Rachel Tachie Agyemang

HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE BEREKUM
A PATIENT AND FAMILY CARE STUDY ON
MALARIA
BY
TACHIE-AGYEMANG RACHEL
4120210178
A PATIENT AND FAMILY CARE STUDY SUBMITTED TO THE NURSING AND
MIDWIFERY COUNCIL OF GHANA IN PARTIAL FULFILMENT TOWARDS THE

AWARD OF A LICENSE TO PRACTICE AS A PROFESSIONAL REGISTERED
GENERAL NURSE.
AUGUST, 2023
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PREFACE
The field of nursing calls, for knowledge, abilities and attitude. It owes a remarkable portion of its
body of knowledge to Florence Nightingale’s (1820-1910) impact, a pioneer who greatly elevated
the profession through her ideas. The capacity of the nurse to assess the patient’s state, analyze,
plan, implement, and assess the impacts of management on patient health status is a perquisite for
providing complete nursing care.
Health care delivery in recent times has progressed and has adopted innovative changes especially
in the nursing care delivery. Due to this, the nurse is compelled to render a comprehensive care to
every client in his or her charge.
Unlike the past, nursing now employs the use of research and the use of scientific data in the
performance of the various roles in ensuring quality health care delivery. This is evidenced by the
broadening services to the door steps of clients, and the involvement of technologically based
initiatives like Computers for effective documentation.
In effect to meet the ever-changing demands of the client with time, there must be corresponding
innovations in providing quality health care for the benefit of all.
The inclusiveness of certain subjects like Sociology, Basic Nursing, Anatomy and Physiology,
Therapeutic Communication, Professional Adjustment to mention but a few provides for dynamic
skills in the care of the patient and family.
The patient and family care study is a detailed written account or report of the comprehensive
individualized nursing care rendered to a particular patient and family within a specific period of
time. This includes the study of the diagnosis, treatment and the actual nursing care rendered to
the patient to meet his/her physical, psychological, social and spiritual needs. It involves the
interaction between the patient, his/her family, the community in which he/she stays and the health
team.
It forms part of the final assessment of the student nurse at the end of the three-year training
program for a license to practice as a Registered General Nurse awarded by the Nursing and
Midwifery Council of Ghana.
It presents the student the opportunity to put into practice the knowledge he or she acquires during
training to give effective nursing care to a patient with reference to the patient’s condition.
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The care also helps the student nurse to acquire more knowledge about the signs and symptoms,
diagnosis, causes and treatment of a specific disease condition managed by the student.
The study serves as a reference paper for other student nurses and qualified health personnel who
may be interested in its content. The patient’s initials were used to maintain confidentiality.
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ACKNOWLEDGEMENT
I am mostly indebted to my father in heaven for all that he showered on me for the successful
completion of this work; may his name be praised now and forever.
I am grateful to my patient, Master O.S. and his family members for their incredible co-operation.
I am much thankful to them for all the information they provided towards the progress of this
study.
The next big thanks also go to my supervisor Mr. Emmanuel Ali and the entire tutors of Holy
Family Nursing and Midwifery Training College- Berekum, for their guidance, time and support
in the course of writing this care study. I do say that God bless them so much.
My sincere appreciation goes to my parents, Mr. Mark Tachie-Agyemang and Madam Charlotte
Yeboaa Tachie-Agyemang and my younger sister for their numerous support both in cash and all
kind during the period of this study. I would also like express my sincere appreciation to Master
Fredrick Ansu Yeboah for his tireless support throughout the period of the study. May the father
in heaven replenish whatever they have wasted on me.
I would also like to express my gratitude to all nurses and doctors of the Bechem Government
Hospital especially the In-Charge, Mrs. Mercy Owiredu and all the staff of pediatric ward that
helped me in multiple ways to make this study a success; I say thank you. How can I forget to also
acknowledge the authors and publishers whose works were used as literature in this study?
Finally, I am grateful to all my course mates for their support during the writing of this care study.
INTRODUCTION
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The care study is the sum total of the nursing care rendered to a patient and his/her family to attain
and maintain a high level of wellness of the patient. It involves an interaction which could be as
brief as a day or as long as the patient care last or to a peaceful death. This care study was made
on Master O. S., a 2-year-old boy who was admitted on 26th November, 2022 at the pediatric ward
of Bechem government hospital with the diagnosis of simple malaria and discharged on 30th
November 2022. Samples were taken from Master O.S. after explaining the procedure to the
patient’s mother and sent to the laboratory for the following investigations:
1. Full blood cell count
2. Blood film for malaria parasite (MPS)
These investigations were done to confirm the disease and know the specific treatment to be used.
Master O.S. was put on the following drugs at the time of admission and initial doses of prescribed
drugs were administered as requested as follows:
1. Intravenous Artesunate 28mg stat, 12hourly for 24hours
2. Intravenous Dextrose Normal Saline 500mls for 24hours
3. Intravenous Paracetamol 144mg tid for 24hours
4. Suspension Artemether Lumefantherine 20/120 mg bd for 3days
5. Syrup Iron III Polymaltose 5mls daily x 7days
Six nursing problems were identified during the time of hospitalization. Objectives were set for all
the problems; nursing orders were implemented and goals were fully met. Patient was scheduled
for review on the 8th December, 2022. Three home visits were made to patient’s house. The first
home visit was made on 28th November, 2022, the second was made on 5th December, 2022 and
last home visit was on 22nd December, 2022. Care was finally terminated on my third home visit.
The script is organized into six chapters;
Chapter one: Assessment of patient and family.
Chapter two: Analysis of data.
Chapter three: Planning for patient/family care
Chapter four: Implementation of patient and family care plan
Chapter five: Evaluation of care rendered to patient and family
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Chapter six: Summary and conclusion.
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TABLE OF CONTENT
Contents
PREFACE i
ACKNOWLEDGEMENT iii
INTRODUCTION iii
TABLE OF CONTENT vi
LIST OF TABLES viii
LIST OF FIGURES ix
CHAPTER ONE: ASSESSMENT OF CLIENT AND FAMILY
1.0 Introduction 1
1.1 Patient Particulars 1
1.2 Patient Family Medical history 2
1.3. Patient Socio-Economic History 2
1.4. Patient’s Developmental History 3
1.5 Patient’s Lifestyle/ Hobbies 3
1.6 Past Medical History 4
1.7 Present Medical History 4
1.8 Admission of Patient 5
1.9 Patient’s Concept of Illness 7
1.10 Literature Review on Simple Malaria 7
1.11 Validation of Data 20
CHAPTER TWO: ANALYSIS OF DATA
2.0 Introduction 21
2.1 Comparison of Data with Standards 21
2.2 Patient/Family Strength 30
2.3 Patient Health Problems 31
2.4 Nursing Diagnosis 31
CHAPTER THREE: PLANNING FOR PATIENT/FAMILY NURSING CARE
3.0 Introduction 33
3.1 Nursing Objective/Outcome Criteria 33
CHAPTER FOUR: IMPLEMENTATION OF PATIENT/FAMILY CARE PLAN
4.0 Introduction 41
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4.1 Summary of the Actual Nursing Care Rendered To Patient and Family 41
4.2 Preparation of Patient/Family for Discharge and Rehabilitation. 52
4.3 Follow-Up/Home Visits and Continuity of Care 53
CHAPTER FIVE: EVALUATION OF CARE RENDERD TO PATIENT AND FAMILY
5.0 Introduction 57
5.1 Statement of Evaluation 57
5.2 Amendment of the Nursing care plan 61
5.3 Termination of care 62
CHAPTER SIX: SUMMARY AND CONCLUSION
6.0 Introduction 63
6.1 Summary 63
6.2 Conclusion 65
APPENDIX 66
BIBLIOGRAPHY 67
SIGNATORIES Error! Bookmark not defined.
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LIST OF TABLES
Table 1: Diagnostic Investigations/Test In Literature Review Compared With Those Carried Out
On Patient. 22
Table 2: Results of Diagnostic investigations carried Out on Patient 23
Table 3: Clinical Features exhibited by Patient Compared with those in the Literature Review 24
Table 3.1: Clinical Features exhibited by Patient Compared with those in the Literature Review25
Table 4: Comparison of treatment outlined in the literature review with those given to patient 26
Table 4.1: Comparison of treatment outlined in the literature review with those given to patient27
Table 5: Pharmacology of drugs administered to patient 28
Table 5.1: Pharmacology of Drugs Administered to Patient continued 29
Table 6: Comparison of complications in literature with what patient developed 30
Table 7.0: Nursing care plan for Master O. S. 35
Table 7.1: Nursing care plan for Master O. S. 36
Table 7.2: Nursing care plan for Master O.S. 37
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LIST OF FIGURES
FIGURE 1: Showing the cells of the blood 19
FIGURE 2: Showing the cycle of malaria transmission 21
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CHAPTER ONE
ASSESSMENT OF CLIENT AND FAMILY
1.0 Introduction
Assessment of the client and family is the first phase of the nursing process and thus forms the
basis of the nursing process. It deals with gathering and organizing vital data pertaining to client’s
health. There are two types of data, objective and subjective data. Subjective data was obtained by
acquiring information from the client’s mother through interviewing. Objective data was obtained
by inspecting and observing the client for any abnormalities or problems and also from laboratory
investigations. Data was collected through interviews, taking of history, physical examination of
client by inspection and observation to determine any abnormalities. Data was also obtained from
nurse’s notes, report book and reviewing related literature for further information. The assessment
covers the patient’s particulars, family medical/surgical history, family socio-economic history
patient’s developmental history, patient’s lifestyle and hobbies, patient’s past medical/surgical
history, the present medical/surgical history of the patient, admission process of the patient and
family, patient/family’s concept about the illness, literature review on the condition and validation
of data. Data was collected from the patient, relatives, health personnel, laboratory investigation
and textbooks from which analysis was made to identify patient’s problems in order to plan and
implement care. The methods used in assessment to obtain data from patient and family include,
observation and interview with patient and family
1.1 Patient Particulars

Patient’s particulars refer to the biological data of a client and also includes areas such as patient’s
name (initials), date of birth, sex, marital status, nationality, next of kin, patient’s address,
occupation, hometown and others (Marilynn, 2017).
Master O.S. a two- years- old child, born to Mr. A.E. and Mrs. I.S. on the 10th March, 2020 at the
Bechem Government Hospital through spontaneous vaginal delivery in cephalic presentation at
term. He is the fifth child of his parents. He lives with both parents at Adum a suburb of Bechem,
Ahafo Region. Both parents of Master O.S. are Christians. They attend Second Chance Ministries.
He isn’t enrolled in school yet. He is dark in complexion. On admission, Master O.S. weighed
9.4kg, a height of 0.5m tall and his BMI was 37.6kg/m2. Client is also a beneficiary of NHIS.
Patient’s father is the next of kin.
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1.2 Patient Family Medical history
A family’s medical history is a record of medical information about an individual and their
biological family. Family history provides a ready view of problems or illnesses within the family
and facilitates analysis of inheritance or familial patterns (Shiel, 2019).
According to Master O.S.’s mother, there is no history of chronic disease and hereditary condition
such as asthma, diabetes mellitus, mental illness or hypertension, epilepsy and leprosy in their
family. Patient’s father, Mr. A.E. normally suffer from headache, diarrhea and common cold.
There had also been a history of enteric fever in the family of which his mother had suffered from
it on two occasions. Sometimes, they purchase drugs from the over-the counter medical shop but
visit the hospital when symptom persists. There is no known history of allergy to any drug or food.
The patient and his parents are beneficiaries of the National Health Insurance Scheme (NHIS)
which enables them to access medical care. According to Master O.S.’s mother all siblings are
alive and has no illness. The grandparents of Master O.S. are all alive but his father’s father is
blind. It runs through their family which mostly affect the men as they age (65 years and above).
She also disclosed that, none of his siblings has been hospitalized before.
1.3. Patient Socio-Economic History

