A PATIENT AND FAMILY CARE STUDY ON A PATIENT WITH

CONGESTIVE CARDIAC FAILURE

BY

ERIC KYERE OFOSU

ID:( 41203120)

A FINAL YEAR STUDENT OF KAAF UNIVERSITY COLLEGE

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA

FOR REGISTERED GENERAL NURSING.

December 2023

i
 PATIENT AND FAMILY CARE STUDY ON

CONGESTIVE CARDIAC FAILURE

WRITTEN BY:

ERIC KYERE OFOSU

(ID: 41203120)

A FINAL YEAR STUDENT OF KAAF UNIVERSITY COLLEGE

KORLE- BU TEACHING HOSPITAL

SUBMITTED TO:

THE NURSING AND MIDWIFERY COUNCIL (N&MC) OF GHANA IN PARTIAL

FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE
REGISTERED GENERAL NURSING (RGN) CERTIFICATE

ACCRA- GHANA

December, 2023

ii
 PREFACE

The patient and family care study is one of the tools used to assess a final year student for the

award of Registered General Nursing Certificate by the Nursing and Midwifery Council of

Ghana. The study helps the student nurse to combine classroom knowledge and clinical

experience in rendering nursing care to a patient from time of admission to the time of

discharge and also includes the continuity of care and rehabilitation.

The care study has therefore been written using the nursing process approach and offers the

student the opportunity to do much research into the causes, clinical manifestations,

diagnosis, complications, treatment and the prevention of congestive cardiac failure. The

study is also carried out to help the student nurse build a good relationship with patient and

family as well as the health team so as to meet the health needs of the patient. It affords the

student nurse the opportunity to put his broad theoretical knowledge acquired from the

classroom in the clinical and community setting.

The study also permits the student nurse to make follow-up visits to the patient’s community

to take a first hand and assessment of patient’s home and its surroundings. This helps in

establishing the possible cause of patient’s ill-health, state and it’s eventually to prevent

relapse of the condition through health education and recommendations as the cause may be.

It is recommended for final year students to carry out this study as an assessment tool to

determine student efficiency and theoretical as well as practical capabilities. The best practice

of nursing in its ethics entreats the practice of confidentiality. For confidentiality, the patient

shall be known as Mr. K. F.

i
 ACKNOWLEDGEMENT

I want to sincerely thank the Almighty God for providing me with the knowledge, insight,

courage, and understanding I needed to do this work effectively. May God exalt his name.

I would especially like to express my gratitude to my patient Mr. K.F. and his family for

their understanding and full cooperation during our therapy session. My sincere

appreciation also goes out to my parents for their financial and emotional assistance with

this work.

I would also like to thank the entire KAAF University College staff, particularly my supervisor,

Mrs. Delphina Abbey, who was able to read through the document with care and make the

required adjustments despite her busy schedule.

My effort would be incomplete if I did not acknowledge the health team of the male medical

ward at Korle-Bu Teaching Hospital for their words of encouragement and support during this

investigation.

Finally, I would like to thank the writers and publishers of the textbooks used in this script.

ii
 INTRODUCTION

A patient care study is a written document on the care rendered to a particular patient and the

family from the time of admission till he/she attains and maintains good health. The care

study uses the nursing process which is a modified scientific method anchored on assessment,

nursing diagnosis, planning, implementation and evaluation. Using the nursing process in the

care of the patient, an emphasis was placed on the health promotion, maintenance and

restoration or enhancement of a peaceful death depending on the patient’s condition.

This patient care study is an account of effective nursing care rendered to Mr. K.F., a 61-

year-old man with the diagnosis of congestive cardiac failure was admitted into the male

medical ward of Korle-Bu Teaching Hospital through the male medical ward on the 5 th of

December, 2023. To render comprehensive care, the assessment was done and problems were

identified. These were resolved using the care plan. The nursing interventions range from

checking vital signs, ensuring proper ventilation, serving of nutritious diet, ensuring personal

hygiene and serving prescribed medications. The patient was hospitalized for five (5) days

and was discharged on the 10th of December, 2023 with much improvement in his condition.

One pre-discharge visit and two follow-up visits were made to the patient’s home to assess

his environment, identify predisposing factors of the patient’s condition, educate the patient’s

family on the condition, know how the patient is fairing and the right education given to

patient and family and to also ensure continuity of care. The patient was reviewed on

20/12/2023 which was scheduled by the doctor. This review was to assess the progression in

health or otherwise. Upon the review assessment, he was declared fit to go back home and

continue his daily life activities.

This script has been carefully organized into five chapters; chapter one covers the assessment

of the patient and family. Chapter two deals with data analysis, chapter three embraces the

nursing care plan instituted on the patient, chapter four consists of actual nursing care and

iii
preparation

iv
of patient and family towards discharge. Chapter five covers evaluation, termination of care,

summary and conclusion of the care study.

v
 TABLE OF CONTENT

PREFACE.................................................................................................................................................i
ACKNOWLEDGEMENT.......................................................................................................................ii
INTRODUCTION..................................................................................................................................iii
TABLE OF CONTENT...........................................................................................................................v
CHAPTER ONE......................................................................................................................................1
1.0 ASSESSMENT OF PATIENT AND FAMILY.................................................................................1

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

1.2 FAMILY MEDICAL HISTORY.......................................................................................................1

1.3 FAMILY SOCIO-ECONOMIC HISTORY......................................................................................2

1.4 PATIENT’S DEVELOPMENTAL HISTORY.................................................................................2

1.5 PATIENT’S LIFESTYLE/ HOBBIES..............................................................................................3

1.6 PAST MEDICAL HISTORY............................................................................................................3

1.7 PRESENT MEDICAL HISTORY.....................................................................................................3

1.8 ADMISSION OF PATIENT.............................................................................................................4

1.9 PATIENT’S CONCEPT OF ILLNESS.............................................................................................5

1.10 LITERATURE REVIEW................................................................................................................6

1.11 VALIDATION OF DATA............................................................................................................15

CHAPTER TWO...................................................................................................................................16
2.0 ANALYSIS OF DATA...................................................................................................................16
2.1 COMPARISON OF DATA WITH STANDARDS.........................................................................16
2.2 CAUSE OF PATIENT’S ILLNESS................................................................................................18
2.3 PATIENT’S SPECIFIC TREATMENT..........................................................................................19
2.4 COMPLICATIONS.........................................................................................................................23
2.5 PATIENT HEALTH PROBLEMS..................................................................................................23
2.6 SPECIFIC STRENGTH..................................................................................................................23
2.7 GENERAL STRENGTH.................................................................................................................23
2.8 NURSING DIAGNOSES................................................................................................................24
CHAPTER THREE...............................................................................................................................25
CHAPTER FOUR..................................................................................................................................33
4.1 IMPLEMENENTATION CARE RENDERED TO PATIENT/FAMILY CARE PLAN...............33
4.2 SUMMARY OF ACTUAL NURSING CARE...............................................................................33

