Professional Documents
Culture Documents
HUYE CAMPUS
GISENYI DH is localized in the Western Province, Rubavu District, in Gisenyi Sector few
meters from Kivu Lake. It is situated in a touristic town of Gisenyi bordering DRC. The hospital
attends a population of over 515083 persons spread over 12 sectors of the Rubavu district, 13
Health centers such as: Busasamana, Bugeshi, Mudende, Kabari, Nyakiliba, Karambo, Nyundo,
Murara, Byahi, Gacuba II, Gisenyi, Kigufi, and Busigari. It serves also some areas of Rutsiro,
Nyabihu Districts and Goma town/Democratic Republic of Congo (DRC).
Gisenyi DH started working during the colonial period in 1930 as a health post in Gisenyi. It was
engaged in promoting preventive and curative services at a primary level.
With population growth, it was necessary to improve the infrastructure and services arrival of a
Belgian surgeon called DEWILDE around the year 1950, Gisenyi health post became Gisenyi
Hospital.
Since 1972, Gisenyi Hospital was under leadership of a nurse who was replaced by a physician
in 1975.Under the leadership of a nurse, Gisenyi Hospital had seven services, radiology services
started in 1976.
Operating theater,
Surgical ward,
Obstetrics and Gynecology ward.
During the tragic events of Rwanda genocide, Gisenyi Hospital stopped working until around
August, 1994. Now Gisenyi hospital has 249 personnel, 316 beds, beds occupation rate 73%.
And has expanded its buildings to:
Emergency ward.
Internal medicine ward.
Pediatry
Ophthalmology.
Laboratory.
OPD
ARV
Isange one stop center.
Kinestherapy.
Mental health ward.
Radiograph and Echography buildings.
1.1.2 Mission
1.1.3. Vision
Hospital's vision is to be the hospital of first choice in western province, to provide high quality
health care service, to comply with the international standards.
Quality: The constant search for quality and efficiency will guide the activities of each staff,
common ambition of the institution's staff will provide quality service for both medical and
administrative logistics accordance with national standards and guidelines for the health policy.
Compassion: The other value will be respect, listening and maintain confidentiality to clients.
Treat customers with compassion and dignity while satisfying the conditions of confidentiality.
Team working: The team will be bound by the staff interrelations; it will have an awareness of
belonging to the group and will pursue a common goal oriented towards a convergence of efforts
of the team of Gisenyi Hospital.
Efficiency: The efficiency value will affect the sound management of all the resources of the
hospital with the same responsibilities to achieve good performance from the production of all
the players in the hospital.
1. SURGERY DEPARTMENT
We seek to be sensitive to the needs of our patients and their families during the course of
offering surgical services.
3. MAIN ACTIVITIES
· Out patients clinics: Out patients consultations, minor surgery and Plaster
clinics
· Pre-operative management
· Theatres activities
· Post-operative management
· In patients consults (Ward rounds)
· Special investigations (ENT, Ophthalmology)
· Training and supervision of Referral and District Hospitals in CHUB
catchment areas
· Community based activities (Outreaches)
· Researches
2. INTERNAL MEDECINE
Also, internal medicine department is divided into two ward one ward for male and other ward
for women and when you combine these can host 60 patients (30 male patients and 30 female
patients) at the same time but also internal medicine it one department which are in charge of
controlling a patient who are hospitalized in private chambers. Where those chambers can host
18 patients means it has 18 chambers. So, internal medicine can host 78 patients at same time.
Department offers different services to adult patients with age varying from 16years to old age.
Patients with different pathologies get the prevention, diagnosis and their care in a general
approach. As well as the staff is mainly composed by general practitioner and internists. The
department offers different services to adult patients with age varying from 16years to old age.
Patients with different pathologies get the prevention, diagnosis and their care in a general
approach. As well as the staff is mainly composed by general practitioner and internists.
We give daily follow up for the good recovery of the patients and for difficult cases transfer to
tertiary level is necessary for further management. It is staffed by certified nurses and physicians.
The tuberculosis service is included for a good follow up for the patients. Mental health service
is integrated in internal medicine to strengthen a good follow up of mental health care
FRACTURE
Names: N.S
Age: 55 years
Sex: Female
Religion: ADEPER
4. History of present illness: The symptoms started that early morning when the patient had an
RTA caused by a motorcycle.
Family and social history: She lives in a 6 membered family, and she is in 2 nd category of
UBUDEHE.
General overall health state: A 55 years old female patient admitted on 08/11/2021.presented
with left leg functional impairment, swelling and tenderness post to RTA.
Differential diagnosis
Investigation summary
• FBC
• Thigh X- ray
Medical diagnosis
Treatment plan:
IM Diclofenac 75 mg
Pct Po 1g TDS 7/7
Traction
-Administer
objective prescribed pain
data: killers.
