TABLE OF CONTENTS

CONTENTS PAGE

PREFACE…………………………………...............................................................I

ACKNOWLEDGEMENT…………………………………………………………..II

INTRODUCTION……………… ……… ………………………………………….III

TABLE OF CONTENT…………………………………………............................V

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

LIST OF FIGURES……………………………………………………………….VIII

1
CHAPTER ONE PAGE

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

Patient’s Particulars…………………………………………..………………………...........1

Patient’s Family Medical and Socio-Economic History………………………….…...........2

Patient’s Developmental History……………………………………..……………..……...2

Patient’s Lifestyle and Hobbies………………………………………………………….…3

Patient’s Past Medical History………………………….......................................................4

Present’s Medical History……………………… ……………………..………....................4

Admission of The Patient……………… ………………………….……………….….……5

Patient’s Concept of Illness……………………………………….…………………,..…….7

Literature Review on Sickle Cell Disease………….……………………………….…….7

Validation of Data……………………… ………………………….....................................20

2
CHAPTER TWO PAGE

ANALYSIS OF DATA……………………………………………………………………21

Comparison of Data with Standard………………………………………………………...21

Patient Health Problem……………………………………………………………………31

Patient and Family Strength………………………………………………………………..32

Nursing Diagnosis…………………………………………………………………………33

CHAPTER THREE PAGE

PLANNING FOR PATIENT/FAMILY……………………………………………………35

Objectives of Nursing Care………………………………………………………………...35

Nursing Care Plan…………………………………………………………………………38

3
CHAPTER FOUR PAGE

IMPLEMENTATING PATIENT/FAMILY CARE PLAN……………………………….47

Summary Of Actual Nursing Care………………………………………………………...47

Preparation of Patient/family for Discharge………………………………………………59

Follow-Up/Home Visit and Continuity of Care………………………………………….61

CHAPTER FIVE PAGE

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY……………...64

Statement of Evaluation………………………………………………………………...64

Amendment of Nursing Care for Partially Met and Unmet Outcome Criteria………….67

Termination of Care…………………………………………………………………….67

Summary of care……………………………………………………………………… 68

4
Conclusions……………………………………………………………………………..70

BIBLIOGRAPHY……………………………………………………………………...72

SIGNATORIES…………………………… …………………………………………..73

LIST OF TABLES

Table 1: Comparison of Investigations Carried Out On Patient To The Literature Review.

23

Table 2: Comparison of Data with Standard Diagnostic Investigation…………………… 24

Table 3: Comparison of Patients Clinical Manifestations with Textbook Standards………27

Table 4: Comparison of Treatment Received by Patient with the Literature Review…….. 29

Table 5: Pharmacology of Drugs Administered…………………………………………….30

Table 6: Nursing Care Plan………………………………………………………………….41

5
 CHAPTER TWO

2.0 ANALYSIS OF DATA

Analysis of data is the act of sorting out information collected from patient, family and friends in order to bring out solution for actual

problems. It is the second stage of the nursing process. This is made up of data comparison with standards which covers diagnostic

investigations ,signs and symptoms , treatments and complications. The contributing factors are considered and possible nursing

diagnosis are made.

The chapter will consider the following topics;

1. Comparison of the data with standards

2. Patient /family strengths
3. Health problems
4. Nursing diagnosi
COMPARISION OF DATA WITH STANDARD DIAGNOSTIC IN VESTIGATION

6
This involves the comparison of information gathered from the patient with that of the standards in the literature review on the
condition. Here , the nurse uses personal knowledge in addition to the past experience when comparing the data. It includes;

1. Causes
2. Clinical features
3. Diagnostic investigations or test
4. Medical treatment
5. Complications

a) Causes
Statement of comparison of literature review on the causes of sickle cell disease
With reference to the literature review, patient`s condition was inherited and thus he inherited an abnormal haemoglobin S and
S from his parents. His disease condition was triggered by exposure to infection.
Table 1: comparison of clinical features manifested by patient with that of literature review

Clinical features in literature review Clinical features manifested by patient

7
Pain ffecting the back, extremities and abdomen Patient complained of pain at the backon the day of
admission

Haemoglobin level usually between 6.9g/dl and 7.8 g/dl Patient’s haemoglobin level was 7.5g/dl indicating
indicating anemia anemia

Severe joint pains Patient complained of severe joint pain on the day of
admission

Anorexia Patient complained of loss of appetite

Fever Patient had fever (38.3)

Jaundice Observation of the sclera and mucus membrane indicated

a yellowish discoloration

Pallor of the extremities Patient’s extremities were pale

8
General malaise /fatigue patient complained of general body
weakness on the day of admission
Headache Patient complained of headache
Enlargement of liver and spleen (hepato There was no hepatomegaly or
splenomehaly) splenomegaly

Statement of comparison of the clinical manifestations to that of the Literature Review

From the above comparison of clinical features to the literature review, C.A exhibited about 90% of the clinical features of
sickle cell disease in the literature review.

