CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

1.0 Introduction

According to Smelter and Bare (2010), assessment is the systematic collection of data to

determine the patient health status and any actual or potential health problems. The first step

in the nursing process is a systematic comprehensive process of collecting data, organizing

and documenting patient’s specific data gathered from various available sources. It includes

the patient’s medical, personal, social and environmental status. This helps to render the exact

nursing care to the patient and family. Information is gathered from patient and family

through interviewing, observation, and reference to past medical records. It involves patient’s

particulars, family medical history and socioeconomic history. Assessment provides

information that forms the patient’s database. Two types of information are collected which

are subjective (data from patients point of view and include feelings, perceptions and

concerns) and objective data (are observable and measurable data that are obtained through

assessment techniques performed during physical examination and diagnostic test). Patient

was the primary source of information; however, other sources like patient folder, patient

relatives etc were not overlooked. The data gathered is analyzed to arrive at the patient’s

problem so that the nurse can determine the possible ways of nursing the patient for good

health and independent life.

1.1 Patient’s Particulars

Patient’s particulars are the details of information of the patient that has been recorded which

includes name, sex, date of birth and religion.

Madam A.F.B is a 63year old woman, who was born on 10th of January, 1946. She is the first

born of her parents. She has 8 children and married to Mr A.F, her husband. Three (3) are

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males and five (5) are females. Madam A.F,B lives at Katakyiekrom, a suburb of Drobo but

comes from Dormaa Akwam in the Brong Ahafo. Madam A.F,B is an illiterate and lives

with her husband and some of her children. She is a farmer.

Madam A.F.B is Bono by tribe and she speaks only Brong Twi. She is a Christiana and

member of Jehova Witness at Katakyiekrom . Her next of kin is Mr. A.F., her husband.

Madam A.F.B is a beneficiary of the National Insurance Scheme. She is dark in complexion,

has small amount of gray hair, about 1.63cm tall and weighs 65kg. She has no physical defect

nor any tribal mark on the face.

1.2 Patient’s Family Medical

The Patient/Family’s Medical History provides information about illness which has a genetic

of families’ tendency (Weller, 2014).

According to patient, there are no known genetic or hereditary disorder such as sickle cell

disease, diabetes, hypertension, mental illness as well as any chronic disease such as, chronic

heart failure and chronic renal failure in her family. She also added that there are no

communicable diseases like tuberculosis or leprosy existing in their family.

According to Madam A.F.B. her maternal and paternal grandparents are all dead due to

aging. Her parents are alive but do not suffer any medical ailment.

According to patient she sometimes suffer attacks of headache, chills and fever which she

treats with over-the-counter (OTC). She said she has been admitted to the St. Mary’s Hospital

on two occasions due to abdominal pains and malaria. Generally, Madam A.F.B. is in good

condition of health.

There are no known allergies to drugs, food or any substances in his family. She was then

educated about buying (over-counter-drug) since it was not prescribed by the medical officer

because it can lead to other health complications.

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1.3 Patient’s Family Socio-Economic History

Mrs. A.F.B has a family size of ten; Her husband, and her eight children. Mrs. A.F.B is a

farmer. She is supported by her husband, who is also farmer and their eldest son, K.A.B,

who is a retailer of clothing, sandals, belt and watches. Her two daughters are all grown up

and married and they also occasionally support her financially. Because of her occupation,

she is prone to occupational hazards like cuts, animal bites or stings. Patient also claim that

on farming days she normally goes to the farm very early in the morning and return late in

the afternoon. The income from the farming is used for the up keep of the family and their

health needs when health insurance does not cover such expenses. Patient and family are

holders of the national health insurance card. Madam A.F.B said her external family

members on some occasions assist them financially but generally her income and that of her

husband is able to support the family.

Madam A.F.B is a Christian and a member of the Jehovah Witness group. She said that she

normally goes to evangelism during the weekend with her husband. According to patient,

she enjoys this because it’s a way through which she serves God. On her traditional belief,

patient said it was taboo in the community to go to farm on Tuesdays. As a Christian and a

mother, she believes in discipline and hard work. She likes people who are hardworking and

discipline and abhors those who are not.

1.4 Patient’s Developmental History.

Development is the increase in complexity of form and functional capacity. Developmental

history refers to the information obtained from the parents of a specific client (child/patient)

regarding potential significant historical milestones and events that might have a bearing on

the client’s current difficulties.

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Patient was born at Dormaa Akwam in Brong Ahafo region of Ghana on 10th of January,

1946. According to patient her mother told her that she was delivered spontaneously through

the vagina after nine months gestation without any complication by a Traditional Birth

Attendant (TBA).

Patient was never immunized against all the six killer diseases according to her mother and

there was no mark on her deltoid muscle to prove of immunization. Madam A.F.B could not

give a detailed account of her developmental milestone. She was told that she passed through

the normal developmental milestone thus went through all normal developmental transitions

being, sitting, crawling, standing, walking etc. without any setback and by age 12 months

could walk without assistance.

She also said, she started showing signs of maturity at the age of 15 years with the

development of pubic hair, enlargement of breast, menstruation and others. She started

having menopausal symptoms at the age of forty-five (45) years. She did not attain formal

education but as part of her aspiration and career plan when she was growing up, she had

wanted to be a seamstress which she couldn’t because of lack of financial support during

that period, currently she is a farmer. She married her husband, when she was 22 years old

and gave her first birth when she was 23 years old. Currently, she has eight children, three

males and five females. Patient has few grey hair which he confirmed started coming when

he was around 55years. Patient’s teeth are all intact and her skin is minimally wrinkled.

According to Eric Erikson’s psychosocial theory of development, a person above the age of

60 falls within integrity verses despair. At this stage, people in their late adulthood reflect on

their lives and feel either a sense of satisfaction or a sense of failure. People who feel proud

of their accomplishment feel sense of integrity and they look back at their lives with few

regrets while people who are not successful at this stage feel as if their lives have been

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wasted. They focus on what would have, should have, or could have been. They face the end

of their lives with feelings of bitterness, depression and despair.

From the above and base on the information gathered from patient it is clear that patient has

succeeded in this stage of life as manifested by the fact that her two female children are all

successfully married and working, her sons also are into retailing business. She is also

actively a church member in her local church. She also enjoys life with her life partner.

1.5 Obstetric History

Madam A.F.B had a normal menstrual cycle of twenty-eight (28) days. She had normal

menstrual flow which lasted for five (5) days and had her menarche at the age of fourteen

(14years) .She has a parity of 8, 3 males and 5 females. All her children were delivered by

Spontaneous Vagina Delivery (SVD) in the hospital without postpartum haemorrhage and

other complications. The spacing between their births was 3years. Patient said she use to

control and space her birth with birth control pills. She had her menopause when she was

around 45 years. According to Madam A.F.B she has never suffered abortion before.

According to her, she never suffered from any sexual transmitted infections (STIs) such as

gonorrhea, syphilis, HIV/AIDS, among others. She has not also suffered from any breast

conditions like breast cancer, mastitis and breast engorgement.

1.6 Patient’s Lifestyle and Hobbies

Madam A.F.B is a woman who is calm and respectful. She is introvert and loved by the

people around her. She is interested in praying, listening to music and reading the scriptures.