Body
temperature
of 36.80c Impaired Patient Teaching exercises to The patient is
physical will maintain the health of showing
Pulse of
mobility achieve a the unaffected functional
110beats/mi
related to pain-free, muscles and to body parts
n
fracture AEB functional increase the strength movement
Respiration inability to , and of muscles needed for after 3 days of
of stable transferring and for hospitalizatio
18cycles/mi move body part using assistive n.
n movemen devices.
t after 3
Therapies
days of
Prescriptio hospitaliz
n: ation.
.
Knowledge The client Providing health After 5
deficit about will be education about the minutes, the
disease r/t able to disease, medication. client is able
lack of know the to respond to
information causes, all questions
AMB preventio concerning
inability to n and the health
answer treatment education
disease of disease given.
related in 5
questions. minutes.
A fracture is a complete or incomplete disruption in the continuity of the bone structure and is
defined according to its type and extent.
Fractures occur when the bone is subjected to stress greater than it can absorb.
When the bone is broken, adjacent structures are affected, resulting in soft tissue edema,
hemorrhage into muscles and joints, joint dislocations, ruptured tendons, severed nerves and
damaged blood vessels.
Classification
Complete fracture. A complete fracture involves a break across the entire cross-section
of the bone and is frequently displaced.
Incomplete fracture. An incomplete fracture involves a break through only part of the
cross section of the bone.
Comminuted fracture. A comminuted fracture is one that produces several bone
fragments.
Closed fracture. A closed fracture is one that does not cause a break in the skin.
Open fracture. An open fracture is one in which the skin or mucous membrane wound
extends to the fractured bone.
Causes
Direct blows. Being hit directly by a great force could cause fracture in the bones.
Crushing forces. Forces that come into contact with the bones and crush them could also
result in fractures.
Sudden twisting motions. Twisting the joints in a sudden motion leads to fractures.
Extreme muscle contractions. When the muscles have reached its limit in contraction, it
could lead to serious fractures.
Clinical Manifestations
The clinical signs and symptoms of a fracture may include the following but not all are present in
every fracture:
The pain is continuous and increases in severity until the bone fragments are
immobilized.
Loss of function. After a fracture, the extremity cannot function properly because normal
function of the muscles depends on the integrity of the bones to which they are attached.
Displacement, angulation, or rotation of the fragments in a fracture of the arm or leg
causes a deformity that is detectable when the limb is compared with the uninjured
extremity.
There is actual shortening of the extremity because of the compression of the fractured
bone.
When the extremity is gently palpated, a crumbling sensation, called crepitus, can be
felt.
Localized edema and ecchymosis. Localized edema and ecchymosis occur after a
fracture as a result of trauma and bleeding into the tissues.
Complications
To determine the presence of fracture, the following diagnostic tools are used.
Medical Management
Nursing Management
The nurse should instruct the patient regarding proper methods to control edema and
pain.
It is important to teach exercises to maintain the health of the unaffected muscles and to
increase the strength of muscles needed for transferring and for using assistive devices.
Plans are made to help the patients modify the home environment to promote safety such
as removing any obstruction in the walking paths around the house.
Wound management. Wound irrigation and debridement are initiated as soon as possible.
Elevate extremity. The affected extremity is elevated to minimize edema.
Signs of infection. The patient must be assessed for presence of infection.
REFERENCES
Katherine, Abel (2013). Official CPC Certification Study Guide. American Medical
Association. p. 108.
Medicine Net Fracture Archived 2008-12-21 at the Wayback Machine Medical Author:
Benjamin C. Wedro, MD, FAAEM.
Compartment Syndrome". The Lecture Medical Concept Library. Retrieved 2021-06-25.
Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal Trauma: Fractures,
Dislocations, Ligamentous Injuries. 2nd ed. Philadelphia, PA: WB Saunders; 1998.
Delee JC Jr, Drez D. Orthopaedic Sports Medicine: Principles and Practice. Philadelphia,
PA: WB Saunders; 1993.
Lieurance R, Benjamin JB, Rappaport WD. Blood loss and transfusion in patients with
isolated femur fractures. J Orthop Trauma. 1992. 6(2):175-9.
Two nursing care procedures/techniques as they are done in service with available
resources.
A. lipectomy
This procedure is done on the female patient who has lipoma near the clavicle bone.
It is the incision process where a benign neoplasm of adipose tissue composed of mature fat
cells have to be removed. It is a minor surgery where they use different surgical instruments.
When the procedure is going to be done you have to prepare yourself and prepare patient then
after material. Sterile procedure requires much attention because if not you can cause further
infections. After receiving consent to perform we washed our hand and rub, opened sterile
gloves, then inner cover is used as preparation sheet, we prepared 5 forceps, needle and syringe,
scissor, suturing materials, suturing materials, sterile surgical blades, local anesthesia(lidocaine),
disinfectant(povidone), dressing materials.
