SMUHIGHER INSTITUTE, BUEA, CAMEROON

An Internship Report Submitted to the School of Health and Human Services of the Saint
Monica University in partial Fulfillment of the Requirement Award
of the Bachelor Degree in Nursing Science

BY

MUSA ROSE ALOKO

(SHHS19NR016)
THEATER

JULY – SEPTEMBER, 2020

THEATER INTERNSHIP REPORT CARRY OUT AT GENERAL HOSPITAL BUEA,
CAMEROON IN SEPTEMBER 2020

JULY- SEPTEMBER, 2020

MUSA ROSE ALOKO

 CERTIFICATION

This is to certify that the internship of Theater unit was carried out by MUSA ROSE ALOKO

(SHHS19NR016) Students of Saint Monica Higher Institute of Buea, South west Region

Cameroon, at General Hospital Buea, Cameroon under the supervision by madam Agbor

Catherine

Internship Approval Committee

_____________________________ Date__________________________
Madam Agbor Catherine H,O,D (supervisor)

___________________________ Date__________________________
Prof. Sylvester Ndeso-Atanga, (Dean)
 ACKNOWLEDGEMENTS

My greatest gratitude is directed to my supervisor Madam Agbor Catherine who served as a

supervisor and a mentor to me.

This acknowledgement remains incomplete without expressing my profound gratitude almighty

GOD for spearing my life and made everything possible for me throughout my Internship at the

General Hospital Buea, Cameroon.

 DEDICATION

This report is dedicated to the Almighty God my creator, my source of inspiration, wisdom, and

knowledge. He has been the source of my strength throughout this internship.

 TABLE OF CONTENT

CHAPTER 1: INTRODUCTION

1.1 Hospital description - -_- - - - - - - - -- - - - - - -- - --- - - - - -- - - - --…… 1

1.2 Hospital organigram ------- -- -- -- - - - - - - - - - - - - - - - ---- - - - - - ……3

1.3 General overview of the work --------- - - - - - - - - - - - - - - - - - - - ……- 4

CHAPTER TWO: LITRETURE REVIEW - - - - - - - - - -- - - - - - - - - - ….- 6

CHAPTER THREE: PATIENT CARE

3.1 Patient identification - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -…. 8

3.2 Assessment data - - - - - -- - - - - - - - - - - - - - - - - -- - - - --- - - - - -…. 9

i) History taking

ii) Physical examination

iii) Head to toe assessment

iv) Laboratory investigation and rationale

3.3 Nursing care plan -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11

3.4 Pharmacological intervention and rationale - - - -- - - - - - - - - -- - - - - - - 14

3.5 Discharge report - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - - 14

CHAPTER FOUR

4.2 Summary-----------------------------------------------------------------------------15

4.1 Conclusion - - - -- - -- - - - - - - - -- - - - - - - - - - - - - - -- - - - - - - - -- -- 16

4.3 Recommendation - - - -- - - - - - -- - - - -- - - -- -- - - -- - - - - - - - -- - - - - -16

References - - - -- - - - - - -- - - - - - -- - -- - - -- - - - - - - - - - - - - - - -- - - -- - - - - - - -- - -- - 17
 CHAPTER ONE

HOSPITAL DESCRIPTION

1.1 DESCRIPTION OF THE REGIONAL HOSPITAL BUEA

The Regional Hospital Buea is found in Buea, in the Fako Division of the South West Region of

Cameroon and it is situated precisely between the Delegations of Education and the Army

Barracks, along the highway to the Bokwango neighborhood in Buea.

The hospital is a referral hospital for the South West region. It receives referred and non –

referred cases from District hospitals and Health centres and therefore has health coverage of the

entire population of the South West region.

The Buea Regional Hospital is a large health facility with modern infrastructure, divided into

units or blocks of which all are surrounded by gardens of beautiful flowers.

At the entrance leading to the hospital, we have the Mortuaries, one on each side of the road, and

the Hemodialysis center before reaching the main gate of the Hospital. The security post is found

at the main gate and controlled by security men.

