REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROUN

Peace – Work – Fatherland Paix – Travail _ Patrie

Ministry of Higher Education Ministere de l’EnseignementSuperieur

ST JOAN HIGHER INSTITUTE (SAJOHIM) OF YAOUNDE

School of Medical and Biomedical Sciences

Department of Nursing

TITLE:
INTERNSHIP REPORT

By

OJONG THELMA NKONGHO

22/SAJOHIM/030

DATE: 1st of Sept. 2024

Dedication
My dedication goes to my sweet mother ; Mme. Ojong Rita Ojong
Acknowledgement
I acknowledge God Almighty who has been my source of strength and wisdom

List of abbreviations
 Table of content
CHAPTER 1: INTRODUCTION
CHAPTER 2: Development of internship objectives
Regarding my specific objectives;
 1. Admission and discharge of patients;
Definition: Admission is a process of receiving a new patient to an individual unit (ward) of the
hospital. (Hospitalized individuals have many needs and concerns that must be identified then
prioritized and for which action must be taken).
Types include; Emergency admission, Elective admission, urgent admission, planned
admission,re-admission, transfer admission,
PROCEDURE
Admission;
1. Patient or family member should provide a personal and demographic information such
as name, address, contact details, and insurance information
2. A nurse assesses patient's condition to determine the level of care needed and
prioritizes admission accordingly,.
3. Patient or legal representative signs the consent forms for treatment , release of
medical information and other hospital policies.
4. Patient provides information about their medical history,allergies, and current
medications
5. Patient is identified with a wrist band or other identifier to ensure accurate treatment
and medical administration.
6. Nurse takes patient's vital signs (temperature, Blood pressure, pulse, etc) and
document them.
7. Patient is assigned a room and bed and their belongings are secured.
8. Doctor writes an admission order, outlining the patient's diagnosis, treatment plan, and
medications.
9. Nurse conducts a comprehensive assessment to develop an individualized care plan
10. Patient receives information about hospital policies, meal times , visiting hours and
other essential details.

Discharge;
1. Discharge order; Doctor writes a discharge order, indicating the patient is ready to leave the
hospital.
2. Nurse evaluates the patient's condition to ensure they're stable for discharge
3. Patient's medication are reviewed and instructions are provided for continuation or changes.
4. Patient receives written and verbal instructions on ; medications, follow- up appointments ,
wound care(if applicable), activity level, diet, warning signs for complications
5. Patient and family members receive education on ; conditions management, self-care, symptom
management.
6. Arrangement for follow up care. Referral are made for primary care physician, specialist
appointment, home health services(if needed), rehabilitation services,(if needed)
7. A summary of the patient's hospital stay is prepared for their primary care physician
8. Nurse performs a final check of; vital signs, wound sites (if applicable), medication.
9. Assistance is provided for transportation home or to another facility
 10. Patient's signs discharge paper work, acknowledging receipt of instructions and understanding
of responsibilities.

Personal involvement;

Once a person comes to the hospital ,he /she is received at the reception.

- The person's hospital book is taken by the receptionist, in case the person is a new client then
he or she will have to purchase a hospital booklet.
- Vital signs of the person is checked and written down on a new page in the booklet.
- Some questions are asked to the client regarding any complaint, or any treatment taken before
arriving the hospital .
- Client is then consulted by the doctor
- Doctor writes an admission order, outlining the patient's diagnosis, treatment plan, and
medications.
- The a bed is made fit for the patient.

Discharge of a patient

- Doctor writes a discharge order, indicating the patient is ready to leave the hospital.
- Nurse evaluates the patient's condition to ensure they're stable for discharge
- Patient's medication are reviewed and instructions are provided for continuation or changes.
- Patient receives written and verbal instructions on ; medications, follow- up appointments ,
wound care(if applicable), activity level, diet, warning signs for complications
- Patient and family members receive education on ; conditions management, self-care, symptom
management.
- Later on we the nurses, clean up the room and bed, making it fit for the next patient.(closed
bed).

2. Basic nursing procedures

a) Bed making
Definition; is a process of arranging a bed to make it look neat and comfortable. In the hospital,
nurses make 4 types of beds namely, closed bed, open bed, occupied bed and post-operative bed.