She said her opinion in life now is to fulfill her mission as Christian thus is to preach the

kingdom of God to others. She wakes up at 6 O’clock in the morning observe her quilt time

and pray to commit herself and her family to the Almighty God. She brushes her teeth with

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toothbrush and toothpaste .she then cleans the house, prepared breakfast, bath, eats and then

takes her medications if any and goes to farm with her husband. She retires to bed at about

8:00pm. She bath twice daily with warm water and empties her bowel ones daily and her

bladder elimination is between 2 to 4 times daily. On days that she goes to the farm, she

leaves very early in the morning and return very late in the afternoon to prepare food for the

family. Patient has no known allergies for food and drugs.

At times she goes for evangelism which she says is a core duty of every Christian.

On Wednesdays and Fridays she goes to church in the afternoon and On Sundays in the

morning. Madam A.F.B is not selective with regards to food but her favorite is fufu with

light soup. She eats three times daily but sometimes she eats twice a day. She baths twice

daily and visits the lava trine every morning.

Madam A.F.B says during her leisure periods she relaxes on her bed and listens to the radio.

She said she tries to take three square meals a day .She does not smoke nor drink alcohol. At

her leisure hours she normally watches Television and her favorite television programme is

“kuch rang”. On weekends, she attends social gatherings such as weddings, naming

ceremonies and funerals. Patient uses both verbal and nonverbal communication style such as

eye movements and gesture to speak to her children to desist from doing certain things.

1.7 Patient’s Past Medical

According to patient, she does not remember any childhood illness she suffered from such as

measles and whooping cough. She has never had an accident. According to Madam A.F.B,

she has never been admitted into the hospital before until six years ago when she was

diagnose of peptic ulcer disease at St. Mary’s Hospital (Drobo). She sometimes manages

minor illnesses like headache, abdominal pains and fever with over the counter drugs and

herbal preparations. She stated that she has not undergone any surgery before. She says also,

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that she does not go for medical checkups and only goes to the hospital when she is seriously

sick. She has no known allergies to any drugs yet. Madam A.F.B has no physical disabilities.

She has easy access to health care because she is nearer to a health facility and always valid

health insurance card

1.8 Patient’s Present Medical History

According to Madam A.F.B, she was well until 18th July, 2019, when she started

experiencing severe epigastric pain, vomiting and heart burns so she was rush to the hospital

for early treatment on that very day. She was given treatment and was manage as an

outpatient case. Two days later, she began to experience the same problem but in severe form

then she was admitted to females ward on 20th July, 2019 at St Marys Hospital (Drobo),

She went through the outpatient department and was seen by Doctor Quansah and was

diagnosed as having peptic ulcer disease and admitted to the females ward.

1.9 Admission Of Patient

Admission of a patient is the entry of a patient into the hospital setting for therapeutic and

diagnostic purposes. There are 2 types; planned and unplanned admission. In the case of my

client, it was unplanned admission.

Madam A.F.B walked into the females medical ward accompanied by a nurse and her

husband at 2:25pm with the diagnoses of peptic ulcer disease on 20th July, 2019 and was

admitted by Dr. Quansah. On arrival at the ward, they were welcomed them and offered a

seats at the nurse’s station. I quickly collected her folder and glanced through the admission

notes and her name was mentioned to make sure she was the right patient to which she

responded to. On admission, Madam A.F.B complained of epigastric pain, vomiting, heart

burns, loss of appetite and was also anxious. Madam A.F.B was made comfortable in an

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already prepared admission bed. Vital signs were checked and recorded on admission as

follows;

Temperature 39.30 C

Pulse 97bpm

Respiration 16cpm

Blood pressure 135/90mmHg

Her weight was 65kg on admission.

The medical officer, Dr. Quansah prescribed the following medications to be used to

manage Madam A.F.B

Intramuscular Promethazine 25mg stat

Intravenous Omeprazole 40mg bd for 72 hours

Intravenous Metronidazole 500mg tds for 24 hours

Intravenous Amoxiclav 1.2g tds for 24 hours

Suspension Nugel O 15mls tds for 5 days

Tablet Paracetamol 1g tds for 5 days

Tablet Multivite I daily for 14 days.

Patient was also ordered to do the following laboratory investigations.

Blood for full blood count

Blood firm for malaria parasites estimation

All drugs were collected and first doses administered as ordered. Her blood sample was

taken and sent to the laboratory for the investigations to be conducted. Madam A.F.B, and her

husband were oriented to the ward and its annex. Daily ward routines were adequately

explained to them. They were also introduced to the other clients in the ward as well as staff

present and her name and other particulars were entered into the admission and discharge

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book as well as the daily ward state. An intravenous line was secured. The patient and Her

were very anxious and I reassured them. I then introduced myself to Madam A.F.B as Student

Nurse Yankyera, a final year student of the Holy Family Nursing and Midwifery Training

College Drobo, who has come to the St Mary’s Hospital to conduct a patient/family care

study and would like to take her as my patient for the care study which is a partial

requirement by the Nursing and Midwifery Council towards the award of a license to practice

as a registered general nurse. I also explained to her how care is going to be rendered to her

from the time of admission until discharge and also told her I will visit her residence during

her admission and after she has been discharged as well. Discharge plan was communicated

to patient and husband including possible duration of hospitalization and after care. She

agreed to be used for the care study.

I took Madam A.F.B for my care study because I wanted to know more about the disease

condition.

1.10 Patient’s Concepts Of Her Illness

Upon interacting with the patient, it was realized that she did not know the actual cause of her

illness but believed that it was precipitated by the ingestion of certain irritating food such as

very hot pepper and spicy foods. The patient however did not relate the cause of her illness to

any spiritual force but believed that after her treatment, she would be healthy once again.

Patient believes that the treatment planned for her in the hospital would be useful to her health

and cure her illness and prevent any complications.

1.11 LITERATURE REVIEW ON PEPTIC ULCER DISEASE (PUD)

Review of the anatomy of the Gastrointestinal System.

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Literature review of a condition gives a detailed insight into the condition. It talks about the

established and laid down facts about the disease condition, which aids in the medical and

nursing diagnoses and the appropriate management for that particular disease. It also entails

the standard with which the patient’s clinical manifestations, diagnostic investigations,

treatment and others are compared. It comprises of the following:

1. Definition

2. Types

3. Incidence

4. Etiologic/Causes

5. Pathophysiology

6. Clinical features

7. Diagnostic investigations

8. Medical management

9. Nursing management

10. Prevention and

11. Complications

Anatomy and physiology of the Gastro-Intestinal Tract (GIT).

The gastro-intestinal system is essentially a long tube running right through the body, with

specialised sections that are capable of digesting food and extracting any useful components

from it, then expelling the waste products at the bottom end. The whole system is under

hormonal control, with the presence of food in the mouth triggering off a cascade of

hormonal actions; when there is food in the Stomach, different hormones activate acid

secretion, increased gut motility, enzyme release etc. Nutrients from the GI tract are not

processed on-site; they are taken to the liver to be broken down further, stored, or distributed.

(Gerard J. Tortora and Bryan Derrickson,2010

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The oesophagus

Once food has been chewed and mixed with saliva in the mouth, it is swallowed and passes

down the oesophagus. The oesophagus has a Stratified squamous epithelial lining which

protects the oesophagus from trauma; the sub mucosa secretes mucus from mucous glands

which aid the passage of food down the oesophagus. The lumen of the oesophagus is

surrounded by layers of muscle- voluntary in the top third, progressing to involuntary in the

bottom third- and food is propelled into the stomach by waves of peristalsis.(Gerard J.