A monument built by the Chinese with cypress trees surrounded by hedges of flowers planted by

the sides of the monument, act as a round - about in the hospital premises for vehicles moving in

and out of the Hospital.

The hospital is divided into 7 main blocks which houses the various units of the hospital.

The main units of the hospital moving in an anti- clockwise direction from and to the main gate

include:

The Administrative block

The Laboratory and Surgical units

The Laboratory and Surgical units

The Family planning unit, Paediatric unit and Blood bank.

The Maternity

The Medical Unit

The HIV/AIDS Unit (UPEC Unit).

The Pharmacy, Ophthalmology unit are found in the Administrative block alongside non-

technical services such as the Cash Office, General Secretariat, Accountant’s Office, etc.

The Tuberculosis Center is found in an isolated area in the hospital away from all the other units.
 HOSPITAL ORGANOGRAM

Tuberculosis
Unit

BLOOD BANKPAEDIATRIC WARD

SURGICAL
CANTEEN UNIT
(FEMALE AND MALE MEDICAL WARD)

MATERNITY UNIT
MEDICAL WARD

HIV/
AIDS
UNIT
(UPE LABORAT
C) ORY UNIT

ADMINISTRATIVE
BLOCK

SECURITY OUT-PATIENT
POST DEPARTMEN
T/
EMERGENCY
Main Gate UNIT
To Army Barracks
MORTUARY
HEMODIALYSIS
CENTER

Main entrance to the Hospital Fig 2.1 Units of the Hospital

GENERAL OVER VIEW OF MY WORK FROM DAY TO THE END

The first day of my internship i was introduced to the chief of theatre and i was oriented to the

theatre department. The major introduce me to the staffs present on duty. The major told me to

observe any procedure for some days before carryout any procedure on a patient. I come to work

by 7: 30am help the cleaner to clean the unit .at 8:30am i assist in doing wound dressing both

the clean and dirty wound, after wound dressing, i wash and disinfect forceps that we have used

for dressing using decontaminated solution to disinfect the forceps i dry the forceps and put

inside sterilizer.

EQUIPMENTS FOR WOUND

 Saline

 Hydrogen peroxide

 betadine

 spirit

 gauze

 Forceps, such as cheatle forceps, dissecting forceps, dressing forceps, sinus forceps,

probe, stitch scissors, clip removers

PROCEDURE FOR WOUND DRESSING

The dresser may require an assistance all procedure should be explain to patient by the dresser

the assistance should gently turn back the bed cloth and undo the binder or remove adhesive

tape. The bed clothes should be arranged so that patient is not exposed. The dresser should wash

his hand with antiseptic solution or cream. the dresser open the instruments packet and tips the
instrument on to the water repellent paper beside the dressing the dresser use one pair of

dressing forceps to remove the soiled dressing and place it in the soiled bag was the wound and

treat the wound as prescribe . The dressing should be bound or strapped in position by the dresser

the trolley should be removed by the dresser and any dressing materials not used are place in the

salvage bag. After completion of the dressing the assistance should remove the soiled dressing

and instrument bags, the dressing are placed untouched by hand in the ward soiled dressing

receptacle the soiled instrument should be empties into the soiled instrument container in

preparation for their return with the unused dressing.

 CHAPTER TWO

LITERATURE REVIEW

APPENDECTOMY

Appendectomy is the surgical removal of the appendix. Its common emergency surgery that’s

performed to treat appendicitis an inflammatory condition of the appendix. The appendix is a

small, tube shape pouch attached to the large intestine. Its located in the lower right side of the

abdomen when the appendix become inflamed and swollen, bacteria can quickly multiply inside

the organ and lead to the formation of pus. This building of bacteria and pus can cause pain

around the belly button that spreads to the lower right section of the abdomen. Walking and

coughing can make the pain worse. You may also experience nausea, vomiting, and diarrhoea.