Types; In most instances, beds are made after the client receives certain care and when beds
are unoccupied. An unoccupied bed can be both open and closed.
 Closed bed: a smooth, comfortable and clean bed, which is prepared for a new patient
 In closed beds: the top sheet, blanket and bed spread are drawn up to the top of the
bed and under the pillows.
 Open bed: It is one which is made for an ambulatory patient, are made in the same way
but the top covers of an open bed are folded back to make it easier for a client to get in.
 Occupied bed: is a bed prepared for a weak patient who is unable to get out of bed.
Purpose:
1. To provide comfort
2. To conserve patient’s energy and maintain current health status.

⇒ Purpose: to facilitate easy transfer of the patient from stretcher to bed.

 Anesthetic bed: is a bed prepared for a patient recovering from anesthesia

⇒ Purpose: to leave the amputated part easy for observation

 Amputation bed: a regular bed with a bed cradle and sand bags

⇒ Purpose: to provide a flat, unyielding surface to support a fracture part

 Fracture bed: a bed board under normal bed and cradle

⇒ Purpose: to ease difficulty in breathing

 Cardiac bed: is one prepared for a patient with heart problem

Procedure

1. Put bed coverings in order of use

2. Wash hands thoroughly after handling a patient's bed linen. Linens and equipment
soiled with secretions and excretions harbor micro-organisms that can be transmitted
directly or by hand’s uniforms.
3. Hold soiled linen away from uniform.
4. Linens for one client are never (even momentarily) placed on another client’s bed.
5. Soiled linens are placed directly in a portable linen hamper or a pillow case before it is
gathered for disposal.
6. Soiled linens are never shaken in the air because shaking can disseminate secretions and
excretions and the microorganisms they contain.
7. When stripping and making a bed, conserve time and energy by stripping and making up
one side as completely as possible before working on the other side.
8. To avoid unnecessary trips to the linen supply area, gather all needed linen before
starting to strip bed.
9. Prepare the bed: Remove any dirty linens, cleaning the mattress and bed frame, and
disinfecting the area.
a. .Put on a bottom sheet: Place a clean bottom sheet on the mattress, tucking in
the corners and edges. Make sure it's smooth and wrinkle-free.
b. . Put a markintorsh: Place a clean markintorsh to prevent urine , or faeces from
reaching the Bottom sheet and mattress
c. Add the draw sheet : Place a draw sheet (a protective sheet that helps with
patient transfers) on top of the bottom sheet.
d. Put on the top sheet: Place a clean top sheet on the draw sheet, smooth out
wrinkles, and tuck in the top sheet at the foot of the bed.
e. Add blankets or a comforter: Put on any additional blankets or a comforter,
smooth out wrinkles, and pull them up to the headboard.
 f. Add a counterpane:
g. Pillowcases*: Put on clean pillowcases and arrange the pillows against the
headboard.
10. While tucking bedding under the mattress the palm of the hand should face down to
protect your nails.
11. Make a 45-degree angle with the sheet and tuck it under the mattress.
12. Pull the sheet tight and smooth out wrinkles.
13. Repeat on the other side.

*Tips*:

- Change linens regularly (usually every 24 hours).

- Use a bed-making checklist to ensure consistency.
- Keep the bed at a comfortable height and ensure the call light is within reach.
- Consider using a bed-making cart to keep supplies organized.
Remember, making a bed in a hospital or healthcare setting requires attention to detail
and a focus on patient safety and comfort.

Order of Bed Covers

1. Mattress cover.
2. Bottom sheet
3. Rubber sheet
4. Cotton (cloth) draw sheet
5. Top sheet
6. Blanket
7. Pillow case
8. Bed spread
Note
Pillows should not be used for babies

Personal involvements
In my place of work, we were opportune to have all the bed linens used in bed making,rather
we used just a single bed sheet to dress the bed. In cases of post up. For women who had
 undergone CS, we make bed with the markintorsh as well,so as to prevent fluid (urine,
blood,stool) from reaching the Bottom sheet and mattress.

b) Bed Bath
Definition; Bed Bath is act of hygiene given to patients ensuring cleanliness and
propagates healing.
Types;
a. Sitz Bath
The Sitz bath cleanses and aids in reducing inflammation of the perineal and anal area. It is for
patients who have undergone rectal or vaginal surgery or childbirth. The Sitz bath also relieves
discomfort from haemorrhoids or fissures.
b. Cold Water Bath
The cold-water bath is given to relieve tension or lower the body temperature. Care must be
taken to prevent the patient from chilling. The water temperature is tepid (not cold) that is 37°.
c. Warm Water tub bath
The warm water bath is primarily to reduce muscle tension. Recommended water temperature
is 43°.
d. Hot water tub bath
The hot water tub bath is given to assist in relieving muscle soreness and spasms. The
procedure is not recommended for children. For adults, the water temperature should be 45°
to 46°C.
Procedure ;
Procedure: Complete bed bath

Care Action Rationale

The bath order may have changed.