9
The following investigations were carried out on my patient;

1. Haemoglobin level estimation

2. White blood cell count

3. Haemoglobin electropherosis

4. Red blood cell count

5. Urinalysis

DATES SPECIMEN INVESTIGATION RESULTS NORMAL INTERPRETAT REMA

VALUE ION

16/02/22 Blood Haemoglobin level 7.5 g/dl Men: 13.2 Below normal Iron
estimation to 16.6g/dl range which supple
Women: indicates anemia were g
11.6 to
15g/dl

10
16/02/22 Blood White blood cell 15.67+ 4.50 -8.50 Above normal Antibio
count (10^3/ul) range indicates IVAmo
the presence of v 1.2g
infection. 48hrs w
given

16/02/22 Blood Red blood cell count 2.25 3.50 -5.50 Below normal Tab zin
(10^6/ul) range and 5mg dl
indicating 30 day
hemolysis given

16/02/22 Blood Mean corpuscular 98.2+ fl 76.0 -96.0 Above normal Tab fo
volume (MCV) acid 5m
dly x30
was gi

11
16/02/22 Blood Mean corpuscular 33.3+ pg 27.0 -30.0 Above normal Sc Cle
haemoglobin range 40mg d
x48hrs

16/02/22 Blood Neutrophils 8.44 2.00 -7.00 Above normal No

(10^3/ul) range treatme
given

16/02/22 Blood Platelet 76+ 150 -400 Below normal No

(10^3/ul) range treatme
given

16/02/22 Blood Haemoglobin Sickling Sickling Patient has a No

electropherosis positive positive or sickle cell disease treatme
(SS) negative was gi

16/02/22 Urine Urine Appearanc Clear Abnormal No

e Amber Abnormal treatme
Colour 6.0 was gi
pH 1.015 Within normal
Specific range
gravity Negative
Glucose Negative Normal
Ketones Negative Normal
Nitrites Negative Normal
Bilirubin Normal Normal
Urobilinog Negative Normal
en
12
 Protein Negative Normal
Leukocyte Negative Normal
Blood Normal

Statement of comparison of Literature Review on the Diagnostic

Investigation
Sickle cell anaemia can be diagnosed in many ways but comparing the diagnostic
investigations done in the literature review, few of the investigations including
haemoglobin electropherosis, full blood count and urinalysis were done to rule
the causative organism which contributed to the disease condition.

Medical treatment given to patient

From the literature review, the medical treatment given to patient were as
follows;
Drug administered

1) IV Morphine 10mg tds x 24 hours

2) IV Paracetamol 1g tds x 24 hours

3) IV Amoksiklav 1.2g tds x 48 hour

4) Sc Clexane 40mg dly x 48 hours

5) Tablet Ibuprofen 4oomg bd x30 days

6) Tablet Folic acid 5mg dly x30 days

7) IV Normal saline 1.5 litres x 24 hours

Table 3: Provides details of drug management

13
14
15
 Table 3: pharmacology of drugs administered to patient

DATE DRUG DOSAGE IN DOSAGE & CLASSIFI- ACTION A

ROUTE CATION A
LITERATURE REVIEW
PRESENTED TO O
PATIENT

16-02-21 Paraceta - Adult: 500mg- 1g. 1g intravenously Antipyretic Inhibits the P

mol Child: 75mg- 500mg/kg. and non opoid synthesis of r
(acetamin analgesics. prostaglandin a
ophine) that may serve as
mediators of
fever and pain.

16-02-21 Amoksikl Adult: 2.4- 4.8g daily in 4 1.2g intravenously Antibiotic To combat I
av divided doses ( penicillin- infection by g
beta- inhibiting DNA e
Child: 75mg/kg daily in 3
lactamase synthesis in n
divided doses.
inhibitor) bacteria which b
results in cellular c
death.

16/02/22 Clexane Child- 2mg-3mg/kg 40mg Anticoagulant To stop blood P

subcutaneously clot formation w
Adult-40mg
and to stop t
already formed a
clot from getting c
bigger. n
a

16
DATE DRUG DOSAGE DOSAGE & CLASSIFI ACTION ACTUAL SIDE EFFECTS
IN ROUTE -CATION ACTION
PRESENTED OBSERVED
LITERATU
TO PATIENT
RE
REVIEW

16/02/2 Adult: 1.5 litres x 24 Crystalloid To restore Patient’s sodium Aggravation of

2 Normal 500mls- hours fluids sodium and and chloride level heat, oedema,
saline 2500mls. Intravenously chloride was maintained. hypothermia.
Child: level Patient was well Patient became
250mls- hydrated. slightly
500mls/kg. oedematous but
later became
normal after
medical and
nursing
interventions.

