Madam A. A. was able to care for her self-care needs within 48 hours.
On the first day postoperative (15/11/11), at 8:00 am, Madam A. A. complained of her inability to care for herself unaided because of her incisional pains. A goal was therefore set to enable her to care for her self-care needs within 48 hours. Self-care activities such as bathing and oral hygiene were planned with them. The patient was assisted in bathing, oral hygiene, toileting, and dressing twice daily (including care of her clothes). The patient was encouraged to actively participate in her postoperative care. The patient and family were involved in inpatient care. The patient was commended for her effort to gain independence in her care. The goal was fully met on 17th November 2011, at 8:00 am as Madam A. A. performed her self-care practices unaided and Madam A. A./family participated in self-care activities and verbalized rationale for self-care practices.
5.2 With the individualized comprehensive nursing care and support from other members of the health team and co-operation of the patient/family, all the goals set were fully achieved. The care plan was therefore not amended.
5.3 Termination of Care
My last home visit to Madam A. A. and her family was made on 12th December 2011. The essence of the visit was to determine whether her condition had improved after review or not, whether they had listened to the advice I gave them concerning the use of ITNs and netting her windows, and to introduce Madam A. F. to them officially as the Registered Midwife who was to continue with Madam A. A.’s care at home.
I congratulated them for the care they had rendered to Madam A. A. and for netting the windows and sleeping under the ITNs which I saw for myself that it was hanging on her bed. I also reminded them of the importance of complying with the activity restrictions until the surgeon says otherwise and observing personal and environmental hygiene practices and also, emphasis was placed on the already given health education.
They were thanked for their co-operation and I officially introduced Madam A. F. to them as the Registered Midwife who will be taken over the care. They were encouraged to give her the same co-operation they gave me. They were told that now that Madam A. A.’s health had been restored, the care for her has officially ended. I informed them of my desire to visit them unofficially whenever I had the opportunity.
They were happy. They said they would miss my care and would give Madam A. F. the maximum support she needed. They also said that they trusted Madam A. F. since she had been visiting them every day and advising them about the post-operative care of my client. All of them prayed for me, asking God to make me prosperous and successful.
It was all tears of joy when I told them of my intention to leave. They gave me a hag and they accompanied me to the Ghana Commercial Bank before they returned home at 10:15 am.
SUMMARY AND CONCLUSION
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.
Madam A. A., a 49-year old farmer was admitted on 14th November 2011, to the Female Surgical Ward after a total abdominal hysterectomy done at the Operating Theatre under spinal anesthesia at 10:10 am with the diagnosis of bleeding uterine fibroid and complains of profuse bleeding and abdominal (pelvic) pain and spent a total of five (5) days in the Holy Family Hospital, Berekum. Her vital signs read; Temperature – 35.5 o C, Pulse – 64bpm, Respiration – 20cpm, Blood pressure – 120/70mmHg. During her stay at the hospital, five (5) health problems were identified. These were anxiety of patient/family related to deficient knowledge on the condition and the related treatment plan, acute pain related to surgical incision, the risk for infection related to break in the continuity of skin, sleep pattern disturbance (insomnia) related to painful incisional wound, and hygiene self-care deficit related to incisional pains. A nursing care plan was drawn and objectives were set to resolve the aforementioned problems. Nursing interventions carried out included reassurance that patient would regain her health, education on the condition and its management, assessment of the patient’s problems, and involvement of patient/family in patient’s care.
The only diagnostic investigation done was hemoglobin (Hb) level estimation.
During her hospitalization, she was served with the following drugs:
- Tab Tranexamic acid 1g tds ´ 7 days
- Tab Mefenamic acid 500mg tds ´ 7 days
- Tab Buscopan 20mg tds ´ 7 days
- IV Hydrocortisone 200mg stat
- IM Atropine 0.5mg stat
- IM Phenergan 25mg stat
- IV Ringers Lactate 2 litres (L) × 24 hours
- IV 5% Dextrose water 2 L × 24 hours
- IV Cefuroxime 750mg bd × 48 hours
- IV Gentamycin 160mg dly × 48 hours
- IM Morphine 10mg bd ´ 12 hours
- IM Pethidine 100mg bd × 12 hours
- Supository Diclofenac 100mg bd ´ 5 days.
- Tab Paracetamol 1g tds × 5 days
- Tab Amoksiclav 625mg bd × 5 days
Three home visits and a follow-up/review in the hospital were made to ensure continuity of patient care. During the home visits, education on patient’s condition and its management, personal and environmental hygiene, diabetes mellitus and malaria (the importance of Insecticide Treated Mosquito Nets, and netting of windows), over-the-counter drugs (OTCDs), and alcoholism were done.
She was discharged home with treatment (drugs) when her condition was clinically satisfactory on the 18th of November, 2011. She came for review on 25th November, when she was in good health (her wound had completely healed), she was not given any medications home and she gave no complaints. She was advised to report to the hospital for early treatment if any problem arose. The official care of Madam A. A. ended on 12th December 2011.
The care rendered to Madam A. A. and her family has really helped me to gain a great knowledge on uterine fibroid after nursing her. It had also offered me a great opportunity to know how to nurse individuals with uterine fibroid. It has also helped me to practice my skills acquired in the classroom theoretically. It has deepened my relationship with patients, families, and the people in a given community as a whole.
It is my recommendation that all students are given the opportunity to embark on the patient/family care study to implement the nursing process in order to render individualized comprehensive care to patients/families.
In brief, I really enjoyed every bit of writing this script despite the challenges encountered