1. Confirm Doctor's order. In some instances a bed bath may be harmful
Check client identification and condition. for a client, who is in pain, hemorrhaging, or
weak. The nurse need to defer the bath.

2. Explain the purpose and procedure to the client.

Providing information fosters cooperation.
If he or she is alert or oriented, question the client
 Encourage the client to assist with care and to
about personal hygiene preferences and ability to
promote independence.
assist with the bath.
 Organization facilitates accurate skill
3. Gather all required equipment.
performance

To prevent the spread of organisms. Gloves are

4. Wash your hands and put on gloves. optional but you must wear them if you are
giving perineal and anal care.

 Organization facilitates accurate skill

5.Bring all equipment to bed-side.
performance

To ensure that the room is warm.

6. Close the curtain or the door.
To maintain the client’s privacy.

7.Put the screen or curtain. To protect the client’s privacy.

8.Prepare hot water (60℃). Water will cool during the procedure.

9. Remove the client’s cloth. Cover the client’s body

with a top sheet or blanket. Removing the cloth permits easier access when
If an IV line is present on the client’s upper washing the client’s upper body.
extremity, thread the IV tubing and bag through Be sure that IV delivery is uninterrupted and
the sleeve of the soiled cloth. Rehang the IV that you maintain the sterility of the setup.
solution. Check the IV flow rate.

Water at proper temperature relaxes him/her

10.Fill two basins about two-thirds full with warm
and provides warmth. Water will cool during the
water (43-46℃or 110-115F).
procedure.

11.Assist the client to move toward the side of the

Keep the client near you to limit reaching
bed where you will be working. Usually you will
across the bed.
do most work with your dominant hand.

12. Face, neck, ears: To prevent the bottom sheet from making wet.
a. Put mackintosh and big towel under the Soap irritates the eyes.
client’s body from the head to shoulders. Place Washing from inner to outer corner prevents
face towel under the chin which is also covered sweeping debris into the client’s eyes. Using a
the top sheet. separate portion of the mitt for each eye
b. Make a mitt with the sponge towel and moisten prevents the spread of infection.
with plain water. Soap is particularly drying to the face.
c. Wash the client’s eyes. Cleanse from inner to
outer corner. Use a different section of the mitt to
wash each eye.
d. Wash the client’s face, neck, and ears.
Use soap on these areas only if the client prefers.
Rinse and dry carefully.

13. Upper extremities:

a. Move the mackintosh and big towel under
the client’s far arm.
b. Uncover the far arm.
c. Fold the sponge cloth and moisten.  To prevent sheet from making wet
d. Wash the far arm with soap and rinse. Use long  Washing the far side first prevents dripping
strokes: wrist to elbow→ elbow to shoulder→ bath water onto a clean area.
axilla→ hand  Long strokes improve circulation be
e. Dry by face towel facilitating venous return
f. Move the mackintosh and big towel under
the near arm and uncover it
g. Wash, rise, and dry the near arm as same as
procedure.

14. Chest and abdomen:

a. Move the mackintosh and bath towel
under the upper trunk
b. Put another bath towel over the chest
c. Fold the sponge towel and moisten  Mackintosh and bath towel ○A prevent
d. Wash breasts with soap and rinse. Dry by the sheet from wetting
big towel covering.  Bath towel ○B provides warmth and
e. Move the bath towel ○B covering the chest to privacy
abdomen.
f. Fold the sponge cloth and moisten.
g. Wash abdomen with soap, rinse and dry
h. Cover the trunk with top sheet and remove
thebath towel ○B from the abdomen.

 Cool bath water is uncomfortable. The

water is probably unclean. You may change
15. Exchange the warm water.
water earlier if necessary to maintain the
proper temperature.