17
16/02/2 Folic Adult: 5mg- 5mg daily for Vitamin Stimulate the Patient blood count Respiratory
2 acid 10mg Child: 30 days orally and normal improved bronchiole spasm
2mg-5mg/kg mineral erythropoiesi skin-allergic
. supplement s synthesis. reaction (rashes,
purities). None w
(haematinic Nutritional
observed on
s) support
patient.

18
 Statement of comparison of pharmacological treatment to the Literature
Review

With reference to the treatment mentioned in chapter one of the literature review, some

drugs were prescribed for Miss Q.J . The drugs include; intravenous paracetamol 1g stat,

intravenous paracetamol 1g tds x 24hrs, intravenous Amoxiclav 1.2g tds x 48hrs,

subcutaneous Clexane 40mg dly x48hrs , intravenous Morphine 10mg tds x 24hrs and

intravenous Normal saline 1.5 litres to run over 65 drops per minute. According to the

doctor, the above mentioned drugs were enough for the management of the condition.

From table 3, the treatments given to my patient while on admission are similar to those

stated in the literature review. Also blood transfusion was not done as stated in the

literature review. There was no surgical treatment given to patient , patient was only

treated medically.

19
Complications

With reference to literature review the complication of sickle cell disease include;

1. Pneumonia

2. Heart failure

3. Retinopathy and nephropathy

4. Infections

5. Repeated occlusion of small blood vessel and consequent infection or necrosis of

major organs.

6. Premature death

7. Stroke

8. Hemolytic anemia

However, my patient did not experience any complication during the period of

interaction due to the competent nursing and medical care rendered from the

health team in charge of her treatment.

Patient and Family Strengths

1. Patient could verbalise location and intensity of pain.

2. Patient understands the need to assess body temperature and could tolerate

axillary temperature measurement.

3. Patient could eat by himself and has resources for feeding.

20
 4. Patient could verbalise the cause of insomnia( hospitalisation and prognosis of

disease condition).

5. Patient hard little knowledge on prevebtion of crises at home.

2.2 Patient Health Problems

16/02/22

1. Patient complained of acute joint, waist and back pain

2. Patient has high body temperature

3. Patient complained of loss of appetite.

17/02/22

4. Patient of insomnia resulting from changes in sleeping environment and prognosis

of disease condition.

5. Patient had little knowledge and understanding on causes and prevention of

disease condition.

Nursing diagnosis

16/02/22

21
 1. Acute pain related to tissue hypoxia due to agglutination

2. Hyperthemia related to infection.

3. Imbalance nutrition less than body requirement

17/02/22

4. Sleep pattern disturbance (insomnia) related to changes in environment and unknown

outcome of prognosis of the disease condition.

5. Knowledge deficit related to inadequate information on causes and prevention of

disease condition.

CHAPTER THREE

3.0 Planning Of Care On Patient And Family care.

Objective / outcome criteria

1) Patient will be relieved of joints, back and waist pains within 2 hours as evidenced by

a) Patient verbalizing that she does not feel pains anymore and

b) Nurse observing that patient looks cheerful and comfortable in bed.

2) Patient’s body temperature will be normal within 4hours as evidenced by

a) Thermometer readings by the nurse showing that patient’s temperature has reduced

into normal range(37.10c).

22
 b) The patient verbalizing that his temperature has reduced and she is feeling much

better.

3) Patient’s nutritional status will be maintained within 48 hours as evidenced by

a) Patient verbalizing that she can eat all foods served.

b) Nurse observing that patient eats all foods served.

4.Patient will resume a normal sleep patterns within 2 days as evidenced by;

a) Patient verbalising that she was able to have a sound and peaceful sleep throughout

the night uninterrupted .

b) Night nurses’ observation that patient sleeps between 6-8 hours at night

uninterrupted.

5 Patient will be educated about precautions and management of sickle cell crisis within

2 hours as evidenced by

a) Patient answering questions about causes and precautions of diseases condition

being put to her after teaching.

b) Nurse observing patient being able to answer at least 80% of questions on causes

and precautions of disease condition.

23
 TABLE 3: NURSING CARE PLAN

DATE/ NURSING NURSING NUSING ORDERS NURSING EVALU

TIME DIAGNOSIS OBJECTIVE/ INTERVENTION

OUTCOME
CRITERIA

20/04/23 Acute pain Patient will be 1. Reassure patient. 1. Patient was 19/04/2
related to relieved of pain reassured that pain
@ tissue hypoxia within 2 hours as 2. Assess patient’s will be relieved by @
due to evidenced by; pain level using the both nursing and
9: 00am pain scale (0-10) 11:00am
agglutination medical
of blood 1. Patient interventions being
vessels. verbalizing that she put in place.
is not feeling the Goal fu
2. Patient’s pain level
pain anymore. verbaliz
was assessed.
3.Remove constrited more in
clothes and bed linen
over painful areas Nurse o
2. Nurse observing 3. All tight clothes over ferelaxe
that patient looks 5. Assist patient into a joints and other painful cheerfu
cheerful. comfortable bed. areas(chest,back and joint )
were removed and bed
linen was elevated over
6. Divert patient’s painful Warm compressors
attention from pain. were also applied at painful
area to help reduce pain.