Socio-economic history is a brief record about patient’s family occupation and source of income.
According to mother, master O.S.’s father is the main bread winner of the family. He is an
electrician who is at the risk of electrical shock and he earns enough money to cater for his family
needs. His mother is also a trader who is also at the risk of developing osteoarthritis. Master O.S.’s
family is of average financial status as they can afford the family daily three-square meals and
other family expenses. According to Master O.S.’s mother, there is no known taboo in their family.
Patient family is a nuclear but they visit their relatives in the extended family if the need arises.
According to client’s mother, they do not belong to any political party. She also mentions that they
do attend social gatherings such as; funerals, naming ceremonies, weddings among others. She is
also the chief usher in their church.
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1.4. Patient’s Developmental History
Development refers to the process of growth and differentiation which involves cognitive,
psychosexual and psychosocial processes (Taylor, 2019). Maturation is the process of developing
(Taylor, 2019). Growth is the progressive development of a living thing, especially the process by
which the body reaches its complete physical development (Taylor, 2019).
According to the mother, she had his pregnancy planned and Master O.S. was born through a
spontaneous vaginal delivery at term on 10th March, 2020 at Bechem Government Hospital. He
had no congenital abnormalities such as cleft lip, cleft palate or club foot and was immunized
against the childhood vaccine preventable diseases such tuberculosis, poliomyelitis, diphtheria,
whooping cough, hemophilus influenza, hepatitis B, measles, pneumococcal, rotavirus and yellow
fever. He was exclusively breastfed by his mother for six months and complementarily fed with
different locally prepared porridge with groundnut paste and milk which he tolerated well at the
age of eight months.
Master O.S. is undergoing normal developmental milestone. He started to sit at four months,
crawled at seven month, began to stand at ten months and walked at 1 and half years. His first
tooth showed up at five months after birth. He began to make few words such as mama and dada
at the age of nine months. Based on Eric Erikson psychosocial theory which involves eight stages
(Erickson 1963), Master O.S. with the help of his family especially the mother, he is currently
going through the second stage which is autonomy versus shame and doubt (18months to 3years).
As a child gains control over eliminative functions and motor abilities, then they begin to explore
their surroundings. The parents still provide a strong base of a security from which they can venture
to assert their will. The parents’ patience and encouragement help foster autonomy in the child.
Highly restrictive parents, however, are more likely to instill in the child a sense of fear and
reluctance to attempt new challenges. He is not enrolled in school yet because parents believe he’s
too young to start school. Mother always takes him to the market.
1.5 Patient’s Lifestyle/ Hobbies

Lifestyle is defined as the pattern of daily living that an individual develops (Taylor, 2019)
Master O.S. is a lovely child who plays around with his older siblings a lot. He wakes up around
7:00 am. His mother baths him with lukewarm water. He gets clothed by his mother with beautiful
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and neat shirts and trousers or shorts. He is bathed two times daily. Normally, he sleeps around
7:30 pm. He eats food served to him, He also eats snacks in between meals such as orange. His
favorite meals include porridge with koose and rice served with tomato sauce. Breakfast is taken
around 8:30am, lunch at 12noon and supper at 5:00pm. On the average, he mostly empties his
bowel once daily that is in the morning. He enjoys playing with his siblings most especially Master
A. B. and normally plays hide and seek with the other children in their house. Patient has no known
allergy.
1.6 Past Medical History

Past medical history is a narrative or record of past events and circumstances that are or may be
relevant to a patient's current state of health (Webster, 2019).
According to patient’s mother, patient did not suffer from any childhood illness such as measles,
whooping cough. Patient has no known allergies; He has not had any accident, or any serious
injuries. Before this current admission, Patient has not undergone any surgery before. Patient is
not currently on any over-the-counter medications. Patient enjoys free medical care since he is
registered under the National Health Insurance Scheme (NHIS). According to patient’s mother,
she always adheres to the routine immunization schedule for Master O.S. Patient has no physical
disability due to illness.
1.7 Present Medical History

Present medical history according to the medical dictionary (2015) is a chronologic description of
the development of the patient’s present illness, from the first sign and/or symptom or from the
previous encounter to the present which includes the location, quality, severity, duration, timing,
content modifying factors and associated signs and symptoms.
Master O.S. was in good health until 23rd November, 2022 when his mother noticed that he
appeared warm to touch and child was looking pale. She purchased some oral medications at the
over- the- counter medications shop, syrup paracetamol for him but his condition did not improve.
His condition became worse as he began vomiting, refused food and had general body weakness.
Three days later, that was 26th November, 2022, she decided to take him to Bechem Government
Hospital where he was diagnosed of Simple Malaria by the medical doctor on duty and was
admitted to the pediatric ward.
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1.8 Admission of Patient
Master O.S. was admitted to the Pediatric ward of the Bechem Government Hospital on the 26th
November, 2022 at 2:15 pm with a diagnosis of Simple Malaria. He was admitted through the Out
Patient Department with the history of fever, vomiting, cough, and loss of appetite. Patient was
brought into the pediatric ward backed by his mother in company of a student nurse. They were
warmly welcomed to the ward and offered a seat. Confirmation of patient was done by mentioning
the name and other particulars like diagnosis and treatment on the patient’s folder. Patient and
mother were introduced to the nurses on duty and Master O.S. was then put into a cot made for
him. Patient’s mother was encouraged to be with the child while treatment commences if she so
wishes.
Procedure was explained to patient mother and baseline vital signs were checked and recorded as
follows; Temperature – 37.8 Degree Celsius, Pulse – 138 beats per minute, Respirations – 32 cycle
per minute and his SpO2 was 99%. His weight and height were also taken and recorded as 9.4kg
and 0.5m and body mass index as 37.6 kg/m2 respectively.
Samples were taken from Master O.S. after explaining the procedure to the mother and sent to the
laboratory for the following investigations:

All these prescribed medications were collected from the Out -Patient Department pharmacy and
administered accordingly at 2:30pm.
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On assessment, the following were revealed; fever, diarrhea, headache, vomiting, body weakness.
Master O.S.’s mother was orientated to the ward. Based on the signs and symptoms present and
the necessary information mother gave, nutritional assessment was done on patient using the
ABCD approach (A- Anthropometric, B- Biochemical, C- Clinical, D- Dietary). These parameters
are the basic tools use to assess a child’s nutritional status. Based on the use of the ABCD approach
it revealed master O.S. was malnourished. Windows were opened to improve ventilation for
reduction in body temperature, Patient was sponged with tepid water and he was covered with light
clothing as well.
Patient’s mother was also introduced to the nurses and other patients lying closer to them. His
valuables were put in the locker beside his bed and informed about the hospital policies such as
visiting hours that is 5:30am -6:30am in the morning, 12:00pm - 1:00pm in the afternoon and
5:30pm - 6:00pm in the evening. The family was asked to bring items that the patient would need
whilst on admission such as child’s favorite toys sponge, soap, towel, tooth brush and paste. They
were also made aware of the possibility to pay some of the hospital bill. Patient was made
comfortable in bed while infusion set on him. Patient particulars such as name, sex, age, folder
number and date of admission were recorded in the admission and discharge book as well as in the
daily ward state.
Master O.S.’s mother was reassured of the competency of the health team and speedy recovery of
his son. He was made aware that the admission was temporary, and that it was aimed at giving the
client the necessary health care to restore his health. This was done to allay their fears and to relieve
them of anxiety.
I introduced myself to Master O.S.’s mother as a final year student nurse of Holy Family Nursing
and Midwifery Training College, Berekum, who would like to take her son and her family for care
study. I explained to Master O.S.’s mother and her family the concept of the patient/family care
study and assured them of privacy and confidentiality. I added that it is a requirement for the award
of license to practice as professional registered general nurse by the Nursing and Midwifery
council of Ghana.
It was also added that a report will be written after the entire event. Master O.S.’s family agreed
to my request and promised to offer me the necessary information and assistance. I however
congratulated them on such a decision.
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Discharge planning was initiated with mother and relatives; thus, they will continue the care at
home once he is well. I decided to choose him for the study because I wanted to know why most
children and adults suffer malaria.
1.9 Patient’s Concept of Illness

According to Merriam-Webster’s Learners Dictionary (2016) patient’s concept of illness can be
defined as an abstract or generic idea generalized from one’s illness or condition. An interaction
with the Master O.S.’s mother, father and other family members revealed that their child’s
condition was not due to any supernatural forces but believed it to be as a result of mosquito bites
which they know to breed in stagnant waters. The mother confirmed that they had not been
sleeping under Insecticide Treated Nets (ITN), though they had some at home. They expressed the
hope that the condition would improve with the treatment regimen and competent nursing care.
1.10 Literature Review on Simple Malaria

This section deals with documented information about the condition Master O.S. was diagnosed
with, that is malaria. 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.
Basic Anatomy and Physiology of the Blood.
The cellular component of blood consists of three primary cell types’ erythrocytes (red blood
cells), leukocytes (white blood cells), and thrombocytes (platelets). These cellular components of
blood normally make up 40% to 45% of the blood volume. Because most blood cells have a short
lifespan, the need for the body to replenish its supply of cells is continuous; this process is termed
hematopoiesis.
Blood makes up approximately 7% to 10% of the normal body weight and amounts to 5 to 6litres
of volume. Circulating through the vascular system and serving as a link between body organs,
blood carries oxygen absorbed from the lungs and nutrients absorbed from the gastrointestinal tract
to the body cells for cellular metabolism. Blood also carries hormones, antibodies, and other
substances to their sites of action or use. In addition, blood carries waste products produced by
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cellular metabolism to the lungs, skin, liver, and kidneys, where they are transformed and
eliminated from the body (Waugh & Grant, 2018).
FIGURE 1: Showing the cells of the blood.
Erythrocytes (Red Blood Cells)
The normal erythrocyte is a biconcave disk that resembles a soft ball compressed between two
fingers. It has a diameter of about 8µm and is so flexible that it can pass easily through capillaries
that may be as small as 2.8µm in diameter. The membrane of the red cell is very thin so that gases,
such as oxygen and carbon dioxide, can easily diffuse across it; the disk shape provides a large
surface area that facilitates the absorption and release of oxygen molecules.
Mature erythrocytes consist primarily of haemoglobin, which contains iron and makes up 95% of
the cell mass. Mature erythrocytes have no nuclei, and they have many fewer metabolic enzymes
than most other cells. The presence of a large amount of haemoglobin enables the red cell to
perform its principal function, the transport of oxygen between the lungs and tissues. Occasionally
the marrow releases slightly immature forms of erythrocytes, called reticulocytes, into the
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circulation. This occurs as a normal response to an increased demand for erythrocytes (as in
bleeding) or in some disease states. The oxygen-carrying haemoglobin molecule is made up of
four subunits, each containing a heme portion attached to a globin chain. Iron is present in the
heme component of the molecule. An important property of heme is its ability to bind to oxygen
loosely and reversibly. Oxygen readily binds to hemoglobin in the lungs and is carried as
oxyhemoglobin in arterial blood. Oxyhemoglobin is a brighter red than hemoglobin that does not
contain oxygen (reduced hemoglobin); thus, arterial blood is a brighter red than venous blood.
The oxygen readily dissociates (detaches) from hemoglobin in the tissues, where the oxygen is
needed for cellular metabolism. In venous blood, hemoglobin combines with hydrogen ions
produced by cellular metabolism and thus buffers excessive acid. Whole blood normally contains
about 12-16g of hemoglobin per 100ml of blood (Waugh & Grant, 2018).
Definition of Malaria
Malaria is an acute disease of the blood caused by a parasite called plasmodium. The disease
presents fever, chills and profuse sweating (World Health Organization, 2019).
Malaria is a febrile disease caused by parasite of the genus plasmodium and transmitted by the bite
of an infective female Anopheles mosquito (Lam, 2018).
It can be described as uncomplicated or severe depending on the patient’s immunity level, species
of parasite and the presence of any other disease, such as malnutrition and anemia.
Severe malaria is also known as Complicated Malaria. It occurs when the infections are
complicated by serious organ failures or abnormalities in the patient’s blood or metabolism. Delay
in diagnosis and inappropriate treatment of uncomplicated malaria, especially in infants and
children can lead to the rapid development of severe malaria. Severe malaria mostly occurs in
children under 5 years of age, pregnant women and non-immune individuals. Patients can
deteriorate rapidly within a few hours or days leading to life-threatening situations. It is a common
cause of avoidable death in Ghana. People at risk are children below five years, pregnant women,
especially primigravidae (first pregnancies) and travelers from areas with little or no malaria,
patients with sickle cell anemia and patients with HIV infection.
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Also, some factors that influence the severity of malaria are Host Factors and clinical conditions:
1. Age (Children under 5 years

2. Pregnancy
3. HIV infection
4. Sickle cell disease
5. Parasite drug resistance:
6. The degree of parasite resistance to anti-malaria drugs.
In all patients, clinical diagnosis of malaria should be made in a patient with fever (history of fever
or axillary temp. ≥ 37.5° C).
In young children, a clinical diagnosis of severe malaria can also be made if there is fever (history
of fever or axillary temp. ≥ 37.5° C) plus any general danger sign in young children are patient is
likely to have experienced some of the typical symptoms of malaria - chills, rigors, headache, body
aches, sweating, nausea/vomiting, loss of appetite, or abdominal pain.
Incidence:
Malaria is one of the most widely prevalent diseases in the world. It is a constant threat and kills
about a billion humans in the world. In Ghana, it is the most common disease and accounts for
about 40-42% of all out-patient attendants. It also accounts for about 7-9% of all certified death
and ranks fifth among the commonest cause of death in children below four years. It affects all age
group irrespective of the blood group. It is most severe in children and pregnant women. It is most
prevalent in the tropics, sub-tropics and temperate zones (World Health Organization, 2019).
Causes and Risk Factors of Malaria are:
1. Poor drainage systems.