16. Lower extremities:  Pillow or cushion can support the lower leg
a. Move the mackintosh and bath towel ○A to and makes the client comfort.
under the far leg. Put pillow or cushion under the
bending knee. Cover the near leg with bath
towel ○B .
b. Fold the sponge cloth and moisten.
c. Wash with soap, rinse and dry.
Direction to wash: from foot joint to knee→ from
knee to hip joint
d. Repeat the same procedure as 16.a.- c. on the
near side.
e. Cover the lower extremities with top sheet
Remove the cushion, mackintosh and big towel ○A .

17. Turn the client on left lateral position with back  To provide clear visualization and easier
towards you. contact to back and buttocks care

18.Back and buttocks:

1) Move the mackintosh and big towel ○A under
the trunk.
 Skin breakdown usually occurs over bony
2) Cover the back with big towel ○B.
prominences. Carefully observe the sacral area
3) Fold the towel and moisten. Uncover the back.
and back for any indications.
4) Wash with soap and rinse. Dry with big towel ○B.
5) Back rub if needed
6) Remove the mackintosh and big towel ○A

19. Return the client to the supine position.  To make sustainable position for perineal care

 Clean the perineal area to prevent skin

20. Perineal care: irritation and breakdown and to decrease the
potential odor.

21.Assist the client to wear clean cloth.  To provide for warmth and comfort

22.After bed bath:

 These measures provide for comfort and
1) Make the bed tidy and keep the client in
safety
comfortable position.
 To confirm IV system is going properly and
2) Check the IV flow and maintain it with the speed
safely
prescribed if the client is given IV.

 Documentation provides coordination of care

23. Document on the chart with your signature and
 Giving signature maintains professional
report any findings to senior staff.
accountability

Personal Involvement
At my place of work, I had to carry out bed bath on a patient who was confined in bed due to a
road accident which crippled both legs (one with a crushed bone).
I explained the procedure to my patient , later on,I washed my hands thoroughtly,gathered
all my equipments necessary for the procedure which were; toilet soap, a face towel, body
lotion, . Warm water of about 70°C , according to patient's comfortability with it,. was what I
used with soap and other toiletries to clean my patient.
I started by cleaning her face including;the eyes, nose, ears,

C. Drug administration and cannulation

Definition:

Drug Administration:
Drug administration refers to the process of giving medications to a patient. This can be done
through various routes, such as:
- Oral (by mouth)
- Parenteral (injectable, e.g., intravenous, intramuscular, subcutaneous)
- Topical (applied to the skin or mucous membranes)
- Inhalation (inhaled medications, e.g., asthma inhalers)
- Rectal (suppositories)
- Vaginal (vaginal creams, tablets, or rings)
The goal of drug administration is to deliver the medication to the body in a safe and effective
manner, ensuring optimal therapeutic effects while minimizing potential side effects.
Cannulation:
Cannulation, also known as venipuncture, is a medical procedure that involves inserting a
needle or cannula (a small tube) into a vein to administer medications, fluids, or collect blood
samples. This procedure is commonly performed in healthcare settings for various purposes,
such as:
- Administering medications or fluids intravenously
- Collecting blood samples for laboratory testing
- Delivering nutrients or electrolytes
- Providing hydration therapy
Cannulation requires proper training, technique, and equipment to ensure safe and effective
execution.
Procedure:

The procedure for drug administration typically involves the following steps:

- Verify the order*: Confirm the medication order with the prescriber or the electronic health
record.
- *Prepare the medication*: Select the correct medication, dose, and formulation.
- Check the patient's identity*: Verify the patient's identity using at least two identifiers (e.g.,
name, date of birth, medical record number).
- *Explain the medication*: Inform the patient about the medication, its purpose, and any
potential side effects.
- *Administer the medication*: Give the medication to the patient via the prescribed route (e.g.,
oral, injectable, topical).
- Document the administration*: Record the medication administration in the patient's medical
record.
- Monitor the patient*: Observe the patient for any adverse reactions or effects.
- *Dispose of waste*: Properly dispose of any unused medication, packaging, and equipment.