Tortora and Bryan Derrickson, 2010)

Diagram of the Stomach

(Scalon and Sanders, 2010)

The stomach is a 'j'-shaped organ, with two openings- the oesophageal and the duodenal- and

four regions- the cardia, fundus, body and pylorus. Each region performs different functions;

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the fundus collects digestive gases, the body secretes pepsinogen and hydrochloric acid, and

the pylorus is responsible for mucus, gastrin and pepsinogen secretion. The stomach is

continuous with the oesophagus at the cardiac sphincter and with the duodenum at the pyloric

sphincter. It has two curvatures; the lesser curvature and the greater curvature. (Gerard J. etal.

2010)

The stomach has five major functions;

1. Temporary food storage

2. Control the rate at which food enters the duodenum

3. Acid secretion and antibacterial action

4. Fluidization of stomach contents

5. Preliminary digestion with pepsin, lipases.(Gerard J. etal. 2010)

Different areas of the stomach contain different types of cells which secrete compounds to aid

digestion. The main types involved are:

1. Parietal cells which secrete hydrochloric acid.

2. Chief cells which secrete pepsin.

3. Entero-endocrine cells which secrete regulatory hormones.(Gerard J. etal. 2010)

The stomach contains three layers of involuntary smooth muscle which aid digestion by

physically breaking up the food particles;

1. Inner oblique muscle

2. Circular muscle

3. Outer longitudinal muscle

The stomach contains small amount of gastric juice present in the stomach, even when it

contains no food. That is the fasting juice. Secretion of its maximum level about 1 hour after a

meal then declines to the fasting level after four hours. There are three phases of secretion of

gastric juice: cephalic phase, gastric phase, intestinal phase.

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The stomach mucosa is protected from the corrosive effect of the acid through the following

ways:

1. A thick coating of bicarbonate rich in mucus is built up on the stomach wall.

2. The epithelial cells of the mucosa are joined together by tight junctions that prevent

gastric juice from leaking into the underlying tissue layers.

3. Damage epithelial mucosa cells are shed and quickly replaced by division of

undifferentiated stem cells that reside where the gastric pits join the gastric gland.

(Gerard J. etal. 2010)

The Small Intestine

The small intestine is the site where most of the chemical and mechanical digestion is carried

out, and where virtually all of the absorption of useful materials is carried out. The whole of

the small intestine is lined with an absorptive mucosal type, with certain modifications for

each section. The intestine also has a smooth muscle wall with two layers of

musclerhythmical contractions force products of digestion through the intestine (peristalsis).

There are three main sections to the small intestine.(Waugh and Grant 2010)

The duodenum

It forms a 'C' shape around the head of the pancreas. Its main function is to neutralise the acidic

gastric contents (called 'chyme') and to initiate further digestion; Brunner's glands in the sub

mucosa secrete alkaline mucus which neutralizes the chyme and protects the surface of the

duodenum. (Waugh and Grant 2010)

Definition

A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosal wall of the

oesophagus, stomach, in the pylorus (the opening between the stomach) and duodenum, or in

the duodenum (the first part of the small intestine), (Hinkle and Cheever.2014).

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A peptic ulcer may be referred to as a gastric, duodenal, or oesophageal ulcer, depending on its

location. It is cause by erosion of a circumscribed area of mucous membrane. This erosion may

extend as deeply as the muscle layers or through the muscle to the peritoneum. Peptic ulcers

are more likely to occur in the duodenum than in the stomach. (Hinkle and Cheever.2014)

Incidence

The disease can occur anywhere, but it is common only in some area. Peptic Ulcer Disease

occurs more in men than women with the ratio 3:1. It was recorded in London 20 years ago

that duodenal ulcer was two to three time’s common than gastric ulcer. The prevalence of peptic

ulcer is higher in Scotland and the North of England than in the South. In the developed world,

duodenal ulcer is common than gastric ulcer and occurs in younger age. Gastric ulcer becomes

relatively common in elderly. After menopause, the incidence of peptic ulcer in women is

almost equal to that of men with duodenal ulcer.(Hinkle and Cheever. 2014)

Causes of peptic ulcer disease

According to Hinkle and Cheever(2014), there are main causative factors of peptic ulcer

disease are;

1. Increase action of hydrochloric acid and pepsin

2. Damaged mucosal barrier

3. Infection with Helico-bacter pylori from food and water, person, to person to contact

and contaminated articles from vomitus, though not all infection develop into ulcer.

Predisposing factors of peptic ulcer disease

1. Chronic use of Non-Steroidal Anti Inflammation Drugs e.g. Diclofenac, aspirin.

2. Alcohol ingestion Age (most often in people between the ages of forty and sixty years)

3. Emotion or stress and anxiety

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 4. Blood type; duodenal ulcer are common in blood type O and gastric ulcer in blood type

5. Family tendency

6. Certain endocrine diseases such as hyperthyroidism, pituitary tumour

7. Impaired activity of the pancreas

8. Excessive smoking

9. Irregularities in hormonal secretion e.g. oestrogen and progesterone lower acid

secretion.

10. Intake of spicy food

Types of peptic ulcer disease

According to Hinkle and Cheever(2014), Peptic ulcer can be classified according to the

location or site of mucosal erosion..

1. Oesophageal Ulcer: This is the less common type of Peptic Ulcer where there is an

excavation in a part of the mucosal lining of the oesophagus.

2. Gastric Ulcer: This is an excavation formed in the mucosal wall of the stomach.

3. Duodenal Ulcer: This is an excavation formed on the mucosa wall of the duodenum.

Peptic ulcer can also be described as acute or chronic depending on the degree of mucosal

involvement

Pathophysiology

Peptic ulcers occur mainly in the gastro-duodenal mucosa because this tissue cannot

withstand the digestive action of gastric acid (HCl) and pepsin. The erosion is caused by the

increased concentration or activity of acid–pepsin or by decreased resistance of the mucosa.

A damaged mucosa cannot secrete enough mucus to act as a barrier against hydrochloric

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acid. The use of Non-Steriodal Anti-inflammatory Drugs (NSAIDs) inhibits the secretion of

mucus that protects the mucosa. Patients with duodenal ulcers secrete more acid than normal,

whereas patients with gastric ulcers tend to secrete normal or decreased levels of acid.

Damage to the gastro- duodenal mucosa results in decreased resistance to bacteria, and thus

infection from Helicobacter pyloribacteria may occur. ZollingerEllision Syndrome (ZES) is

suspected when a patient has several peptic ulcers or an ulcer that is resistant to standard

medical therapy. It is identified by the following: hypersecretion of gastric juice, duodenal

ulcers, and gastrinomas (islet cell tumors) in the pancreas. Diarrhoea and steatorrhea

(unabsorbed fat in the stool) may be evident. The most common symptom is epigastric pain.

Stress ulcer is the term given to the acute mucosal ulceration of the duodenal or gastric area

that occurs after physiologically stressful events, such as burns, shock, severe sepsis, and

multiple organ traumas. As the stressful condition continues, the ulcers spread. When the

patient recovers, the lesions are reversed. This pattern is typical of stress ulceration.

Differences of opinion exist as to the actual cause of mucosal ulceration in stress ulcers.

Usually, the ulceration is preceded by shock; this leads to decreased gastric mucosal blood

flow and to reflux of duodenal contents into the stomach. In addition, large quantities of

pepsin are released. The combination of ischemia, acid, and pepsin creates an ideal climate

for ulceration. A small portion of patients who bleed from an acute ulcer have had no

previous digestive complains, but they develop symptoms thereafter. Patients may present

with Gastrointestinal bleeding as evidenced by the passage of tarry stools. (Hinkle and

Cheever. 2014)

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Clinical features

1. Dull gnawing pain or burning sensation in the mid-epigastrium or the back (epigastric

pain).

