SAINT MONICA HIGHER INSTITUTE, BUEA, CAMEROON

An Internship Report Submitted to the School of Health and Human Services of Saint
Monica Higher Institute in Partial Fulfilment of the Requirement for the
Award of a Bachelor of Science Degree in Nursing Sciences (BNS)

At Hopital Laquintinie de Douala

BY

SHEKINA-RHODA CHIOMA AMAKA

(SHHS21NR020)

14th October to 14th November, 2021

 Dedication

This piece of writing is dedicated to the patients of the psychiatric unit at the
Laquintinie Hospital, Douala.
 Acknowledgements

I give glory and honor to the most high God for life and strength He provided me
with, for the realisation of this practicum exercise.

My heartfelt cknowledgements go to my parents for their tireless and continous

support as I trodded the path of education during this period.

I appreciate the entire SMHI staff as well as friends whi created a conducive
learning atmosphere for me.

Not forgetting my extended family, loved ones well wishers from the Church and
neighborhood whose presence served as grease to my elbow.
TABLE OF CONTENT

Dedication..........................................................................

Acknowledgements...........................................................................

CHAPTER 1: INTRODUCTION..........................................................................

1.1 Description of the Hospital...........................................................................

1.2 Hospital organigram..........................................................................

CHAPTER TWO: GENERAL OVERVIEW OF WORK..........................................................

CHAPTER THREE: PATIENT CARE..........................................................................

3.1 Case Study.............................................................................

CHAPTER FOUR: SWOT Analysis...........................................................................

4.1. Strength............................................................................

4.2. Weaknesses..............................................................................

4.3. Opportunities.............................................................................

4.4. Threats.............................................................................

References................................................................................
 CHAPTER ONE
INTRODUCTION

Nursing can be referred to as an art as well as science which deals with the
rendering of care to individuals by a trained personnel, from a recognized
institution. Before the completion of the academic program for an award of a
Bachelor's degree in nursing, It is expected that the student understands the
practices in some specialties and how to render appropriate care to patients. For
better comprehension and application of the theories learnt at school, the students
were sent to the specialty unit (psychiatry) to engage in learning by keen
observation and performance. In this report, the student will point out some
practices pertaining to the nursing approach at the psychiatric department. This
practical exercise was carried out at the Laquintinie Hospital in Douala for a period
of one Month.

1.1. Description of the Hospital

Laquintinie hospital Douala or Hopital Laquintinie de Douala (HLD) is one of the
largest hospitals in Douala and is at the first category as far as classification of
hospitals in Cameroon is concerned , and a reference hospital of 2nd category.
Founded in 1931, it is located in the Akwa district of Douala and has been subject
to the indigenous regime of the French administration. It is bounded to the West by
Douch, East by Deido, North by Bonapriso and to the south by Bonakanwa. In the
1950s, the hospital was named "Laquintinie" in homage to Dr Jean Auguste
“LAQUINTINIE”, a French military doctor who stayed in Cameroon twice and
died in Yaoundé on the 5th of March 1994.
The hospital is continually improving its scope of services and skills available
within the division and Nation. Its nurses and support staff are committed to the
well-being of the inhabitants. Its mission is to ensure the daily qualitative and
quantitative medical and medico-sanitary care of cases and adapted response
during major events.
It covers a wide range of specialties organized within departments such as:
hygiene and medical sanitary technology, obstetrics and gynecology, pediatrics,
medical, surgical , multidisciplinary care and services.
Some of the services it renders include; Out-patients and In-patients services,
Ophthalmology services, Dental services, Physiotherapy services, Pediatric and
Neonatal services, Pharmacy, Laboratory services, Radiologic services, Intensive
care services, Oncologic Services, Nephrology services and Cleaning services.