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4.3 PREPARATION OF PATIENT/FAMILY FOR DISCHARGE/REHABILITATION..................37
4.4 FOLLOW UPS/ HOME VISITS/CONTINUITY OF CARE..........................................................38
CHAPTER FIVE...................................................................................................................................41
5.0 EVALUTION OF CARE RENDERED TO PATIENT AND FAMILY........................................41
5.1 STATEMENT OF EVALUATION.................................................................................................41
5.2 AMENDMENT OF NURSING CARE...........................................................................................42
5.3 TERMINATION OF CARE............................................................................................................43
5.4 SUMMARY.....................................................................................................................................43
5.5 CONCLUSION................................................................................................................................43
5.6 RECOMMENDATIONS.................................................................................................................44
Bibliography..........................................................................................................................................45
Signatories.............................................................................................................................................46

vii
 LIST OF TABLES

TABLE 1 LABORATORY INVESTIGATIONS................................................17

TABLE 2 CLINICAL FEATURES ACCORDING TO LITERATURE…........19

TABLE 3 PHARMACOLOGY OF DRUGS........................................................21

TABLE 4 PATIENT AND FAMILY CARE PLAN FOR MR. M.Y…................29

vi
ii
 CHAPTER ONE

1.0ASSESSMENT OF PATIENT AND FAMILY

Assessment is to gather, verify and differentiate information about client to establish a

database. It includes the family history of illness, history of past illness, health history,

psychological history, signs and symptoms and the care goal of the patient.

The data was collected from the patient, his relatives through communication and by

establishing a nurse-client relationship, and physical examination of the client, laboratory and

diagnostic test are also conducted.

1.1 PATIENT’S PARTICULARS

Mr. K.F is a 61-year-old guy who was born on September 10, 1962, to Mr. E.F and Madam

S.M (both deceased) in Agogo, the capital of Asante Akim North District. He is an Asante by

tribe and comes from Agogo. He speaks both Twi and English. He has a dark complexion,

weighs approximately 65 kilograms, and is about 152 centimeters tall. He currently resides in

Accra at the Abeka Adom junction at house number A453, a suburb of Accra metropolis.

He is married to Madam D.A. and has seven children: four males and three females. Mr. K.F.

is an educated, retired government worker who practices Christianity. His first daughter, age

45, is his next of kin. He is a health- insured patient.

1.2 FAMILY MEDICAL HISTORY

According to Mr. K.F, there has not been a history of hereditary disease such as

hypertension, diabetes, and sickle cell disease in the family. However, his family members do

sometimes suffer from minor ailment such as abdominal pains, common cold, headache and

1
minor injuries sustained in the course of their activities which they treat by purchasing over

the counter drugs rather than reporting to the hospital.

1.3 FAMILY SOCIO-ECONOMIC HISTORY

Patient has seven children consisting of four males and three females. Six of the children are

married and are staying with their partners. Mr. K.F. is a retired civil servant, his pension pay

is their main source of livelihood for his nuclear family derived their daily bread. They are

living in their own house. He is able to provide the family with their basic needs.

1.4 PATIENT’S DEVELOPMENTAL HISTORY

Patient learnt from his mother that; he was born at home through spontaneous vaginal

delivery under the supervision of a Traditional Birth Attendant at Agogo in the Asante region

of Ghana. He is the first born of Mr. E.F. and Madam S.M. He was breastfed from the

day of delivery to the ninth month, with the introduction of weaning foods after six months

and was immunized against the six-killer disease. According to my patient, he does not know

when he started sitting unaided; crawling and walking but his mother told him he was one of

the most active children among his age mates. He started schooling in 1968 when he was six

years at Asenkyem D/A basic school and completed university at age 35. He was employed

into the civil service of Ghana. While perusing his education he also ventured into farming at

the age of 20 to support his parents in funding his education. Mr. K.F. also got married at the

age of 26.

2
1.5 PATIENT’S LIFESTYLE/ HOBBIES

Mr. K.F goes to bed between the hours of 8:00pm-9:00pm and wakes up at 5:00am every

morning to say his morning prayers and take a morning walk. He then brushes his teeth, takes

his bath, eats breakfast and then goes to the news stand to read and sit for some time. Fufu

and groundnut soup is his favorite food. He takes breakfast around 7:00am, lunch at 12noon

and supper at 5:00pm. Patient is currently on retirement and does not like attending social

activities like wedding ceremonies but loves to read and listen to radio. He takes in alcohol

(Beer) and used to be a smoker but has now stopped smoking for the past years. He goes to

toilet twice a day but passes urine as many times as possible depending on the quantity of

water taken and the prevailing weather condition of a particular day.

1.6 PAST MEDICAL HISTORY

Upon discussions, he said that he has never suffered from any serious illness until some

months ago, when he started feeling symptoms of fatigue, restlessness and pains in the

chest. It was then that he was diagnosed as having congestive cardiac failure at Korle-Bu

Teaching Hospital.

1.7 PRESENT MEDICAL HISTORY

Patient was well until on the 30th November, 2023 he started experiencing heart pains,

coughing, tiredness and severe headache. According to him, he took tablet paracetamol for

three days and he could not bear the pain any longer so he was rushed to the emergency ward

of the Korle-Bu Teaching Hospital where he was diagnosed of Congestive Cardiac Failure

and then sent to the male medical unit for further treatment of his condition.

3
1.8 ADMISSION OF PATIENT

On Tuesday, the 5th of December, 2023 at 11:00am, Mr. K.F. was admitted through the

Accident and Emergency unit of Korle- Bu Teaching Hospital by doctor J.A with the history

of coughing, breathlessness, headache and chest pain for three days. He was diagnosed as

having congestive cardiac failure. He was immediately put into a well laid bed and then

transferred to the male medical ward for further treatment. A nurse at Accident and

Emergency unit pre-informs the nurse in charge at the male medical ward of the patient’s

condition. An admission bed was prepared (cardiac bed) in readiness for his arrival. Later,

patient was brought into the ward in a wheel chair by the nurse at Accident and Emergency

unit accompanied by patient’s daughter, sister F.Z. They were warmly welcomed and patient

folder taken from the accompanying nurse. Patient was then put into the cardiac bed prepared

for him.

His vital signs on admission recorded as:

 Temperature 36.00c

 Pulse 107bpm

 Respiration 26cpm

 Blood pressure 138/199mmHg and

 Weight 58kg.

Laboratory Investigations requested to be done includes;

1) Chest X-ray

2) Electrocardiogram

3) Blood urea nitrogen

4) Blood Creatinine level

5) Blood film for malaria parasite

6) Sickling test

4
He was put on the following treatments as prescribed:

1. Furosemide 100mg stat then 80mg 12 hourly for 48 hours

2. Tablet Lisinopril 5mg daily for 30 days

3. Tablet Paracetamol 1gram tds for 3days

4. Intravenous Aminophylline 250mg tds for 5 days

All drugs were collected and administered as prescribed. Patient was reassured and made

comfortable in bed. Patient’s daughter was also informed of visiting hours as 4:00- 5:30am

and 4:00- 5:30pm daily and was asked to go and bring patient’s toiletries and other items

needed. Other hospital protocols were outlined to her. Patient was oriented to the ward later

when his condition was stable. It was during the admission process that I used the opportunity

to throw more light on my intention to involve patient and the rest of the family in my care

study which they agreed. Patients’ particulars such as his full name, age, sex, religion, date of

birth, address, and diagnosis were entered into the admission and discharge book.