2. Poor refuse disposal.
3. Bushy environments which can serve as breeding place for mosquitoes.
4. Empty tins lying around can collect water and breed mosquitoes.
Pathophysiology of Malaria
According to Van Eij AM, Hill J, Larson DA, Webster J, Steketee RW and Eisele TP et la Malaria
for Africa (2017), the pathophysiology of malaria has two aspects;
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1. Asexual development in man
2. Sexual development in mosquito
Asexual Development in Man. The parasites are passed to the bloodstream through the bite of an
infective female anopheles’ mosquito in whose body the parasite has developed. They localized in
the cells of the liver, grow and multiply. This is known as pre-erythrocytic phase. From there, they
enter into the erythrocytic phase. During this phase, the parasites undergo further development
such as trophozoids, schizoites and merozoites. The merozoites then attacks the red blood cells,
terminates with rapture of cells and release of merozoites into circulation.
At about two weeks or at times long periods, mosquitoes bite from an infected person can take
place and continue with the process.
The paroxysms of chills and fever that occur in malaria are due to liberation of metabolic
byproducts of the parasites in the red blood cells. During the asexual development of the parasite
in man, there is a period of gametogamy, that is, few merozoites develop into sexual forms of the
parasite known as gametocytes. Thus, when an anopheles’ mosquito ingests a human blood
containing gametocytes, this marks the commencement of the sexual cycle of the plasmodium in
the mosquito.
Sexual Development in Mosquito
Some of the parasites do not repeat the asexual cycle of development but produce male and female
forms of gametocytes. The sexual development is completed in the stomach of the female
anopheles’ mosquito. When a female mosquito ingests male and female parasites into an infected
person, a rather complicated sexual cycle begins in the stomach.
The female parasite or gametocyte is fertilized by the male gametocyte. The fertilized parasites
move into the stomach wall and become encysted (oocyst) and divides into many small spindles
shaped sporozoites or parasites. The cyst raptures and the parasites are carried to the salivary gland
of the mosquito which is so constructed in such a way that the parasites are injected into the
salivary glands which the mosquito bites.
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FIGURE 2: showing the cycle of malaria transmission
Types of Plasmodium Parasite
According to (stanford health care, 2022), there are five (5) main species of plasmodium parasites.
1. Plasmodium ovale
2. Plasmodium vivax
3. Plasmodium malariae
4. Plasmodium falciparum
5. Plasmodium knowlesi
Mode of Transmission
1. Vector transmission; malaria is transmitted by the bite of certain species of infective

mosquitoes. A single infective vector during its life time may infect several people. The
mosquito is not infective unless sporozoites are present in its salivary gland.
2. Direct transmission; malaria may be introduced accidentally by hypodermic, intramuscular
and intravenous infection of blood or plasma example blood transfusion. Blood transfusion
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poses a problem because the parasites keep their infective activity during at least fourteen
days in the blood stored at -4o C.
3. Congenital malaria; congenital infection of the new-born from an infected mother may also
occur but this is very rare.
Types of Malaria
Malaria occurs in four characterized types, each caused by its own distinct species of the
Plasmodium.
1. Tertian malaria: This is characterized by paroxysms of chills and fever every 48 hours and
caused by plasmodium vivax.
2. Quartian malaria: Is characterized by paroxysms of chills and fever every 72 hours and is
common. It is caused by plasmodium malariae.
3. Malignant malaria: Here there are irregular paroxysms of chills; there is diarrhea, vomiting
and delirium. Patient may become comatose and die. This is the most severe form of
malaria and is common in Tropical Africa, example Ghana. It’s caused by plasmodium
falciparum.
4. Benign tertian malaria: This is usually mild and onset is preceded with chills and fever
which is intermittent in nature. It is caused by plasmodium ovale.
Clinical Features of Malaria
According to World Health Organization (2019), the following signs and symptoms may be
exhibited by the patient
1. Fever (history of fever or axillary temp. ≥ 37.5° C) because of rupture erythrocytic-stage

schizonts where parasitized red blood cell may obstruct capillaries leading to local hypoxia
and the release of toxic cellular products. Plus any “sign of malaria” from the list below.
2. Profuse sweating; as result of ruptured mature schizonts.
3. Headache; as result of elevated levels of cytokines.
4. Malaise; due to activities of the plasmodium parasites.
5. Loss of appetite; due to bitterness in the mouth.
6. Bitterness in the mouth; due to inflammatory proteins that affects the tongue and taste buds.
13
7. Diarrhea; due to the activities of oxygen free radicals which cause injury to tissues of the
gastrointestinal tract.
8. Abdominal pain; may be caused by ischemic bowel changes due to impaired
microcirculation as a result of the destruction of red blood cells.
9. Jaundice; due hemolysis
10. Altered consciousness (change of behavior, confusion, delirium, coma persisting for over
30min after convulsion); due to reduced local perfusion.
11. Signs of hypoglycemia (sweating, pupil dilation, abnormal breathing, coldness, blood
sugar-<40mg/dl. or 2.2mmol/L);
12. Signs of renal failure (passing very little urine); may be due to hemodynamic dysfunction
and immune response
13. Repeated generalized convulsions (fits) – 2 or more in 24 hours;
14. Signs of hemoglobinuria (dark or cola-colored urine) due to hemolysis
15. Repeated profuse vomiting
16. Coma; due to intracranial sequestration of malaria parasite
17. Inability to take fluids
18. Extreme pallor (severe anemia; hematocrit <15% or Hb <5g/dl).
19. Circulatory collapse or shock (cold limbs, weak rapid pulse).
20. Hyperpyrexia (axillary temperature ≥38.5°C)
21. Hyperparasitemia (“3+” more; or 250,000 parasites per dl of blood”)
22. Hepatomegaly
23. splenomegaly
Diagnostic Investigations
According to Lam (2018), the following diagnostic investigations are done for cases of malaria;
1. By the clinical manifestations.

2. Blood film for malaria parasite (MP’s) – it reveals the parasite load (plasmodium) in the
blood.
3. Full blood count (FBC) - it is carried out to estimate the constituents of blood (RBC, WBC,
HB etc.) and their deviations from the normal ranges.
4. Rapid diagnostic test (RDT) if microscopy is unavailable.
14
Medical management
Drug treatment and dosage depend on the age and weight of patient. The goal of the treatment is
to destroy the blood trophozoites and schizoioites of plasmodium that cause the condition.
1. Fluid management: Intravenous fluids such as normal saline, ringers’ lactate and others are
useful. Patient with severe malaria are often relatively rehydrated due to combination of
decrease intake of fluid and increase in micturition.5% dextrose, 10% dextrose and
dextrose saline are given to provide energy and expand blood volume.
2. Anti-malaria treatment: Example is Artesunate amodiaquine, quinine, Arthemether
Lumifanthrine, etc. Quinine remains the parenteral drug of choice in Africa. Loading dose
of 20mg per kg in normal saline run in over 4 hours and maintenance dose of quinine,
10mg per kg of body weight should be given at interval of either 8 or 12 hours. Quinine is
cardiotoxic and must not be given in bolus. Artesunate amodiaquine is the drug of choice
for treatment of acute malaria. If treatment failure is confirmed, treat with quinine (120mg
tid x 2days).
3. Analgesics and Antipyretics should be given for pain and fever example; paracetamol,
ibuprofen, aspirin, codeine, etc.
4. Management of anemia: many people develop anemia from severe malaria. Many people
with haemoglobin concentration between 4 and 6g/dL, without signs of severe malaria do
well with oral anti malaria and hematinics. In severe cases blood transfusion is
recommended.
5. Management of Convulsion: Convulsion maybe present in children with malaria.
Diazepam is given in dose of 0.3mg per kg (up to a maximum of 10mg in both older
children and adults). Paraldehyde is an anticonvulsant with less risk of respiratory distress,
but its use has declines and not available in many settings. Others include; phenobarbitone,
phenytoin, etc. 20
6. The use of antibiotics: Pathological bacteria are isolated in significant minority of patient
with severe malaria. A reasonable compromise is to target antibiotic to those at high risk.
7. Oxygen therapy: This is given to counter tissue anoxia in patients experiencing
breathlessness.
8. Hematinics: Are given to correct anemia.
15
Nursing management
Nursing management of malaria include:
Psychological care/Emotional support
This is done to relax them and also to win their confidence and co-operation in caring for the
patient.
1. Patient and relatives are reassured that they are in the hands of competent health personnel
who are willing and ready to help him to recover.
2. Encourage relatives to visit patient to promote self-esteem and integration.
3. Encourage patient’s mother and other relatives to ask questions and answer them tactfully.
Rest and Sleep
This is ensured to conserve energy, promote relaxation and healing. Rest and sleep could be
achieved by:
1. Making bed free of creases

2. Giving warm bath to relax the muscles of the patient
3. Providing good ventilation by opening nearby windows.
4. Minimizing the noise on the ward by reducing the volume of the radio/television sets and
restricting visitors.
Position
Ensure comfortable position which is not contraindicated to patient’s condition. This is done to
ensure his safety, and to relieve pain.
Observation
1. Vital signs, that is temperature, pulse, respiration and blood pressure are monitored and
recorded on the nurses’ note depending on patient’s condition to know if patient’s condition
is getting better or worsening
2. Infusion site is observed for patency and fluid intake and output chart is monitored.
Possible complication like respiratory distress is observed. Moreover, the mental
16
orientation of the patient to time, place and persons are observed as well as desired and a
side effect of the drugs patient is given.
3. In patients with fever, if there are chills, more clothing is added to keep him warm, nearby
windows are closed and fans are put off.
4. In hot stage, extra blankets/clothing are removed, patient is tepid sponged to reduce
temperature. Nearby windows are opened and cold nourishing drinks can be served? Vital
signs are checked and compared with baseline vital signs.
Personal Hygiene
1. Good personal hygiene is ensured from hair to toe by washing patient’s hair with shampoo
and water, and cutting of fingernails and toenails to prevent harboring of dirt and microbes.
2. Patient’s mouth is cared for with toothbrush at least twice daily to prevent infection and
stimulate appetite.
3. Patient could be given bed bath or assisted bed bath to remove dirt and microbes from the skin,
to improve circulation and also patient’s comfort. At least, the bath should be twice daily and
pressure areas like the occiput, sacrum and shoulder are treated by applying soap into the palm
and massaging in a circular motion to improve circulation. Patient’s bed linens are changed
frequently when soiled or dirty to make patient comfortable.
Nutrition
1. Patient is given a well-balanced diet, vitamins to boost immunity, carbohydrate for energy
and protein to build worn-out tissues.
2. Food should be served in bits and attractive manner.
3. Patient should be involved in planning of food menu.
4. Patient is also encouraged to drink a lot water to keep the body hydrated.
Exercise
1. Patient is encouraged to do active and passive exercises to improve circulation, prevent

muscle wasting and relieve boredom.
2. Exercises also help peristalsis for digestion and help remove toxins from the body.
17
Elimination
1. Bowel and bladder elimination, patient is served with bedpan and urinal on demand or
bedpan round.
2. Fluid and roughage intake is encouraged depending on patient’s condition. If elimination
fails, a nearby tap is turned on to psyche-up the patient to urinate.
3. Warm compresses can be applied on the lower abdomen to relax the muscle and aid
elimination.
4. If all these nursing measures fail, catheter is finally passed to empty the bladder.
Education
1. Patient with malaria should be advised to complete the prescribed dosages even if the signs
and symptoms of the condition subside. People infected with plasmodium, especially that
of ovale and vivax type may harbor the parasite (plasmodium) in their liver cells
(hepatocytes) after treatment and the risk of frequent remissions are possible.
2. They should also be educated on the predisposing causes such as stagnant chocked gutters.
3. The signs and symptoms such as high temperature, nausea and vomiting should be made
known to people to enable them seek for early treatment.
4. All patients should be told to return to the hospital for blood examination after 4-5days
completion of treatment to assess whether the parasite has been completely eliminated from
the body.
5. People should be thought on the use of personal protection measures like the use of
insecticide treated nets (ITNs) and mosquito repellents.
6. Educate patient and relative to change or retreat the mosquito net after washing it for 20
times or change it when there is a tear.
Complications of malaria
According to Van Eij AM, et al. Malaria for Africa (2017), client with malaria may suffer the
following complications;
1. Cerebral malaria- this occurs when parasite-filled blood cells (plasmodium parasite) block
small vessels in the brain and this mostly occurs when malaria is not treated earlier.
2. Coma- this occurs after cerebral malaria has been developed.
18
3. Convulsion- the presence of the parasite-filled blood cells as well as untreated fever may
lead to convulsions.
4. Acute renal failure- this occurs as a result of mechanical obstruction of infected
erythrocytes in the afferent arterioles leading to necrosis of the kidney tissues.
5. Hepatic failure (hepatic dysfunction) - mechanical obstruction of blood vessels with vessels
with infected erythrocytes causes multiple organ failure including hepatic failure.
6. Shock (circulatory collapse) - obstruction of blood vessels with infected erythrocytes
causes failure of blood flow to the vital organs of the body (circulatory collapse).
7. Severe anemia- malaria damages many red blood cells, which causes severe anemia.
8. Bleeding abnormalities- there is low platelet count in severe malaria that leads to the
bleeding problems. These complications mostly come about when early treatment is not
given.
Prevention of Malaria
Primary Level
1. Ensure good environmental sanitation, example:

2. Weeding the environment
3. Draining all stagnant waters
4. Desilting of gutters for proper drainage
5. Proper means for storing and disposing refuse
6. Regular spraying of breeding places of mosquitoes
7. Use of mosquito repellents and coils
8. Sleeping under mosquito treated nets
9. Use of mosquito-proof doors and windows
10. Encourage chemoprophylaxis, example pyrimethamine.
Secondary Level
1. Early detection of malaria is by screening for those who have malaria and tracing their
contacts.
2. Keeping surveillance
3. Treat those who have malaria.
19
Tertiary Level
Rehabilitation, example getting adults back to work, children being taught by the hospital school
teachers.
1.11 Validation of Data

Data validation is a method of checking for the accuracy and quality of your data. It also includes
the process of ensuring that data entered fall within the accepted boundaries (Alley, 2019).
All the data collected from patient’s mother was cross checked in the literature review for
confirmation. The patient’s medical history was confirmed by some of the signs and symptoms he
manifested. The information obtained regarding patient’s home environment was verified during
home visits. The clinical features presented and diagnostic investigations conducted on him
confirmed that he was suffering from malaria. When the data collected from were compared with
the literature review, it was vivid that Master O.S. was suffering from malaria.
20
CHAPTER TWO
ANALYSIS OF DATA
2.0 Introduction
Analysis of data is the second phase of the nursing process, which involves careful comparison of
the patient’s problems or the information gathered from patient and relatives with standards and
then putting these problems in order of priorities to plan for the care of the patient and family
(Delaune & Ladner, 2019). This section covers the under listed areas; comparison of data with
standards, patient and family’s strength, patient’s health problems and nursing diagnoses
2.1 Comparison of Data with Standards

Comparison is the process of comparing the information collected from patient/family and the care
given, with standards set in the textbooks. This includes diagnostic investigations, causes, signs
and symptoms, treatments and complications found in the literature review.
A. Diagnostic Investigation/Test
Diagnosis is the determination of the nature of a disease (Taylor, 2019). Investigation refers to
procedures performed to establish a diagnosis, to monitor a person’s health, disease or the
effectiveness of treatment (Taylor, 2019).
The diagnostic procedures performed on Master O.S. are listed below to help with him diagnosis
and proper care.
21
Table 1: Diagnostic Investigations/Test In Literature Review Compared With Those
Carried Out On Patient.
Diagnostic Test outlined in literature review Diagnostic Test Carried out on Patient
History and clinical manifestations History of client and clinical manifestations
were taken
Blood film for malaria parasites Blood film for malaria parasite was carried out
on my patient
Full blood count Full blood count was carried out with my client
Rapid diagnostic test Rapid diagnostic test was not carried out
With reference to the above table, investigative measures to confirm Patient’s diagnosis included;
from clinical manifestations, blood sample for malaria parasite estimation, blood sample to detect
white blood cell count and hemoglobin level estimation. These investigative measures are all in
line with the literature review which means that the appropriate diagnostic procedures were carried
out on the patient.
Details of the tests carried out on the patient have been presented in the table below.
22
Table 2: Results of Diagnostic investigations carried Out on Patient
Date Specimen Investigation Results Expected values Interpretation Remarks
26/11/2022 Blood Blood film for Malaria No malaria parasites Malaria parasites Anti - malaria drug prescribed
malaria parasites parasites (+) should be seen. present, indicating and administered.
number of client has malaria.
parasites
(272800 seen)
26/11/2022 Blood Full blood count
Wbc 6.2 x 10^6 5.4 – 11 x 10 l Normal range No specific treatment given.
Rbc 3.4 x 10^12l 3.4 – 5.20 x 10^12l Below the normal Educated on the need to take
range. more iron foods such liver,
vitamin c rich fruits such as
orange.
Hemoglobin 10.6 g/dl 12.0 -16.0g/dl Below the normal Advised to take foods adequate
range this indicate mild in all nutrients especially iron.
anemia.
23
B. Causes of Patient’s condition
With reference to the causes of malaria from the literature review, it was obvious that my Patient’s
condition was as a result of bites from infected female anopheles’ mosquitoes.
According to the investigations, the plasmodium parasites were present in the patient’s blood
which is responsible for the cause of his condition.
Also, from the home visit that I made; it was found out that the patient was not sleeping under long
lasting insecticide treated net.
C. Clinical Features/ Signs and Symptoms

Table 3: Clinical Features exhibited by Patient Compared with those in the Literature
Review
Clinical Features in Literature Review Clinical Features Exhibited by Patient
Fever Patient had high body temperature
Profuse sweating Patient had no profuse sweating
Headache Patient had headache
Malaise Patient had malaise
Loss of appetite Patient had loss of appetite
Bitterness in the mouth Patient had no bitterness in the mouth
Diarrhea Patient had diarrhea
Abdominal pain Patient had no abdominal pain
Jaundice Patient had no jaundice
Repeated profuse vomiting Patient experienced vomiting
Altered level of consciousness Patient had no altered level of consciousness
Hypoglycemia Patient had no hypoglycemia
24
Table 3.1: Clinical Features exhibited by Patient Compared with those in the Literature
Review
Clinical Features in Literature Review Clinical Features Exhibited by Patient
Hyperpyrexia Patient had hyperpyrexia
Hyperparasitemia Patient had hyperparasitemia
Hepatomegaly Patient had no hepatomegaly
splenomegaly Patient had no splenomegaly
Signs of renal failure Patient had no signs of renal failure
Convulsion Patient had no convulsion
Hemoglobinuria Patient had no hemoglobinuria
Coma Patient had no coma
Inability to take fluids Patient was able to take fluids
Extreme Pallor Patient had no anemia
Shock Patient had no weak pulse
From the table above, patient experienced some clinical features as outlined in the literature
review. Patient did not experience all the clinical features because she reported to the hospital quite
early for treatment.
D. Specific medical treatment given to patient

Treatment is the action or way of treating a patient or a condition medically or surgically:
management and care to prevent, cure, ameliorate, or slow progression of a medical condition
(webster, 2022)
25
The following were the treatment which was given to my Patient;
1. Intravenous Artesunate 28mg for stat, 12hourly for 24hours
3. Intravenous paracetamol 144mg tid for 24hours
4. Suspension Artemether + Lumefantherine 20/120 mg bd for 3days
Table 4: Comparison of treatment outlined in the literature review with those given to
patient
Treatment outlined in the literature review Treatment Given to my patient
1. Anti-malaria drugs 1. Anti-malaria drugs administered
(i) Artesunate-Amodiaquine (i) Intravenous Artesunate was given
(ii) Quinine (ii) Quinine was not given
(iii) Arthemether Lumifanthrine (iii) Suspension Arthemether Lumifanthrine was

given
2. Antipyretics and analgesics 2. Antipyretics and Analgesics administered
(i) Paracetamol (i) Intravenous Paracetamol was given
(ii) Aspirin
(ii) Aspirin was not given
(iii) Codeine
(ii) Ibuprofen (iii)Codeine was not given
(iv) Ibuprofen was not given

3. Hematinic 3. Hematinics administered
(i) Hematinic (i) Syrup Iron III Polymaltose was given
26
Table 4.1: Comparison of treatment outlined in the literature review with those given to
patient
Treatment outlined in the literature review Treatment Given to my patient
4. Anticonvulsants 4. Anticonvulsants administered
(i) Diazepam (i) Diazepam was not given
(ii) Phenobarbitone (ii) Phenobarbitone was not given
(iii) Phenytoin (iii) Phenytoin was not given to patient
5. The use of Antibiotics Antibiotics was not given
6. Crystalloids 6. Crystalloids administered
IV fluids Intravenous Dextrose Normal Saline was given

7. Oxygen therapy Oxygen therapy was not given
From the above comparison of drugs in the literature review to drugs given to my patient, the
above drugs were chosen to help treat patient’s condition without resultant complications.
Hematemics were not ordered because patient was educated on foods that are good sources of
blood such as Kontomire.
27
Table 5: Pharmacology of drugs administered to patient
Date Drug Dosage/ Route of Dosage/ Route of Classification Desired Effect Actual Side
Administration Administration Action Effects/
(Literature) Given to Patient Observed Remedies
26/11/22 Artesunate Dosage 28mg stat ,12 hourly Anti-malarial Kills malaria parasites and patient’s Nausea, tinnitus.
3mg/kg at 0,12 and for 24 hours relief signs and symptom of condition None was
24 hours respectively same malaria improved observed.
for adult and children
Route:
Route Intravenously
Intravenous
26/11/22 Paracetamol Dosage 144mg tds for Non – opioid To relieve pain and fever. It Patients’ Dark urine,
Depends on the patient’s 24hours analgesic, lowers febrile body temperature clay- colored
weight and age as well as Intravenously antipyretic temperatures by acting on reduced to stools, breathing
prescribed by the doctor. the hypothalamus, the 36.2C difficulty,
structure in the brain that among others.
Route regulates body temperature.
Intravenous and oral
26/11/22 Suspension 20/120 mg bd for 3 days 20/120 mg bd for 3 Anti-malarial To interfere with the Patient’s Nausea, tinnitus.
Artemether + Dose for both adults and days growth and eradicate condition None was
Lumefantrine children Orally malaria parasite improved. observed.
3.2mg/kg stat (plasmodium falciparum).
Orally
26/11/20 Dextrose Dosage: Depends on 500mls for 24hours Glucose elevating Replaces extracellular fluid Patient was Edema,
22 normal saline patient’s fluid and agents loss hydrated and hypothermia and
electrolyte level and age skin turgor dyspnea. None
as well as by doctor’s Route: Intravenously maintained. was observed.
prescription.
Route: Intravenous
28
Table 5.1: Pharmacology of Drugs Administered to Patient continued
Date Drug Dosage/ Route of Dosage/ Route of Classification Desired Effect Actual Action Side
Administration Administration Observed Effects/
(Literature) Given to Patient Remedies
28/11/2022 Syrup Iron Dosage 5mls daily for 7 days Oral iron Iron is absorbed Client’s Nausea, vomiting,
III Adult dose: 10-15mls preparations and stored in the condition abdominal pain.
polymaltose for 7 days liver and improved. None was
Children dose: subsequently observed.
5-10mls for 7 days made available to
the body for
Route: Route: various
Orally Orally functions,
primarily for
incorporation
into the red
blood cell.
29
E. Complications
According to Taylor (2019), complication is an accident of second disease process arising du the
course of or following the primary condition which may be fatal.
Table 6: Comparison of complications in literature with what patient developed

Complications in Literature Review Complications developed by patient
Cerebral malaria Not developed by patient
Coma Not developed by patient
Convulsion Not developed by patient
Acute Renal Failure Not developed by patient
Hepatic Failure Not developed by patient
Shock Not developed by patient
Severe Anemia Not developed by patient
Due to the holistic, effective and efficient management progress of Master O. S.’s condition by the
health care team, he did not experience any the complications indicated in the literature review.
2.2 Patient/Family Strength

Strength refers to the physical power and energy that makes an individual determined in dealing
with difficult or unpleasant situations (Rundell,2019) This is what the patient can do aside all that
she is going through
1. Patient’s mother could verbalize the number of times child vomited and passed diarrhea
stools.
2. Patient could eat three tablespoons of rice and stew served.
30
3. Patient’s mother could verbalize child was warm to touch
4. Patient could verbalize pain
5. Patient’s mother could express her fears.
6. Patient‘s mother expressed interest in knowing more about his condition by asking
question.
2.3 Patient Health Problems

Problem is defined as a situation that causes difficulties or a disorder with your health or with part
of your body (Longman, 2019). To provide effective nursing care to the patient, it is essential for
the health problems of the patient to be identified through assessment, observation and data
collection. These problems include actual and potential health problems. The following problems
were identified;
1. Patient had diarrhea and vomiting (26/11/22)
2. Patient had loss of appetite (26/11/22)
3. Patient had high body temperature (37.8oc) (26/11/22)
4. Patient had headache (26/11/22)
5. Patient’s parents were anxious (27/11/22)
6. Patient’s mother had less knowledge of his current disease condition(27/11/22)
2.4 Nursing Diagnosis