THE PSYCHIATRIC UNIT

This unit comprises of three separate buildings: two linked by a corridor and the
third being a cabanon (where aggressive and agitating patients are kept) with
10rooms. At the entrance of the unit is the 1st building with the major’s office on
the right and the doctor’s office on the left. A little bit further and to the left is the
office of the doctor’s secretary. Following the corridor to the 2nd building is the
hospitalization wards for patients who are relatively calm and cooperative. The
wards are able to contain at least 30 patients. They are organized as follows;

Admission room 1 (two beds)

Admission room 2 (two beds)
Admission room 3 (two beds)
 Admission room 4 (six beds)

VIP 1 (one bed)

Coordinator’s office
Admission room 5 (two beds)
Admission room 7 (six beds)
Admission room 6 (six beds)
VIP 4 (one bed)
VIP 4 (one bed)

1.2 Hospital organigram

1.3 General overview of the work
The call duty or shift system of the staff is such that the first shift begins at 7:30am and ends at
5:30pm, while second shift from 5:30pm to 7:30am- a two shifts system. Students where also
called upon to align to this shift system during the internship. A duty roster was drawn by the
student and presented to the major who approved of it. Each student was to work for three
mornings, one night and go off duty for three days. It was such that there was a student on duty
each day at school.

Handing over is a process which entails a conversation between the exiting team on duty and the
team entering, about the state of the patients throughout the shift, those on medications, the
number of patients in the ward, those who were discharged, those newly admitted and number of
deaths, as well as the equipments of the unit.

For a number of days during morning shifts, the student ran errands for the senior nurse ("Major"
) on behalf of patients.

*Morning Duty

Upon arrival at 7:30a.m., the student changes into her uniform and accompanies the nurse for
duty. She partakes in the taking over process. The nurse looks into the report and patients files
from which she gets information of the patients on treatment, when and what medication. Being
aware of how the previous shift was spent, the overall atmosphere and state of the patients, the
student goes into the wards and cabbanon for a nurse's round. Here, she checks on the patients by
viewing them, conversing with them, enquiring from their carers or neigbors about them.

After rounds, the information gotten is recorded in the patients file. Treatments are then prepared
and served to the patients respectively. Those in the cabbanon are being restrained by security
officers in order for the medications to be served. After this, charting is done in the files of the
patients.

At 4pm, the vital signs of all patients in the regular wards are checked. They include the blood
pressure, temperature and pulse. However, patients on critical conditions have their vital signs
checked more frequently.

Throughout the day of a regular duty period, the nurse is involved in admitting new patients,
serving medications, discharging others, listening to patient's complaints and attending to their
needs which may include changing of bedsheets, assisting them take their medications and do
some selft care activities.

*Night duty

Upon taking over at 5:30pm, the student changes into her uniform and accompanies the nurse for
duty. Nurse's rounds are done as during a morning shift and the findings recorderd in the
respective files of the patients. Patients are seeved medications respectively. Vital signs are
checked by 6 a.m. and charted.

A regular night duty is similar to that of the morning, except for the fact that patients are not
discharged at night.

*Off Duty

Being off duty is an official period of not being at work for a period of time as stated on the duty
roster. The students can rest better and prepare for the next working period.

The objectives of the practicum were also taken to heart and nursing care of patients prioritised
during this exercise.

CHAPTER THREE: PATIENT CARE

3.1 Routine Care

Patients were admitted for a variety of disease condition. Others were readmitted
after being discharged days back. Some cases received at the psychiatric unit
included patients with bipolar disorder, Psychosis and Schizophrenia.

The treatment protocol for patients at the psychiatric unit usually comprised of ;

 Largatil 100mg IM 2 times per day

 Haldol 5mg IM 2 times a day
 Valium 10mg IM 1 times a day for 72hours
The student noticed that, the first line treatment which was served to
patients was diazepam. This was given to both agitating and non agitating
patients by an intravenous route. It seeved to sedate the patients, hence
preventing any violent reactions to the admission as most of the patients
dislike being admitted.