When the appendix burst (perforated appendix) and release bacteria and other harmful substance

in to the abdominal cavity. This can be life threatening and will lead to a large hospital stay.

PURPOSE FOR PERFORMING APPENDECTOMY

An appendectomy is often done to remove the appendix when an infection has made it inflamed

and swollen. This condition is known as appendicitis. This infection may occur when the

opening of appendix becomes dogged with bacteria and stool this causes the appendix to become

swollen and inflamed. So the easiest and the quickest way to treat appendicitis is to remove the

appendix. If the appendix ruptures, the bacteria and fecal particles within the organ can spread in

to the abdomen. This may lead to a serious infection called peritonitis.

PROCEDURE OF APPENDECTOMY

During appendectomy, surgeons make one incision in the lower right side of the abdomen. Then

appendix is removed and wound is closed with stitches.

CAUSES OF APPENDICITIS

When there is a blockage inside the appendix, a person may develop appendicitis, causes of the

appendix blockage include faces, bacteria or viral infection in the digestive tract, traumatic injury

or genetic.

SIGN AND SYMTOMS OF APPENDICITIS

- Stomach pain that stars suddenly near the belly button and spread to the lower right side

of the abdomen.

- A abdominal swelling

- Rigid abdominal muscles

- Constipation

- Nausea and vomiting

- Loss of appetite

- Low grade fever.

COMPLICATION OF APPENDECTOMY

- Bleeding

- Infection

- Injury to nearby organ

- Blocked bowels
SIDE EFFECT OF APPENDECTOMY

- Allergic reaction to medication

- Breathing problem

- Obstruction of bowel

- Inflammation of the abdomen, if the appendix ruptures during the procedure

 CHAPTER THREE

IDENTIFICATION OF PATIENT

- Name: Mrs Mary

- Address: Buea

- Age: 40 years

- Sex: Female

- Occupation: Teacher

- Religion: Christian

- Nationality: Cameroonian

- Marital status: Married.

- Number of children: Five (4).

- Diagnosis: Acute appendicitis

- Ward/ unit: Surgical ward.

ASSESSMENT DATA

HISTORY TAKING

According to Mrs. Mary Health is a good thing and a pieces of commodity which every

individual need to help him or her carry out their normal duties for daily living, she further refers

to health as the possession of strength and power. She believes that health is obtainable (when

there is any deviation) from the hospital. According to Mrs. Mary She believes that no one can

be totally healthy, but one can be said to be healthy when he or she treat every symptoms and
never takes drugs accept with the direction of qualified health practitioner and who is licenses to

practice

PAST MEDICAL HISTORY

The client had never been hospitalized except for the present medical condition. He said to have

been experiencing some mild symptoms was quarried for haemorrhoids.

SURGICAL HISTORY

Mrs. Mary Said She have had no surgery in past until now.

HISTORY OF PRESENT ILLNESS

The patient said the condition begin with the manifestation of episodic back pains, which last for

about fifteen years now. And which she said because of the last severity she had not considered it

for anything and had by herself purchased paracetamol to relieve the symptom. She further said

whenever the symptom began it normally hinders her from carrying out her job such as farming,

until now that the manifestation of repeated abdominal pain that is located at the right iliac fossa

with tenderness at the area, symptom where accompanied with headache, fever and chills .This

led to her contact with the medical health and finally admission.

HISTORY OF MENTAL ILLNESS

She has no history of mental disorder, not even in his family.

PHYSICAL EXAMINATION (HEAD TO TOE)

VITAL SIGNS:

- Blood pressure: 205/100mmhg

- Pulse: 85 b/minutes

- Respiration 18 c/minute

- Temperature 37.10C, Weight 70kg

HEAD TO TOE ASSESSMENT

HEAD: She has greyish hair.

EYES: No discharge seen and the lens and cornea are clear, the eyes general condition is normal.

NOSE: She has a flat nose with no discharge.

MOUTH: No dentures, no stomatitis and no dental caries.

CHEST: Normal appearance.

ABDOMEN: Normal in appearance and soft on palpation..

