. Health and Illness Perspective. (7th Edition)
National Drug Program (2010). Standard Treatment Guideline, Accra Ghana Justice.
Offei, V and Abeka- Quansah, J (2009), Practice and Disease Prevention in Ghana (Vol. 2)
Accra, Adonai Publication. Principles of Public/Community Health Nursing.
World Health Organization (2010). The Treatment of Tuberculosis Guidelines. Geneva World
Health Org.
Murray, P. R., Rosenthal, K. S., & Pfaller, M. A. (2020). Medical Microbiology. Elsevier.
Centers for Disease Control and Prevention (CDC). (2021). Tuberculosis (TB).
Kumar, V., Abbas, A. K., & Aster, J. C. (2017). Robbins and Cotran Pathologic Basis of
Disease. Elsevier.
World Health Organization (WHO). (2020). Latent tuberculosis infection: Updated and
consolidated guidelines for programmatic management.
Global Tuberculosis Report 2020. World Health Organization.
Fauci, A. S., & Longo, D. L. (2018). Harrison's Principles of Internal Medicine. McGraw-Hill
Education.
Tuberculosis: A Comprehensive Clinical Reference. (2010). Edited by Heaf, R. Oxford

University Press.
American Thoracic Society, CDC, Infectious Diseases Society of America. (2016). Treatment of
Drug-Susceptible Tuberculosis.
62
Zumla, A., Raviglione, M., Hafner, R., & von Reyn, C. F. (2013). Tuberculosis. New England
Journal of Medicine.
National Institute for Health and Care Excellence (NICE). (2016). Tuberculosis: Prevention,
diagnosis, management, and service organization.
European Centre for Disease Prevention and Control (ECDC). (2018). Public Health Guidance
on Screening and Vaccination for TB.
63
SIGNATORIES
NAME OF STUDENT : STELLA AMANKWAA AGYEMANG
SIGNATURE :………………………….……………………
DATE :………………………………………………
NAME OF SUPERVISOR : PROF. PRUDENCE
SIGNATURE :………………………………...………………
DATE :…………………………………………………
NAME OF PUBLIC HEALTH NURSE : DOMINIC AMOAH
SIGNATURE :…………………………………………………
DATE :…………………………………………………
NAME OF DEAN/HOD: DR. DOMINIC DOGLIKUU
SIGNATURE :…………………………………
DATE :…………………………………
64

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CLIENT/FAMILY CENTERED CARE STUDY

STELLA AMANKWAA AGYEMANG

A FINAL YEAR STUDENT OF CATHOLIC UNIVERSITY OF GHANA-

FIAPRE, SCHOOL OF PUBLIC HEALTH NURSING

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF

GHANA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR

environment of the patient to assist him in his recovery" (Nightingale,1860).Miss Nightingale

his or her training period.

BSc in Public Health Nursing.

ASSESSMENT OF THE CLIENT/FAMILY…………………………………………… 3

CLIENT’S MEDICAL/SURGICAL HISTORY………………………………………… 5

CLIENT’S FAMILY SOCIAL-ECONOMIC HISTORY…………………………………5

CLIENT’S DEVELOPMENTAL HISTORY…………………………………………… 5

CLIENT’S HOBBIES AND LIFE STYLE……………………………………………… 6

PAST MEDICAL HISTORY………………………………………………………………6

CLIENT’S PRESENT MEDICAL/SURGICAL HISTORY………………………………6

CLIENT CONCEPT OF ILLNESS………………………………………………………..7

LITERATURE REVIEW OF THE CONDITION…………………………………………10

PUBLICHEALTH IMPORTANCE OF TUBERCLOSIS…………………………………10

NURSING MANAGEMENT AND CLIENT EDUCATION……………………………...22

HOME VISITS AND NURSING CARE PLANS………………………………..…………26

SPECIAL HOME VISIT……………………………………………………………………..27

AIMS OF HOME VISIT……………………………………………………………….….27

ADVANTAGES OF HOME VISIT ………………………………………………………28

TABLE1; RECOMMENDED TREATMENT REGIMEN FOR TB………………………18

TABLE 2; THE TABLE BELOW INDICATES A COMPARISON OF SIGNS AND

SYMPTOMS OF TUBERCULOSIS IN LITERATURE AND THOSE MANIFESTED BY

TABLE 3; THIS TABLE BELOW SHOWS A COMPARISON OF DIAGNOSTIC

INVESTIGATIONS OF TUBERCULOSIS IN LITERATURE AND THOSE CARRIED

TABLE 4; THE TABLE BELOW INDICATES DRUGS IN LITERATURE COMPARING

WITH DRUGS USED IN TREATING CLIENT WITH TB………………………….…..25

NURSING CARE PLAN

TABLE 1: NURSING CARE PLAN FOR FIRST HOME VISIT……………………..….31

TABLE 2; NURSING CARE PLAN FOR SECOND HOME VISITON…………………33

TABLE 3; NURSING CARE PLAN FOR THIRD HOME VISIT……………………….34

TABLE 4: NURSING CARE PLAN FOR FOURTH HOME VISIT…………………….38

TABLE 5: NURSING CARE PLAN FOR FIFTH HOME VISIT………………………..41

TABLE 7: NURSING CARE PLAN FOR SEVENTH HOME VISIT…………………..47

TABLE 8; NURSING CARE PLAN FOR EIGTH HOME VISIT……………………….49

TABLE 9; NURSING CARE PLAN FOR NINETH HOME VISIT……………………..51

TABLE 10: AMENDMENT TABLE……………………………………………………..55

TABLE 11; PHARMACOLOGY OF DRUGS USED…………………………………….60

environment of the patient to assist him in his recovery" (Nightingale,1860).Miss Nightingale

old man who was diagnosed of Tuberculosis.

symptoms of pulmonary Tuberculosis may include a persistent cough up blood or phlegm,

fever, weight loss, night sweats, and difficult breathing.

overview of tuberculosis, definition of tuberculosis, causes, mode of transmission,

importance, prevention and control and complications.

in breathing and loss of appetite.

Tuberculosis and has been put on medication till now.

will be addressed. It is the gathering of information about client psychological, physical,

Date of Birth. : 07/06/1987

Marital status. : married

Number of children. : 1 (male)

Home Town. : Tepa

House Number. : ward one

Language spoken. : Twi , English

Allergies. : Not known allergies

Date of admission : 02/01/2024