2. Feeling of hot water babbling in the back of the throat

3. Vomiting

4. Weight gain/weight loss depending on the type

5. Pyrosis (heartburns)

6. Bloating (abdominal tenderness)

7. Nausea

8. Constipation or diarrhoea

9. Hematemesis (vomiting blood)

10. Gastrointestinal bleeding

11. Tarry stools

12. Anaemia (if the ulcer has bled)

13. Night awaking: this normally occurs in patients with duodenal ulcer due to severe pains

that is relieved by eating.(Hinkle and Cheever. 2014).

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Table 1: Difference Between Gastric And Duodenal Ulcer(Charles, Gilbert, etal. 2008)

GASTRIC ULCER DUODENAL ULCER

Male-Female ratio is 1:1 Male-Female ratio is 2-3:1

There is loss of weight. Rapid weight gain.

Vomiting is common. Vomiting is uncommon.

Pain does not commonly occur at Pain commonly occurs at midnights.

midnights.

Pain will not occur in sleep. Pain awakes patient from sleep usually in

the middle of the night.

Pain is aggravated by the intake of Pain is relieved by the intake of food.

food.

Pain occurs ½-1 hour after meals Pain occurs 2-3 hour after meals.

Less likely to perforate. More likely to perforate.

Ulcerations normally occur at the Ulcerations normally occur in the first 1-

antrum, body and fundus of the 2cm of the duodenum.

stomach.

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Table 2: Comparison of duodenal ulcer and gastric ulcer (Hinkle and Cheever. 2014)
Criteria Duodenal ulcer
1. Age 30–60.
2. Male: female 2–3:1.
Incidence 3. 80% of peptic ulcer are
duodenal.
Signs and 1. Hypersecretion of stomach
symptoms, and acid (HCl).
clinical findings 2. May have weight gain
3. Pain occurs 2–3 hours after a
meal and often awakened
when it is 1–2 am and
relieved by food ingestion.
4. Vomiting uncommon.
5. Haemorrhage more likely to
occur than with duodenal
ulcer; hematemesis more
common than melena stools.
Malignancy 1. Rare
possibility
Risk factors 1. Helicobacter pylori, alcohol,
smoking, cirrhosis, stress.
Pain 1. Burning, cramping pain
across the epigastrium.
Diagnostic investigations
1. Upper gastric intestinal tract endoscopy and biopsy to rule out cancer.
2. Stool analysis reveals occult blood.
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Gastric ulcer
1. Usually 50 and over.
2. Male: female 1:1.
3. 15% of peptic ulcers are
gastric.
1. Normal-hyposecretion of
stomach acid (HCl).
2. Weight loss may occur.
3. Pain occurs 1-2 hours after a
meal and rarely occurs at night
and may be relieved by
vomiting but ingestion of food
does not help, sometimes
increases pain.
4. Vomiting common.
5. Haemorrhage less likely in
gastric ulcer, but if present,
melena stool is more common
than hematemesis.
1. Occasionally
1. Helicobacter pylori, gastritis,
alcohol, smoking, use of
NSAIDs, stress.
1. Dull, gnawing or burning
sensation in the mid-
epigastrium or back.
 3. Barium radiographic studies of the intestinal tract reveal changes in the mucosa.

4. Computed tomography scan of the stomach and duodenum.

5. History from patient.

6. Serum gastrin levels.

7. Antigen test to detect presence of helicobacter pylori antigen in blood.

8. Esophagogastroduodenoscopy (EGD) to determine the size and depth of the ulcer.

9. Presenting signs and Symptoms. (Hinkle and Cheever. 2014)

Medical treatment

Advances in drug therapy have dramatically changed the management of Peptic Ulcer

Disease and significantly improved its effectiveness. A variety of changes exists and the

specific protocol for any particular patient is determined based on the preference of the

physician and the patient’s unique profile. The goal of the management is to eradicate

helicobacter pylori, to manage gastric acidity, promote healing of the ulcer, and prevent

reoccurrence and complications and to alleviate symptoms. Drug therapy control peptic ulcer

symptom effectively often in a matter of days;

1. Antacids are given to neutralize the HCL. E.g. Magnesium Trisilicate, Aluminium

Hydroxide.

2. Histamine 2 receptor antagonist is given to reduce gastric secretion. E.g. Cimetidine

and Ranitidine.

3. Proton Pump inhibitors are given to eliminate acid secretions. E.g. Omeprazole,

lansoprazole, rabeprazole.

4. Mucosal Protective Agent is given to form a protective coat that prevents further

excavation. E.g. Sucralfate, Misoprostol.

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 5. Antimicrobial agent is given to prevent further infection. E.g. Metronidazole,

Amoxicillin.

6. Antispasmodic eg Buscopan is given to reduce gastric muscle motility thereby

reducing pain.

7. Antiemetics eg Promethazine is also given patient is vomiting

8. Analgesics to relive pain. E.g. Paracetamol, Tramadol.(Kumar and Clark, 2011)

Specific Medical and Surgical Intervention

Peptic ulcer disease can be treated both medically and surgically. The aim of treating peptic

ulcer disease includes:

1. To prevent complications and recurrence.

2. To alleviate symptoms of the disease.

3. To optimize the condition that promotes healing.

4. To decrease the offensive factors responsible for ulceration. (Kumar and Clark, 2011)

Surgical intervention

Surgery is used primarily for the management of complication such as perforation, suspected

cancer and the treatment of the occasional interactable ulcer that is resistant to all standard

therapy. Surgery procedures adopted include:

1. Vagotomy – This is the surgical removal of the vagus nerves. There are three types and

these are truncal, selective and highly selective.

2. Antrectomy–This is the surgical removal of the pyloric (antrum) portion of the

stomach with anastomosis to the duodenum either (gastroduodenostomy or Billroth I)

or jejenum (gastrojejunostomy on Billroth II).

3. Pyloroplasty – This is the surgical removal of the pyloric sphincter.(Kumar and Clark,

2011)

21
Nursing Management

Position

Patient is made comfortable on a well prepared admission bed with enough pillows for comfort.

Patient is made to assume a normal position that was not contrary to her health example supine

position. This helps the patient to relax and reduce pain. The patient is positioned to avoid neck

pain and joint stiffness.

Reducing anxiety/ reassurance

1. The nurse assesses the patient’s level of anxiety and reassured that she was in the hands

of competent and well trained staff that are always ready to offer care and support to

ensure good health.

2. Patient should be introduced to other patients who have similar conditions as her and

have had their treatment waiting to be discharged.

3. Relatives are reassured that all necessary procedures will be done for her.

4. Diversional activities such as watching of televisions and the use of slide pictures are

provided to divert patients mind from her condition.

5. Patients with peptic ulcers are usually anxious, but their anxiety is not always obvious.

Appropriate information is provided at the patient’s level of understanding, all

questions are answered, and the patient is encouraged to express fears openly.

Explaining diagnostic tests and administering medications on schedule also help to

reduce anxiety.

6. The nurse interacts with the patient in a relaxed manner, and relaxation methods, such

as biofeedback, hypnosis, or behaviour modification.

7. The patient’s family is also encouraged to participate in care and to provide emotional

support.

