ERA UNIVERSITY /

ERA’S COLLEGE OF NURSING

CASE PRESENTATIONS ON
UTERINE PROLAPSE

SUBMITTED TO: SUBMITTED BY:

MS.GODHULI GHOSH MS. ARCHANA DEVI
ASSISTANT PROFESSOR M.Sc. NURSING 1ST YEAR
ERA COLLEGFE OF NURSING ERA COLLEGFE OF NURSING

SUBMITTED ON : - -2020
 STUDENT PROFILE

Name – Archana Devi

Course- M.sc Nursing 1 st year
Subject – Medical Surgical nursing
Name of Institution- Era College of nursing
Sarfarajganj, lucknow.
Patient selected from- Gynae ward, Era medical college lucknow

INTRODUCTION – Mrs. Sunila got admitted in the {obstetric ward} Era medical college lucknow on 26-
3-2020 at 2:30 pm, with complaints of lower back pain and abdomen ,uterus slipout of position ,feeling of
pressure in pelvis , excessive vaginal bleeding , . The case was diagnosed as uterine prolapse byDr, Parul
Saini.
As a part of my obstetrics and gynecology nursing of MSc nursing requirement, I took this case for my case
study, I started care from 26.3.2020 at end 30.3. 2020.. I gave hygienic care to the patient and educated
about post-operative care at home, diet and follow up and medication, the patient health status gradually
improved and now she is better.

CASE PRESENTATION -

PATIENT’S IDENTIFICATION DATA

a) Name Of The Patient : Mrs. Sunila
b) Age : 40yrs
c) Gender :Female
d) Bed no : unit 1 (bed no 2)
e) Address : balaganj ,hardoi road , U.P.
f) Nationality : India
g) Religion : Hindu
h) Educational Status :12
i) Occupation :Housewife
j) Marital Status : Married
k) Family members : 7
l) Addiction : No any drug addiction

m) Diganosis : Uterine prolapse

n) Consultant Doctor :Dr. Parulsoini
o) Source of information :Patient
 p) Date of Admission : 26.03. 2020
q) Time of admission :2:30 pm

CHIEF COMPLAINTS: My patient Mrs. Sunila was admitted to ERA’S hospital lucknow on 26.03.2020
at 2:30 pm with the complaints of –

 lower back pain and abdomen ,

 uterus slipout of position ,

 feeling of pressure in pelvis ,

 excessive vaginal bleeding

HISTORY OF PRESENT ILLNESS:Mrs. Sunila was apparently well when suddenly she developed
lower back pain and abdomen, uterus slipout of position, feeling of pressure in pelvis, excessive
vaginal bleeding and passage of blood clot (++).At present no history of bleeding , heaviness on abdomen.
but having fever and pain because surgical intervention. Patient has no history of trauma, injury falling. So
she came to the hospital and admit as per doctors’ orders.
PAST MEDICAL HISTORY –
Childhood illness – Patient is having no history of any disease in childhood.
Immunization status – complete vaccinations.
Medical history - Patient does not having any history of disease there are no history of hypertension,
tuberculosis.
No History of abortion
No history of still birth and pre mature labour.

PAST SURGICAL HISTORY – There is no any past history of surgery is noted.

PERSONAL HISTORY
 Dietary habits : Vegetarian
 Diet /day : 3 times / days
 Immunization : taken all T.T.dose.
 Food habit : non vegetarian
 Contraceptive prior to pregnancy: no any contraceptives.
 Smoking : No history of Smoking.
 Alcohol : No history of alcohol.
 Pervious history of blood transfusion : No
 Pervious history of drug allergy : absent
 Pervious history of anti D immunoglobin: absent
MENSTRUAL HISTORY -
Menarche – 14 yrs
Cycle – 28-30 days
Duration – 3-4 days
Amount of blood flow- normal
Dysfunctional uterine bleeding – abnormal
OBSTETRIC HISTORY –
S.NO. YEAR AND PREGNANCY LABOUR METHOD PUERPERIUM BABY
DATE EVENT AND OF DELIVERY STATUS
EVENT
1 Feb 1997 Full term Full term NVD Normal Normal
NVD male baby
2 May 2000 Full term Full term NVD Normal Normal
NVD male baby
3 Dec 2001 Abortion of 8 -------- D&C UNEVENTFUL --------------
weeks
4. April 2003 Full term Full term NVD Normal Normal
NVD male baby
5 Aug 2004 Abortion of 8 -------- D&C UNEVENTFUL --------------
weeks
6 May 2006 Full term Full term NVD Normal Normal
NVD male baby
7 March 2008 Full term Full term NVD Normal Normal
NVD female
baby