Additionally, healthcare professionals should:

- Follow the "Five Rights" of medication administration:

- Right patient

- Right medication

- Right dose

- Right route

- Right time

- Use barcode scanning or other safety mechanisms to verify the medication and patient identity

- Be aware of potential medication interactions or allergies

- Provide patient education and counseling as needed

The procedure for cannulation, also known as venipuncture, typically involves the following steps;

- _Prepare the equipment_: Gather the necessary supplies, including a cannula (needle),
collection tube, tourniquet, and antiseptic wipes.
- _Select a suitable vein_: Identify a suitable vein for cannulation, typically in the antecubital fossa
(bend of the elbow) or dorsal hand.
- _Position the patient_: Place the patient in a comfortable position, with their arm extended and
supported.
 - _Clean and disinfect_: Clean and disinfect the skin at the selected site with antiseptic wipes.
- _Apply a tourniquet_: Apply a tourniquet to restrict blood flow and make the vein more visible.
- _Insert the cannula_: Hold the cannula at a 45-degree angle and insert it into the vein, aiming
for the direction of blood flow.
- _Advance the cannula_: Once in the vein, advance the cannula until blood flows freely.
- Secure the cannula_: Secure the cannula with tape or a dressing to prevent dislodgement.
- _Release the tourniquet_: Release the tourniquet to restore blood flow.
- . _Monitor and maintain_: Monitor the cannula site for signs of infiltration or other
complications and maintain patency with saline flushes as needed.

Additional considerations:
- Use proper hand hygiene and aseptic technique
- Use a cannula with a safety mechanism (e.g., retractable needle)
- Avoid cannulating areas with scar tissue or inflammation
- Consider using ultrasound guidance for difficult cannulations
- Document the procedure and patient response

Personal involvement

D. Tube feeding(for neonate)

Definition!
Tube feeding, also known as enteral nutrition, is a way of delivering nutrition directly into the
stomach or small intestine through a tube. This approach is used for individuals who have
difficulty consuming food orally due to various reasons such as:
1. Swallowing disorders (dysphagia)
2. Neurological conditions (e.g., stroke, brain injury)
3. Head or neck cancer
4. Digestive system issues (e.g., Crohn's disease, ulcerative colitis)
5. Critical illness or injury

There are different types of tube feeding, including:

1. Nasogastric tube (NG tube): A tube inserted through the nose and guided into the stomach.
2. Gastrostomy tube (G-tube): A tube inserted directly into the stomach through the abdominal
wall.
3. Jejunostomy tube (J-tube): A tube inserted directly into the small intestine (jejunum) through
the abdominal wall.
4. Nasojejunal tube (NJ tube): A tube inserted through the nose and guided into the small
intestine (jejunum).
Tube feeding formulas are specially designed to provide essential nutrients, including proteins,
carbohydrates, fats, vitamins, and minerals. The feeding process can be done continuously or
intermittently, depending on individual needs.
Tube feeding aims to:
1. Support nutritional needs
2. Promote healing and recovery
3. Maintain hydration
4. Manage digestive issues
5. Enhance quality of life

Healthcare professionals, including doctors, nurses, and dietitians, work together to manage
tube feeding and ensure individualized care.
Procedure
The procedure for tube feeding involves several steps to ensure safe and effective delivery of
nutrition. Here's a general overview:

1. *Assessment and preparation*:

- Evaluate the patient's nutritional needs and gastrointestinal function.
- Choose the appropriate tube feeding formula and rate.
- Prepare the feeding equipment (tubing, syringes, etc.).
2. *Tube placement*:
- Insert the feeding tube (NG, G, J, or NJ) using appropriate techniques and guidelines.
- Confirm correct placement via X-ray or other methods.
3. *Feeding preparation*:
- Prepare the formula according to manufacturer instructions.
- Warm the formula to room temperature or body temperature (if recommended).
- Use a feeding pump or gravity feeding system.
4. *Feeding administration*:
- Connect the feeding tubing to the patient's tube.
- Set the feeding rate and duration according to the prescribed plan.
- Monitor the feeding process for any issues (e.g., tube clogging, digestive discomfort).
5. *Monitoring and adjustments*:
- Regularly assess the patient's tolerance, nutritional status, and gastrointestinal function.
- Adjust the feeding rate, formula, or tube placement as needed.
6. *Tube maintenance*:
- Regularly clean and maintain the feeding tube to prevent clogging and infection.
- Rotate the tube to prevent skin irritation and promote comfort.
7. *Complication management*:
- Be prepared to address common complications (e.g., tube dislodgement, aspiration,
diarrhea).
 - Have a plan in place for emergency situations (e.g., tube occlusion, gastrointestinal
bleeding).
Personal involvement

E.Vital Signs
Definition

Vital signs are a set of measurable bodily functions that indicate the state of a person's essential body
functions. They are used to assess the overall health and well-being of an individual, and are typically
recorded by healthcare professionals during medical encounters. The four main vital signs are:

1. *Pulse* (or heart rate): The number of heartbeats per minute.