5. Patient was assisted into

a comfortable bed.

7. Serve prescribed 6. Patient’s attention was

analgesic. diverted from pain by
engaging patient in
conversation, and watching
T.V with a lowered

24
 volume.

7. Prescribed analgesic
Tablet Paracetamol 500mg
was administered to relieve
8. Administer oxygen pain and procedure was
as prescribed. recorded in the drug
administration chart and
the nurse’s notes.

8. Prescribed oxygen of 4
liters was administered to
patient as and when needed
to enhance tissue
respiration.

25
DATE/ NURSING OBJECTIVE/ NURSING NURSING
TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION
CRITERIA
20/04/23 Hyperthemia Patient’s body 1. Reassure patient. 1. Patient was reassured 20/0
At (pyrexia 38.50) temperature that measures will be put @
10:00am related to will be normal in place to control the rise 10:0
infection within 4 hours 2. Assess vital signs of in temperature.
as evidenced by patient again. Goa
2. Patient’s vital signs
nurse observing obse
were again checked and
that patient’s body
were still outside the
body 3. Remove extra and redu
normal body temperature
temperature constricted clothes ( 37
range (38.10c) to confirm
reducing to from patient.
nursing diagnosis.
normal range (3
37.10c). 4. Tepid sponge patient.
3. Extra clothes around
patient were all removed
to improve circulation
around patient.

4. Patient was tepid

sponged with tepid water
5. Open nearby
and towel, this was
windows for
carried out in strokes
ventilation.
leaving traces of water on
the skin to evaporate
bringing about a cooling
effects.
6. Serve patient with
cold drink.
5. Nearby windows were
opened to for fresh air to
26

7. Administer
prescribed antipyretics
and antibiotics.
improve air circulation in
the room.
6. Cold beverage was
served to patient to help
her loss some bodily heat.

7. Prescribed antibiotics
Penicillin V 15mg and
antipyretics Tablet
Paracetamol 500mg were
administered respectively
to control infection and
to reduce temperature.

DATE/ NURSING OBJECTIVES/ NURSING NURSING EVALUATIO

TIME DIAGNOSI OUTCOME CRITERIA ORDERS INTERVENTIO N
S NS
20/04/2 Imbalance Patient’s nutritional status 1. Reassure 1. Patient was 21/04/23
3 nutrition less will be maintained within patient that reassured that she @
@ than body hours as evidenced by; she will be would be able to 8:30am
12:pm requirement. a) Patient verbalizing that able to eat eat normally.
she can eat all foods food 2.The importance Goal fully met
served. normally. of good nutrition as evidenced
b) Nurse observing patient 2. Explain was explained to by;
eat all foods served. the patient. Patient
importance 3. Patient was verbalizing that

27
 of good included in she can eat all
nutrition to planning of menu foods served.
patient. and patient’s
3.Plan choice of meal was Nurse
menu with considered. observing that
patrient by 4.Nauseating patient can eat
considering objects such as all foods
her bedpans were kept served.
choices. away from the
4. Provide environment to
a make it conducive
conducive for eating.
environme 5. Oral care was
nt for performed.
patient 6. Rice with
especially kontomire and
during fish( palava) was
meal times. served to patient.
5. Perform Food was in bits
oral care. and at frequent
6.Serve intervals. Food was
patient’s nicely garnished
meal in bits hence making it
and at attractive.
frequent 7. 24hour intake
intervals. and output chart
7. Maintain and IV fluids was
a 24hours maintained .
intake and 8. Allprocedures
output were duely
chart and recorded.

28
 record IV
fluids as
ordered.
8.
Document
procedures.

EVALUATION
21/04/23
@
10:00pm

Goal fully met

as patient
verbalized that
he was relieved
of headache and
also felt
comfortable and
more relaxed in

29
bed.
Nurse observing
that patient looks
relaxed and
cheerful.