FAMILY HISTORY
-Male died
FAMILY TREE

- Male

Mr. Ramu Mrs. sunila

45 yrs 40 yrs - - Female patient

Mr.sunil Mr.sameer Mr.sudhir Mr. rohanms. Roshni

22 yrs 19 yrs 16 yrs 14 yrs 12 yrs
Name of Relationship Age/ Sex Marital Occupation Health Status Educational
the family with patient status Background
member
Mrs.Sunila 40 yrs Married House wife Unhealthy B.A.
Patient
Mr.Ramu Husband 45 yrs Married bussiness Unhealthy B .A
Mr.sunil Son 22 yrs unmarried Student Healthy B .A
Mr.sameer Son 19 yrs unmarried Student healthy 12 th
Mr.sudhir son 16 yrs Unmarried Student Healthy -10 th
Mr. rohan Son 14yrs unmarried Student Healthy 8th
ms.Roshni Daughter 12 yrs unmarried Student Healthy 6 th

PSYCHOSOCIAL HISTORY –
a) Primary language : Hindi

b) Secondary language :Hindi

c) House :Own

d) Type of family : Nuclear

e) Relationship of patient with family : Satisfactory

f) Mood of patient : Anxious

g) Position of patient in the society : Respectable

h) Position of patient in the family : Respectable

i) Socio economic status of the patient: low socio economic status.

ENVIRONMENTAL HISTORY -
a) Cleanliness of house : clean house

b) Type of residence : clean

c) Area : Village

d) Hazards : No environmental hazards.

e) Pollutants : Smoke and dust

f) Water supply : Handpump

g) Sanitation :Adequate

h) Drainage system : Adequate

 i) Method of disposal of waste : Deep burial

j) Method of cooking pratices : frying and boiling

k) Any epidemic disease : Absent

l) Sanitation : Adequate

m) Environmental hazards : Near industrial waste dispose

n) Mode of transportation : Public transport service

VITAL SIGNS –
S.NO. VITAL SIGN PATIENT NORMAL EVALUATION
VALUE VALUE
1 Temperature 98.4F 98.6F Slightly low
2 Respiration 20 b/m 16-20 b/m Normal
3 Pulse 80 b/m 70- 100 b/m Normal
4 Blood pressure 120/70 mmof hg 120/80 mmof hg Normal
5 Oxygen saturation 96% 95-100% Normal

INVESTIGATION: (3 days)
Day -1
S.No. Tests Normal Value Patient Value
1 Haemoglobin 10-16.5 g/dl 12.5 g/dl
2 WBC 4000- 11000 cells/cumm 7000 cells/cumm
3 Neutrophills 40-75% 58%
4 L ymphocyte 20-45% 26%
5 Eosinophills 1-6% 15%
6 Monocytes 2-8% 01%
7 Platelet count 1.5 -4 lakh 2.6 lakh
8 RBC 3.8- 6 m/mm3 4.21 m/mm3

Day -2
S.No. Tests Normal Value Patient Value
1 Blood urea 15.0- 36.38 mg/dl 38 mg/dl
2 Creatinine 0.52-1.04 mg/dl 2.0 mg/dl
3 Sodium 135-145 mmol/L 145 mmol/L
4 Potassium 3.4- 5.1 mmol/L 5.4 mmol/L
5 PT 9.8- 12.1 sec 12.9 sec
6 INR 0.6 – 1.5 1.14