Nursing diagnosis is a statement of potential or actual health problems in the patient’s health status
that a nurse is professionally competent to treat (. The nursing diagnoses made were;
1. Risk for fluid and electrolyte imbalance related to excessive loss of water from the mouth
and anus. (26/11/22)
2. Imbalanced nutrition: less than body requirement: related to poor appetite. (26/11/22)
31
3. High body temperature (37.8°C) related to infection by plasmodium parasites (26/11/22)
4. Headache related to the presence of malaria parasite in the blood. (26/11/22)
5. Parental anxiety related to unknown outcome of patient’s condition. (27/11/22)
6. Knowledge deficit (mother) related to inadequate information about the condition
(malaria). (2711/22)
32
CHAPTER THREE
PLANNING FOR PATIENT/FAMILY NURSING CARE
3.0 Introduction
Planning is the process in which the nurse and patient together consider the goals to achieve in
meeting the patient’s identified or potential problems in daily life and produce an individual care
plan (Taylor, 2019) . Following assessment and analysis of data, the nursing care is marked
according to sequence of activities that nurses use to meet the individual health needs of the client.
Planning is necessary as it serves as a logical system that permits the nurse and relatives to set
objectives considering the patient and family strength that can be utilized in the nursing activities.
3.1 Nursing Objective/Outcome Criteria

A nursing outcome refers to a measurable behavior or perception demonstrated by an individual,
a family, a group, or a community that is responsive to nursing intervention (Herdman &
Kamitsuru, 2018).
1. Patient will maintain normal fluid volume within 24 hours as evidenced by;
a. Nurse visualizing child resolution of vomiting.
b. Patient having good skin turgor, moist skin and mucus membrane, absence of thirst
and normal urine output.
2. Patient would maintain adequate nutrition throughout period of hospitalization as
evidenced by;
a. Patient’ mother verbalizing improvement in child’s appetite.
b. The nurse observing patient eating more than half of his usual meals served.
3. Patient would regain normal body temperature within 24 hours as evidenced by:
a. Nurse recording patient body temperature within normal limits (36.30 C-37.20 C).
b. Patient lying calmly and relaxed in bed and not warm to touch.
33
4. Patient’s headache will subside within 24 hours as evidenced by;
a. Patient’s verbalizing headache has subsided.
b. Nurse observing patient lie calm and comfortable.
5. Patient’s mother anxiety will resolve within 24 hours as evidenced by;
a. Patient’s mother verbalizing the absence of anxiety
b. The nurse observing patient’s mother have cheerful facial expressions.
6. Patient’s mother will have adequate knowledge on child’s condition within period of
hospitalization as evidence by;
a. The patient’s mother verbalizing a basic understanding of the causes, management
and prevention of malaria.
b. The nurse observing patient’s give accurate answers to questions posed on Malaria.
34
Table 7.0: Nursing care plan for Master O. S.
Date & Nursing Objective/ Nursing orders Nursing intervention Date & Evaluation Sign
time diagnosis Outcome criteria time
26/11/22 Risk for Patient will maintain 1. Reassure patient’s 1. Patient’s mother was reassured of 27/11/21 Goal fully met as; T.A.R
2:34pm
normal fluid volume competent nursing care.
fluid and mother. 2:34am Nurse visualizing
within 24 hours as 2. Vital signs were checked and recorded
electrolyte 2. Monitor vital signs. resolution of vomiting
evidenced by; four hourly to monitor the risk of
imbalance 3. Assess for signs and dehydration. and diarrhea Patient
1. Nurse visualizing 3. Clinical features of dehydration were
related to symptoms of having good skin turgor,
child resolution of assess as patient has good skin turgor,
excessive dehydration. moist skin and mucus
vomiting and diarrhea moist skin and mucus membrane and
loss of 4. Encourage the reported of no thirst. membrane, absence of
2. Patient having 4. Mother was encouraged to give about
water from intake of oral fluids. thirst and normal urine
good skin turgor, eight glasses of water a day to ensure
the mouth 5. weigh patient daily output.
moist skin and mucus rehydration.
and anus. membrane, absence of 6. Monitor intake and 5. Patient’s weight was monitored daily.
thirst and normal urine 6. Intake and output chart was instituted to
output of patient and
output. monitor intake and output of patient and
report abnormalities
balanced every 24hours with no anomaly
7. Administer observed.
7. Prescribed Intravenous Dextrose Normal
prescribed IV fluids.
Saline was administered.
35
Table 7.1: Nursing care plan for Master O. S.
Date/Time Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Diagnosis Outcome Criteria Time
26/11/22 Imbalanced Patient would 1. Plan diet with clients’s 1. Diet was planned with client’s mother 30/01/22 Goal fully T.A.R
at nutrition: less maintain adequate mother. with pawpaw and pineapples being added to at met as
2:45pm than body nutrition throughout his meals. 08:30am patient ate
requirement the period of 2. Do oral care 2. Oral care was done to boost appetite. more than
: related to hospitalization as 3. Serve patient meal small 3. Fufu was served in bits, attractively and at half of his
poor appetite. evidenced by: but in a frequent interval. regular frequencies to maintain proper meals served
1. Patient’s mother nutrition. and also
verbalizing 4.Stay and encourage patient 4. Patient was encouraged to eat his usual mother
improvement in to eat. meal served. verbalized an
child’s appetite. 5.Reassure client’s mother. 5. Patient’s mother was reassured to allay improvement
2. The nurse fear and anxiety on his appetite. in child’s
observing patient 6. Remove all nauseating 6. Nauseating objects such as bedpan, appetite.
eating more than half objects patient’s bed site. urinals, vomitus bowls were removed from
of his usual meals patient’s bed side to help prevent triggering
served. of nausea.
7.Weigh patient on daily 7. Patient was weighed daily; at the same
basis; at the same time in the time and the same dress to monitor for weigh
same dress and document. loss.
36
Table 7.2: Nursing care plan for Master O.S.
Date/Time Nursing Objective/ Nursing orders Nursing intervention Date & Evaluation Sign
diagnosis Outcome criteria time
26/11/22 High body Patient will regain 1. Reassure mother. 1. Patient’s mother was reassured 27/11/22 Goal fully met as T.A.R
At temperature normal body of competent nursing care to at evidenced by:
3:00 pm (37.8°C) temperature within 24 allay fear 3:00pm patient’s
related to hours as evidenced by: 2. Tepid sponge patient. 2.Patient was tepid sponged with temperature
infection by lukewarm to help cool the body reduced to 36.3°C
plasmodium 1..Nurse observing and patient laid
parasites. Patient’s temperature 3. Monitor temperature. 3.Patient’s temperature was calmly and relaxed
measuring within checked every 30 minutes and in bed.
normal range (36.2°C to recorded to know the outcome of and patient’s body
37.2°C) and the intervention given not warm when
touched.
2. Patient lying calmly 4. Encourage mother to serve 4. Patient’s mother was
and relaxed in bed and liberal fluids to patient encouraged to serve liberal fluids
Patient not warm to to patient such as water, fruit
touch. juice
5. Open nearby windows. 5. Nearby windows were opened

to ensure ventilation in the ward.
6. Remove all tight clothing 6. Patient’s clothes were removed
on patient. to ensure optimum ventilation on
the skin.
7. Administer prescribed 7. Intravenous Paracetamol
antipyretics 144mg was administered to help
reduce patient’s body
temperature.
37
Date/Time Nursing Objective/ Nursing orders Nursing intervention Date & Evaluation Sign
diagnosis Outcome criteria time
26/11/22 Headache Patient headache will 1. Reassure the patient and 1. Patient and family was 27/11/22 Goal was fully met T.A.R.
subside within 24 hours family. reassured that measures were as patient
at at
related to as evidenced by: been put in place to relieve pain verbalized that he
3:30pm presence of and also to improve his health. 3:30pm does not feel any
malaria 1. The patient 2. Assess verbal complaints
pain and nurse
of discomfort. 2. Patient’s verbal complaints of
parasite in the verbalizing relief of observed patient
discomfort were assessed by
blood pain. has a relaxed facial
asking him.
3. Assess patient level and expression and
2. The nurse observing 3. Pain assessment was done increased
intensity of pain.
patient has relaxed using the FLACC pain rating participation in
facial expression and scale and Master O.S.’s facial activity.
increased participation expressions indicated pain
in activities. intensity.
4. Ensure noise reduction to 4. All forms of noise were
encourage rest. reduced by restricting visitors,
reducing volume of radio and
television.
5. Monitor his vital signs 5. Patient’s vital signs were
regularly monitored regularly to know if
there is increased patient’s
temperature and pulse
6. Prescribed analgesic such as