1.9 PATIENT’S CONCEPT OF ILLNESS

Mr. K.F. does not attribute the cause of his illness to any evil spirits but believes his illness

came as a surprise to him. He believes that once he is in the hospital, he will be fine by the

grace of God and the medical team.

5
 1.10 LITERATURE REVIEW

Congestive Cardiac Failure (CCF)

DEFINITION:

Congestive cardiac failure can be defined as an insufficient cardiac output to meet the

metabolic demands or needs of the body. The term congestive cardiac failure is most

commonly used when referring to both left sided and right sided heart failure. (Wash, 2002)

universityhealthnews.com

INCIDENCE

Globally, heart failure affects 1% of people aged 50 years, about 55 of those aged 75 years

and 25% of those aged 85 years or older. In U.S.A, near to 5million people have heart

failure, it is responsible for one million hospital admissions and 50000 deaths annually

(American Heart Association, 2007). The condition is more common among African

Americans than whites. The rate of death from heart failure is about 10% after 1year. About

half of those with congestive heart failure die within five years after diagnosis

(Smelter,&Bare,2018)

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AETIOLOGY OR CAUSE

According to Smelter, and Bare, (2010); congestive heart failure can result from any clinical

situation that alters the myocardial performance. They include the following:

1. Hypertension (High blood pressure)

2. Coronary artery disease (CAD) including angina and heart attack.

3. Valvular heart disease (Aortic regurgitation, Aortic stenosis, mitral regurgitation,

mitral stenosis)

4. Cardiomyopathies (Dilated cardiomyopathy, Myocarditis, amyloidosis and

hemochromatosis)

5. Toxic exposure like alcohol or cocaine

6. Anesthesia and surgery

7. Prolonged serious arrhythmias

8. Pericardial disease such as pericardial effusion

Congestive heart failure may also occur in the presence of the following lifestyle habits:

1. Unhealthy habits such as smoking and excessive use of alcohol are often to blame.

2. Obesity and lack of activity may contribute to congestive cardiac failure, either

directly or indirectly through accompanying high blood pressure, diabetes and

coronary artery disease.

PATHOPHYSIOLOGY

Congestive cardiac failure manifests as organ hyper fusion and inadequate reserve as well as

pulmonary systemic venous congestion. A variety of compensatory adaptations occurs;

including increased left ventricular volume and mass (hypertrophy). The myocardium

hypertrophies in order to be able to pump the accumulated blood. Also, there is an

increased
7
systemic vascular resistance secondary to enhanced activity of the sympathetic nervous

system and elevated levels of circulating catecholamine, the heart rate increases in order to

raise the cardiac output to meet the demands of the body. The renin–angiotensin mechanism

where renin is released from the cardiac output and anaerobic metabolism, when the cells get

little oxygen, metabolism decreases and there are alterations in the methods of energy

production in the body. This leads to production of adenosine triphosphate which causes

metabolic acidosis which decreases myocardial contractility.

When all compensatory mechanisms then reach their critical levels, they begin to fail. The

right ventricle fails to function properly, the right atrium becomes distended and this leads to

stasis in the venous system. The pressure in the inferior and the superior vena cava increases.

The veins in the neck are distended, the liver become engorged, the legs become edematous

. The left side heart fails when blood returns to the left side of the heart more quickly than the

left ventricle can pump out, it leads to decrease stroke volume hence decrease in cardiac

output and also increase in left ventricular diastolic pressure and left atrium, then increase in

pressure of the pulmonary veins and capillaries. Some fluid will leak out causing edema of

the lungs and also pulmonary hypertension (Smelter, & Bare, 2018).

8
 universityhealthnews.com

CLASSIFICATIONS OF HEART FAILURE

According to Smelter, and Bare, (2018), Heart failure can be described or classified in

several ways:

1. Left sided Failure: There is a reduction in the left ventricular output and/or an increase in

the left atrial or pulmonary venous pressure resulting in pulmonary edema.

2. Right sided Failure: There is a reduction in right ventricular output for any given right atrial

pressure. Causes of isolated right heart failure include chronic lung disease (Cor-pulmonale).

3. Congestive heart failure (Involving both sides): Failure of the left and right heart may

develop because the disease process (e.g. dilated Cardiomyopathy or ischemic heart disease)

affects both ventricles or because disease of atrial pressure, pulmonary hypertension and

right heart failure.

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 CLASSIFICATION BASED ON THE SYMPTOMATOLOGY BY

NEW YORK HEART ASSOCIATION

According to Smelter, and Bare, (2010), the classifications based on the symptomatology by

New York heart association are as follows:

1. NYHA I: Heart disease present but no undue breathlessness from ordinary activity.

2. NYHA II: Comfortable at rest, breathlessness on ordinary activity.

3. NYHA III: Less than ordinary activity causes breathlessness, which is limiting

4. NYHA IV: Breathlessness present at rest, all activities cause discomfort

CLINICAL MANIFESTATIONS

According to Smelter, and Bare, (2018), the clinical manifestations of congestive heart failure

are:

1. Difficulty in breathing (dyspnea)

2. Fatigue

3. Orthopnea

4. Cough which is productive or dry

5. Dizziness

6. Pallor

7. Anxiety

8. Headache

9. Fever

10. Pedal or sacral edema

11. There may be evidence of pleural effusion (especially on the right side)

10
COMPLICATION OF CONGESTIVE CARDIAC FAILURE

According to Smelter, and Bare, (2018), the complications in congestive cardiac failure are as

follows:

1. Myocardial infarction

2. Cardiac arrhythmia

3. Pulmonary edema

4. Pneumonia

DIAGNOSTIC INVESTIGATION

According to Smelter, and Bare, (2018) the following diagnostic test can be done in

congestive cardiac failure:

1. Full blood count

2. Chest x-ray

3. Electrocardiogram

4. Echocardiogram

5. Coronary angiogram

6. Myocardial biopsy

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 MANAGEMENT

Medical management

1. Diuretics: An example is furosemide (Lasix) used to eliminate excess body water. It

decreases pulmonary venous pressure and reduce preload. Diuretics cause the

excretion of excess extracellular and this reduces the volume of blood returning to the

heart and improves cardiac function.

2. Beta-adrenergic blockers: An example is metoprolol which decreases myocardial

workload and protects against fatal dysrrhythmiably blocking norepinephrine effects

of the sympathetic nervous system.

3. Aldosterone antagonist decreases sodium retention, sympathetic nervous system

activation and cardiac remodeling. Example is spironolactone (Aldactone)

4. Angiotensin II receptor blockers which are similar to angiotensin-converting enzyme

inhibitors (ACE inhibitors) are used in patients who cannot tolerate. ACE inhibitors

due to angioedema or cough. Valsartan (Diovan) is an example of ARBs.

5. Supplemental oxygen therapy: This may become necessary as the heart failure

progresses. Then need is based on pulmonary congestion resulting in hypoxia.

Basically, oxygen administration increases the amount of oxygen delivered to the

myocardium and other vital organs.