Day -3
S.No. Tests Normal Value Patient Value
1 SERUM BILIRUBIN 0.2 – 1.3 mg/dl 0.4 mg/dl
2 S.G.P.T 9-52 U/L 25 U/L
3 S.G.O.T 14-36 U/L 30 U/L
ULTRASOUND FINDINGS_
Bulky uterus (visualized part appears bulky) measuring in 8.8 X4.5X6.1 cm in size ,myometrium fined
lesions of 2.4 CMX2.6 CM is seen in fundal region posteriorly causing bleeding and 4-5 mm uterus appear
low lying and slip off. .
MEDIACTION –
S.NO. MEDICATION DOSE ROUTE FREQUENCY ACTION
1 InjGramocef 1.5 gm I/V B/D Antibiotic
2 Inj Gentamycin 80 mg I/V B/D Antibiotic
3 Inj Tramadol 5 mg I/V O/D Analgesic
4 InjMetrogyle 500 mg I/V TDS antidiarreal
5 InjMethergine 1 mg I/M O/D To stop
bleeding

OTHER SUPPORTIVE THERAPIES-

 Provide complete bed rest to the patient.

 Provide balance diet to the patient.

 Provide blood transfusion to increase blood and maintain HB level.

 Provide education to the patient regarding hystectomy and prepare for them.

PHYSICAL EXAMINATION
GENERAL EXAMINATION:
 Consciousness: Conscious

 Orientation :Altered

 Nourishment :Well nourished

 Body Built :Moderately built

 Activity : dull

 Look : Dull

 Hygiene : Proper

 Speech :normal

 Height : 5’’ inch

 Weight : 56 kg
INTEGUMENTARY SYSTEM
SKIN
 Colour : Pale in colour

 Texture : dryness

 Skin Turgor : Normal

 Hydration : Normal

 Lesions/ Masses : No lesions present

NAILS
On observation :
 Nail beds : Normal

 Nail plate :Normal

HAIR
 Colour : white

 Texture : Normal

 Grooming : Normal

 Distribution : Normal

HEAD
 Scalp :Clear, no lesion or dandruff present

 Distribution of hair : Equally distributed

 Hair colour: blackish

 Pediculosis : Absent

 Alopecia : Absent

 Headche: Present

 Dizziness : Absent

FACE
  Cholosma : Absent

 Colour : Fair

 Turgor : Absent

 Texture : Normal

 Scar : Absent

EYES
 Symmetry : Normal

 Eye brows :both eyebrows look symmetrical and regular in shape.

 Eye lashes :There are no inflammation present.

 Eye lids :no edema, swelling or redness found.

 Pupillary reflex : Normal

 Pupil shape : Normal

 Sclera : White in colour

 Conjunctiva : Moist

 Vision : Normal

 Discharge : No discharge present

 Spectarles: Absent

EARS
 Pinna : Normal

 Shape and size : Normal

 Location : Symmetrical

 Hearing : Normal , Good

 Discharge : No discharge present

 Crust formation : Absent

NOSE
 Nasal septum : No septal deviation present.

 Nasal pathway : Clear

 Smell : Good

 Sinuses : Normal

 Discharge :Absent

MOUTH AND PHARYNX

Lips-
 Colour :Pinkish

 Cracking : Absent

 Symmetry : Normal

 Cheilosis : Absent

Mucosa –
 Hydration : Poor

 Integrity : Normal

Tongue –
 Coating : Absent

 Colour :pallor

Teeth-
 Colour : white

 Dental caries : present

 Dental infection : absent

 Gums : Pallor

NECK

 Range of Motion :Stiff neck

 Lymph nodes : Palpable, no lymphadenopathy.
  Trachea : Normal

 Thyroid Gland : No goiter present, no inflammation.

 Jugular vein distention : Absent

BREAST –
INSPECTION-
 Shape : globular

 Primary areola : Present

 Secondary areola : Present

 Nipple shape : Erected

 Dryness : Present

 Crackled Nipples : Absent

 Scar formation : Absent

PALPATION
 Tenderness : Present

 Axillary lymph node tait : Absent

 Enlargement : Present

 Masses : Absent

 Lesion : striate present

CHEST
INSPECTION-
 Symmetry : normal

 Lesions : Absent

 Expansion : normal

PALPATION-
 Respiratory rate : 16-18breath / min.