30
 DATE/ NURSING OBJECTIVE/ NURSING NURSING EVA
TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION
CRITERIA
21/04/23 Sleep pattern Patient will 1. Reassure patient. 1. Patient was reassured that 17/02
@ disturbances resume a 2. Open nearby windows measures will be put in place @
10:00am (insomnia) normal sleeping for good ventilation. to ensure adequate sleep. 10:00
related to within 48hours 3. Provide enough
change of as evidenced by warmth to avoid cold. 2. Nearby windows were Goal
environment a) patient opened to promote enough Night
and prognosis verbalising that circulation. obser
of condition. she was able to 4. Restrict visitors. patien
have enough 3. Warm bath, drinks and demo
sleep that was enough blankets were resum
uninterrupted 5. Minimize noise on the provided for patient. norm
and night ward. patter
nurses’ 4. Visitors were restricted
observing that from interrupting in patient’s Patien
patient sleeps at sleep. demo
least 6-8 hours abilit
uninterrupted. 6. Organize all activities 5. Nurses and other health asleep
and perform them at a go staff were encouraged to speak few m
to limit interference. undertone and volumes of T.V lying
and radios were lowered to
help patient sleep.
7. Make patient bed and
assist in bathing. 6. All interventions either
medical or nursing were
organized not to interfere with
patient’s sleep.

7. A comfortable bed with

31
 clean sheets with enough
8. Adjust close light to pillows were provided for
patient’s preference. patient the bed was free from
creases and cramps. Patient
was also assisted to have a bed
bath to enhance comfort.

8. A dim light as preferred was

provided to patient to enhance
sleep.

32
 DATE/ NURSING OBJECTIVE/ NURSING NURSING EVALUATION
TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION
CRITERIA

17/02/ 22 Knowledge Patient will have 1. Reassure patient. 1. Patient was reassured that 17/02/22
At deficit related to adequate he would be able to know @
management of information about and manage and prevent 10:00am
crisis at home. precautions and crisis at home.
management of Goal fully met as
sickle cell crisis 2. Educate patient on 2. Patient was educated on patient gave
within 2 hours as the predisposing factors the predisposing factors such feedback
evidenced by a) of disease condition. as infection exposure to information on
patient answering cold, stress, poor nutrition what has been
questions being and strenuous physical taught. Also he
put to her after exercise and the need to answered
teaching. avoid them. correctly all
b) Nurse question asked on
observing patient 3. Educate patient on the education
3. Patient was educated that
being able to the disease condition, its given.
sickle cell disease is a
answer at least prevention and on home Nurse observing
hereditary disease which can
80% of questions management that patient was
be transferred to offspring
on causes and able to answer all
by sickle cell traits and the
precautions of questions poised
need to prevent it by
disease condition. to her correctly.
choosing a life partner with
no trait. With home
management stress, infection
and adequate nutrition was
also emphasized
4. Emphasis on the need
for frequent follow-ups
and review and also
how to detect the onset

33
of crisis.
4. Patient was again
educated on the need for
frequent follow-ups and
review to prevent
complications. Signs such as
5. Encourage patient to fever, mild joint pains were
join a sickle cell signs of onset of crisis and
association. the need to know its
detection.
6. Ask patient for
feedback. 5. Patient was educated to
join an association such as
the National Association of
Sickle Cell to learn more
about the disease condition
and seek help when the need
arises.

6.Questions about the causes

and precautions of disease
condition were poised to
patient and answers were
provided by patient.

34
 CHAPTER FOUR

4.0 Implementation Of Patient /Family Care Plan

Implementation is the fourth phase in the nursing process. This involves is process of

putting into action nursing orders and interventions designed for the management of the

4.1 Summary of actual nursing care rendered to patient

This is the actual care rendered to my patient and family from the time the time of

admission, discharge and to the third home visit.

Day Of Admission (20/04/23)

On the 20th of April 2023 at 3:30pm, patient was admitted at the Korle-bu teaching

hospital medical ward III through the Emergency department. He came with fever, joint,

back and chest pain, fatique and loss of appitite. The diagnosis made was sickle cell

disease with Vaso Occlusive Crisis. He came to the ward conscious and alert

accompanied by his brother. Patient’s information was taken and cross-checked with

information in the folder to verify if she he was the right patient after welcoming them to

the ward.

Patient and relatives were reassured about the competency of health team at the ward

after introducing them to other nurse and staff on duty at the ward.

Since patient was in pain and and tired, he was put into an admission bed and made

comfortable. Vital signs were checked and recorded as follows:

Temperature 38.5 degree Celsius,

35
Pulse 66 beats per minute,

Respiration 23 cycles per minute

Blood pressure 128/90millimetre of mercury.

Since the temperature, above normal ranges, an antipyretic intravenous paracetamol 1g

state was administered to help reduce the temperature to normal range and patient was

made to rest to reduce the blood pressure.

Medications prescribed for patient included: intravenous normal saline 1.5litres within 24

hours, tablet folic acid 5mg daily within 30 days, Intravenousparacetamol1gtds x 24hrs,

Intravenous Amoxiclav 1.2g tds x 48hrs, Subcutanous Clexane 40mg dly x 48hrs,tablet

paracetamol1g x 7 days, tablet Ibuprofen 400mg bd, intravenous Morphine 10mg tds x

24hrs, tablets Amoxiclav 1g bd x 7 days, Zincovit tablet 1 daily x 30 days.