6. Angiotensin-converting enzyme inhibitors: With these, the conversion of angiotensin

I to the vasodilator angiotensin II. Angiotensin-converting enzyme inhibitors such as

Lisinopril and captopril decreases left ventricular afterload with subsequent decrease

in heart rate thereby reducing the workload of the heart and increasing cardiac output.

A positive inotropic agent such as digoxin increases the hearts’ ability to pump more

effectively by improving the contractility of the myocardium, it also decreases the left

12
ventricular diastolic pressure and decreases systemic vascular resistance (Smelter, & Bare,

2010)

7. NURSING MANAGEMENT

According Smelter, and Bare, (2018), Nursing management of person with congestive heart

failure focuses on several specific problems, these include;

1. Decreased Cardiac output

2. Fluid volume excess

3. Anxiety

4. Alteration in lifestyle and self-care

The nursing management according to Smelter, & Bare, (2018) are:

1. REST

 Patient is assisted to assume a semi-recumbent position to decrease work of

respiratory muscles and oxygen utilization.

 Intermittent rest periods during the day and after activities are arranged

and the patient rest before and after meals and between procedures.

 Nursing activities are planned such that they do not interfere with patient’s rest

period

2. IMPROVING ACTIVITY TOLERANCE

 The limbs should be put through passive movement to promote venous

drainage and prevent phlebothrombosis.

13
  A gentle massage of the limbs is also helpful

 If the patient’s condition permits, it may be suggested that he or she gradually

commences foot leg exercises.

 The patient is also encouraged to take 5-10 deep breathe every 1-2 hours to

expand the lungs fully.

 Observations are made of reactions to any activity so that undue stress on

heart may be avoided.

3. NUTRITION

 Basically, the oedema associated with chronic congestive failure is treated

with dietary restriction of sodium.

 The use of flavorings, spices, herbs and lemon juice are encouraged with salt

substitutes

 Patient is given a written list of permitted and restricted foods.

 Patient is advised to look at all labels to ascertain sodium content (Antacids,

laxatives, cough remedies).

 Patient’s diet is planned together with the family taking into consideration

patient’s preferences and dislikes, patient and family are made aware of the

essence of sodium-restricted diet (that is to combat the oedema associated with

the condition).

4. RESTORING FLUID BALANCE

 Keep intake and output chart; weigh to determine if oedema is controlled.

 Measure the patient’s abdominal weight daily.

 Encourage the client to elevate the lower extremities while sitting.

14
  Limit salt intake to 2-3grams daily.

 Administer diuretics as ordered in the morning for daily dose and the second

dose in the late afternoon if it’s twice to avoid frequent urinating in the night.

 Diet should be rich in protein to bring down the oedema.

5. OBSERVATION

Monitor vital signs 4 hourly, assess for evidence of hypoxia (restlessness, tachycardia and

angina) give drugs ordered and observed for side effects, monitor client’s response to the

drug, observe mental status of client completely.

6. ELIMINATION

 Constipation and straining at defecation are to be avoided because of the

undue strain placed on the heart. A mild laxative may be given to keep the

stool soft.

 Use of the bedpan requires more energy than getting out of bed and using a

commode, therefore it is preferable for the patient to use a bedside commode.

1.11 VALIDATION OF DATA

Data obtained from client was verified from relatives and crossed checked from patient

folder, health workers, laboratory investigation, and physical assessment in order to get

correct information devoid of errors, biases and misinterpretations. The data were also

recorded as obtained and so there could be no gross distortion related to care giver

biases.

15
 CHAPTER TWO

2.0 ANALYSIS OF DATA

Data analysis is the next step in the nursing process and involves the proper organization of the data collected from the client, family and the health

team. It involves breaking down of data collected during the period of assessment of the patient in order to arrive at conclusion about the patient

condition.

2.1 COMPARISON OF DATA WITH STANDARDS

The table on the next page shows the comparison of results of various diagnostic investigations carried out on Mr. K.F. with literature values so

as to identify potential alterations in physiological functioning.

The following investigations were carried out to confirm the actual diagnosis of the patient’s condition:

1) Chest x-ray

2) Blood film for malaria parasite

3) Blood urea nitrogen

4) Blood creatinine level

5) Sickling test

6) Electrocardiogram

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 TABLE 1: LABORATORY INVESTIGATIONS

Date Specimen Investigation Results Normal values Interpretations Remarks

05/12/2023 Chest Chest X-ray The x-ray showed The cardiothoracic ratio 1. The hearth Patient was given
cardiothoracic should be less than 0.50 was enlarged furosemide to drain fluid
ratio of 0.75 2. The alveolar out of the alveolar space
alveolar oedema space was filled
with fluid.

05/12/2023 Chest Electrocardiogram Left ventricular Normal ventricles Left ventricle was Treatment was given.
hypertrophy enlarged

05/12/2023 Blood Blood film for Zero plasmodium Malaria parasites should Patient had no No anti-malaria drugs
malaria Parasites parasites not be seen malaria given
(MPs)

06/12/2023 Blood Blood urea nitrogen 15.5g/dl 7- 20 mg/dL (2.5- Results indicate that No treatment given
level estimate 7.1mmol/L) patient is in a normal
range

06/12/223 Blood Blood Creatinine 1.0mg/dL 0.84-1.21mg/dL (74.3- Results indicate No treatment given
estimate level 107mmol/L) patient is in normal
range
06/12/2023 Blood Sickling test Negative Negative RBC’S should be No sickling No treatment was given
circular biconcave and
nucleated
06/12/2023 Chest Electrocardiogram ECG showed subtle ST and T waves should be It is suggestive of IV Aminophylline 250mg
nonspecific ST and normal CCF administered to improve
T wave cardiac dialatation.
abnormalities.
Waves
17
 2.2 CAUSE OF PATIENT’S ILLNESS

With reference to the causes of congestive cardiac failure as indicated in the literature review,

Mr. K. F’s condition could be due to the smoking he engaged himself some years back.

TABLE 2: CLINICAL FEATURE ACCORDING TO LITERATURE

CLINICAL FEATURES ACCORDING CLINICAL FEATURES EXHIBITED BY

TO LITERATURE PATIENT

1.Dyspnoea Patient experienced severe difficulty in breathing

2.Fatigue Patient experienced fatigue

3. Orthopnea Patient experienced orthopnea

4. Productive cough with pink frothy sputum Patient presented dry cough

5.Dizziness Patient experienced dizziness

6. Pallor Patient was pale

7. Anxiety Patient was anxious

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8. Headache Patient had headache

9. Fever Patient was feverish

10.Pedal or sacral oedema Patient present oedema of the lower extremities

11.Pleural effusion especially on the right Patient had pleural effusion on the side of the heart

side of the heart

2.3 PATIENT’S SPECIFIC TREATMENT

During the course of treatment, client was put on the following medication:

1. Intravenous Furosemide 100mg stat then 80mg 2 hourly x48 hours

2. Tablet Lisinopril 5mg daily for 30 days

3. Tablet Paracetamol 1gram tds for 3days

4. Spironolactone 50mg daily for 30days

5. Intravenous Aminophylline 250mg tid for 5 days

19
 TABLE 3: PHARMACOLOGY OF DRUGS

DATE DRUG DOSAGE/ROUTE OF CLASSIFICATION DESIRED SIDE EFFECT REMARKS

ADMINISTRATIOM OF DRUG EFFECT

STANDAR PRESCRIBED
D DOSAGE DOSAGE

5/12/2023 Furosemide 1-2mg/kg not 100mg start then Loop diuretic Inhibits sodium Patient had frequent No side effect
to exceed 80mg 1 2hourly and chloride urination, excessive observed
600mg per for 48hours reabsorption at sodium and
day proximal and subsiding the
distal tubules oedema especially
and the of the lower
ascending loop extremities.
of Henle of the
kidney.