PALMS: No deformity seen, fingers are neatly cut.

LEGS: They are normal with no scar seen, no deformity

SKIN: Patient has a dark skin in complexion and with no wrinkles

EARS: Nos discharge from the ear and patient can hear well
LABORATORY INVESTIGATION

TEST RATIONALE

Blood test This allows the doctor to check for a high white blood cell

count, which may indicate an infection.

Urine test Urinalysis to make sure that urinary tract infection or kidney

stone is not causing the pain.

Imaging test The doctor may also recommend an abdominal x-ray an

abdominal ultrasound.
 NURSING CARE PLAN OF MRS MARY WITH DISEASE CONDITION

(APPENDICITIS)

s/n Nursing diagnosis Nursing objective Nursing Scientific rationale Expected Evaluation

intervention outcome

1 INFFECTIVE AIR- Patient will have 1. Place patient in 1. This helps to Patient air ways

WAY a patent air ways a supine position prevent was kept patent

CLEARANCE within 3hours of and turn the head accumulation of 3hours of

RELATED TO nursing to one side. nasal secretion in nursing

EFFECT OF the passage and interventions.

intervention 2. Sanctions the
ANESTHESIA. prevent the tongue
patient.
from falling
3. Often nearby backward and
windows. obstruction the

4. Admission passage.

oxygen when 2. To remove any

necessary. secretion

accumulating the

air ways.

3. To ease

distress(air

hunger)by fresh air

supply to the

environment.
 4. Helps to reduce

respiratory distress.

2 RISK FOR Patient will not 1. Regular 1. To detect any Patient did not

INFFECTION show any sign of monitoring of sign of infection. show any sign

RELATED TO infection operation sign. of infection

2. This remove
SURGICAL throughout the throughout the
2. Daily change of inhibits microbial
INCISION. period of period of
dressing. growth and
hospitalization. hospitalization.
activities on
3. Maintain aseptic
operative site.
technique.

3. To ensure that
Served prescribed
infections organism
antibiotic e.g. I.V
are not introduce in
TEROFTOXACIN
to the wounds.
500mg daily and

tabs metronidazole They provide

400mg t.d.s bacteria static

effect.
3 ACUTE PAIN Patient will 1. Asses the level 1. Serve as base line Patient

RELATED TO verbalize less of pain, location for treatment. verbalized less

ABDOMINAL pain 2-3 hours of and report pains two hours

2. This will ease the
DISCOMFORT nursing immediately. of nursing
patient pain
EVIDENCE BY intervention. intervention.
2. Allow patient to sensation.
VERBALIZATION.
assume the most
3. It alleys patient
comfortable
anxiety and reduce
position for him.
pain exaggeration.

3. Reassure the
4. It inhibits pains
patient.
conduction there by

4. Serve reducing its

prescribed pain sensation.

reliever e.g. I.M

Pentazocine 30mg.

4 HYPERTHERMIA Patient 1. Observed 1. To give base for Patient body Patient body

RELATED TO temperature will patient vital sign. treatment. temperatures temperature had

INFECTION reduced by 2Oc will normal after reduced from

2. Expose patient 2. Fresh air reduces
PROCESS within 1-2hrs of nursing 38.4c
by removing extra high temperature.
EVIDENCE BY nursing intervention. to36.4within
and heavy or tight
THERMOMETER intervention. 3. Facilitate cross 1hours of
clothing.
READING (38.4oc) ventilation. nursing
3. Open nearby intervention.
4. Heat is lost when
 window and turn water droplets are

on the fan. allowed to dry and

the skin surface.

4. Tepid sponge

the patient.

PHARMACOLOGIC INTERVENTION (PRE-OPERATION MEDICATION)

s/n Drugs Route Dose Side effect

1 Ceftriaxone Intravenous 500mg Nausea, Vomiting

2 Metronidazole intravenous 500mg Nausea, Dizziness, Loss of appetite ,

Diarrhoea, constipation

3 Pentazocine intravenous 15mg Cough, Sore throat, Joint or muscle

pains, Painful or difficulty urination.