6. Administer prescribed intravenous paracetamol 144mg
analgesics. was administered.
38
Date & Nursing Objective/ Nursing orders Nursing intervention Date & Evaluation Sign
time diagnosis Outcome criteria time
27/11/22 Parental Patient’s mother 1. Reassure patient’s mother of competent 1. Patient’s mother was reassured 28/11/22 Goal fully T.A.R
8:30am anxiety anxiety will resolve nursing team and nursing care. that he will be relieved of his 8:30am met as;
related to within 24 hours as symptoms through competent Patient’s
unknown evidenced by: nursing care. mother
outcome 2. Assess for signs and symptoms of anxiety. 2. Patient mother’s anxiety level verbalized
1. Patient’s mother
of was assessed by asking her of her that she feels
verbalizing the
patient’s fears and worries. less anxious.
absence of anxiety
condition. 3. Allow patient’s mother to voice his fears 3. She was allowed to voice her and Nurse
2. Nurse observing and ask questions. feelings and questions were observed a
patient’s mother tactfully answered. relaxed facial
have cheerful facial 4. Introduce other patients who have been 4. She was allowed to interact with expression of
expressions. relieved from same condition to patient and other relatives of patients with the the patient’s
allow her to interact with them. same condition. mother.
5. Introduce health team members to the 5. Health team members were
patient’s mother. introduced to her to allay anxiety.
6. Engage mother diversional activities 6. Mother was watching television
to diverse her attention.
39
Date & Nursing Objective/ Nursing orders Nursing intervention Date & Evaluati Sign
time diagnosis Outcome criteria time on
27/11/22 Knowledge Patient’s mother will have 1. Reassure patient’s 1. Patient’s mother was reassured of a 30/11/22 Goal T.A.R
8:45am deficit adequate knowledge on mother. competent nursing care. 8:35am fully met
(mother) child’s condition within 2. Ensure a quiet and 2. Conducive environment was as patient
related to period of hospitalization conducive environment ensured during the education section and
inadequate as evidence by; for education. to facilitate her understanding. relatives
information 1. The patient’s mother 3. Assess patient and answered
about the verbalizing a basic family’s level of 3. Patient’s mother and relative were questions
condition understanding of the causes, knowledge. asked about the knowledge they had well.
(malaria). management and prevention 4. Educate patient’s on her condition.
of malaria family on the disease 4. Education on disease condition,
2. Nurse observing that she condition. desired and adverse effects of drugs
gives accurate answers pose 5. Encourage patient were provided to patient’s mother
to them on malaria. mother and family to ask and relatives
questions and answer 5. Questions were tactfully answered.
tactfully. 6. Mother was encouraged to ask
6. Encourage asking of question for clarification
question.
40
CHAPTER FOUR
IMPLEMENTATION OF PATIENT/FAMILY CARE PLAN
4.0 Introduction
The implementation phase of the nursing process involves carrying out the proposed plan of
nursing care. The nurse assumes responsibility for the implementation and coordinates the
activities of all those involved in implementation, including the patient and family, other members
of the nursing team and other members of the health care team, so that the schedule of activities
facilitates the patient’s recovery (Cheever, 2018). This aspect of study deals with a description of
the actual care rendered to Master O.S. and family during the period of hospitalization. It further
describes the preparation made towards discharge and follow ups including the home visits made
to the patient’s home and community while he was on admission and after discharge.
4.1 Summary of the Actual Nursing Care Rendered To Patient and Family
The actual nursing care rendered to patient and his family commenced on the day of admission,
26th November, 2022 to time care was terminated. The management of patient and his family was
planned to meet their physiological, psychological, emotional, and spiritual needs. The summary
of the care was written on daily basis as follows;
First day of admission (26th November, 2022)
brought into the pediatric ward backed by his mother in company of a student nurse. They were
warmly welcomed to the ward and offered a seat. Confirmation of patient was done by mentioning
the name and other particulars like diagnosis and treatment on the patient’s folder. Patient and
mother were introduced to the nurses on duty and Master O.S. was then put into a cot made for
41
him. Patient’s mother was encouraged to be with the child while treatment commences if she so
wishes.
Procedure was explained to patient mother and baseline vital signs were checked and recorded as
follows; Temperature – 37.8 Degree Celsius, Pulse – 138 beats per minute, Respirations – 32 cycle
per minute and his SpO2 was 99%. His weight and height were also taken and recorded as 9.4kg
and 0.5m and body mass index as 37.6kg/m2 respectively.
Samples were taken from Master O.S. after explaining the procedure to the patient’s mother and
sent to the laboratory for the following investigations:
All these prescribed medications were collected from the Out-Patient Department pharmacy and
due medications were administered accordingly at 2:30pm.
42
On assessment, the following were revealed; fever, diarrhea, headache, vomiting, body weakness
loss of appetite. Master O.S.’s mother was orientated to the ward. Based on the sign and symptom
present and the necessary information mother gave, nutritional assessment was done on patient
using the ABCD approach (A- Anthropometric, B- Biochemical, C- Clinical, D- Dietary) These
parameters are the basic tools use to assess a child’s nutritional status. Based on the use of the
ABCD approach it revealed master O.S. was malnourished. Windows were opened to improve
ventilation for reduction in body temperature, Patient was sponged with tepid water and he was
covered with light clothing as well.
Patient’s mother was also introduced to the nurses and other patients lying closer to them. His
valuables were put in the locker beside his bed and informed about the hospital policies such as
visiting hours that is 5:30am - 6:30am in the morning, 12:00pm - 1:00pm in the afternoon and
5:30pm - 6:00pm in the evening. The family was asked to bring items that the patient would need
whilst on admission such as child’s favorite toys sponge, soap, towel, tooth brush and paste. They
were also made aware of the possibility to pay some of the hospital bill. Patient was made
comfortable in bed while infusion set on him. Patient particulars such as name, sex, age, folder
number and date of admission were recorded in the admission and discharge book as well as in the
daily ward state.
Master O.S.’s mother was reassured of the competency of the health team and speedy recovery of
his son. He was made aware that the admission was temporary, and that it was aimed at giving the
client the necessary health care to restore his health. This was done to allay their fears and to relieve
them of anxiety. The following nursing interventions were done to manage the problems identified.
At 2:34pm, a nursing diagnosis of risk for fluid and electrolyte imbalance related to excessive loss
of water from the mouth and anus was formulated. An objective was set that patient will main
43
normal fluid volume within 24hours. The following interventions were carried out to help maintain
the patient’s fluid volume. Patient’s vital signs was checked and recorded four hourly to monitor
the risk for dehydration and assess for any abnormalities, clinical features of dehydration were
assess as patient has good skin turgor, moist skin and mucus membrane and reports of no excessive
thirst, patient’s mother was encouraged to give about eight glasses of water a day to ensure
rehydration, patient’s weight was monitored every morning with the same scale to know the
patient’s weight, Intake and output chart was instituted to monitor intake and output of patient and
balanced every 24hours with no anomaly, prescribed intravenous dextrose normal saline was
administered, patient’s mother was reassured of competent nursing care.
Also, at 2:45pm, a nursing diagnosis of imbalanced nutrition: less than body requirement: related
to poor appetite was set. An objective was set that patient will maintain adequate nutrition
throughout the period of hospitalization. The following interventions were carried out to help
patient maintain adequate nutrition ;Diet was planned with patient’s mother with pawpaw and
pineapple being added to his meals, oral care was done to boost appetite, fufu was served in bits,
attractively and at regular frequencies to maintain adequate nutrition, patient was encouraged to
eat his meal served, patient’s mother was reassure of reliable nursing interventions to help her
restore child’s nutritional status, nauseating objects such as bedpan urinals, vomitus bowls were
removed from patient’s bed side to help prevent triggering of nausea, patient was weighed daily;
at same time and in the same dress to monitor for weight loss and all procedures carried out were
documented in the nurse’s note.
Patient had high body temperature was managed at 3:00pm, a nursing diagnosis of high body
temperature (37.80 c) related to infection by plasmodium parasites was formulated and the
objective that patient will regain normal body temperature within 24 hours was set. The following
44
interventions were carried out to ensure reduction in temperature; Patient’s mother was reassured
of competent nursing to care to allay fear. Patient was tepid sponged with lukewarm water to cool
the body. Patient’s temperature was checked every 30 minutes and recorded to know the outcome
of intervention given. Patient’s mother was encouraged to serve liberal fluids to patient such water,
fruit juice. Nearby windows were opened to ensure ventilation in the ward. Patient’s clothes were
removed to ensure optimum ventilation on the skin. Intravenous Paracetamol 144mg was
administered to help reduce patient’s body temperature.
On that same day, at 3:30pm patient’s headache was managed, a nursing diagnosis, Headache
related to the presence of malaria parasite in the blood was formulated and the objective that;
Patient headache will subside within 24 hours was set. The following interventions were carried
out to achieve the said objective; Patient and mother were reassured that measures were been put
in place to relieve pain and also to improve his health, patient’s verbal complaints of discomfort
were assessed by asking him, pain assessment was done using the FLACC pain rating scale and
Master O.S.’s facial expression indicated pain intensity, all forms of noise were reduced by
restricting visitors, reducing volume of radio and television, patient’s vital signs were monitored
regularly to know if there is an increased in patient’s temperature and Pulse, prescribed analgesics
such as intravenous paracetamol 144mg was administered
At 6:00pm, patient’s vital signs were checked and recorded as shown in the appendix. His due
medications were administered and due documentation were made. Master O.S.’s mother was
informed about my intention to visit their home the next day and I explained to them that it is a
requirement and part of the care.
Patient was served with boiled rice with beef sauce for his supper but he ate four teaspoons from
his usual plate served. His mother helped in grooming him after the meal.
45
Patient’s vomiting and diarrhea was assessed by asking the patient’s mother the number of times
he had vomited and mother verbalized that, he vomited and passed diarrhea stool once. Patient was
well hydrated when skin turgor was assessed. At 10:00pm Master O.S.’s vital signs were checked
and recorded. And his due medications were administered. He slept around 10:30pm.
Second day of admission (27th November, 2022)
On the second day of admission, at 7:00am, I went to the ward to continue with my nursing care
for Master O. S. His morning vital signs had already been checked at 6:00am and recorded as in
shown in appendix. He woke up at 6:05am according to night nurses who handed over to me. The
night nurse reported patient woke up slightly better than the previous day and the second dose of
IV Artesunate 28mg had been administered. He was bathed with lukewarm water. During the In-
patient review at 7:30am, Dr. A. attended to Master O. S. and the plan was to continue his
medications. Patient was fed with koko with koose for breakfast but he ate small amount of the
food served.
On assessment at 8:30am, it was discovered that patient’s mother was anxious. A nursing diagnosis
of parental anxiety related to unknown outcome of the condition was formulated. An objective was
set to resolve patient’s mother anxiety within 24 hours.
Nursing interventions carried out were as follows; Patient’s mother was reassured that child will
be relieved of his symptoms through competent nursing care. Patient mother’s anxiety level was
assessed by asking her of her fears and worries. She was allowed to voice her feelings and
questions were tactfully answered. She was allowed to interact with other relatives of patients
with the same condition. Health team members were introduced to her to allay the anxiety.
Patient’s mother was encouraged to listen to favorite programs on the radio to divert her mind
46
from anxiety. Rapport was established with mother aimed at winning her cooperation with the
care.
Also, it was revealed that mother had less knowledge about her child’s condition at 8:45am,
therefore a nursing diagnosis, knowledge deficit (mother) related to inadequate information about
the condition (Malaria) was formulated and the objective that, patient’s mother will have adequate
knowledge on his condition within period of hospitalization was set.
The following interventions were carried out to achieve the said objective;
Patient’s mother was reassured of competent nursing care. Conducive environment was ensured
during the education section to facilitate proper understanding. Patient’s mother level of
knowledge was assessed to clarify any possible misconception about malaria. Education on disease
condition, desired and adverse effects of drug was given to patient’s mother. Questions were
tactfully answered. Patient’s mother was asked to summarize what she heard to ascertain if
learning have taken places. His 10:00am vital signs were checked and recorded as in appendix.
On assessment, it was discovered that patient still had loss of appetite and the following nursing
interventions were carried out on him, patient’s mother was reassured of competent nursing care,
nutritional needs of patient was assessed and education on diet was given to mother. Mother was
encouraged to visit the nutritional department on Monday for further education on the diet of the
child. Patient food was served attractively and at regular intervals, patient’s oral hygiene was
maintained by cleaning the mouth of the patient with tooth brush and paste twice daily. Patient’s
mother was involved in planning his diet, his likes and dislikes were taken into consideration.
Patient was weighed daily at same time and in the same dress. Mother was informed about my
intention to visit their home the next day and I explained to them that it is a requirement and part
47
of the care. His vital signs were checked and recorded. At 2:00pm vital signs were checked and
due medications were administered and documented.
At 2:34pm, I evaluated the objective that was set on 26th November, 2022 that patient’s normal
and electrolyte status would be maintained within 24hours and goal was fully met as nurse
visualized resolution of vomiting and diarrhea, patient had good skin turgor, moist skin and mucus
membrane, absence of excessive thirst and normal urine output.
On the same day, at 3:00pm, the objective that was set on 26th November, 2022 to reduce patient’s
body temperature was evaluated and goal was fully met as patient’s temperature reduced to 36.30C
and patient laid calmly and relaxed in bed and patient’s body not warm to touch.
Also, at 3:30pm, evaluation on the goal set on 26th November, 2022 to relieve patient’s headache
was done. Goal was fully met as patient verbalized that he does not feel any pain and nurse
observed patient has a relaxed facial expression and increased participation in activity.
He took a nap for some hours. He was served fried plantain and beans stew for lunch and he ate
2/4 of his usual meal served. Patient’s vital signs were checked at 6:00pm and due medication was
administered. He was served plain rice and tomato sauce at supper, bathed and made comfortable
in bed. 10:00pm vital signs were checked and recorded as shown in appendix and he slept around
10:20pm.
48
Third Day of Admission (28th November 2022)
On this day Master O.S. woke up as early as 6:00 am; mother brushed his teeth, took him to visit
the toilet and bathed him. I arrived at the ward around 7:30am and saw him taking his breakfast.
Master O.S.'s condition was improving and he looked healthy. Report from the night nurses read
that he was able to sleep well upon the measures put in place. Vital signs checked and recorded at
6:00am as in appendix. At 8:00am patient was reviewed by Doctor A. and plan was to continue all
his medications. Syrup Iron III polymaltose 5mls daily for 7 days was also added to his medication.
I evaluated the objective set on 27th November, 2022 to help relieve patient’s mother anxiety and
goal was fully met at 8:30am as patient’s mother verbalized that she feels less anxious and nurse
observed a relaxed facial expression of the patient’s mother. Child was served rice with egg sauce
and fruit juice but he only ate few teaspoons of his meal served. Mother visited the nutritional unit
with child and patient was assessed by a nutritionist. History revealed that child was exposed to
unhygienic environment leading to mosquito bites. The following are nutritional intervention
given by the nutritionist; counselling on healthy eating lifestyle. Eat more of dark green leafy
vegetables. Add egg, beans, red meat and milk to meal. Mother was encouraged to add fruits to
meal. Practice personal and environmental hygiene. Sleep under a well -treated insecticide net and
do not stay long in the dark at night. During interaction with mother, questions were asked about
the education given on the previous day and she was not able to give accurate information about
the education given to her. I embarked on my first home visit after work. The main aim of the visit
was to acquaint myself with the patient’s home environment, to familiarize myself with the other
family members, to confirm information given by my patient’s mother about the family and their
home environment and to find out their health needs and assist towards effective solutions to any
49
health problems that may be identified. He was served Tuo-zaafi with Ayoyo soup for lunch,
which he took six morsels of it. Patient vital signs were checked and recorded at 2:00pm as shown
in the appendix. He was also seen playing with other kids at the ward in the afternoon. He took ten
morsels of fufu with light soup and beef served as supper. Vital signs were checked and recorded
at 6:00pm He was bathed with lukewarm water and made comfortable in bed. His 10:00pm vital
signs were checked as shown in the appendix and due medication was administered. He slept
around 10:35pm.
Fourth Day of Admission (29th November, 2022)
On the fourth day of admission, patient woke up at 5:50am looking more cheerful than the previous
day. He was bathed and oral hygiene was done. Patient’s vital signs were checked and recorded at
6:00am. Due medication was administered and documented. He was dressed with his favorite
outfit. He was served breakfast which he drank 500mls of 600mls of tea and three of slides of
bread served, which showed improvement in child’s appetite. On assessment master O.S. did not
show any health problems and his mother did not lodge any complaints. During the usual ward
rounds around 8:30am, the doctor was satisfied with Master O.S progress in health after
examination and hinted on possible discharge the following day. He was taken for a walk afterward
rounds. Mother expressed her understanding on child’s condition. On assessment mother was able
to give the mode of transmission, clinical manifestation and some treatment of child’s condition
(malaria). At 2:00pm, vital signs were checked and recorded as shown in the appendix. He took
ten teaspoons of rice and stew was served for lunch in his favorite bowl. At 6pm, evening vital
signs were checked and recorded as shown in the appendix. All routine nursing actions were
carried out and documented for references and to ensure quality care as well. After all these, patient
50
and relative were informed about possible discharge the next day as said by the doctor and they
were very happy about that. We later had conversation regarding work and activities that will
promote their health. Master O. S. was made comfortable in bed after he took his bath. Evening
medications were served and he slept around 10:00pm.
Day of discharge (30th November, 2022)
Master O.S. woke up on this day fully recovered from the health problems. He looked cheerful in
bed. He was bathed with luke-warm water. Mouth care was done for him and his bed was made
for him. On 26th November, 2022 at 2:45pm, mother admitted son has loss of appetite. A nursing
diagnosis of Imbalance nutrition less than body requirement; related to poor appetite was set. It
was evaluated and goal was fully met at 8:30am as patient ate more than half of his usual meal
served and also patient’s mother verbalized improvement in child’s appetite.
At 8:45am the objective that was set on 27th November, 2022 at 8:30am to help mother gain
adequate knowledge about disease condition was evaluated and goal was fully met as child’s
mother answered questions well.
Master O.S. was discharged from admission at 9:30am during the ward rounds after the doctor was
satisfied with his progress. This was documented into the admission and discharge book as well
as daily ward state. The rest of the medication was handed over to patient’s mother and reminded
of the dosage and the number of times each drug was supposed to be taken. Patient’s parents were
informed about the review date (8th December, 2022). They were told to always report to the
hospital early any time they felt sick and also the need to take in nutritious diet and to avoid self-
medication. Patient’s mother was also advised to maintain good personal hygiene in and around
51
the house. Patient’s family was helped to pack their belongings. They thanked the nurses and
doctor present for our care and support during their hospitalization. I went to the revenue
department to settle all pending bills after which I gave the receipts to mother as proof of payment.
They were escorted to the entrance of the hospital where they left with a tricycle (pragyia). I
removed the bed linen and disinfected the bed.
4.2 Preparation of Patient/Family for Discharge and Rehabilitation.