2. *Blood Pressure*: The force of blood pushing against the walls of blood vessels, measured in
millimeters of mercury (mmHg).

3. *Respiratory Rate*: The number of breaths taken per minute.

4. *Body Temperature*: The measurement of the body's thermal state, usually taken orally, rectally, or
via the ear canal.

Additional vital signs that may be monitored in certain situations include:

1. *Oxygen Saturation* (SpO2): The percentage of oxygen-carrying capacity in the blood.

2. *Pain*: A subjective measure of discomfort or distress.

3. *Level of Consciousness*: A patient's level of awareness and responsiveness.

4 *body weight*

Vital signs are essential in:

- Assessing the severity of a patient's condition

- Monitoring the effectiveness of treatments

- Identifying potential complications

- Making informed decisions about care

Types and instruments used to measure

Here are the instruments commonly used to measure each of the vital signs:

1. *Pulse* (Heart Rate):

- Pulse oximeter ( Measures heart rate and oxygen saturation)

- Stethoscope (Listens to heart sounds)

- Sphygmomanometer (Manual blood pressure cuff)

2. *Blood Pressure*:

- Sphygmomanometer (Manual or automatic blood pressure cuff)

- Automatic blood pressure monitor (Electronic device)

3. *Respiratory Rate*:

- Respiratory rate monitor (Counts breaths per minute)

- Stethoscope (Listens to lung sounds)

4. *Body Temperature*:

- Thermometer (Oral, rectal, or ear canal)

- Infrared thermometer (Forehead or ear canal)

- Digital thermometer (Oral or rectal)

5. *Oxygen Saturation* (SpO2):

- Pulse oximeter (Measures oxygen saturation and heart rate)

6. *Pain*:

- Pain scale (Verbal or visual assessment)

 - Pain rating scale (Numerical rating)

7. *Level of Consciousness*:

- Glasgow Coma Scale (Assesses eye opening, verbal response, and motor response)

Note: Some instruments, like the pulse oximeter, measure multiple vital signs simultaneously.
Additionally, some vital signs, like pain and level of consciousness, are assessed through observation and
patient reporting rather than direct measurement.

Procedure for each.

Here is a general procedure for collecting each of the vital signs:

1. _Pulse_ (Heart Rate):

- Locate the radial artery on the thumb side of the wrist.

- Place your index and middle fingers on the artery.

- Count the number of beats per minute (bpm).

2. _Blood Pressure_:

- Choose the appropriate cuff size for the patient's arm.

- Wrap the cuff around the upper arm, about an inch above the elbow.

- Inflate the cuff and slowly release it while listening with a stethoscope.

- Record the systolic and diastolic pressures.

3. _Respiratory Rate_:

- Observe the patient's chest rise and fall.

- Count the number of breaths per minute (bpm).

4. _Body Temperature_:

- Choose the appropriate thermometer (oral, rectal, or ear canal).

- Follow the manufacturer's instructions for proper use.

- Record the temperature in degrees Celsius or Fahrenheit.

5. _Oxygen Saturation_ (SpO2):

- Attach the pulse oximeter sensor to the patient's finger or earlobe.

- Wait for the reading to stabilize.

- Record the percentage of oxygen saturation.

6. _Pain_:
 - Ask the patient to rate their pain on a scale (e.g., 0-10).

- Assess the patient's facial expressions and body language.

7. _Level of Consciousness_:

- Assess the patient's response to verbal commands and stimuli.

- Evaluate the patient's eye opening, verbal response, and motor response.

- Use the Glasgow Coma Scale to quantify the level of consciousness.

Additionally, consider the patient's comfort, privacy, and safety during the process.

