PLANNING FOR PATIENT/FAMILY CARE
The chapter is the third phase of the patient and family care study and deals with planning the nursing care.
It comprises the process of formulating nursing strategies required, to prevent, reduce or eradicate the client and the family’s health problems which were identified at the analysis stage.
To achieve this, setting of clear objectives or outcome criteria and the stating of specific nursing measures are necessary as they go a long way to help the client and family to meet their health needs.
3.1 Objectives for Patient/Family Care
- Patient and family will be relieved of anxiety within the period of hospitalization.
- Patient will be relieved of pain within 48 hours.
- Patient’s wound will be protected from infection within the period of hospitalization.
- Patient will be able to care for herself within 48 hours.
- Patient will regain her normal sleep pattern within 48 hours
IMPLEMENTATION OF PATIENT/FAMILY CARE PLAN
This chapter forms the fourth part of the care study. This area throws more light on the summary of the exact nursing care rendered to Madam A. A. and family from the day of admission to the day of discharge, home visits, and follow-up.
4.1 Summary of the Actual Nursing Care
The actual nursing care of Madam A. A. began right from admission into the Female Surgical Ward. She was admitted through the Operating Theatre after a total abdominal hysterectomy had been done under spinal anesthesia on the 14th of November, 2011, at the Holy Family Hospital, Berekum.
Day of Admission/Immediate Post-Operative Care (14/11/11)
An operation bed was made with the following bed accessories:
- Infusion or drip stand
- Suction machine
- Vital signs tray and blood pressure apparatus
- Mouth care tray
- Dressing pack
She was admitted into a warm comfortable operation bed that had been prepared. She was put in the supine or recumbent position. The incisional wound on inspection was clean and dry. Vital signs, intake, and output were observed and all interventions, findings, and orders were documented in the vital signs sheets, fluid balance chart (as indicated in the appendix), and nurses’ notes. She was admitted into the admission and discharge book and ward state.
At 11:00 am, it was realized that both Madam A. A. and her elder sister were very anxious because of their deficient knowledge of the condition and its related treatment plan. A nursing diagnosis of anxiety (patient/family) related to deficient knowledge about the condition and the related treatment plan was made. An objective to relieve patient/family of anxiety within the period of hospitalization was set. Nursing interventions implemented included reassuring patient/family that the disease is manageable and the staff was ever ready to help in caring for her, assessing their knowledge on the condition and its treatment (post-operative management), fears and concerns, keeping them informed about the availability of modern equipment and expertise, condition and its treatment (post-operative management); clarifying misinformation/misconceptions and helping them to cope with stress. Others include encouraging them to express their fears and concerns, explaining all procedures to them and encouraging them to ask questions and answering them tactfully, and introducing patients to other patients in the ward suffering from the same disease and are doing well.
The patient complained of incisional pains at 11:30 am. A nursing diagnosis of acute pain related to surgical incision was made and an objective to relieve the patient of pain within 48 hours was set. The nursing interventions carried out included reassurance of patient/family that pain would minimize as healing of wound occurs, explanation to patient/family the reasons for the pain and the available management, provision of diversional therapy such as watching television and conversing with her and administration of analgesics such as morphine as prescribed.
The patient was likely to contract the infection through the surgical incision, so a nursing diagnosis of risk for infection related to a break in the continuity of skin was made at 11:45 am. An objective was set to protect the patient’s wound from infection throughout the period of hospitalization. Some of the nursing interventions carried out included education of patient/family on the need to prevent wound infection, educating them on the signs and symptoms of wound infection such as purulent wound discharge, increased persistent pain, and increase in body temperature, dressing wound aseptically and checking for signs and symptoms of wound infection and reporting for prompt management. Other interventions included encouraging and assisting patients with their personal hygiene needs, encouraging them to avoid touching the wound or wetting it and serving prescribed antibiotics such as gentamycin.
The care plan for my patient was drawn with the help of the patient/family to promote recovery.
In the evening, vulva toileting and a warm bed bath were done for the patient. Madam A. A. slept at 11:00 pm.