Table 1. Details Of Some Essential Drugs Frequently Used At The Psychiatric

Unit

DRUGS COMPONENTS
HALOPERIDOL Drug Class: Antipsychotics
(Haldol) injection Therapeutic effect: for treatment of some disease
5mg/kg IM/IV/Oral conditions like mania in bipolar disorder,
schizophrenia, agitation delirium, hallucinations in
alcohol withdrawal and psychosis.
Side effects: Tardive dyskinesia (movement
disorder) and neuroleptic malignant syndrome.
Contra-indication: Older patients with dementia,
pregnant women and those with Parkinson's disease.

Chlorpromazine/ Drug Class: Antipsychotics

Largactil/
Therapeutic effect: Used in treatment of disease
thorazine(IM/IV/ Orally)
conditions such as bipolar disorder, schizophrenia
and some severe behavioural problems in children
like attention deficit, hyperactivity disorder,
vomiting and nausea.
Side effects:. Sleepiness, Low blood pressure upon
standing, increased weight , low white blood cell
levels and tardive dyskinesia.
Contraindications: Order patients with psychosis
due to dementia.
Diazepam Drug Class: benzodiazepines
(IV/IM/Orally/Rectally/ Therapeutic effect: Control of anxiety, alcohol
Nasal) withdrawal syndrome, insomnia, seizures and
muscle spasm.
Side effect: body weakness and feeling sleepy.
Contra-indication: .Patients less than 18years of
age, elderly and very ill patients.

Tergretol/ Carbamazepine Drug Class: Anticonvulsant

(orally)
Therapeutic effect: treatment of neuropathic pain,
epilepsy, acts as an adjunctive and a second-line
agent in the treatment if schizophrenia and bipolar
disorder respectively.
Side effect: nausea, drowsiness, confusion and
suicidal thoughts.
Contra-indication: lactating mothers

3.2 CASE STDY

 Information of Patient

Name: XX

Gender: Male

Age: 22years

Marital status: Single

Residence: Douala

Occupation: Business

Nationality: Cameroonian

Date of Admission: 18/10/2021

 Main Complaints: Violence, Aggitation, Kleptomania, Insomia and Incurie.

 History of illness: Third episode.

 Patient's Social history: Consumes Thai, Caillou, cigarettes and other drugs.

 Medical Diagnosis: Polytoxicomania

 Medications prescribed:

-For start; *Diazepam 1ampoule (IV)

*Chlorpromazine 3ampoules + Diazepam 2ampoules (IM)

-Further treatment (3days)

*75mg of Chlorpromazine 25mg injectable served IM twice a day

*10mg of haldol 5mg injectable served twice a day

*10mg of Diazepam 10mg served twice a day.

 Relay medications

*Haldol 5mg taken : 1- 0- 2

*Largactil 10mg taken orally : 1 -0 -2

*Artane 5mg taken orally: 1 -0 -0

Literature Review: POLYTOXICOMANIA

Polytoxicomania refers to a behavioral and mental disorder which entails a state of abnormally elevated
affect, arousal and energy levels that can be as a result of poly drug abuse.
During an episode of mania, there is an experience of rapidly changing emotions, moods which are
mainly influenced by surrounding stimuli, anxiety or anger can result can also result from mania.

In the same vein, mania can also be referred to as a psychological condition which leads to the
experience of veey intense moods, unreasonable euphoria, hyperactivity and delusion. It may be
dangerous enough to cause insomnia in an episode or cause the victim not to eat well.

*Signs and Symptoms

-Flight of ideas, -Elevated mood , -Pressure of Speech, -Decreased need and desire for Sleep, -Increased
Energy, -Hyperactivity

*Causes

Polytoxicomania can result from poly drug abuse.

Patient XX was a victim of poly drug abuse and as such, a victim of polytoxicomania. Poly drug use
means using more than one drug at a time. Depending on the type and quantity, combining drugs may
amplify pleasure but can also present risk of heart attack and other negative effects. The greatest risk is
"Combined drug intoxication" which is a common cause of emergency visits and increased mortality of
its victims.