5/12/2023 Acetaminophen 15mg/kg tid 1gram tds for Non-narcotic Relieve of pain Nausea and No side effect was
for 3days 3days and reduce fever vomiting, urticaria, observed.
jaundice and
hypoglycemia
DATE DRUG DOSAGE /ROUTE OF CLASSIFICATION DESIRED SIDE EFFECT REMARKS
ADMINISTRATION OF DRUG EFFECT

STANDARD PRESCRIBED
DOSAGE DOSAGE

5/12/2023 Lisinopril 5-10mg daily 5mg daily for 30 ACE inhibitors Blocks a Dry cough, fever, Patient blood
Days substance in the itching blur vision, pressure was
body that causes drowsiness, Decreased
the blood to headache and
tighten. This tiredness.
lowers blood
pressure and
increases the
supply of blood
and oxygen to
the heart

21
DATE DRUG DOSAGE/ROUTE OF CLASSIFICATION DESIRED SIDE EFFECTS REMARKS
ADMINISTRATION OF DRUG EFFECT OF
DRUG
STANDARD PRESCRIBED
DRUG FOR
PATIENT

6/12/2023 Aminophylline 5-7mg/kg 250mg for Bronchodilator Relieve Arrhythmias’, No side effect

5days bronchospasm nausea, seizures observed.

6/12/2023 Spironolactone 20-75mg daily 50mg Diuretic Relieve fluid Tingling No side effect

daily x build up due feeling, muscle observed

30days to heart weakness or

failure shortness of

breath.

22
2.4 COMPLICATIONS

With reference to the complications stated under the literature review, it was observed that

the patient did not have any complications during admission due to the excellent nursing care

rendered to him.

2.5 PATIENT’S HEALTH PROBLEMS

1. Patient had difficulty in breathing

2. Patient had swollen feet

3. Patient complained of not being able to sleep well

4. Patient complained of not being able to eat well

5. Patient and his family had no knowledge on the condition

6. Patient complained of fatigue

2.6 SPECIFIC STRENGTH

1. Patient was able to sit up in bed

2. Patient was able to take warm bath to induce sleep for 2 hours

3. Patient could take food served in bits

4. Patient and family showed readiness to be educated on condition

5. Patient was able tolerate activities of daily living with assistance

2.7 NURSING DIAGNOSES

1. Dyspnea related to decrease cardiac output and low oxygen supply to the body.

2. Fluid volume excess(oedema) related to sodium retention

3. Sleep pattern disturbances (insomnia) related to chest pain

4. Imbalance nutrition (less than body requirement) related to loss of appetite

5. Knowledge deficit related to inadequate information about disease condition.

23
6. Activity intolerance(walking) related to fatigue

24
 CHAPTER THREE

This is the third stage of the nursing process in which the nurse, patient and the patient’s

family put heads together to see the possibility of rectifying the patient’s health problems. In

planning for the care of a patient, one has to draw a plan for short term needs and long-term

needs. The short-term goals are expected to be achieved within a short period of time whereas

the long-term goals take some time to be achieved.

3.1 OBJECTIVE / OUTCOME CRITERIA

In order to render a comprehensive nursing care to the client, it is important for the nurse to

develop objectives as a guide to determine when the nursing activities are expected to yield

results. These objectives can either be short term or long term. Short term objectives are those

that are set to be achieved within a relatively short period of time, whilst the long-term

objectives are expected to be met at a much longer term.

OBJECTIVES

1. Patient will regain a normal breathing pattern within 48hours as evidenced by:

i. patient having a normal breathing pattern (18-20 cycle per minute).

ii. Patient verbalizing that he breath without difficulty.

2. Patient will maintain a normal fluid and electrolyte balance throughout hospitalization as

evidenced by:

i. patient not having pitting oedema at his lower extremities.

ii. Patient regaining normal skin turgor.

3. Patient will regain normal sleep pattern (6-8 hours) within 24hours as evidenced by:

i. night nurse reports

25
 ii. verbalization by the patient that he slept well.

4. Patient will be relieved of pain in the chest within 24 hours as evidenced by patient

verbalizing absence of pain

5. Patient will regain his normal eating pattern within 48hours as evidenced by:

i. patient eating at least ¾ of meals served.

ii. Patient verbalizing that he has regain his appetite

6. Patient will gain optimal knowledge on cause, signs and symptoms, prevention and drug

regime within 5hours as evidenced by:

i. patient discussing and displaying in – depth knowledge about the condition.

ii. Nurse observes patient remain calm in bed.

26
 TABLE 4: PATIENT AND FAMILY CARE PLAN FOR MR. K.F

DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION/ SIGN
TIME DIAGNOSIS OUTCOME TIME STATEMENT
CRITERIA
5/12/23 Dyspnea Patient will have 1. Put patient in a semi 1. Patient was put in a semi fowler position to 6/12/23 Goals fully met E.K.
O
@ related to a normal fowlers position ease in breathing. @ as evidenced by

11:00am decrease breathing 2. Remove tight 2. Tight garments around patient’s 11:00pm patient’s

cardiac pattern (18- garments around patient’s neck, waist, and chest were loosen. respiration rate

output and 20cycles per neck, waist and chest 3. Patient was taught deep breathing reduced to

low oxygen minute) within 3. Teach patient deep and coughing exercise 18cycle per

supply to the 24 hours as breathing exercise 4. Patient was told his condition will improve minute and

body. evidenced by the 4. Reassure patient 5. patient was given comfortable device to patient

nurse checking 5. Support patient with aid in breathing verbalizing relief

and recording pillows or back rest. 6. Patient vital signs was checked of difficulty in

the normal 6. Monitor vital signs and recorded. breathing.

respiratory rate 7. Administer prescribed 7. Oxygen 3litre per minute was served as

of the patient oxygen. ordered.

27
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION/ SIGN
OUTCOME TIME STATEMENT
TIME DIAGNOSIS CRITERIA
5/12/23 Fluid volume Patient will 1. Reassure patient 1. Patient was told he would be relieved of the 10/12/23 Goal fully met as E.K.O.