Laboratory investigation requested include; white blood cell count and blood specimen

for haemoglobin level, haemoglobin electrophoresis, liver function test, blood urea

nitrogen and serum creatinine test, urine routine examination.

Stat medications were administered and infusion intravenous normal saline stat insitu and

charted in the drug administration sheet.

Patient was oriented to the other patients on the ward and later his brother was also

oriented to the nurses’ office, toilet and bathroom facilities available at the ward.

Patient information was documented in the admission and discharge book and daily ward

state.

36
One problem identified on patient was pain. She was reassured that pain would subside

wis after both medical and nursing intervention was done. All constricted clothing and

bed linen over painful areas were removed and elevated using a bed cradle respectively.

Painful areas were immobilised to reduce metabolic activity after patient was educated

for its need. Warm compressors were later applied at painful areas. Patient was induced

to rest by making a comfortable bed with clean sheets and linen with nearby windows

opened to allow fresh air.

Diversional therapy was employed by engaging patient in conversation and switching on

the television for patient to watch. Prescribed analgesic was administered and oxygen

administered to increase oxygen content in circulation.

Vital signs were checked and patient recorded an increase in temperature of 38.4 degree

Celsius at 6:30pm. She was reassured that temperature will be reduced to normal range.

Constrictive clothes were removed from patient for her to loose heat. She was made

comfortable in bed and nearby windows was opened to improve circulation. Cold drink

was served to patient and prescribed antibiotic and antipyretic was administered

respectively to help control infection and pyrexia.

Patient had his body temperature reduced to37.1 degree Celsius around 10:00pm in the

evening. He complained of severe headache which . She was reassured that pain would

be relieved in no time. Cold compresses were applied to patient’s forehead and was again

encouraged to empty bowel which could also cause headache. She was urged to have

enough rest and try to avoid stress by conversing with other patients and watching

37
television. Prescribed analgesic tablet paracetamol 500mg and haematinics of tablet folic

acid 5mg once daily was also given.

Patient had her lunch after which medication was served. She was then encouraged to

rest. Patient’s relative was reassured that adequate measures would be put in place to help

manage her condition.

Patient’s relative was educated on the need and importance for patient to be admitted for

further observation and continuity of care for a couple of days to ensure full recovery.

The disease condition, causes, signs and symptoms were made known to patient and

family. Prognosis of disease was made known to them. They were allowed to ask

questions and answers were provided accordingly. They later became less anxious and

this helped promote cooperation and established a good therapeutic relationship between

them and health providers.

Patient had her supper around 7:00pm in the evening. She was then handed over to the

night nurse for continuity of care.

First day of admission (21 02/ 2023)

On the second day of admission, patient’s condition was better than the previous day.

Patient’s routine care such as oral hygiene, bathing ,hair care and grooming were taken

care of. His bed linen was changed and his bed was made and was made free from

crumps and creases.

38
Medications were served and vital signs monitored and recorded at 6am. They were

within normal range and was recorded as follows;

Temperature – 36.5

Pulse – 65 beats per minutes

Respiration -20 cycles per minute

Oxygyen saturation -99%

Blood pressure - 120/60mmHg

He was served with banku with soup but she was not able to eat even half of the food

served. The following nursing interventions were done;

Client was reassured that she will be able to eat few days. Diet was also planned with

patient to help wet her appetite by including her likes and dislikes within in choosing her

merals.

Client was served with iron rich foods such as meat,green vegetables (rice with

kontomire stew and meat) and prescribed iron supplement was given(folic acid 5mg).

Food was served in bit but frequently and attractively to help client tolerate more.

He was handed over to afternoon nurses and care was continued with her being in good

condition.The afternoon nurses also cared for her and handed her over to the night nurses.

They cared for and made sure she was relaxed and comfortable in bed and had a good

night sleep.

39
Second day of admission (22/04/23))

On the third day of admission, client’s condition improved than the previous day.

Interactions with patient revealed that he had little insight into the management and

precautions of crisis at home. He was reassured that he would have knowledge about the

management and precaution of crisis at home. Patient was educated on the predisposing

factors such as exposure to cold, infection, stress, poor nutrition and strenuous exercises

and the need to avoid them. Since patient was an adult he understood everything.His was

educated on the disease sickle cell and that it is transferred from parents with sickle cell

traits to their offspring and the need to choose a life partner with no sickle cell trait. The

importance and need for frequent follow-ups and reviews to prevent complications was

emphasized upon to him. The family were encouraged to make him join a sickle cell

organization such as t he National Association of Sickle Cell Patients to know more about

disease condition. Patient was asked questions for her to give answers and she provided

answers accordingly.