Some side effects of this combination are ; Coma, Seizures, Heart problems, brain damage and
respiratory failure.

Nursing Care Plan:

Nursing Diagnosis Nursing intervention

-Risk of returning to previous unhealthy social life °Considering that the patient was being
hospitalized following the third episode of his
illness and his return to the same residence upon
discharge, the patient was counseled against the
tendency to return to an unhealthy social lifestyle.
 °He was encouraged to stay away from the
truggers of thus unhealthy practice and get
engaged in productive activities like family
commitments, School or even relocating.

Perceived lack of Adequate Knowledge of the °Considering the fact that this patient was being
Underlying Condition hospitalized the third time and was not a regular
student, it was necessary to educate him on his
underlying health condition.

°He was enlightened on the long-term and short-

term harm such as lung disease, mental health
didorders and death.

Risk of not taking medications regularly
°As expected, a mental health patient has to be
followed up in order to ensure medications are
taken as prescribed. This is due to the tendency for
patients to stop taking medication when they feel
better.

CHAPTER FOUR: SWOT Analysis

4.1. Strength

 The rooms and office were kept clean by the ward maids.
 Some nurses showed concern and offered counsel to the patients.
4.2. Weaknesses

 Late coming was observed among the staff a number of times.

 Some staff members were rather harsh towards some patients.
4.3. Opportunities
  The students were given the opportunity to work on patients under supervision. This
enhanced learning, dexterity and perfection of skills.
 Nurses enabled the students to be engaged in service rather than idle by assigning them to
patients either alone or in pairs. This led to judicial use of internship time.
 The nurses advised the patients about their activities and comportment in the unit since the
patients were mentally unstable. This helped to prevent injuries or colitions with patients and
enhance a peaceful and comprehensible atmosphere.
 Some patients and staff were bilingual. It served as a great opportunity for the student to learn
and understand the French language better.

4.4. Threats

 The presence of uncleared bushes ariund the hospital posed a threat to the security of
patients health as it could act as a breeding ground for mosquitoes and snakes.
 When the student were many in number during night shifts, they were asked to go out in search
of where to sleep. This left some sleeping on benches with bugs and the lose of money.

Conclusion

The period of time spent for practicals at the psychiatric unit of Laquintinie
Hospital Douala was interesting and productive. Under supervision or by
observation, i was able to gain knowledge and perfect my skills. Despite the
challenges faced at the hospital, objectives were attained and it will be a delight to
have such experiences again.
 REFERENCES

"Polydrug Abuse -Dangerous Drug Combinations-Addiction Center"

https://googleweblight.com/i?u=https%3A%2F%2Fwww.addictioncenter.com
%2Faddiction%2Fpolydruguse%2F&geid=NSTNR

Mania.Definition & Patient Education. Healthline (2021).

Https://googleweblight.com/i?u=https%3A%2F%2Fwww.helathline.com
%2Fhealth%2Fmania&geidNSTNR

Chlorpromazine hydrochloride. The American Society of Health system

pharmacists. Archived from the original onn8th December 2015. Retrieved
1December 2015.
"Carbamazepine" (2015). The Amarican Society of health-System Pharmacists.
Archived from the original in February 27th. Retrieved March 28th.

"Haloperidol" (2015). The Amarican Society of health-System Pharmacists.

Archived from the original on January 22.

"Diazepam" (2006). PDRHealth.com. PDRHealth.com.2006. Archived from the

original on January 17. Retrieved March 10

"Diazepam: Precautions" (2006). Rxlist.com.Rxlisr Inc. January 24th, Archived

from the original on April 7th. Retrieved March 10.

Calcateera NE, Barrow JC (2014). "Classics in chemical neuroscience: diazepam

(valium)". ACS Chemical Neuroscience. 5(4):253-60.

"Valtoco-diazepam spray" (2020). DailyMed 13th January. Retrieved on February

13.

"Diazepam" (2015). The American Society of Health-System Pharmacists. Archived

from the original on June 30. Retrieved June 5.