@ excess maintain a 2. Elevate the feet swollen feet with the drugs given @ evidenced by

11:45am (pitting normal fluid side of the bed of 2. Foot end side of the bed was raised with 11:45am patient not

oedema of and electrolyte the patient patient’s feet elevated with pillows having pitting

feet) related balance 3. Monitor input and 3. Input and output chart was monitored oedema at his

to sodium throughout output lower

4. Patient was taught to take in low salt diet, avoid
retention hospitalization 4. Teach patient on extremities.
spicy foods but rather should eat flavorings, herbs
as evidenced dietary restrictions
and lemon.
by patient not 5. Teach patient
5. Patient was educated to do moderate
having pitting weight reduction
exercise such as walking around the bed to and
oedema at his measures
from of the ward as well as weighing himself
lower 6. Serve prescribed
daily.
extremities. Medications
6. Intravenous Furosemide 80mg was served as

28
Ordered

29
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION/ SIGN
OUTCOME TIME STATEMENT
TIME DIAGNOSIS CRITERIA
6/12/23 Activity Patient will regain 1. Reassure patient 1. Patient was told that he would regain 7/12/23 Goal fully met E.K.O.
2. Place items close to
@ intolerance strength within 24 enough strength as the days went b, by @ as evidenced by
the bedside
8:00am (walking) to hours as evidenced the care rendered by the doctors and 8:00am patient
3. Alternate activities
fatigue by patient nurses. performing
with care
performing 2. Items needed by the patient were activities
4.Give high calorie diet
activity of daily put within reach to help conserve without

living with little 5. Serve prescribed energy assistance

assistance medication 3. Patient was made to rest intermittently

with less performance of activities

4. Carbohydrate foods were given to

provide energy

5. Lisinopril 5mg was administered.

30
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION/ SIGN
TIME DIAGNOSIS OUTCOME TIME STATEMENT
CRITERIA
6/12/23 Sleep pattern Patient will regain 1. Reassure patient 1. Patient was told he would have a 7/12/23 Goal fully met E.K.O
@ disturbances normal sleep 2. Prevent patient normal sleep with the nursing care @ as evidenced by
8:00am related to pattern (6-8 hours) from falling rendered. 8:00am patient
chest pain within 24 hours as 3. Provide a very 2. Side rails were provided verbalizing
evidenced by 1. quiet environment ability to sleep
night nurse report. 4. Perform all nursing 3. Nurses and relatives were told to 6-8 hours at
2. verbalization by activities together minimize their voices, lift chairs and night.
the patient that he 5. Restrict visitors not drag them. 2. night nurse
slept well. during periods of 4. Vital signs, serving of meals report

sleep and medications were done

6. Put patient in a together

position that helps

relief the pain 5. Relatives were restricted to visiting time

7. Administer 6. Patient was put in a Fowles position.

prescribed
7. Tablet spironolactone 50mg and iv
medications aminophylline 250mg were administered
to help reduce chest congestion and
improve breathing.

31
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION/ SIGN
OUTCOME TIME STATEMENT
TIME DIAGNOSIS CRITERIA

7/12/2023 Imbalance Patient will regain 1. Plan diet with patient 1. Diet was planned with patient 9/12/2023 Goal fully met as E.K.O

@ nutrition his normal eating 2. Provide mouth care for 2. Patient was assisted to do @ evidenced by 1.

8:15am (less than pattern within patient Mouth care 8:15am patient eating ¾

body 48hours as 3. Serve food in bits 3. Food (salt free light soup) of served meal.

requirement) evidenced by 1. and attractively was served in bits and 2. Patient

related to patient eating at 4. Serve patient with fruits attractively verbalized that
boost appetite.
loss of least ¾ of meals 4. Fruits such as oranges, apples, he has regained

appetite. served. etc were given to boost patient his appetite.

2. Patient appetite

verbalizing that

he has regain his

appetite

32
DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION/ SIGN
TIME DIAGNOSIS OUTCOME TIME STATEMENT
CRITERIA
8/12/2023 Knowledge Patient will gain 1. Assess the 1. Patient knowledge was assessed 8/12/2023 Goal fully met as E.K. O
@ deficit related optimal knowledge of patient on on the condition @ evidenced by 1.
8:20am to inadequate knowledge on condition 1:20pm patient
information cause, signs and 2. Explain the nature of 2. Nature of condition was explained verbalized his
about disease symptoms, condition to the patient to the patient and both written and understanding of
condition prevention and and provide written and oral information provided. the disease
drug regime oral information condition.
3. Rational of prescribed
within 5hours 3. Explain prescribed 2. Nurse
medications was explained to the
as evidenced by medication to patient Observed that
patient
1. patient along their rational i.e., patient was calm
4. Patient and family were given
discussing and purpose and side in bed.
opportunity to ask questions and
displaying in – effects
also express their concerns
depth 4. Provide opportunity
knowledge for patient and family
about the to ask questions,
condition. discuss concerns and
2. Nurse make necessary
observes patient lifestyle changes.
remain calm

33
bed

34
 CHAPTER FOUR

• IMPLEMENENTATION CARE RENDERED TO PATIENT/FAMILY CARE

PLAN

This is the fourth stage of the nursing process. This includes the summary of the actual

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

discharge and follow-up care.

• SUMMARY OF ACTUAL NURSING CARE

The actual nursing care rendered to the patient and family in the management of the condition

on the day of admission, 05/12/2023 through to the time of discharge, (10/12/2023) and

continued into follow-up visits. He was nursed using the nursing care plan which was

prepared based on identified health problems.

FIRST DAY OF ADMISSION (5TH December, 2023)

Mr. K.F. was admitted into the male medical ward of the Korle-Bu Teaching Hospital on the

5th of December,2023 from Accident and Emergency unit in a wheel chair accompanied by a

nurse and his daughter into the ward. They were warmly welcomed to the ward and he was

made comfortable in a cardiac bed and all necessary information was collected from patient

and accompanying nurse. Patient and his relative were reassured of the competency of the

health team.

Patient’s vital signs were checked and recorded as Temperature; 36.0 0 c, Pulse; 107 bpm,

Respiration; 26cpm, and Blood pressure; 130/99mmhg. Prescribed medications were also

collected and started after setting up an intravenous line.

Upon assessing the patient, it was found out that patient had dyspnea and the objective was to

help patient have a normal breathing pattern (18-20cycles per minute) within 24 hours of
33
nursing care. To achieve this goal, patient was put in a semi fowler position to ease in

breathing, patient tight clothing was loosened and prescribed oxygen administered. Patient’s

particulars were documented in the admission and discharge book and into the daily ward

state. Also, patient had oedema on the lower extremities as a result of sodium retention.

Patient was told he would be relieved of the swollen feet with the drugs given, end side of

the bed was raised with patient feet elevated with pillows, input and output chart was

monitored, patient was taught to take in low salt diet. Patient was also educated to do

moderate exercise such as walking around the bed to and fro of the ward as well as weighing

himself daily. Intravenous furosemide 80mg was served as ordered. Patient was then handed

over to the night staff at 11:20pm after he was stabilized.

SECOND DAY OF ADMISSION (6th December, 2023)

Patient’s vital signs were checked and recorded and medication at 6:00am was served and

taken. From the report book, patient complained of waking up frequently to urinate at night

as such did not sleep adequately. Patient was greeted and enquired about his condition and he

said he was fairly well. Mr. K.F. was assisted to take his bath, oral hygiene, and his bed linen

was changed. Dusting of unit was done and a simple cardiac bed was made for her.