Personal involvement

3. Pre and post operative preparations

Definition

Preoperative preparations refer to the actions taken before surgery to prepare the patient for the
operation. This includes:

1. Medical evaluations and tests (e.g., blood work, imaging studies)

2. Medication management (e.g., stopping certain medications, adjusting dosages)

3. Fasting and bowel preparation (e.g., avoiding food and drink, colon cleansing)
 4. Patient education and informed consent

5. Preparation of the surgical site (e.g., shaving, cleaning, marking)

6. Anesthesia preparation (e.g., selecting the appropriate type, administering pre-anesthetic

medications)

Postoperative preparations refer to the actions taken after surgery to ensure a smooth recovery. This
includes:

1. Monitoring vital signs and pain management

2. Wound care and dressing changes

3. Medication management (e.g., pain control, antibiotics)

4. Mobility and positioning (e.g., turning, ambulation)

5. Nutritional support (e.g., IV fluids, diet progression)

6. Patient education and discharge planning

7. Follow-up care and appointments

These preparations aim to minimize risks, optimize outcomes, and promote a comfortable and safe
experience for the patient.

Procedure

Here is a more detailed procedure for pre and postoperative preparations:

*Preoperative Preparations:*

1. *Medical Evaluation*: Conduct a thorough medical history, physical exam, and review of medications.

2. *Lab Tests*: Order and review lab results (e.g., blood work, imaging studies).

3. *Medication Management*: Adjust or stop medications as needed.

4. *Fasting and Bowel Prep*: Instruct patient on fasting and bowel preparation (if necessary).

5. *Patient Education*: Educate patient on procedure, risks, and expected outcomes.

6. *Informed Consent*: Obtain patient's informed consent.

7. *Surgical Site Prep*: Prepare the surgical site (e.g., shave, clean, mark).

8. *Anesthesia Prep*: Prepare for anesthesia (e.g., select type, administer pre-anesthetic meds).

*Postoperative Preparations:*

1. *Vital Sign Monitoring*: Monitor vital signs (e.g., pulse, blood pressure, oxygen saturation).

2. *Pain Management*: Assess and manage pain.

3. *Wound Care*: Clean and dress the wound.

4. *Medication Management*: Administer medications (e.g., pain control, antibiotics).

5. *Mobility and Positioning*: Encourage mobility and proper positioning.

6. *Nutritional Support*: Provide IV fluids and progress diet as tolerated.

7. *Patient Education*: Educate patient on postoperative care and expectations.

8. *Follow-up Care*: Schedule follow-up appointments and tests.

Note: These procedures may vary depending on the specific surgery, patient needs, and institutional
policies.

Personal involvement

4. Health Talk at ANC: Family planning and Contraception

Definition

Elaboration of chosen topic (def,types,procedure)

Personal involvement

5. Paturient follow-up from labour to delivery

Definition of labour
Stages and phases of labour,
Follow up procedure
Personal involvement
6. Admissions of women in the post natal unit and complications of
mother and child in unit including prevention/management
Definition of some terms
Types
NormalProcedure for admission
Complications in the PNU
Prevention and management
 7. Preparation for theatre and theatre equipments to sterilize and
for operation respectively
Definition of terms
Types of eq uipments and function.
Procedure for sterilization
Procedure for theatre preparation
Personal involvement
8. Position of patient in theatre
Definition
Types
Procedure
Personal involvement
9. Method of enhancing asepsis
Definition of terms;
Types scrubbing, gowning, giving.
Procedure for each
Personal involvement
10. Induction, maintenance and recovery from
anaesthesia/emergence of anaesthesia
Definition of terms
INDUCTION
Process of initiating GA(unconsciousness) by administration of drug or
combination of drugs. The most critical phase in the whole process.
Selection of drugs for induction and maintenance of anesthesia depends
on; the patient preexisting condition and type of anesthetic planned.
Before induction,
- Minimum basic standard monitor should be applied & base line values are
recorded. Intravenous access should be opened always before anesthesia .
- Before administering anesthesia we have to administer 100% oxygen for 3
to 5 minutes (pre-oxygenation) to replace the air which contains 78% of nitrogen
in the lungs with oxygen.
- This practice should increase the margin of safety during periods apnea
that may accompany induction of anesthesia.
 MAINTENANCE
It is the time from the end of induction to emergence phase in which procedures
are performed safely.
Drugs used to initiate the anesthetic are beginning to wear off, the pt must
be kept anesthetized using a maintenance agent.
RECOVERY
Should ideally be smooth and gradual awakening in a controlled env’t.
Experience and close communication enable to predict the time at which the
application of dressings and casts will be complete.