22
Rest and sleep

1. A quiet environment must be provided by reducing noise to allow patient to get enough

rest.

2. Windows are opened to allow ventilation.

3. Visitors should be restricted to allow patient gets enough rest and sleep.

4. Bed should be made free from creases and cramps by straighten the bed linen. Warm

beverages were served.

5. Warm bath must be given with warm water, soap, sponge and towel in order to relax

patient and to induce sleep.

6. Teach patient rest and relaxation techniques e.g. guided imagery emphasizes the need

to avoid stress.

Observation

1. Vital signs are checked and recorded which comprises of temperature, pulse, respiration

and blood pressure.

2. Intake and output chart should be monitored by observing intake and output chart to

know patient’s fluid and electrolyte balance.

3. The desired effect and side effect of drugs served are also observed.

4. Side effects of drugs should be observed and reported if any and skin and mucous

membrane for signs of dehydration.

5. Physical findings of epigastric or abdominal pain, nausea, vomiting, tarry stools,

bleeding should be observed.

6. Patient’s response to medication therapy, nutritional therapy and emotional rest are

observed.

23
Personal hygiene

1. Body hygiene is done by giving an assisted bed bath twice daily with warm water, soap,

sponge and towel to prevent offensive odour and to remove microorganisms from the

skin. Bony prominences, which are prone to be sore, are well cared for by treating the

area to prevent bedsore.

2. Soiled bed linens are also changed when dirty or wet to prevent bad odour and

harbouring of microorganisms.

3. Oral hygiene must be also done twice daily with toothpaste and toothbrush. This is done

to prevent oral offensive smell and to prevent the harbouring of micro bacteria.

4. Patient’s hair must also cared for by washing it with soap and water and drying it with

a towel.

5. Patient’s hands and feet are cared for by soaking them in water and trimming the nails

with nail clippers, washing and filling the nails. This will prevent harbouring of

microbes or prevent injury from scratching.

Nutrition / Diet

The intent of dietary modification for patients with peptic ulcer is to avoid over secretion of

acid and hypermobility in the gastric intestinal tract.

These can be minimized by avoiding extremes of temperature and over secretion from

consumption of meat extracts, alcohol, and coffee (including decaffeinated coffee, which also

stimulates acid).

Dietary compatibility becomes an individual matter. The patient eats food that can be tolerated

and avoids those that produce pain. Certain substance such as spicy food cause severe pain and

has to be avoided.

24
Smoking should be avoided as it has been shown to delay ulcer healing regardless of the

therapy.

Serve small frequent and bland foods. Avoid alcohol and give milk in between meals. Patient

is encouraged to take enough roughage to enhance bowel elimination.

Vitamin and minerals such as fruits like orange, banana, pawpaw should be encouraged to

boost up the immune system.

Patient / family education

1. Patient is educated on the factors that trigger the condition.

2. Modify lifestyle include health processes that will prevent recurrence of ulcer pain

and bleeding.

3. Plan for rest periods.

4. Learn to cope with stressful situation.

5. Chew food thoroughly and eat in leisurely manner.

6. Eat meals in regular schedule.

7. Avoid eating large meals, as they tend to over stimulate acid secretion.

8. Adhere to prescribed treatment.

9. Educate patient to report on signs and symptoms.

10. Educate patient that antacids causes changes in bowel movement.

11. Avoid over – the counter drugs unless prescribed by doctor.

12. Explain pathophysiology of condition to patient and family.

13. Encourage stress-reducing activities.

14. Educate patient on medication to be taken home, it doses, frequency, therapeutic

effects and possible side effects and explain maximum compliance.

15. Educate patient to come for regular check-ups.

25
 16. Educate patient to avoid irritating substances such as caffeine, carbonated drinks,

alcohol, and extremely spiced foods.

17. Patient should identify and avoid foods that cause distress and pain.(Hinkle and

Cheever, 2014)

Indications for surgery in peptic ulcer

1. Failure of ulcer to heal.

2. Increased risk of bleeding.

3. Multiple ulcer sites.

4. Pyloric or pre-pyloric ulcer. (Recurrence) (Hinkle and Cheever, 2014)

Complications

1. Haemorrhage with hematemesis and melena-This occurs as a result of the rupturing of

blood vessels due to the actions of the HCL.

2. Pyloric obstruction-Pyloric stenosis is the narrowing of part of the stomach (the

pylorus) that leads into the small intestines. This occurs as a results of scars which forms

when worn out tissues are been repaired.

3. Perforation-Perforation is the erosion of the ulcer through the gastric serosa into the

peritoneal cavity without warning. It is an abdominal catastrophe and requires

immediate surgery.

4. Penetration-Penetration is erosion of the ulcer through the gastric serosa into adjacent

structures such as the pancreas, biliary tract, or gastro-hepatic omentum.

5. Anaemia-This occurs as results of excessive bleeding from the ruptured vessels.

(Hinkle and Cheever, 2014)

26
Post-operative complications

1. Dumping Syndrome

2. Bile reflux(Hinkle and Cheever, 2014)

Prevention of peptic ulcer disease

1. High intake of spicy and fried foods should be avoided as much as possible.

2. A regular eating pattern should be established and abnormal long periods between

meals should be discouraged.

3. Intake of ulcer genic drugs such as salicylates, other non-steroidal anti-inflammatory

drugs and corticosteroids should be avoided.

4. Individuals with blood type O should adopt good lifestyle in order not to be

predisposing to the condition.

5. As far as emotional trauma, leading to stress and anxiety should be reduced.

6. Smoking and alcohol intake should be avoided since they irritate the gastric mucosa.

(Hinkle and Cheever, 2014)

1.10 Validation Of Data

This is the process of cross checking information collected from patient and other relatives to

confirm that they are accurate and precise. The purpose is to keep data as free from error, bias

and misinterpretation as possible. All data and information collected on the patient was

confirmed by the patient and husband.

The validation of data on Madam A.F.B was done by comparing the signs and symptoms

exhibited by her with that of the literature review from the textbook to get the difference and

similarities.

27
Information collected from various sources concerning client diagnosis was free from bias and

really proved the client was suffering from Peptic Ulcer Disease (PUD), hence the data

collected is valid.

28
 CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction

In respect to Weller (2009), analysis is the process of studying or examining something in

detail in order to understand it or explain it. Analysis involves making of conclusion from

data collected from a patient and relative. The signs and symptoms exhibited are compared to

what exist in the literature review and various laboratory investigations. The nurse analyzed

such information to deduce the exact nursing diagnosis to enable him or her to formulate

appropriate nursing care plans for the patient. Based on the analysis, the nurse is able to

identify the problems of the patient, her strengths, makes her nursing diagnoses, objectives

and gives appropriate interventions.

It comprises:

1. Comparison of data with standard

2. Patient/Family strength

3. Health problems

4. Nursing diagnosis

2.1 Comparison of Data with Standards.

This is where the data collected on the health of the patient is compared with those in the

Literature review. These include diagnostic investigation, causes, signs and symptoms,

treatment and complication.

Diagnostic Investigations/ Tests

A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of

disease, injury or any other medical condition, to monitor a person’s health, disease or the

effectiveness of treatment.

29
The following diagnostic investigations/tests were carried out on Mrs. A.F.B

Blood for full blood count

Blood firm for malaria parasites estimation.

Table 3: Diagnostic tests/investigation in literature review compared with those carried

out on Mrs. A.F.B

Diagnostic tests outlined in literature Diagnostic tests carried out on patient

review

Upper gastric intestinal tract endoscopy. Test was not conducted on patient.