 Bilateral expansion : normal

  Apical pulse : 76 b/min

PERCUSSION-
 Fluid accumulation : Absent

AUSCULATION-
 Wheezing sounds : Absent

 S1 and S2 sounds : Present

 Heart rate : 76 beats / min

 Heart murmars : Absent

ABDOMEN
 Inspection

 Size : Normal

 Abdominal girth : 95 cm

 Linea nigra : Absent

 Lesion : Present

 Palpation-

 Fundal grip : Absent

 Lateral grip : Absent

 Pelvic grip : Absent

 Powlick grip : Absent

 Percussion

 Brauton hicks contractions : Absent

 Bowel Sounds : No abnormal accumulation of fluid or gas bowel sounds 3 beat/ min.

 Appetite : Loss of appetite.

UPPER EXTREMITIES
 Symmetry :Normal
  Range of motion : No restriction of range of motion , normal flexion

LOWER EXTREMITIES
 Symmetry : Normal

 Range of motion : No restriction of range of motion , normal flexion

 Edema/ swelling : Absent

 Cyanosis : No cyanosis present

 Joints : No joint pain present.

 Deformity : No any deformity present

 Gait : Normal

GENTIO- URINARY
 Lesions/ Scars : No scars and lesions present

 Discharge/ Infection : discharge present

 Hygiene : Present

RECTUM AND ANUS

 Bowel Elimination Pattern : Normal

CASE STUDY -
INTRODUCTION-
ANATOMY AND PHYSIOLOGY OF UTERUS –
The uterus is an organ of the female reproductive system. It’s shaped like an upside-down pear and has thick
walls. The uterus’s main function is to house and nourish a fetus until it’s ready for birth.
Location
The uterus sits in the middle of the pelvis, behind the bladder and in front of the rectum. The actual position
of the uterus within the pelvis varies from person to person. Each position has its own name:
Anteverted uterus- An anteverted uterus tips slightly forward.
Retroverted uterus- A retroverted uterus bends slightly backward.
FUNDUS-
The fundus is the upper part of the uterus. It’s broad and curved. The fallopian tubes attach to the uterus just
below the fundus.
 CORPUS
The corpus is the main body of the uterus. It’s very muscular and can stretch to accommodate a developing
fetus. During labor, the muscular walls of the corpus contract to help push the baby through the cervix and
vagina.
The corpus is lined by a mucus membrane called the endometrium. This membrane responds to reproductive
hormones by changing its thickness during each menstrual cycle. If an egg is fertilized, it attaches to the
endometrium. If no fertilization occurs, the endometrium sheds its outer layer of cells, which are released
during menstruation.
ISTHMUS
The portion of the uterus between the corpus and the cervix is called the isthmus. This is where the walls of
the uterus begin to narrow toward the cervix.
CERVIX
The cervix is the lowest part of the uterus. It’s lined with a smooth mucous membrane and connects the
uterus to the vagina. Glands in the cervical lining usually produce a thick mucus. However, during
ovulation, this becomes thinner to allow sperm to easily pass into the uterus.The cervix has three main parts:
Endocervix- This is the inner part of the cervix that leads to the uterus.
Cervical canal-The cervical canal links the uterus to the vagina.
Exocervix-The exocervix is the outer part of the cervix that protrudes into the vagina.

FUNCTION OF UTERUS-
The reproductive function of the uterus is to accept a fertilized ovum which passes through the utero-
tubal junction from the fallopian tube. The fertilized ovum divides to become a blastocyst, which
implants into the endometrium, and derives nourishment from blood vessels which develop
exclusively for this purpose

INTRODUCTION:
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer
provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the
vagina. Uterine prolapse can occur in women of any age.
Normally, supporting ligaments and other connective tissues hold your uterus in place inside your
pelvic cavity. Weakening of these supportive structures allows the uterus to slip down into the
vagina. As a result, the vagina also is pulled down and may turn inside out.
DEFINITION-A uterine prolapse is when the uterus descends toward or into the vagina. It happens when
the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus. In some
cases, the uterus can protrude from the vaginal opening.
CAUSES-