Preparation of patient and family towards discharge started on the day of admission to the day of
discharge. The patient and relatives were told that the ward was a temporal place for the patient
and that he would be discharged home as soon as he recovers. This was to prevent over dependence
on the health care team after discharge. In view of this, patient’s health status was assessed daily
and compared with baseline data to see the level of improvement.
Parents were educated on the mode of transmission, causes, clinical manifestation, complication,
treatment as well as prevention of malaria. They were encouraged to seek regular check-up and
report if any symptoms appear to the hospital for treatment. The importance of good personal
hygiene and environmental hygiene were explained to them in order to prevent the breeding of
mosquitoes and improve their health. The importance of eating food adequate in all the food
nutrients was also explained to them since it would boost Master O. S.’s immunity and improve
her health and the need to sleep under insecticide treatment net to prevent the reoccurrence of the
condition.
On the day of discharge that is 30th November, 2022, discharge papers were duly signed by the
physician on duty. They were assisted to pack their belongings. Patient’s hospital bills were
covered under the National Health Insurance Scheme. Patient’s mother and relatives were educated
on how to take remaining medications at home. Patient was discharged in the admission and
52
discharge book, daily ward state and nurse’s note. Patient’s bed linen was removed from the bed
and disinfected. Master O. S. and family were happy and willing to leave the hospital premises.
They expressed their heartfelt gratitude to all the health care team who helped in their son’s
recovery.
Before Master O. S. was discharged, the first visit was paid to their house at Bechem-Adum while
they were still on admission. The purpose of this visit was to inspect the family’s living
environment for predisposing factors that might have led to his condition and to assess available
resources at home as well as the community that can help in the recovery of the patient
4.3 Follow-Up/Home Visits and Continuity of Care

A home visit may be defined as visit to a person’s home, especially one made by a health care
professional or social worker. It may also be explained as a visit made by a health personnel to a
patient’s home, usually with face-to-face contact between the health professional and the patient
and family. Home visit is an important component of the patient/family care study. It does not only
ensure continuity of care at the comfort of patient’s home, but also gives the nurse the perfect
opportunity to obtain first-hand information about patient’s home environment. With home visit,
the health care provider would be able to direct his/her education to meet patient’s needs. Other
family members, breastfeeding mothers, the aged and those with chronic illness also benefits from
services rendered. It also helps to the care giver to evaluate the patient’s condition even after
discharge.
First Home Visit (28th November, 2022)
My home first visit to patient’s home was done the 28th November, 2022 while patient was still on
admission. I visited the patient’s house alone per the directions given to me by patient’s mother.
My main aim for the visit was to assess their environment and to find out about factors that may
53
have contributed to patient’s health problems. Master O. S. lives with both parents and siblings at
Bechem-Adum. I left the hospital around 2:00pm and arrived safely at the house at 2:20pm. The
house is a four-bedroom single block house and roofed with iron sheet. It is plastered, but not fully
painted. The kitchen is made of wood which is found inside the compound. Their toilet and
bathroom are also found in the compound. The house is close to the main refuse disposal site in
the area. The house also closer to the Assemblies of God Church. The surroundings was tidy and
this would promote faster and early recovery of the patient. There is a drainage tube connected
from their house to the main gutter which drains all their domestic waste. Each room had windows
but was closed. They have access to pipe borne water. Their source electricity is by the VRA. I
left their house after assessing the environment since there was nobody at home. I didn’t meet any
vulnerable at patient’s home. I left their house at 2:40pm.
Second Home Visit (5th December, 2022)
This visit was made on 5th December, 2022 at 1:30pm and got there at 1:50pm, as it was scheduled
with Master O. S. mother to pay them a second visit. The purpose of this visit was to find out how
Master O. S. was faring and how he was going about with his activities. The visit was also done
to enquire whether the education given to them during the period of hospitalization and had been
adhered to and also to remind them of the review date which was on 8th December, 2022. Upon
entering the house, Master O. S. was eating with his mother and two of his siblings in the kitchen.
They were very happy to see me. I was warmly welcomed and offered a seat. I told them my
mission for coming to the house and they were delighted. Based on observation and interaction, it
was observed that, Master O. S.’s condition had improved tremendously. This was as a result of
patient’s mother and relatives’ compliance to drug therapy and commitment to the education that
was given on his condition including maintain good personal hygiene, rest and diet and adherence
54
to treatment regimen. On assessment the environment was neat and they were commended for that.
I informed mother about review date and the need for the review. They were educated on the need
to seek early treatment any time they felt sick. There were vulnerable (grandmother and other
children under five years) in the house. They were educated on the need to wear boots to protect
them from injury. They were also educated to eat well-balanced diet, take fruits and maintain
personal hygiene (oral hygiene) at all times. Ensure proper immunization especially children under
five. Patient’s mother and siblings were thanked for their cooperation and I asked permission to
leave at 2:00pm. I promised them another visit which is the last visit.
Day of Review (8th December, 2022)
On Thursday, 8th December, 2022 Master O. S. and his mother met at the Out-Patient Department
of Bechem Government Hospital, Bechem at 9:00am looking cheerful and lovely as noted from
facial expression. They were warmly welcomed. Patient’s folder was taken from the records
department and after which vital signs was as follows; Temperature - 36.5 degree Celsius, Pulse
95 beat per minute, Respiration -25 cycle per minute and his Spo2 was 99 percent.
Patient was arranged to meet the doctor on duty. Blood sample of patient was taken the laboratory
for investigation and while patient and mother were waiting for the laboratory results, Master O.
S. was assessed. Upon assessment by the doctor, Master O. S. looked healthy and mother did not
lodge any complains. The laboratory investigation results were all within normal ranges and hence
Master O. S. was declared fit. Patient’s mother was educated on the need to maintain personal
hygiene, eat balanced diet, sleep under treated mosquito net and report to the hospital early any
time they are sick. Patient’s mother was informed about the last home visit. I escorted them to the
hospital gate and bid them goodbye.
55
Third Home Visit (22th December, 2022)
The main aim of conducting the third home visit was to assess patient’s condition and know how
the family was doing and to terminate the care by handing over my patient to his family to continue
the care. I left my house around 11:30am in the morning. I arrived at my patient’s house at exactly
12:00 noon since it is 30-minute drive from my home. I was welcomed and offered a seat. Patient’s
condition had improved greatly. Patient’s mother had no complains and he had not developed any
complications. Patient was completely strong and well. I highlighted on the various health
education that I had previously been given. I also stressed on the importance of regular check-ups
and to seek prompt medical intervention anytime they are sick and should not rely on Over-the-
counter medication. They were reminded of the need to eat nutritious food with plenty fruits that
are assessable to them and also maintain good personal hygiene. I educated them to keep their
environment clean always and to sleep under treated insecticide net, weeding their environment to
prevent breeding of mosquitoes. They promised to adhere to the education. They expressed their
sincere appreciation for the care I rendered to them throughout hospitalization and after discharge
and I also showed my gratitude and I asked their permission to leave for school. I bid them goodbye
and left to my house at 1:00pm.
56
CHAPTER FIVE
EVALUATION OF CARE RENDERD TO PATIENT AND FAMILY
5.0 Introduction
Evaluation in simple terms is the outcome of nursing actions against the anticipated goals and it is
the final step in nursing process (Hinkle & Cheever, 2018). The chapter gives information about
the statement of evaluation, amendment of nursing goals and the termination of the care rendered
to my patient and family.
5.1 Statement of Evaluation