Stool analysis. Test was not conducted on patient.

Barium X-ray of the intestinal tract. Test was not conducted on patient.

Computed tomography scan of the Test was not conducted on patient.

stomach and duodenum.

Physical examination Conducted on patient

Antigen test to detect presence of Test was not conducted on patient

helicobacter pylori antigen in blood.

Esophagogastroduodenoscopy Test was not conducted on patient.

History and presenting signs and Patient’s health history and signs and
symptoms were taking.
symptoms of patient

30
The table shows that history and presenting signs and symptoms of patient and Physical

examination were done for patient. It was based on these investigations that patient was

diagnosed as peptic ulcer disease.

Full blood count and blood for malaria parasite were carried out even though they were not

stated in the literature review. Malaria parasite test to rule out malaria and full blood count to

rule out infection and anemia were all done.

Details of the test carried out on the patient have been presented in table 4

31
 Table 4: Diagnostic Investigation/Test conducted on patient
The table shows that results for malaria parasite, red blood cell, haemoglobin, heamatocrit and neutrophils count were all normal. White blood
Date Specimen Investigation Results Normal value Interpretation Remarks
20/07/2019 Blood Full blood count
(FBC)
Haemoglobin level 12.3g/dl Male: 12.5 – 18.5g/dl Within normal range. No treatment given.
estimation Female: 12– 16g/dl
White blood cell count 12.0 x 109/L 4.0– 10.0 x 109/L Above normal range. Antibiotic therapy was
(WBC) given.

Red blood Cell Count 3.94 3.9 -6.5 x 10/l Within Normal range No treatment given.
(RBC) 46% 40-75% Within Normal range No treatment given
Neutrophils count 45.9 40-54% Within Normal range No treatment given
20/07/2019 Blood Film for malaria Negative Negative No malaria parasite was No treatment given.

parasites found

cell count was above normal. Appropriate antibiotics were administered to ensure white blood cell count came within normal.

32
B. Causes Of Patient’s Condition

The literature review and the diagnostic investigations carried out on patient revealed that

patient had peptic ulcer disease but the cause was not clear since the actual cause of the

disease is not well understood.

c. Clinical features/signs and symptoms

Comparison of clinical features exhibited by patient with those outlined in literature review.

Table 5 below shows the comparison of the clinical features.

Table 5: Clinical manifestations exhibited by patient compared with those in the

literature review.

Clinical features in textbooks Clinical features exhibited by client

Epigastric pain. 1. There was epigastric pain.

Haematemesis. 2. Client did not exhibit haematemesis.

Loss of appetite. 3. Client had loss of appetite.

Loss of weight. 4. Client had loss of weight.

Malena. 5. Client had no Malena stools.

Bloating and abdominal fullness. 6. Client had no bloating and abdominal

fullness.

Heart burns. 7. Client experienced heartburns.

Nausea and vomiting. 8. There was no nausea and vomiting.

Weakness. 9. Client had weakness.

33
 Insomnia. 10. Client has insomnia.

From the table above, patient experienced some clinical features as stated in the literature

review like pain in epigastric region, heart burns, sleeplessness, epigastric tenderness, loss of

appetite.

However, patient did not experience other clinical features such as bleeding, indigestion and

anaemia. Patient did not experience all the clinical features because she reported to the

hospital quite early for treatment.

D. Medical Treatment Given To Client

With reference to medical treatment in the literature review, the disease condition is

intervened by both medical and surgical means. Client was put on the following treatment;

Intramuscular Promethazine 25mg stat

Intravenous Omeprazole 40mg bd for 72 hours

Intravenous Metronidazole 500mg tds for 24 hours

Intravenous Amoxiclav 1.2g tds for 24 hours

Suspension Nugel O 15mls tds for 5 days

Tablet Paracetamol 1g tds for 5 days

Tablet Multivite I daily for 14 days.

Capsule Omeprazole 20mg bd for 14 days

Table 6 below shows the treatment given to patient compared with those in the literature

Review

34
Table 6 : Comparison Of Treatment Outlined In The Literature Review With Those

Given To Mrs. A.F.B

Treatment in literature review Treatment given patient

1.Antacids eg; Suspension Nugel O Antacids (Suspension Nugel O 15mls tds

for 5 days) was given to patient.

2.Proton-pump inhibiters eg; omeprazole Intravenous Omeprazole 40mg bd for 72

hours and Capsule Omeprazole 20mg bd

for 14 days were prescribed

3.Analgesicseg paracetamol Tablet Paracetamol 1g tds for 5 days

4.Antimicrobial agent eg; Metronidazole Intravenous Metronidazole 500mg tds for

24 hours, Intravenous Amoxiclav 1.2g

tds for 24 hours were prescribed

5.Anticholinergic drugs None was ordered for patient

6.Histamine 2 receptor antagonist None was ordered for patient

7.Antispasmodic None was ordered for patient

8.Antiemetics Intramuscular Promethazine 25mg stat

was administered

9.Surgery No surgical treatment was given to

I. Vagotomy patient

II. Gastrojejunostomy

III. Gastrectomy

From the table above comparing drugs in the literature review to the drugs given to patient,

the treatments given to patient were in line with the literature review .This shows clearly that

35
patient was given the correct management of her condition which contributed to her rapid

recovery.

Table 7 below shows the pharmacology of drugs given to patient.

36
 Table Four (7): Pharmacology Of Drugs

Date Drug Dosage & route Classification Desired effect Actual effect Side effect(s) / remedies

20/07/ Omeprazole 20mg bd x 14 days Proton pump Heals ulcer in the GIT by Gastric acid Oedema, fever, headache, dizziness,

2019 Orally. inhibitor reducing gastric acid secretion was malaise, diarrhoea, abdominal pain.

secretion. suppressed. Client experienced headache and

40mg bd for 72 hours
Intravenous constipation. She was encouraged to rest.

20/07/ Metronidazole 400mg three times Synthetic A synthetic antibacterial Therapeutic effect Should be administered with meals to
2019 daily x days orally Antibiotic and antiprotozoal agent that of drug was decrease
500mg three times inhibits the nucleic acid observed as there GI upset; may cause anorexia and metallic
daily for 2 days Antimicrobial disrupting the DNA of was remission of taste
Intravenous microbial cells. signs and symptoms Patient should avoid alcohol; Flagyl
of disease increases blood-thinning effects of warfarin
(Coumadin).
None of these was observed
20/07/ Multivite 5mg daily . Haematinic Enhances the production of Client hemoglobin Diarrhea, nausea, indigestion and
2019 Orally Iron red blood cells. level increased constipation.
supplement To treat iron deficiency and gradually to normal. None was observed in except constipation.
improve on hemoglobin
level.

37
 Date Drug Dosage & route Classification Desired effect Actual effect Side effect(s) / remedies

20/07/ Amoxiclav 1.2 g tds for 24 hours B-Lactam Control infection by Infection was Nausea, vomiting, diarrhea, rashes.
2019 Orally Antibiotic inhibiting bacterial cell controlled None was observed in client.
wall synthesis.

20/07/ Paracetamol 1g tds for 5days Analgesic Relieves mild to moderate Relieved patient of Rashes, hypotension, flushing, tachycardia
2019 Orally pain and pyrexia. pains. and liver damage.
None was observed in client.