Procedure

Induction of GA can be achieved by;

- IV induction agents (e.g., Ketamine 1-2 mg IV or 5- 10 mg IM,
- Thiopentone 3-5mg IV & propofol 1-2.5 mg/kg) or propofol
- Inhalation of VAA (e.g., halothane) or combination of both.
- In addition to the induction drug, most patients receive an injection of
narcotic analgesic (e.g., pethedine .5 to 1 mg/kg, Fentanyl 1-2 µg/kg).
Initiation of anesthesia (Induction):
 GA may be initiated by the administration of IV drugs or VAA(volatile
anesthetic agents).
 GA renders a patient insensible to pain (analgesia); make the patient
unaware of the procedure (amnesia); and muscle relaxation for surgical
purposes.
 Vigilance, to be alert to danger or threats, is essential.
 The patient is reliant upon the anesthetist to maintain a patent airway,
provide adequate oxygenation, and support of adequate heart function.
Intravenous induction of GA
- The administration of anesthetic drugs (propofol, thiopental, or ketamine)
to produce rapid onset of unconsciousness usually used in adult patients by
the IV administration of an anesthetic.
 - Ventilation can be sustained via a face mask or a Laryngeal mask may be
inserted or a neuromuscular blocking drug may be given IV to facilitate
direct laryngoscopy before tracheal intubation
Intramuscular induction:
 Uncooperative children
 Usually ketamine….increase in secretions….Atropine 0.1 to 0.2mg/kg
 Patients sometimes complain afterwards of vivid dreams and
hallucinations, an experience of seeing an imaginary scene or hearing
an imaginary sound as clearly as if it were really there.
 Diazepam before or at the end of anesthesia can reduce these.
 Hallucinations may not occur if ketamine is used only for induction
and is followed by inhalational anesthetic.
Inhalation induction:
 The administration of VAA (e.g., halothane) through a mask
 Often used in the pediatric population.

Maintenance is achieved by;

For the most part, this refers to the delivery of anesthetic gases into the patient's
lungs.These may be inhaled as the patient breathes himself or delivered under
pressure by bagging manually, or each mechanical breath of a ventilator.
Usually the most stable part of the anesthesia.However, it is important to
understand that anesthesia is a continuum of different depths. A level of
anesthesia and relaxation that is satisfactory for surgery to the skin of an
extremity may be inadequate for manipulation of the bowel.Appropriate levels of
anesthesia must be chosen both for the planned procedure and for its various
stages.
If muscle relaxants have not been used, inadequate anesthesia is easy to
spot.The patient will move,cough, or obstruct his airway if the anesthetic is
too light for the stimulus being given.If muscle relaxants have been used, then
clearly the patient isunable to demonstrate any of these phenomena.In these pts,
rely on observation of autonomic phenomena such as HTN, tachycardia,
sweating, and capillary dilation.Excessive anesthetic depth is associated with
decreased HR & BP, and can jeopardize perfusion of vital organs.

Recovery is achieved by;

In advance of that time, anesthetic vapors have been decreased or even switched
off to allow time for them to be excreted by the lungs.
 Reverse residual MR using Neostigmine 0.2 – 0.5mg/kg.
 Removal of ETT or other airway device when the pt has 8s1ufficient.
 The patient recovering from anesthesia should be monitored for common
problems postop to ensure their safety, providing for a smooth and
uneventful recovery.
 Common complications may include, Hypoxemia related to AWObsn or
inadequate response, hypoVx, HN, hypothermia, pain, nausea and vomiting
and ∆HR and rhythm.
 These should be addressed PACU until full recovery of consciousness and
complications are managed.
Documentation
 Written relevant information about the patient which contains
 An evidence of client findings,
 Detail of procedure and events happened during the procedure.
 It is an indicator of quality care and is the responsibility of an anesthetist to
record throughout the procedure on time.
 While anesthesia care is a continuum, it is usually viewed as consisting of
preanesthesia, intraoperative/procedural anesthesia and post anesthesia
components.
 Anesthesia care should be documented to reflect these components and to
facilitate review.

Personal involvement
Chapter 3: Clinical