BOOK PICTURE PATIENT PICTURE

 Pregnancy  Delivery of a large baby
 Difficult labor and delivery or trauma  Being overweight or obese
during childbirth  Lower estrogen level after menopause
 Delivery of a large baby
 Being overweight or obese
 Lower estrogen level after menopause
 Chronic constipation or straining with
bowel movements
 Chronic cough or bronchitis
 Repeated heavy lifting

RISK FACTORS-
BOOK PICTURE PATIENT PICTURE
 One or more pregnancies and vaginal births  Increasing age
 Giving birth to a large baby  Obesity
 Increasing age  Family history of weakness in connective
 Obesity tissue
 Prior pelvic surgery
 Chronic constipation or frequent straining
during bowel movements
 Family history of weakness in connective
tissue
 Being Hispanic or white
PATHOPHYSIOLOGY –
Due to etiological factors such as(trauma, obesity, constipation)

Weaking of pelvic floor muscles and ligament

Pelvic floor muscle and ligaments stretch, become damaged and weakened.

Inability of the pelvic ofloor muscle and ligaments and hold the uterus in positon.

Allowing the uterus to fall into vagina.

CLINICAL MANIFESTATION-
BOOK PICTURE PATIENT PICTURE
 Sensation of heaviness or pulling in pelvis  Sensation of heaviness or pulling in pelvis
 Tissue protruding from vagina  Tissue protruding from vagina
 urine leakage (incontinence) or urine  urine leakage (incontinence) or urine
retention retention
 Trouble having a bowel movement
 Feeling as if patient sitting on a small ball or
as if something is falling out of vagina
 Sexual concerns,

DIAGNOSTIC EVALUATION –
BOOK PICTURE PATIENT PICTURE
 History collection
 Physical examination  History collection
 Blood tests  Physical examination
 Ultrasonography  Blood tests
 Computer tomography  Ultrasonography
 Renal sonography

MEDICAL MANAGEMENT –
BOOK PICTURE PATIENT PICTURE
 Kegal exercise  Kegal exercise
 Estrogen replacement therapy  Estrogen replacement therapy
  Vaginal support device  Vaginal support device
 Analgesic
 Antibiotic
 fluids
SURGICAL-
 Removal of uterus (hysterectomy
 Repair of weakened pelvic floor tissues.
 Colpocleisis
 Removal of uterus (hysterectomy
 Colpocleisis

PREVENTION
To reduce risk of uterine prolapse, try to:

 PERFORM KEGEL EXERCISES REGULARLY -These exercises can strengthen pelvic floor
muscles especially important after patient have a baby.

 TREAT AND PREVENT CONSTIPATION- Drink plenty of fluids and eat high-fiber foods, such
as fruits, vegetables, beans and whole-grain cereals.

 AVOID HEAVY LIFTING AND LIFT CORRECTLY- When lifting, use your legs instead of
your waist or back.

 CONTROL COUGHING- Get treatment for a chronic cough or bronchitis, and don't smoke.

 AVOID WEIGHT GAIN- Talk with doctor to determine ideal weight and get advice on weight-loss
strategies, if patient need them.

NURSING MANAGEMENT –
 Proper assessment of the patient should be done

 Administer prescribed medicine.

 Monitor vital signs every 4 hourly.

 Provide education regarding hygiene, medication, diet and exercise.

 Educate to avoid sitting for long time.

 Maintain fluid and electrolyte balance.

 Strickly monitor intake and output chart.

PHYSICAL EXAMINATION-
 Physical head to toe examination.

 Check the vital signs.

 Check height, weight and nutritional appearance and colour of skin, presence of oedema is assessed.

NURSING DIAGNOSIS –

 Excessive vaginal bleeding related to presence lesion in uterus as evidence by ultrasound report.

 Acute abdominal pain related to bulky size of uterus as evidence by verbal report or facial expression.

 Altered body temperature related to physiological changes as evidenced by taking vital signs or as
thermometer reading.