20/07/ Promethazine 25mg stat Antiemetic/ Blocks dopamine and Patient was relieved Drowsiness, trachycardia, dry mouth,
2019 Intramuscular Antihistamine alphadrenergic receptors in of vomiting urticaria, urinary retention.
the brain, leading to less None was observed .
vomiting
20/07/ Nugel 0 15mls three times antacid Provides a protective Help to reduce acid Constipation, diarrhea.
2019 daily for 7 days suspension coating on the stomach content in the None of these was observed
Orally lining and lowering acid stomach and
level. relieved patient of
pain

38
Complications

This is any disease or disorder that occurs during the course of or because of another disease.

With reference to the literature review, this listed complication as perforation, intractability,

pyloric obstruction and anaemia.

However client did not develop any of these complications.

2.1 Patient/Family Strengths

Strength is a resource and ability that a client has which can help him or her cope with the

stress and problems resulting from his or her condition.

It also involves those that the family can also do to help facilitate the speedy recovery of the

client.

During the period of hospitalization, patient and family strengths that were identified were;

1. Patient is able to verbalise the intensity and location of abdominal pain (20/07/2019)

2. Patient is able to take in copious amount of fluid after vomiting (20/07/2019)

3. Patient was able to voice her fears about unknown outcome of disease (20/07/2019)

4. Patient can eat at least 5 teaspoons of food served (20/07/2019)

5. Patient could sleep for about three (3) hours at night(21/07/2019)

6. Patient can verbalise feeling of urge to eliminate her bowel (22/07/2019)

7. Patient and family were ready and willing to learn about the disease condition

(22/07/2019)

2.3 Patient/Family Health Problems

Weller (2010) defines problems as, any health care condition that requires diagnostic,

therapeutic, or educational action. It also refers, in nursing, to any unmet or partially met

basic human need. The patient/family’s problem means, the difficulties they faced because of
39
the disease condition .The following were the actual and potential health problems identified

with the patient during the period of hospitalization. They include;

1. Patient complained of abdominal pain (20/07/2019)

2. Patient vomited twice during the day (20/07/2019)

3. Patient and family were anxious about disease condition (20/07/2019)

4. Patient complained of loss appetite (21/09/2019)

5. Patient could not sleep well (21/07/2019)

6. Patient could not void well (constipation) (22/07/2019)

7. Patient had inadequate knowledge about disease condition (22/07/2019).

2.4 Nursing Diagnoses

A nursing diagnosis according to the NANDA International (2016) is a clinical judgement

concerning a human response to health conditions/ life processes, or vulnerability for that

response, by an individual, family, group or community. It is a clear and definite statement of

the patient’s health status that can be influence by nursing interventions. It is derived from a

validated, critically analysed and interpreted dated collected during assessment. Conclusions

are drawn regarding the patient’s needs, problems, concerns or human responses. The nursing

diagnosis, once identified, provides a central focus for reminder of the stages that is based on

the nursing process. The plan of care is designed, implemented and evaluated, hence making

it possible to give comprehensive health care to the problems. This is done by identifying,

validating and responding to specific health problems. The nursing diagnosis also provides an

efficient method of communicating the patient’s health problems.

Nursing diagnosis for Mrs. A.F.B are as follows;

1. Acute pain related to ulceration of the gastric mucosa (20/07/2019)

40
2. Risk for fluid volume deficit related to vomiting (20/07/2019)

3. Anxiety related to unknown outcome of disease condition (20/07/2019)

4. Imbalance nutrition (less than body requirement) related to anorexia (20/07/2019).

5. Sleep pattern disturbance ( Insomnia) related to abdominal pain (21/07/2019)

6. Altered bowel movement (constipation) related to side effect of medications

(omeprazole) (22/07/2019)

7. Knowledge deficit related to lack of inadequate information on causes, signs and

symptoms and prevention of disease condition(peptic ulcer disease) 22/07/2019

41
 CHAPTER THREE

PLANNING FOR PATIENT/FAMILY CARE

3.0 Introduction

Planning is the third phase of the nursing process and it involves setting of goals,

determination of priorities and planning a care to prevent or relief patient’s health problems

and as well as identifying nursing intervention to meet the set goals. It is the process of

developing a plan and establishing goals to achieve a desired outcome. Nursing care plan

entail nursing diagnosis, objective/outcome criteria, nursing orders, interventions and

evaluations. It helps the nurse to strategize and plan appropriate care for the patient to

promote recovery and discharge.

3.1 Objectives/Outcome Criteria

The following objectives were set for patient and family care during the period of hospitalization

to help solve their health problems identified.

1. Patient will be relieved of abdominal pains within 48 hours

2. Patient will attain normal fluid balance within 48 hours.

3. Patient will be relieved of anxiety within 24 hours.

4. Patient will regain her normal eating pattern within 48 hours.

5. Patient will regain her normal sleeping pattern within 48 hours.

6. Patient will resume her bowel movement within 48 hours.

7. Patient will gain adequate knowledge on the disease condition within 2 hours.

Table 6 below shows the nursing care plan for Madam A.F.B

42
 Table 8: Nursing Care Plan for Mrs. A.F.B

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
20/07/20 Acute pain Patient will be 1. Listen to patient expression of pain, 1. Patient was reassured of speedy 22/07/20 Goal fully
19 related to relieved of abdominal reassure her of proper nursing care and recovery since she is in the hands of 19 met as
speedy recovery competent nurses and medical team.
ulceration of pain within 48 hours evidenced
2. Assess level of patient’s epigastric 2. The level of pain was assessed
11am the gastric as evidenced by; pain every 30mins on a scale of 1-10. every 30mins on a pain scale 11am by patient
mucosa 1. Nurse observing indicated pain level of 7. verbalizing
3. Assist patient to assume a position 3. Patient was put in a comfortable
that, the patient looks absence of
that will be comfortable to her. position.
relaxed in bed. 4. Educate patient on relaxation 4. Patient was educated and assisted abdominal
2. Patient verbalizing techniques and assist her to carry out to carry out the relaxation technique. pain.
the exercise.
that she does not feel
5. Identify and limit foods that that 5. Foods that aggravates abdominal
the pains anymore. causes and aggravate the pain. pain such as spicy food, pepper was
limited.
6. Provide food frequently and in small 6. Patient food was served
amount. frequently and in small amount.
7. Administer prescribed analgesic and 7. Prescribed analgesics and antacids
antacid. i.e Paracetamol 1g and Suspension
Nugel O 15mls were served.
7. Monitor the therapeutic effects of the 7.The therapeutic effects of the
served drugs served drugs was monitored.
8. Encourage patient to take in bland 8.Patient was encouraged to take in
diet bland diet

43
 Table 8: Nursing Care Plan for Mrs. A.F.B continued

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
20/07/20 Risk for fluid Patient will retain a 1. Reassure patient/family that she is 1. Patient/family were 22/07/20 Goal fully
19 in hands of health team and that all reassured that she is in the 19 met as
normal fluid volume
volume deficit measures will be put in place to hands of health team and that patient
11:15am within 48 hours as reduce the vomiting. all measures will be put in 11:15am verbalise
related to place to reduce vomiting. absence of
evidenced by;
2. Observe patient for signs of 2. Patient was observed for signs of vomiting.
vomiting 1. Patient verbalizing dehydration such as pitting of the dehydration such as skin turgor
skin and appearance of the skin. and the appearance of the skin.
that nausea and
3. Maintain and keep strict intake and 3. Patient’s intake and output was
vomiting has output. maintained in the chart and it
was balanced at the end of each
ceased.
24 hours.
2. Patient having 4. Encourage patient to drink about 2- 4. Patient was encourage to
3 litres of fluid per day. drink about 2-3 litres of fluid per
normal skin turgor.
day to replace fluid loss.
5. Provide frequent oral care for 5. Frequent oral care was
patient. provided for patient to replace
6. Remove nauseas items from the fluid loss.
ward environment. 6. Nauseas items such as bed pan
were removed from patient’s bed
side.