At 8:00am, he was reviewed by Dr. A.P during ward rounds and he complained of insomnia,

and headache. Mr. K.F was reassured he would have a normal sleep with the nursing care

rendered, side rails were provided to prevent him from falling, a very quiet environment was

provided for him, all nursing activities too were also performed together and visitors were

restricted during his period of sleep. Also, patient could not walk due to fatigue. Patients

was told he would regain strength as the days went by, by the care rendered by the doctors

and nurses, items needed by patient was put within his reach to conserve energy, he was also

made to rest with less performance of activities, and carbohydrate foods were given to

34
 provide energy. A towel was damped and placed on his forehead; windows opened for

ventilation; noise in the ward was reduced as much as possible. Dr. A.P asked for treatment

to be continued. Intravenous fluids were continued. Vital signs were checked at 10:00a.m and

recorded as; Temperature-36.30C, Pulse-100bpm, Respiration-24cpm, Blood pressure-

124/100mmHg

Patient was made comfortable in bed and was also advised to have enough bed rest. All

prescribed medications were served and all procedures carried out were documented

appropriately.

My intention of paying a first visit to his home with his daughter who promised to take me to

the house the next day was discussed with him.

THIRD DAY OF ADMISSION (7th December, 2023)

The patient was said to have slept comfortably, which he verified following an exchange of

pleasantries. He had maintained his personal cleanliness and taken his prescriptions as

prescribed at 10:00 p.m. and 6:00 a.m. Mr. K.F. expressed the lack of headaches, insomnia, and

weariness. An evaluation of earlier days of admission was performed, and it was clear that the

goals had been fully met. The patient was evaluated, and it was discovered that he had

nutritional imbalance (less than body requirement) due to a loss of appetite.

. Mr. K.F's diet was arranged with him, mouth care was provided, food was supplied in bite-

sized portions, and fruits such as oranges and apples were offered to stimulate his appetite. At

10:00am, his vital signs were 36.4◦C, 94bpm pulse, 20cpm respiratory rate, and

120/80mmHg blood pressure.

During our conversation, he expressed a desire to be with his family at home, and he was

urged to engage with other patients to alleviate boredom. The objective of his admission was

explained to him, as well as the fact that he would recover and return home soon.

35
Care plan for the previous day was evaluated and it was realized that all goals were fully

met. Routine nursing care such as vital signs and serving of medications were done and

documented appropriately.

FOURTH DAY OF ADMISSION (8th December, 2023)

Much improvement was seen in patient’s condition on the fourth day of admission. After

reading through the report book, the patient reported to have slept soundly at night and

maintained his personal hygiene. Patient’s loss of appetite was ceased. He had taken

breakfast and lunch. He was assessed on knowledge of his condition and it was realized that

the patient had knowledge deficit related inadequate information about the disease condition.

He was reassured of competent nursing care and the nature of the disease condition, rational

of prescribed medication as well as prevention of the disease condition was explained to the

patient.

His vital signs at 2:00pm read; Temperature-36.8 ◦C, Pulse-94bpm, Respiration-22cpm,

Blood pressure-120/70mmHg. His medication at 2:00pm was served and recorded. Patient

was observed to be communicating with others and looked calm and relaxed in bed. Patient`s

vital signs were checked at 6:00pm and recorded and medications were administered as

prescribed.

FIFTH DAY OF ADMISSION (9thDecember, 2023)

After greeting and asking patient of her condition he said he was doing well and hoped to be

discharged home. He had maintained his personal hygiene and other ward routine activities

carried out. His vital signs were checked at 6:00am as; blood pressure-120/70mmHg,

temperature-36.2˚ C, pulse-96bpm and respiration-22cpm.

36
At 8:30a.m, he lodged no complaint during the ward rounds. His medication was

continued by Dr. A.P and was told of possible discharge the next day. At 2:45pm, care

plan for 08/12/23 was evaluated and realized that goal was fully met.

SIXTH DAY OF ADMISSION (10TH December, 2023)

Patient health was better on the sixth day of admission. After greeting and asking him

about his condition, he said he was doing well and hope to be discharged home. He

maintained his personal hygiene and other ward routine activities carried out. His vital

signs were checked at 6:00am as; temperature-36.5 0 C, pulse 94bpm, respiration 24cpm

and blood pressure- 120/74mmHg.

At 8:30am, he was seen by Dr. A.P and discharged home with tablet Acetaminophen 1g

tds for 7days and tablet Lisinopril daily for 5days and he was told to come for review on

20th of December, 2023.

Drugs were collected and Mr. K. F’s knowledge was evaluated and he was able to give an

account on the causes, signs and symptoms and some preventive measures of her disease

condition. Patient was taken through the disease condition for some few minutes and he

was taught how to take the drugs. His discharge was entered into admission and discharge

book as well as the daily ward state form. Patient was assisted to pack his belongings and

he thanked me and said goodbye to the other patients in the ward and the staff. Mr. K.F

was accompanied to the car park where he boarded his son’s car to his house.

• PREPARATION OF PATIENT/FAMILY FOR DISCHARGE/REHABILITATION

The preparation of Mr. K.F and family for discharge started on the day of admission during

the first interaction with him. Patient and family were reassured that his condition would

improve and soon be discharged home. The care took the form of reassurance, education on

diet, personal hygiene and drug regimen. Patient was made to understand that it was a

right
37
choice he made by coming to the hospital to seek early treatment. They were encouraged to

continue with health care and avoid self-medication. They were also educated on the causes,

signs and symptoms of congestive heart failure. The needed cooperation from patient was

made known to him and the family pledged their maximum cooperation.

A visit to patient’s home was made on the 8 th of December, 2023, that is three days after the

patient was still on admission. This was done to assess and prepare the home setting. The

necessary information and education were given to the family for preparation of receiving the

patient back home. Patient and family were advised on the importance of follow-up visits by

the nurse.

• FOLLOW UPS/ HOME VISITS/CONTINUITY OF CARE

Home visit is a planned visit a health care provider makes to the patient’s house to study,

identify and know the conditions of the client’s home that might contribute to the condition

or cause a recurrence and find possible solutions to their health problems.

PREDISCHARGE VISIT (8th December, 2023)

The first home visit was made whilst patient was on admission. The patient’s home was

visited in the company of his daughter. Patient’s home is located at Abeka Adom junction

near the Harvest chapel. Upon reaching the house, a quick observation was made of the

environment and it was noticed that the environment was clean. The house was built with

cement blocks and roofed with aluminum sheets. The house is a four-bed room self-

contained. The doors and windows were well netted to prevent mosquitos from biting them.

38
The source of drinking water was pipe-borne. Refuse was collected into dustbins with lid and

pick by a swage company weekly. Patient’s family members and other people in the house

were encouraged to maintain a healthy environment which would promote good health.

The family members showed appreciation for the visit and permission was sought to leave.

They were promised of my next visit after which they accompanied me to the taxi station

where they bade me goodbye.

FIRST FOLLOW UP VISIT (15thDecember, 2023)

The second home visit was made on the said date. On reaching the house, the family

members were happy to see me again. After being offered a seat and pleasantries exchanged,

an enquiry into patient’s health was made and also to know if they had any new complaints.