During procedure, we disinfect the site with povidone, we inject anesthesia, we took blade and
cut for separating skin, we applied forceps for fixing skin out of the suture, then after we
penetrated inside and removed lipoma as our purpose. Approaching to the end of procedure we
sutured the wound and dressing it then after we ambulance the patient to the best for taking a
short rest and recovery from anesthesia.
Highlights: positively they perform the procedure referring to standard measures even if sterile
sheet is insufficient they find another way of maintaining sterility and addition to that client are
aware about what they are doing, better material arrangement. Negatively, sometime they can
pass across the sterile field while they are serving him/herself otherwise there is high quality of
procedure as it is.
Student input made for improving the quality of the procedure: prepare the materials to be
sterile, prepare safe working environment, prepare patient for the procedure and assists during
the procedure then after the procedure they also prepare room and clean used material for next
use.
Weakness is slow speed during procedure, some of them can have fear of the procedure,
mastering names and function of each instruments to be used.
B. Wound dressing
In the wards where wound dressing is performed it is done in this way: when performing wound
dressing first you have to greet the patient and ask a permission from the client after allowing
you, you have to put on gloves after you keep the privacy then position the client put
impermeable protection. this is followed by assessing the wound and remove gloves after you
disinfect hands with alcohol then you have to arrange materials and put normal saline in the
sterile cup and then put on protective gloves in order to remove the old dressing then you remove
them and disinfect hands and put on gloves then you put a sterile cloth on impermeable
protection in order to maintain the sterility then you dress a wound and after you thank client and
give him/her a health education.
Highlight positive and negative points bearing in mind the standards of the procedure:
Positive points to keep in mind include asking consent from client, keeping his privacy, to put a
sterile cloth and a protection, to use solutions like normal saline and hydrogen peroxide where
necessary and hand washing.
Negative points to keep in mind dressing without assessing the wound, failure to maintain
sterility as it should be done
Describe briefly the student input made for improving the quality of the procedure
Keeping privacy, asking a consent from the client, to know the wound type and appropriate
solution, and the way of arranging materials.
The student strength and weakness accounted in the described case in group
The strength includes preparing the materials, dressing a wound, and to know the solution to
use, to know the stage of wound healing and providing a health education to the clients. And the
weakness includes failure to maintain sterility hundred percent.
in this clinical placement based on clinical objective we learnt many different lessons like taking
quick exams (covid 19,glycaemia, HIV test, hepatitis test ) that we couldn`t learn in the class, we
assisted some different procedures like operations in minor surgery and casting, usage of
available resources to perform the different procedures depending on available resources, we
learnt to be self-confident and competent in apply theories skills into practice, improvement of
communication skills and friendship with the clients, well triage form filling and we learnt some
first aid that can be given appropriate to a certain case.
During period of clinical placement, we have been encountered by different challenges including
overcrowding of student in the hospital, and addition to this there are fewer number of cases to
be done so that to achieve all objectives is somehow complicated.
And also, we have found that the routine we studied in college as student nurse is somehow
different to routine the registered nurse they use.
Other challenge is there is no enough materials to perform some specific thing in its manner way
like in its sterile way. Other time we miss the cases in order to cover our objective 100% like
enema
We really thanking the hospital about how they accepted us for practicing in their field. They
have good administration and nurses who helped us to achieve our goals and we are saying that
stay ahead in the way you organize your service, so for the hospital side we got what we had to
get and all needed one are available. Recommendation is to continue in the way they are in, and
how they are working with clients or students in the hospital. We are also thankful to University
of Rwanda. Huye Campus leaders who had though to provide us this importance period to put
into practice what we had learnt into theories so we are encouraging them to increase this period
because it is really very importance and needed by the student to increase their knowledge and
skills, Thanks a lot.
We would like to recommend our institution that for promoting the quality learning, not only this
also we can recommend our institution to work with many district hospitals according to the
number of students they have, because we were a lot of students at the sites so it was hard for us
to perform many cases so that we can be fully know them.
Finally, we can say that the clinical placement lasting five weeks has gone well just no student
has failed this clinical placement but the objective is not achieved hundred per cent according to
different challenges we have highlighted above.
REFERENCES
In conclusion, according to the above detail’s information, this clinical portfolio includes/holds
different hints which helped me to identify my gaps in practices and where to put more efforts.
Among those hints includes daily activities record, case studies where there is one case on
pyumyostatitis, malaria. Three reflective journals one for better management of client with
wound, for good way of drug administration, poor management of client with bedsores and poor
follow up of vital signs as well as self-assessment where the covered and not covered objectives
found. This is important for my daily learning. Depending on the experience that I have acquired
from this portfolio, I would like to ask Huye campus, to help all students to have a common
understanding about the fulfilment of student clinical portfolio.