In the afternoon patient was reviewed again by doctor on ward rounds and she verbalized

that his pain had subsided and he was feeling better. After thorough physical examination

the doctor ordered that patient should continue with her medications with assurance that

she would be discharge the next day. Patient’s relative was informed about discharge on

the next day so she was urged to prepare for patient’s arrival at home.

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Patient’s day of discharge (22/04/23 )

On the day of discharge, patient looked healthy and cheerful. He was grateful to the

nursing and medical staff. He took his warm bath and maintained his oral hygiene.

Medications were served as ordered and vital signs monitored and recorded.

During ward rounds, the doctor examined patient physically and discharged home home

to continue her medication especially tablet folic acid.

Around 10:00am patient’s relative was informed about patient’s discharge. She was so

grateful to the medical and nursing staff for helping her sister to recover without any .

Patient and relative were educated on the need to take nutritious diet which was rich in

folic acid from green leafy vegetables and iron rich foods to prevent anaemia.

High caloric diet is recommended to be given to patient for energy, also, protein to build

and repair worn out tissue and supplemented with vitamins and fruits to boost immune

system. They were again educated to avoid predisposing factors of sickle cell crisis such

as infections, exposure to cold, poor nutrition, strenuous physical exercise and stress.

They were later asked questions and answers were provided and this revealed that they

had understood everything made known to them.

Patient and relative were informed about the review date which was 1 st May

2023 and was asked to report at consulting room two on the said date. After telling them

about the day of review they were helped to pack their belongings after which they said

41
goodbye to the health staff and other patients on the ward and were escorted to the bus

station for a bus home.

Preparation Of Patient And Family Towards Discharge And Rehabilitation

Preparation of patient and family toward discharge started as soon as patient was

admitted to the ward. They were given insight into sickle cell disease and how best to

prevent future occurrence. While patient was on admission, relatives and patient were

informed that she will go home as soon as her condition improves. They were

thereforeencouraged to take active part in the care to ensure speedy recovery.

On the day of discharge, which was 22nd

of April, 2023, patient and relatives were educated on the need to complete her

medications. They were also educated on the need to serve patient with nutritious diet

rich in protein, carbohydrates and vitamins. They were also encouraged to renew their

National Health Insurance Scheme on time so they can be able to visit the hospital

anytime they fall ill. Opportunity was also given to her and her mother to ask any

questions bothering them and answers were provided accordingly. Personal hygiene and

all health education that was given during hospitalization were revised with Miss Q.J and

her mother. Correct answers of questions given indicated that they really understood the

education given. Some health problems were identified in admission and with the

cooperation between the patient and family and the whole medical team, patient was

discharged home without any complications .

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Because patient was a student, she was given three days (3) excuse duty for her to rest

and recover fully. Patient was not given any other therapy or rehabilitation.

Follow-up/Home Visit/Continuity Of Care and Rehabilitation

This is the act of rendering health service to a patient in his or her home environment to

ensure continuity of care. It also determines the health status of the patient following

discharge, identify other problems and help find solutions to the identified problems.

This involves visiting the patient home before and after discharge to have first hand

information on the condition of the house and its influence on the patient’s health. This is

of a great importance in the care of the patient.

First Home Visit

The first home visit was made on the 21st of Appril 2023 while patient was still on

admission. I went to patient’s house with her mother at Agavernya, a suburb of Koforidua

with the aim of finding out much about patient’s vicinity and environmental conditions to

help in the giving of health education.

On reaching the house, I was warmly welcomed by patient’s father and siblings. We had

a conversation concerning patient’s current condition and the way to ensure patient’s

speedy recovery. The house had a kitchen, bathroom and toilet with well ventilated

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rooms and a good sanitation facility. I took the opportunity to educate the family on

patient’s condition and measures to be taken to prevent future occurrence of sickle cell

crisis.

Second Home Visit

The second home visit was made on 25th of April2022 . The purpose of the visit was to

find out how patient was fairing. Education was given to patient and family to ensure that

patient avoid stressors such as infection, extreme cold and physical exertion as these

trigger sickle cell crisis.

I emphasized on the need to serve patient with nutritious diet and the importance of

completing medication as prescribed. I also took the chance to educate the entire family

on the cause of sickle cell disease and encouraged them to ensure that their children

marry partners who are without sickle cell trait to prevent occurrence.

Patient was later reminded on the review date with the promise to meet them on the day

at the out- patient department.

Day Of Review

Patient came for review on 1st May 2022. I met patient and his brother at the out patient

department (O.P.D) around 8:00am as planned. I ensured that patient’s folder was

retrieved from the records room and taken to see his doctor in consulting room five.

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On examination patient was declared fit and the doctor informed him to continue with her

folic acid therapy as ordered. I saw them off but reminded them about the advice given

by the doctor to patient his brother. I promised to visit them again.