No complaints were made and patient was found to be doing well. The need to reduce sodium

intake and the intake of a balanced diet was emphasized. They were also advised to give the

patient’s medications as prescribed. Patient’s wife was reminded of the date for review and

advised to adhere to it. The need to terminate the care on the next visit was also discussed. He

was also informed of the need for another health personnel close to his house to take over his

care. He was promised that a community health nurse, who will be doing this, will be

introduced to him during the next visit. Permission was sought to leave with a promise of a

third and final visit. They were thankful for the visit.

Day of Review (20th December, 2023)

On the day of review, patient was assisted to go for his folder and accompanied to the

consulting room. Patient had no complaint and was advised to continue with his medications

and report any abnormality noticed. Patient was accompanied to the car and he was bid

goodbye.

39
THIRD HOME VISIT (30th December, 2023)

The third home visit was made to assess the progress of patient’s condition and to finally

hand him over to a community health nurse to continue with the care. On reaching the house,

I was welcomed by the patient. After exchanging greetings, patient and family were thanked

for their cooperation throughout the care. The community health nurse who would continue

with the care was introduced to him. Patient was advised to continue to give his maximum

cooperation. Patient and family took time to express their appreciation for the care rendered

to them after which they pledged their continued cooperation.

40
 CHAPTER FIVE

5.0 EVALUTION OF CARE RENDERED TO PATIENT AND FAMILY

The last phase of the nursing process is evaluation; it gives insight into the effectiveness of

the care rendered to the patient. Evaluation runs through all the steps in the nursing process. It

indicates patient’s state of condition at the time of discharge.

5.1 STATEMENT OF EVALUATION

From the day of admission (5/12/2023) to the day of discharge (10/12/2023), Mr. K.F. was

rendered individual care. Problems were identified and managed in order of priority. All

the objectives and goal set were met.

1. On the first day of admission (5th December, 2023), he complained of difficulty in breathing.

Objectives were set to relieve patient of the difficulty in breathing within 24 hours as

evidenced by the nurse checking and recording the normal respiratory rate of the patient The

goals were fully met as his breathing pattern became normal.

2. On the 5th of December, 2023, an objective set at 11:45am to help patient have a

reduced oedema on the lower extremities as evidenced by the nurse observing pitting

oedema. The goals were fully met as evidenced by patient not having pitting oedema at

his lower extremities.

3. On the 6th of December, 2023 at 8:00am, an objective was set to help patient regain normal

sleep pattern (6-8 hours) within 48 hours as evidenced by the night nurse report. On that same

day at exactly 8:00am objectives were set for the patient to gain strength within 24 hours as

evidenced by patient performing activity of daily living with little assistance. Goal was fully

41
met as evidenced by patient verbalizing ability to sleep 6-8 hours at night and patient

performing activities without assistance.

4. On the 7th of December, 2023 at 8:20am objectives were set to help patient regain his

normal eating pattern within 48hours as evidenced by patient eating at least ¾ of meals

served. Goal fully met as evidenced by patient eating ¾ of served meal.

5. On the 8th of December, 2023 at 8:00am an objective was set to help patient gain

optimal knowledge on cause, signs and symptoms, prevention and drug regime within

5hours. Goal fully met as evidenced by met as evidenced by patient verbalizing the

understanding of the disease condition.

Mr. K.F. was nursed using the nursing process throughout his period of hospitalization.

Based on the various health problems identified on him, a nursing care plan was developed

and initiated under which objectives were set and the nursing interventions carried out

accordingly.

Mr. K. F’s condition improved and he was discharged home after six days of admission. Mr.

K.F and his family understood the disease condition and promised to take in necessary

measures to prevent the recurrence of the condition. Most of the health problems identified

were alleviated.

5.2 AMENDMENT OF NURSING CARE

Amendment is drawn when set goals are not fully achieved. With effective nursing care

rendered to the patient and with support from the medical staff and patient’s family, all set

goals were successfully met within the stipulated time. There was no need for amendment

of any of the objectives.

42
5.3 TERMINATION OF CARE

It is the last stage of the relationship between the nurse and the patient. It is the most difficult

and important part of the cordial relationship that exist between the two parties. This is the

interactions between the nurse, patient and family is brought to a successful end. This aspect

was made known to Mr. K.F and family on the day of admission. As a result, they were not

worried about separation when it was made known to them during the last home visit. Patient

and family were reminded of the need to report any abnormalities to the hospital and not to

hesitate to call for help when the need arises. Patient looked healthy and his general condition

had improved. They were thanked for their maximum support and cooperation throughout the

hospitalization and writing of this case study. They also expressed their sincerest gratitude for

the care rendered to them.

5.4 SUMMARY

The nursing care study is a documentary on the nursing care given to Mr. K.F, a 61years old

man. He was admitted to the male medical ward of the Korle-Bu Teaching Hospital on the

5th of December 2023 with the diagnosis of Congestive Cardiac Failure.

On admission, he looked ill but with a good management and effective nursing care together

with support from patient and relatives, his condition improved satisfactorily.

He was discharged on the 10th December 2023 without any complications. He looked healthy

and happy on the day of discharge. Three home visits were carried out during which patient

and family were educated. On the last visit, patient’s condition had improved tremendously.

5.5 CONCLUSION

In conclusion, the care study has been an educating and challenging experience. The study

has helped me gain insight into the condition congestive cardiac failure. It has also helped me

43
to understand comprehensive nursing care especially to patients with this condition. It has

also given me the adequate practical knowledge to confidently take care of patients using the

nursing process approach in the clinical field.

5.6 RECOMMENDATIONS

Schools should allow students to start their care study early in order for students to spend

enough time on their work and also to do more than one, so that students will be well

equipped and then gain more experience.

44
 BIBLIOGRAPHY

Abrams, A.C (1995), Clinical drugs therapy rational for nursing practice (4th edition)

Philadelphia; J.B Lippincott company

Bloom A. & Bloom S. (1986); Tooheys Medicine For Nurses (14th edition) Churchill

Livingstone , London

Smelter, S.C. & Bare, B.G. (2018). Brunner and Suddarth textbook of medical and surgical

nursing 12th edition . Philadelphia: Wolters Kluwer Health/Lippincott Williams &

Wilkins .

Standard Treatment Guidelines (2010). Ghana National Drug Programm.6th Edition. Accra:

Yemen Press Limited.

Wash, M. (2002). Watson's Medical And Surgical Nursing And Related Science (7th ed).

London : Elsevier limited.

45
 SIGNATORIES

1. NAME OF STUDENT ERIC KYERE OFOSU

SIGNATURE……………………………………………………………………………….

DATE……………………………………………………………………………………….

2. NAME OF SUPERVISOR MRS. DELPHINA ABBEY

SIGNATURE………………………………………………………………………………

DATE……………………………………………………………………………………….

3. NAME OF CLINICAL SUPERVISOR

SIGNATURE …………………………………………………………...............................

DATE …………………………………………………………………………………........

4. NAME OF HOD

SIGNATURE ………………...…………………………………………………………...

DATE ………………… ……...……………………………………………………….......

46