Administer intravenous fluids such as Ringers Lactate, Dextrose Normal Saline and Normal Saline for the first 24 hours after the operation until condition improves. Sips of water, fluid diet and light diet are given to patient within 48-72 hours post-operatively as prescribed. As bowel sounds return, patient is put on normal diet.
Medications such as analgesics like paracetamol, diclofenac or pethidine and antibiotics such as IV ampicillin, IV gentamycin or IV metronidazole are administered as prescribed by the physician to help relieve pain and prevent infection. The rights of drug administration such as right patient, right drug, right time, right dosage and right route are observed. The therapeutic effects and side effects of served drugs are observed, recorded and reported.
The patient is encouraged to do deep breathing and coughing exercises to help prevent hypostatic pneumonia. Patient is encouraged to ambulate early to prevent deep vein thrombosis, promote blood circulation and in bladder emptying to prevent urinary tract infections.
Patient is assisted to do passive exercises and encouraged to do active exercises. The position of the patient is changed every 2 hours to prevent pressure sores.
Patient is advised to support incisional site with hands while coughing or sneezing to help prevent wound dehiscence and evisceration.
The patient’s personal hygienic needs is provided for through regular baths (at least twice daily); assisted bed bath or bed bath, depending on patient’s condition. Oral hygiene is maintained by giving patient mouth care immediately after recovery from anaesthesia and regular oral hygiene at least twice daily. The urethral catheter is cared for by cleaning daily with antiseptic lotion. The patient’s hair, nails and pressure areas are also cared for to prevent pressure sores. Soiled or dirty linens are changed frequently.
Fluid balance chart is maintained by way of intake and output chart. IV fluids given and any oral fluid taken by patient is recorded. Patient is encouraged to take enough fluids about 2500-3000mls daily. Adequate roughages are given to patient to prevent constipation.
Urine output is observed for colour, odour, amount and constituents and this is recorded. Patient is also served with bed pan or assisted to visit the toilet to empty the bowels regularly.
As soon as patient is received from the theatre, the incisional site is observed for bleeding, abnormal discharges or redness around it. If the incisional site is bleeding, the dressing is reinforced with additional dressing. If the bleeding is profuse, the surgeon and the theatre team are informed and patient is prepared and sent to the theatre for management.
The wound is first inspected by the surgeon and dressed within the 3rd to 5th day post-operatively by the surgeon. The wound is assessed for dryness, signs and symptoms of infections such as purulent discharges, redness, increasing persistent pain and rising body temperature and wound dehiscence and evisceration. All findings are documented and reported. Stitches are removed on the 7th to 10th day if not absorbable and the wound is dressed with methylated spirit and painted with povedon iodine aseptically and left open or covered with guaze daily as required until complete healing is obtained.
Providing information about the findings of the Women’s Health Initiative (2002) study about the benefits and risks of HRT promotes informed decision making about its use. The patient is reminded to discuss HRT and alternative therapies with her primary care provider.
1.12 Validation of Data
Madam A. A. provided the necessary information needed which was crosschecked with those from her elder sister and eldest son for confirmation. What her elder sister and her eldest son said were not different from what she said. The information gathered during my home visits before and after discharge confirmed that what she said was true. To clarify the information collected, I kept asking my patient and her elder sister and eldest son the same question concerning the data collected initially and they gave me the same answer.
Doctors notes, nurses records, previous health history and personal observations on the patient were essential tools for gathering information on her. I therefore have the belief that the information given and gathered was accurate and therefore suitable for the study.