Admission of the Patient
On the 14th day of November, 2011, at 10:10am, Madam A. A., a 49-year old farmer diagnosed of Bleeding Uterine Fibroid at the Accident and Emergency Unit was admitted through the Operating Theatre to the Female Surgical Ward, per stretcher, after Total Abdominal Hysterectomy was done under spinal anaesthesia. Two student nurses (including myself) accompanied by her sister and eldest son brought her to the ward in a conscious state. At the Theatre, incisional site on inspection was clean and dry.
At the ward, the patient was admitted into a prepared warm operation bed in the supine or recumbent position. The bed accessories that were made available for the purpose of resuscitation included the following: Infusion or drip stand, suction machine, vital signs tray and blood pressure apparatus, mouth care tray and dressing pack. On inspection, there was a very small amount of vaginal bleeding so a perineal pad was applied to monitor further bleeding. In in-situ was Intravenous Fluid Ringers Lactate 300mls. The infusion was set on the drip stand and was ensured that it was flowing. Also in in-situ was urethral catheter with 400mls of bloody urine drained. The urine bag was emptied and the output recorded in the intake and output chart. The catheter bag was tied to the bottom of the bed. Her vital signs were checked to serve as the baseline for evaluation and the following were the results:
Temperature 35.5 o C
Blood pressure 120/70mmHg
These were recorded on the vital signs sheet. The vital signs were checked and recorded again, 15mins for the first one-hour and every 30mins for 2 hours and every hourly for 4 hours until they were stable.
The incisional site was again observed for any sign of bleeding and swelling but it was dry and clean. The client was covered with extra blankets because of her subnormal temperature.
The client was encouraged not to raise or turn the head up and down or side to side respectively to prevent headache after she had recovered from anaesthesia. Her family together with her were reassured that they were in competent hands of health workers and they would help her to regain her health to allay fears and anxiety. Her relatives were warmly welcomed and were given seat to relax and also helped to feel at home. They were orientated to the ward and its annexes, made aware of the ward routines and visiting hours. They were informed that Madam A. A. would be discharged home as soon as her condition gets better. Patient complained of incisional pains.
Vital signs monitoring was ordered for her and she was put on the following medications post-operatively;
- IV Ringers Lactate 1 litre (L)´ 24 hours
- IV 5% Dextrose water 11/2 L ´ 24 hours
- IV Cefuroxime 750mg bd ´ 48 hours
- IV Gentamycin 160mg dly ´ 48 hours
- IM Morphine 10mg bd ´ 24 hours then Rectal Diclofenac 100mg bd ´ 5 days.
She was served with IM morphine 10mg to relieve her incisional pain.
They were assisted to arrange her personal items like soap tooth paste and brush, toilet roll, cup and other materials into her bed side locker.
I introduced myself to them as a student nurse of the Holy Family Nursing and Midwifery Training College, Berekum, a final year student. They were informed of my desire to take Madam A. A. as a patient for the patient/family care study to enable me render to her individualized comprehensive nursing care until she was discharged. I informed them that it was a requirement by the Nurses and Midwives Council that I had to fulfill as a partial fulfillment towards the award of Diploma in Registered General Nursing in the country. They were very happy and agreed to my request and promised to co-operate fully in caring for Madam A. A..
With the help of patient’s relatives, her valuables were arranged nicely in her bedside locker. The patient’s particulars and all the care given were documented on the nurses’ continuation sheet, admission and discharge book and the daily ward state. The nursing care plan for Madam A. A. was drawn with the help of her relatives and Madam A. A. herself to promote recovery. Her relatives were told to go home and come later the same day during the visiting hours and that they should not worry because she was in safe hands.
1.10 Patient’s Concept of Illness
According to Madam A. A., her family and her thought that after one had had a miscarriage, the part of the uterus that the embryo embedded then grew to become fibroid. But with the common diagnosis of fibroid and the fact that she has never had a miscarriage before, they do not believe that any more. They however have no knowledge on fibroid or its management. They believed that it was like any other condition such as hypertension, and they had faith that she would recover soon and go home.
1.11 Literature Review on Uterine Fibroid
Basic anatomy and physiology of the uterus
The human uterus is a pear-shaped organ composed of two distinct anatomic regions: the cervix and the corpus.