Master O. S. was admitted into the pediatric ward through the Out Patients department with the
diagnosis of Simple Malaria. During the interaction with his mother with patient assessment, six
(6) problems were identified and objectives and interventions were put in place to solve them.
5.1.0 Patient’s fluid and electrolyte balance was maintained (27th November, 2022)
On 26th November, 2022, patient mother complained that child has been vomiting and passing
watery stool before his admission and hence the nursing diagnosis; risk for fluid and electrolyte
imbalance related to excessive loss of water from the mouth and anus was formulated and the
objective that; patient’s normal fluid volume will be maintained within 24hours was set.
Patient’s vital signs was checked and recorded four hourly to monitor the risk for dehydration and
assess for any abnormalities, clinical features of dehydration were assess as patient has good skin
turgor, moist skin and mucus membrane and reports of no excessive thirst, patient’s mother was
encouraged to give about eight glasses of water a day to ensure rehydration, patient’s weight was
monitored every morning with the same scale to know the patient’s weight, Intake and output chart
was instituted to monitor intake and output of patient and balanced every 24hours with no anomaly,
57
prescribed intravenous dextrose normal saline 500mls was administered, patient’s mother was
reassured of competent nursing care.
On 27th November, 2022 at 2:34pm, I evaluated the objective that was set on 26th November, 2022
that patient’s normal and electrolyte status would be maintained during hospitalization and goal
was fully met as nurse visualized resolution of vomiting and diarrhea, patient had good skin turgor,
moist skin and mucus membrane, absence of excessive thirst and normal urine output.
5.1.1 Patient normal nutritional balance was maintained (30th November, 2022)
On the same day, 26th November, 2022 at 2:45pm, mother admitted son has loss of appetite. A
nursing diagnosis of Imbalance nutrition less than body requirement; related to poor appetite was
set. An objective that patient would maintain adequate nutrition throughout the period of
hospitalization was set. The following nursing interventions were executed; diet was planned
with patient’s mother with pawpaw and pineapple being added to his meals, oral care was done to
boost appetite, fufu was served in bits, attractively and at regular frequencies to maintain adequate
nutrition, patient was encouraged to eat his meal served, patient’s mother was reassure of reliable
nursing interventions to help her restore child’s nutritional status, nauseating objects such as
bedpan urinals, vomitus bowls were removed from patient’s bed side to help prevent triggering of
nausea, patient was weighed daily; at same time and in the same dress to monitor for weight loss
and all procedures carried out were documented in the nurse’s note.
Goals were fully met on 30th November, 2022 at 8:30am as patient ate more than half of his usual
meal served and also patient’s mother verbalized improvement in child’s appetite.
58
5.1.2 Patient was relieved of hyperthermia (27th November, 2022)
On 26th November, 2022 at 2:20pm a nursing diagnosis, high body temperature (37.50C) related
to infection by plasmodium parasites was formulated and the objective that patient will regain
normal body temperature within 24 hours. The following interventions were carried out to ensure
reduction in temperature; Patient’s mother was reassured of competent nursing to care to allay
fear. Patient was tepid sponged with lukewarm water to cool the body. Patient’s temperature was
checked every 30 minutes and recorded to know the outcome of intervention given. Patient’s
mother was encouraged to serve liberal fluids to patient such water, fruit juice. Nearby windows
were opened to ensure ventilation in the ward. Patient’s clothes were removed to ensure optimum
ventilation on the skin. Intravenous Paracetamol 144mg was administered to help reduce patient’s
body temperature.
On 27th November, 2022 at 2:20pm, the objective that was set on 26th November, 2022 to reduce
patient’s body temperature was evaluated and goal was fully met as patient’s temperature reduced
to 36.30C and patient laid calmly and relaxed in bed and patient’s body not warm to touch.
5.1.3 Patient’s headache was relieved (27th November, 2022)
On 26th November, 2022 at 3:30pm a nursing diagnosis, Headache related to presence of malaria
parasite in the blood was formulated and the objective that; Patient headache will subside within
24 hours was set. The following interventions were carried out to achieve the said objective; Patient
and family were reassured that measures were been put in place to relieve pain and also to improve
his health, patient’s verbal complaints of discomfort were assessed by asking him, pain assessment
was done using the FLACC pain rating scale and master O.S.’s facial expressions indicated pain
intensity, all forms of noise were reduced by volume of radio and television, patient’s vital signs
59
were monitored regularly to know if there is an increased in patient’s temperature and pulse,
prescribed analgesic such as intravenous paracetamol 144mg was administered.
On 27th November, 2022 at 3:30pm, evaluation on the goal set on 26th November, 2022 to relieve
patient’s headache was done. Goal was fully met as patient verbalized that he does not feel any
pain and nurse observed patient has a relaxed facial expression and increased participation in
activity.
5.1.4 Patient’s mother was relieved of anxiety (28th November, 2022)
On the 27th November, 2022 at 8:30am, patient’s mother complained of been anxious. A nursing
diagnosis of parental anxiety related to unknown outcome of the condition. An objective was set
to resolve patient’s mother anxiety within 24 hours.
Nursing interventions carried out were as follows; Patient’s mother was reassured that child will
be relieved of his symptoms through competent nursing care. Patient mother’s anxiety level was
assessed by asking her of her fears and worries. She was allowed to voice her feelings and
questions were tactfully answered. She was allowed to interact with other relatives of patients
with the same condition. Health team members were introduced to her to allay the anxiety.
Patient’s mother was encouraged to listen to favorite programs on the radio to divert her mind
from anxiety. Rapport was established with mother aimed at winning her cooperation with the
care.
Goal set to relieve patient’s mother of anxiety was fully met on the 28th November, 2022 at 8:30am
as patient’s mother verbalized that she feels less anxious and nurse observed a relaxed facial
expression of the patient’s mother.
60
5.1.5 Patient’s mother gained adequate knowledge on her child’s condition (30th November,
2022)
On 27th November, 2022 at 8:45am, the interaction with child’s mother revealed that she had less
knowledge on condition and hence the nursing diagnosis, knowledge deficit (mother) related to
inadequate information about the condition (Malaria) was formulated and the objective that,
patient’s mother will have adequate knowledge on child’s condition within period of
hospitalization was set.
Patient’s mother was reassured of competent nursing care. Conducive environment was ensured
during the education section to facilitate proper understanding. Patient’s mother level of
knowledge was assessed to clarify any possible misconception about malaria. Education on disease
condition, desired and adverse effects of drug was given to patient’s mother. Questions were
tactfully answered. Patient’s mother was asked to summarize what she heard to ascertain if
learning have taken places.
On 30th November, 2022 at 8:45am the objectives that was set on 27th November, 2022 at 8:45am
to help mother to have adequate knowledge about disease condition was evaluated and goal was
fully met as child’s mother answered question well.
5.2 Amendment of the Nursing care plan

Despite all the health problems identified, with the individualized comprehensive nursing care and
support from other health team member and cooperation of patient and mother, all goals set were
fully met on the allocated time. The care plan was therefore not amended.
61
5.3 Termination of care
Every nurse-patient relationship at the hospital needs to be terminated. Termination of care was
not an easy thing to do since a good rapport was established with Master O. S.’s family. The
termination of care was made known to mother right from the day of admission through discharge,
review to the third home visit. During these periods, Master O. S.’s family were educated on topics
related to improving child’s condition and preventing the occurrence of the disease. I congratulated
the mother and family for the care they had rendered to Master O. S. I handed him over to family
to continue with the care and to report to the hospital whenever they observe any abnormalities in
the child. I also educated them on importance to sleep under treated insecticide net, wear long-
sleeved clothing and pants if he is outdoors at night to prevent mosquito bites. Education on
personal hygiene, proper nutrition and need to seek early medical care whenever they feel sick was
given to them. I thanked them for their co-operation. I informed them that the care has ended since
Master O. S. health has been restored. I also informed them of my desire to visit them whenever
I had the opportunity. I was assured that they would adhere to all the education and instructions
given to them.
62
CHAPTER SIX
SUMMARY AND CONCLUSION
6.0 Introduction
This is the last step of the patient/family care study which entails the student’s personal
appreciation of the therapeutic relationship with the patient as well as the use of the nursing
process.
6.1 Summary
brought into the pediatric ward backed by his mother in company of a student nurse. Patient’s vital
signs was checked and recorded as follows; Temperature – 37.8 Degree Celsius, Pulse – 138 beats
per minute, Respirations – 32 cycle per minute and his SpO2 was 99%.
They were warmly welcomed to the ward and offered a seat. Confirmation of patient was done by
mentioning the name and other particulars like diagnosis and treatment on the patient’s folder.
Patient and mother were introduced to the nurses on duty and Master O.S. was then put into a cot
made for him. Patient’s mother was encouraged to be with the child while treatment commences
if she so wishes. Six nursing problems were identified throughout patient’s stay at the ward. They
include; Patient’s mother complains that child had vomited (six times) and passed diarrhea stools
(four times), Patient’s complain that child had loss of appetite, Patient had fever (37.50C), patient
had headache, patient’s mother was anxious and patient’ mother had less knowledge on
condition(malaria). Nursing diagnosis was formulated for each of the problems and in order to
solve these problems, objectives were set, nursing orders were implemented and goals were fully
met.
63
The following laboratory investigations were carried out to confirm diagnosis;
2. Blood film for malaria parasites
Master O. S. was managed on the following medication;
Patient’s mother was assisted in maintaining child’s personal hygiene, rest and sleep, and proper
nutrition was also ensured. Patient was discharged on 30th November, 2022. On 8th December,
2022 patient and mother reported for review as scheduled. The aim of the review was to find out
if patient’s condition had improved and also to know if patient’s family was adhering to the advice
and all the education given to improve their health and standard of living. Three home visits were
embarked on. The first home visit was done while patient was still on admission, the aim of the
visit was familiarized myself with the patient’s home environment and other family members, to
confirm information given by patient’s mother about the family and their home environment and
to identify their health needs and assist towards effective solutions to their health problems. The
second home was conducted on 5th December, 2022 the purpose of the visit was to ascertain
whether the education given to mother and family during the period of hospitalization had been
adhered to and also to remind them of the review date. The termination of care was done during
64
the third home visit on the 22nd December, 2022. The main aim of the visit was to find out how
patient and family were doing and to hand over patient to family to continue with the care.
6.2 Conclusion
The study has equipped me with knowledge on how to care for a patient as an individual. Through
this study, I have been able to put into practice actual and holistic nursing care as has been learnt
theoretically. The study provided a therapeutic environment for nursing patient as an individual
and has promoted a good nurse-patient/family relationship as well as broadened my knowledge on
malaria. The study has enlightened the patient’s family of risk factors, causes and treatments of
malaria and how to prevent themselves from acquiring the infection. Master O.S. had speedy
recovery for his condition because of the competent care rendered by the medical team and they
also gained knowledge on the condition, therefore his family will communicate the good work of
the hospital which will increase the patronage of the services of the hospital. It is recommended
that, the idea and principle behind the adoption of the nursing process which is the core approach
to the writing of patient and family care study should be embraced by all health institutions and
nurses to ensure total patient care.
65
APPENDIX
Table 8: Vital Signs and SPO2 (%) of Master O. S. throughout the period of hospitalization
Date Time Temperature (oC) Pulse (bpm) Respiration (cpm) SPO2 (%)
26/11/22 2:150pm 37.8 138 32 99
6:00pm 37.4 124 29 99
10:00pm 36.0 122 30 98
27/11/22 6:00am 36.1 130 28 97
10:00 am 36.9 120 27 97
2:00pm 36.6 126 32 100
6:00pm 36.8 125 25 97
10:00pm 36.7 122 26 99
28/11/22 6:00am 36.3 119 23 100
10:00am 36.5 103 22 100
2:00pm 36.8 104 25 100
6:00pm 36.5 100 22 99
10:00pm 36.9 106 24 97
29/11/22 6:00am 36.5 120 30 98
10:00pm 36.6 120 24 96
6:00pm 36.6 102 24 99
10:00pm 36.7 126 22 98
30/11/22 6:00am 36.5 95 25 99
08/12/22 9:00am 36.5 119 23 98
66
BIBLIOGRAPHY
https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-andmaps/nursing-diagnosis
Herdman, H. T., & Kamitsuru, S. (Eds.). (2018). NANDA Internation, Inc. nursing diagnosis: definitions
and classifications: 2018-2020 (11th ed.). New York: Thieme.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of medical-surgical nursing (13th
ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Longman Dictionary. (2019, May 4). Longman. Retrieved from Longman:

https://www.ldoceonline.com/dictionary/strength
Marilynn, M. A. (2017). Nurse's pocket guide. philadelphia: F.A Davis.
Merriam, W. (2019, August 5). Medical history. Retrieved from merriam-webster.com dictionary:
www.merriam0-webster.com/dictionary/medical%history
Scott, J., & Marshall, G. (2015). Oxford Dictionary of Sociology. Oxford University Press.
Shiel, W. C. (2019, March 3rd). Medical Definition of Family history. Retrieved from
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HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE BEREKUM

A PATIENT AND FAMILY CARE STUDY ON

A PATIENT AND FAMILY CARE STUDY SUBMITTED TO THE NURSING AND

MIDWIFERY COUNCIL OF GHANA IN PARTIAL FULFILMENT TOWARDS THE

1. Full blood cell count

2. Blood film for malaria parasite (MPS)

1. Intravenous Artesunate 28mg stat, 12hourly for 24hours

2. Intravenous Dextrose Normal Saline 500mls for 24hours

3. Intravenous Paracetamol 144mg tid for 24hours

4. Suspension Artemether Lumefantherine 20/120 mg bd for 3days

5. Syrup Iron III Polymaltose 5mls daily x 7days

FIGURE 2: Showing the cycle of malaria transmission 21

1.1 Patient Particulars

1.3. Patient Socio-Economic History

1.5 Patient’s Lifestyle/ Hobbies

1.6 Past Medical History

1.7 Present Medical History

1. Full blood cell count

2. Blood film for malaria parasite (MPS)

1. Intravenous Artesunate 28mg stat, 12hourly for 24hours

1.9 Patient’s Concept of Illness

1.10 Literature Review on Simple Malaria

Basic Anatomy and Physiology of the Blood.

FIGURE 1: Showing the cells of the blood.

Erythrocytes (Red Blood Cells)

1. Age (Children under 5 years

Causes and Risk Factors of Malaria are:

1. Poor drainage systems.

2. Sexual development in mosquito

Sexual Development in Mosquito

Types of Plasmodium Parasite

1. Vector transmission; malaria is transmitted by the bite of certain species of infective

Clinical Features of Malaria

1. Fever (history of fever or axillary temp. ≥ 37.5° C) because of rupture erythrocytic-stage

1. By the clinical manifestations.

Nursing management of malaria include:

Psychological care/Emotional support

Rest and Sleep

1. Making bed free of creases

1. Patient is encouraged to do active and passive exercises to improve circulation, prevent

1. Ensure good environmental sanitation, example:

1.11 Validation of Data

2.1 Comparison of Data with Standards

1. Full blood cell count

2. Blood film for malaria parasite (MPS)

condition was as a result of bites from infected female anopheles’ mosquitoes.

which is responsible for the cause of his condition.

lasting insecticide treated net.

C. Clinical Features/ Signs and Symptoms

Fever Patient had high body temperature

Profuse sweating Patient had no profuse sweating

Headache Patient had headache

Malaise Patient had malaise

Loss of appetite Patient had loss of appetite

Bitterness in the mouth Patient had no bitterness in the mouth

Diarrhea Patient had diarrhea

Abdominal pain Patient had no abdominal pain

Jaundice Patient had no jaundice

Repeated profuse vomiting Patient experienced vomiting

Altered level of consciousness Patient had no altered level of consciousness