4 Normal saline intravenous 500mg

Fever, injection site swelling, fast

heartbeat, rash, joint pains and

shortness of breathing.
 DRUGS ADMINISTERED DURING OPERATION BY ANESTHETIST

S/N DRUGS ROUTE DOSE SIDE EFFECT

1 Atropine Intravenous 0.05mg 1. Dry mouth,

2. Blurred vision,

3. Sensitivity to light,

4. Lack of sweating,

5. Dizziness,

6. Nausea,

7. Loss of balance,

8. Hypersensitivity reactions (such as skin rash), and

9. Rapid heartbeat (tachycardia)

2 Ketamine Intravenous 2mg 1. Feeling sleepy.

2. Not hungry.

3. Upset stomach or throwing up.

3 Diazepam Intravenous 2mg 1. Shakiness and unsteady walk

2. unsteadiness, trembling, or other problems with

muscle control or coordination

4 Ringer Intravenous 500mg 1. Allergic reactions, such as localized or

lactate fluid generalized hives and itching, swelling of the

eyes, face, or throat, coughing, sneezing, or

difficulty breathing.

2. Other side effects of Lactated Ringer's Injection

may include fever, Infection at injection site, or

redness/red streaking and swelling from the site

of injection.

5 Analgin Intravenous 2mg 1. Dizziness,

2. Kidney damage,

3. Pink colored urine,

4. Abdominal pain,

5. Choking,

6. Dry mouth,

7. Low blood pressure (hypotension),

8. Agranulocytosis and allergic reactions.

 PHARMACOLOGIC INTERVENTION (POST-OPERATION MEDICATION)

s/n Drugs Route Dose Side effect

1 Normal Intravenous 500mg Fever, injection site swelling, fast heartbeat, rash,

saline fluid joint pains and shortness of breathing.

2 Paracetamol intravenous 300mg 1 Skin rash, hives, or itching

2 Sores, ulcers, or white spots on the lips or

in the mouth

3 Unusual tiredness or weakness

4 Yellow eyes or skin

4 Ceftriaxone intravenous 500mg 1. Black, tarry stools

2. Chest pain

3. Cough

4. Fever

5. Painful or difficult urination

6. Shortness of breath

7. Sore throat

8. Sores, ulcers, or white spots on the lips or

in the mouth

9. Swollen glands
 CHAPTER FOUR

SWOT ANALYSIS

Theatre doesn’t have enough equipment to meet the normal surgical procedure. Theatre have

limited staffs, some of the staff are not friendly to patient and also have inability to control anger

toward patient. One of the major Challenges of theatre is there is not enough facility to carryout

major surgery

SUMMARY

Appendicitis is the inflammation of the vermiform appendix of the caecum which may be cause

by an obstruction of the appendix opening in the large intestine either by feacalith (impacted

stool) or tumor, lymphoid tissue enlargement or solid body etc. Causing the rapid growth and

irritation of appendix by microbes. Patient with appendicitis will normal present with some

symptoms which include pain at the lower abdominal quadrant, nausea and vomiting, fever and

generally body weakness. The theatre it a place where surgical procedure are been carryout in

order to cure for any abnormalities

RECOMMENDATION

- Create awareness about the cause of appendicitis.

- Teach people on the advantage of balance diet

- Teach people on the important of reporting to the hospital any sign or state of

abnormalities in their health status.

- Teach people to avoid food that are not well prepared

- Focus on prevention and control of appendicitis rather than curing it.

Organize public health education (talks) to people on the causes of appendicitis

CONCLUSION

Appendicitis can be managed and restoration to normal physiological state can be attained, an

individual can live without the appendix and can still be with no noticeable complication. It

further reveals that the condition can result from the appendceal lumen obstruction; therefore

measures must be taken by the government and the general public to prevent the occurrence of

the condition
 REFERENCE

www.Regional hospital Buea