 Anemia related to excessive blood losss from vagina as evidence by blood report that is 4.4 gm.

 Altered sleep pattern related to pain and vaginal discomfort as evidence by frequent awakening during
night and verbal speech.

 Risk of shock related to excessive blood loss from body through vagina.

 Anxiety related to surgical procedure as evidenced by change facial expression.

 Fluid volume deficit related to dehydration as evidence by altered fluid and electrolyte balanced.

SHORT TERM GOAL –

 To relieve pain.

 To stop vaginal bleeding.

 To reduce infection.

 To improve condition of the patient.

 To provide comfortable position.

 To reduce anxiety and fear related to disease condition of the patient.

 To restore the normal functioning.

LONG TERM GOAL –

 To relieve post-surgical pain.
  To prevent further complication.

 To provide health education regarding diet and exercise and follow up.

 To encourage patient for adherence treatment.

 To rehabilitate the patient.

NURSING PROCESS-
 Excessive vaginal bleeding related to presence lesion in uterus as evidence by ultrasound report.

Assessment Nursing Goal Planning Rationale Implementatio Evaluation

Diagnosis n
Subjective  Excessive To  To assess  Assesse  To know the Expected
Date- vaginal reduce the d the condition of outcome is
Patient is bleeding the general general the patient. partially
complaining related to bleeding condition conditio met as
of vaginal presence . of the n of the evidenced
bleeding. lesion in patient. patient.  Bleeding that patient
uterus as  Bleeding  It noted endly vaginal
evidence by should be provided 2 hourly. bleeding is
Objective ultrasound noted 2 the reduced.
Data- On report. hourly. baseline
observation s data
that patient for
bed sheet further  Provided the
and pad  Provide
treatmen complete
were soaked complete t. bed rest.
in blood. bed rest.
 Pad is
 Pad  It reduce changed.
should be the
changed bleeding
as needed. .  Foot end is
 Provide
 foot end  To elevated
elevated. prevent with extra
for pillow.
infection
.

 To
prevent
bleeding
.

 Acute abdominal pain related to bulky size of uterus as evidence by verbal report or facial expression

Assessment Nursing Goal Planning Rationale Implementatio Evaluation

Diagnosis n
Subjective  Acute To -To assess the -Assessed To know the Expected
Date- abdominal relieve general the general condition of the outcome is
Patient is pain related patient condition of condition of patient. partially
complaining to bulky size from the patient. the patient. - met as
about the of uterus as pain. -Assess the - assessed To know evidenced
pain evidence by duration, the duration, characters of that patient
verbal report intensity and intensity, pain. pain is
or facial character of and reduced. .
Objective expression pain. character of
Data- On  pain.
observation
that patient -
facial Psychological Psychologic -To provide
expression support. al support support
changed and given.
looking dull.
-Provide -Provided -To divert
 diversional diversional patient mind.
therapy therapy.
-Change the -changed the -To provide
position of position of comfort.
the patient the patient
-Provide -provided -To provide
medication as medication comfort.
per doctors as per To reduce pain.
order doctors
order.

2-Altered body temperature related to physiological changes as evidenced by taking vital signs or as
thermometer reading.

Assessmen Nursing Goal Planning Rationale Implementati Evaluation

t Diagnosis on
Subjective To  Assess  Know the  Assessment Expected
data- Hyperthermi maintain the general was done. outcome is
patient is a related to the normal general condition. partially met
complainin infection as body conditi as evidenced
g about he evidence by temperatur on of that patient
is feeling patient e. the gastrointestin
warm. verbalizatio patient. al function
n and  Provide It helps to make Fiber soft diet maintained.
Objective increased fiber defecation provided like
data-on respiratory soft easier. banana.
observed rate. diet.
that patient
facial Encourage  Prevent Fluid was
expression fluid stools from encouraged.
changed intake. become dry
and and hard. s
Provided the
increased Provide  Maintain the
sponge bath to
respirator sponge thermoregula the patient.
rate.. bath to the tion system.
patient.
 Anxiety related to surgical procedure as evidenced by change facial expression.