44
 Table 8: Nursing Care Plan for Mrs. A.F.B continued

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
20/07/20 Anxiety Patient will be 1. Reassure patient and immediate 1. Patient and immediate family was Goal was
19 21/07/20
family of remission with available reassured that the condition will fully met as
related to relieved of anxiety 19
11:30am treatment. resolve with the available treatment. 11:30am patient and
unknown within 24hours as
2. Reassure patient and immediate 2. Patient and immediate family immediate
outcome of evidenced by family of the competence and readiness was reassured of the competence family
of the staff. and readiness of the staff. verbalized
disease 1. Nurse observing
3. Educate patient and immediate 3. Patient and immediate family relieve of
condition that patient is relaxed
family on the condition were educated on condition anxiety and
and has a cheerful 4. Encourage patient and immediate 4. Patient and relatives were they had
family to ask questions. encouraged to ask questions. relaxed
facial expression.
5. Answer all questions tactfully and 5. All questions were answered facial
2. Patient verbalizing
honestly tactfully and honestly expression
that, she is no more
6. Explain all procedures carried out on 6. All procedures carried out on
anxious. patient. patient were explained.

45
 Table 8: Nursing Care Plan for Mrs. A.F.B continued

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
20/07/20 Imbalance Patient will attain 1. Reassured patient. 1. Patient was reassured that measures will 22/07/20 Goal was
19 be put in place to help gain and maintain her 19
nutrition (less
adequate nutritional 2. Assess patient’s nutritional normal nutritional requirement. fully met as
12pm than body 12pm
status. 2. Patient’s nutritional status was assessed.
status within 48 hours evidenced
requirement) 3. Maintain patient’s oral
related to as evidenced by: hygiene twice daily. 3. Patient’s oral hygiene was maintained by by
cleaning the mouth with tooth paste and
anorexia
1. Nurse observing tooth brush twice daily (morning and Patient
evening) and the mouth rinsed with water
that patient tolerate 4. Encourage patient to take in after each meal to stimulate appetite. verbalizing
more fluids. 4. Patient was encouraged to take in pure
at least half of an improved
fluid like water and fruit drinks to help
each meal served. rehydrate her and remove toxins from hee appetite and
5. Plan diet with patient. system.
2. Patient verbalising 5. Patient was involved in planning her diet, can eat very
so her likes and dislikes were taken into
she has increased 6. Remove offensive odour and consideration. well
dirty scenes on the ward before 6. All bed pans, urinals and sputum mugs
appetite for food.
serving meal. were removed and emptied before meals.
These measures helped to get rid of
7.Serve meals in smaller anything that may not promote appetite
quantities at a time 7. Smaller quantities of meals were served
at a time to enhance her appetite

46
 Table 8: Nursing Care Plan for Mrs. A.F.B continued

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
21/07/20 Sleep pattern Patient will regain her 1. Assess the sleeping pattern of 1. Patient’s sleeping pattern was 23/07/ Goal fully
19 patient. assessed. 19
disturbance normal sleeping 2. Ensure that the room is well 2. Ventilation of the room was met as
8:00am 8:00am
ventilated ensured by turning on the fans and
( Insomnia) pattern within 48 evidenced by
folding of the curtain
related to hours as evidenced by 3. Carry all nursing activity at ago 3. All nursing activities such as nurse
vitals and medication was carried
abdominal : out at ago observing
4. Lay a comfortable bed free from 4. A bed free from creases and
pain 1.patient verbalizing creases and cramps cramps was made. patient sleep
5. Restrict visitors 5. Visitors were restricted during
she had a sound sleep for 6 hours at
the period patient was sleeping or
2.Nursing observing taking a nap. night
6. Serve warm beverage at bed time 6.Warm milo drink was served
that patient sleeps for and give warm bath before bed time. uninterrupted
7. Ensure a quiet and serene 7. Noise free environment was
6 hours at night environment. ensured by lowering the television
set in the ward.
uninterrupted
8. Administer prescribed analgesics and 8. Prescribed analgesics and
antacids. antacids i.e tab paracetamol and
Suspension Nugel O were
administered.

47
 Table 8: Nursing Care Plan for Mrs. A.F.B continued

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
22/07/20 Altered bowel Patient will regain her 1. Reassure patient/family 1. Patient/family were reassured that 24/07/19 Goal was
19
normal bowel activities of the competent health team fully met as
movement 8:00am
8:00am movement within 48 will help her quick recovery. evidence by
(constipation)
hours as evidenced 2. Encourage patient to take 2. Patient was encouraged to take in patient been
related to side 1. Patient verbalizing more fluid diets more fluid and light diet to soften stools. able to pass
that she is able to pass 3. Engage patient in passive 3. Patient was encouraged to perform stool without
effect of
stool without exercise mild to moderate exercise to facilitate any
medications
difficulties. bowel movement. difficulty.
(omeprazole) 4. Educate patient on the 4. Patient was educated to attend to her
2. Nurse observing importance of responding to her bowel when the need arises.
patient passing stool at bowel.
frequent interval 5. Encourage patient to add 5. Patient was encourage to add
roughages to her diet. roughages to her diet.
6. Educate patient on the side 6. Patient was educated on the purpose
effects of the drug (omeprazole). and side effects of the drug (omeprazole

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 Table 8: Nursing Care Plan for Mrs. A.F.B continued

Date/ Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
22/07/20 Knowledge Patient will gain 1. Reassure patient /family that 1. Patient /family was reassured that 22/07/20 Goal fully met
19 with detailed information they detailed information on peptic ulcer 19 as patient and
deficit related adequate knowledge
will have understanding of will be given for better family gave
9am to lack of on the disease peptic ulcer understanding. 11am correct
2. Schedule time with patient and 2. Time was scheduled with patient and answers to
inadequate condition within 2
relatives to educate them on relatives to educate them on peptic questions
information hours as evidenced by; peptic ulcer. ulcer. asked on
3. Make patient comfortable by 3. Patient was made comfortable by peptic ulcer
on causes, 1. Patient / family
lying in bed whiles relatives lying in bed whiles relatives and the correctly and
signs and being able to answer and the nurse sit by bedside. nurse sit by bedside. .patient/
4. Assess patient and family 4. Patient and family knowledge on family
symptoms and some questions on
knowledge level on peptic peptic ulcer was assessed. verbalizing
prevention of peptic ulcer correctly ulcer understanding
5. Correct any misconception and 5. Accurate information on the on the
disease 2.Patient/family
provide accurate information predisposing causes, signs and information
condition verbalizing on the predisposing causes, symptoms, prevention, drug given them
signs and symptoms, management and lifestyle
(peptic ulcer understanding on the
prevention, drug management modification were provided to
disease) information given and lifestyle modification correct misconceptions
6. Invite questions and answer 6. Questions were invited and tactfully
them.
them tactfully. answered.
7. Give patient pamphlets on 7. Pamphlets on peptic ulcer were given
peptic ulcer to read to patient

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