ANALYSIS OF DATA
2.0 Introduction
This chapter forms the second phase of the patient/family care study. Analysis of data collected deals with the critical examination and interpretation of the data collected during the assessment phase of the patient/family care study. It deals with the comparison of the results of investigations carried out with standards in the literature review. It also gives the pharmacology of drugs prescribed by the medical officer. It further involves the interpretation and identification of the patient and family health needs; physical, spiritual, social, and psychological. The chapter entails the causes and clinical manifestation of my client’s condition (Uterine Fibroid), the diagnostic investigations, medical management, complications, patient and family’s strength, related health problems identified, and their corresponding nursing diagnosis.
2.1 Comparison of Data with Standards
- Diagnostic Investigations/Tests
These are the investigations that are carried out to diagnose or confirm the patient’s condition. The literature review pointed out a bimanual pelvic examination, ultrasonography, magnetic resonance imagery, computed tomography, hysterosalpingography, sonohysterography, hysteroscopy, and laparoscopy as diagnostic investigations. Before Madam A. A. was hospitalized bimanual pelvic examination and ultrasonography were done. The other diagnostic investigations were not done since the bimanual pelvic examination, ultrasonography and the presenting signs and symptoms confirmed the condition beyond doubt. Also, the urine pregnancy test was conducted before her hospitalization to rule out pregnancy. However, while hospitalized, hemoglobin (Hb) level estimations were conducted on her to rule out or correct anemia before the surgery (Total Abdominal Hysterectomy).
The cause of patient’s illness
Although there is no known cause of the condition, Madam A. A.’s age (49 years) and ethnic origin (being a black) and hormonal factors might have predisposed her to develop the condition.
- Treatment is given to the patient
According to the clinical manifestations presented by Madam A. A., the following treatments were prescribed and administered to her.
- 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 (pre-medication)
- IM Phenergan 25mg (pre-medication)
- IV Ringers Lactate 2 litres (L) × 48 hours
- IV 5% Dextrose water 2 L × 48 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 then Suppository Diclofenac 100mg bd ´ 5 days.
- Tab Paracetamol 1g tds × 5 days
- Tab Amoksiclav 625mg bd × 5 days (on discharge)
The surgical treatment given to my client was a total abdominal hysterectomy. It can therefore be concluded that the treatment given to my patient was in line with the standard set.
Table 2: Medical Treatments Prescribed For Madam A. A. as Compared with Literature Review
| Medical Treatments In The Literature Review | Medical Treatments Prescribed For Madam A. A. |
| Gonadotropin-releasing hormone agonists (GnRHa) | GnRHa was not prescribed for the patient |
| Steroid hormones oestrogen and progesterone | Steroid hormones were not prescribed for a patient |
| Gonadotropin-releasing hormone (GnRH) antagonist | GnRH antagonist was not prescribed for the patient |
| Progesterone antagonist, mifepristone (RU 486) | Progesterone antagonist and Mifepristone were not prescribed for the patient |
Medical Treatments Prescribed For Madam A. A. as Compared with Literature Review continued
| Medical Treatments In The Literature Review | Medical Treatments Prescribed For Madam A. A. |
| Androgenic agents, progestins, and oral contraceptive pills | Androgenic agents, progestins, and oral contraceptive pills were not prescribed for a patient |
| Intravenous fluids | Intravenous fluids were prescribed for a patient |
| Analgesics | Analgesics were prescribed for the patient |
| Antibiotics | Antibiotics were prescribed for the patient |
| Premedications | Premedications were prescribed for the patient |
Apart from Tab Tranexamic acid and IV Hydrocortisone which were prescribed to treat and prevent the patient from bleeding and to counteract acute allergic reaction (rigor during blood transfusion) respectively, all other drugs given to the patient can be found in the literature review.
Pharmacology of drugs
The medical treatment that was given to Madam A. A. is outlined in table 3 below. It consists of the date of the order, the drug name, the standard dosage and route of administration, the dosage, and route of administration for the patient, classification, desired effect, the actual effect observed, and remarks.
Complications developed by the patient
With reference to the literature review, complications of uterine fibroid include severe pain or excessively heavy bleeding, fibroid twist that blocks nearby vessels that supply the tumor, anemia, urinary tract infection, leiomyosarcoma and infertility and the potential complications of surgery (Total Abdominal Hysterectomy) include hemorrhage, deep vein thrombosis, and bladder dysfunction. The client did not present any of the stated complications.
2.2 Patient/Family’s Strength
Post-operative
- Patient/family could participate in patient’s care despite they were anxious.
- The patient had good pain coping mechanism.
- The patient and family knew that keeping the wound wet could cause infection.
- The patient could sleep for five (5) hours during the night.
- The patient was willing to maintain her personal hygiene.
2.3 Patient/Family’s Health Problems
Post-operative
- On 14/11/11, patient/family were anxious .
- On 14/11/11, patient was in pain due to abdominal incision.
- On 14/11/11, patient’s was likely to contract infection due to break in continuity of skin (incisional wound).
- On 15/11/11, patient had difficulty sleeping due to painful incisional wound.
- On 15/11/11, patient could not provide for her self-care needs due to incisional pain.
2.4 Nursing Diagnoses
- Anxiety (patient/family) related to deficient knowledge about the condition and the related treatment plan.
- Acute pain related to surgical incision.
- Risk for infection related to breaking in the continuity of skin.
- Sleep pattern disturbance (insomnia) related to painful incisional wound.
- Hygiene self-care deficit related to incisional pains.