Assessment Diagnosis Goal Planning Rationale Implementati Evaluation

on
Subjective  Anxiety To reduce -To assess To know the -Assessed the Patient
data related to anxiety of the level of level of level of anxiety knowledge
Patient is surgical the patient. anxiety of anxiety of of the patient. level has
complaining procedur the patient. the patient. been
about the e as improved
fear related evidence -Clarify -To clarify -Clarified after
to surgery. d by patient’s the patient patient’s explanation.
Objective change doubts doubts. doubts
data facial regarding regarding
Patient looks expressio postoperative postoperative
anxious. n. care. care.

-Explain -To explain -

patient about patient about Explained
postoperative exercise of patient about
exercises. postoperative postoperative
care. exercise.
-To -To reduce
encourage the anxiety . -
patient to ask encouragement
questions. was done.

4- Deficit knowledge about treatment as evidenced by patient asking frequent question regarding
postoperative care.
Assessment Diagnosis Goal Planning Rationale Implementati Evaluation
on
Subjective Deficit To increase -To assess To know the -Assessed the Patient
data knowledge the the knowledge knowledge knowledge
Patient is about knowledge knowledge level of level of patient. level has
asking treatment as level of level of patient. been
question evidenced by patient patient. improved
 regarding patient regarding after
postoperativ asking postoperativ -Clarify -To clarify -Clarified explanation.
e care. frequent e care. patient’s the patient patient’s
question doubts doubts. doubts
regarding regarding regarding
Objective postoperativ postoperativ postoperative
data e care. e care. care.
Knowledge
deficit is -Explain -To explain -
experienced patient about patient about Explained
by frequent postoperativ exercise of patient about
questioning. e exercises. postoperativ postoperative
e care exercise.

OTHER INTERVENTIONS-
- Provide assessment of the patient should be done.

- Vital signs should be checked daily.

- All prescribe medicine is given at right route and time, dose and frequency.

- Monitor intake and output.

- Blood transfusion is given to correct anemia.

- Patient is under close observation.

- Psychological support is given.

- Clarify all the patient doubts.

- Documentation should be properly.

HEALTH EDUCATION; HYGIENE-

MEDICATION
- Advise patient to take home medications following right drug, frequency, dosageand timing as prescribed
by the Physician.
Iron and folic acid supplement, calcium and vitamins tablets provided.
NUTRITIONAL ADVICE-
 - Advice patient to take iron rich diet like spinach, apples and green leafy vegetables.

- Advice patient to take nutritious and fibers rich diet to reduce constipation.

- Advice the patient to take light and fibers diet after surgery.

EXERCISE-
- Advice patient to do minimum exercise like morning walk.

- Donot lift heavy objects.

- Avoid long time sitting.

- Educate patient to perform kegal exercise.

H – Health Teachings
- Inform patient to avoid lifting heavy objects for 1-2 weeks- Stress the importance of proper hygiene like
handwashing, toileting, toothbrushingand bathing.
- Encourage client to engage to range of motion exercises.
- Instruct patient to increase intake of protein-rich foods to promote faster woundhealing
- Advise patient to increase adequate fluid intake for hydration purposes.
- Discourage patient to participate in strenuous activities that might precipitate stressand trauma to the
wound.
- Tell patient not to hesitate to ask for assistance when waking up in bed or whengoing to comfort room.-
Promote rest periods among the client but also encourage ambulation

FOLLOW UP –
- Advice the patient to come on proper date as per doctor advice.

- Advice patient if any complication or problem occurs immediately come for proper follow up.

BIBLIOGRAPHY- Black M. joyce, Hwkshokansonjane, medical surgical nursing.8th edition. Volume 1.

New delhi; Reed elsevierindia private limited: 2009.p 645-647.
 Suddarth’s and brunner, Hinkle L.Janice, Cheever H.Kerry. Text book of medical surgical
nursing.13th edition. Volume 1.New delhi: wolterskluwerindiaPvt ltd; 2014.p550-555.

 https://emedicine . Medscape.com/article/overview.

 https://www.healthline.com/human-body-maps/heart failure..