Third Home Visit

On my third visit which was on 2 nd May of ApriI 2023 observed that patient was very fit

and looked good.

On arrival, his relatives were very happy about his improvement .

Patient told me that she felt good as if she were never sick. I encouraged them to care for

him and keep their environment as clean as possible.

Finally, patient was not handed over to the community health nurse because her condition

was not a communicable disease but rather she was advised with her relatives to visit the

sickle cell clinic for further continuity of care and they were made aware that the care has

been terminated from that day.

Any other health problem pertaining to the condition should be discussed at the sickle

cell clinic but when the condition needs further management, they should report to the

nearest hospital. I finally terminated the care after congratulating them for the effort to

comply with the instruction given during the care.

After some few interactions with them, I asked of their permission to leave. I also

thanked them for their cooperation.

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 CHAPTER FIVE

5.0 EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

This is the final and the fifth component of the nursing process which is used to deduce

whether goal set for patient and family were either met, partially met or unmet and what

other goals was set to solve the problem including amendment. Evaluation of care

consists of the following;

1. Statement of evaluation

2. Amendment of nursing care

3. Termination of care

5.1 Statement Of Evaluation

During the care of C.A objectives set for problems were identified.

With good nursing management and co-operation from patient and family, all objectives

were fully met and patient’s health condition improved remarkably.On the 20th

of April, 2023 at 9:00am an objective was set to relieve patient off pain within 2 hours.

This goal was fully met at 11:00 pm on the same day as patient verbalised that she was

no more in pain and through the nurses own observation that patient was feeling relaxed

in bed.

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On the same day at 10:00am, an objective was set to relieve patient from pyrexia within 4

hours. This goal was fully achieved the same day at 1:00pm as patient’s body

temperature reduced to the normal range.

At 12:00pm on the 21st of April 2022,patient complained that she is unable to eat well

and objective was set to relieve her from the headache within 2 hours. This goal was fully

achieved as patient was able to eat all servef food .Moreover, at 10:00am on the same

day, patient complained of insomnia so an objective was set to enable patient resume a

normal sleeping pattern within 3hours. This goal was fully met on the as patient

demonstrated ability to fall asleep within few minutes after lying down.

On the 22nd of Appril 2022 at 8:00am, a goal was to educate patient on the disease

condition and its management within 2 hours. This goal was fully met at 10:00am as

patient answered all questions put to her correctly.

5.2 Amendment Of Care

Throughout patient’s stay on the ward, good nursing and medical interventions were

instituted. Coupled with cooperation from patient and her relatives, all goals and

objectives that were set were fully met. Therefore there was no amendment to be made.

5.3 Termination Of Care

Termination of care is the end of the care rendered to the patient and relatives by nurse.

Interactions with patient and relatives started on the 20 th of April and went for discharge

47
on the 22nd of April 2022 after condition became well and satisfactory. Patient was in

good state of health and her condition had improved during discharge.

Finally, after three home visits the care was finally terminated on the 29 th of April, 2023

on the third home visit.

5.4 Summary of Care

The care of C.A, a 25year old young man started on the 20 th of April 2023, when he was

admitted at medical III through the Emergency Unit of korle-bu teaching Hospital with

diagnosis of sickle cell disease with Vaso Occlusive Crisis. Patient who was in pain

during admission was reassured together with his relative that measures were taken to

relieve their anxiety and pain.

Health problems identified on patient during the period of hospitalization included

pain, .increased body temperature, fatique, insomnia, , loss of appetite, weakness . All

these problems were attended to with appropriate nursing and medical interventions.

The following drugs were prescribed for patient and they were served accordingly;

intravenous normal saline 1.5 litre, intravenous morphine 10mg as a stat dose,

intravenous paracetamol 1g stat dose, intravenous amoxiclav 1.2g tds x 48 hrs, tablets

folic acid 5mg x 30 days, intravenous paracetamol 1g tds x

24hrs ,subcutacutaneousclexane 40mg dly x 48hrs, tablet ibuprofen 400mg bd , tablet

paracetamol 1g x 7 days, intravenous artesunate 200mg 0,12,24hrs, and zincovit 1 dose

daily x 30 days.

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All goals and objectives set for patient’s health problems were fully met due to effective

nursing and medical care rendered leading to her recovery and discharge on of 22 nd of

April 2023. Two follow-up visits were made to patient’s home until she was declared fit

on the review date.

5.5 Conclusion

In conclusion the patient/family care study has not only broadened my knowledge in

sickle cell disease but also helped me to put the knowledge I have acquired from the three

year nursing course into practice. It has also helped me to understand comprehensive

nursing care that has to be given to individual patient and also improved my interpersonal

relationship with patients.

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Smeltzer S.C and Bare, B.F (1980). Brunner and Saddarth Medical Surgical Nursing.

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