Adlucem Bali Paediatric Internship - 104109

INTERNSHIP REPORT
: PAEDIATRIC UNIT
TABLE OF CONTENT
CHAPTER I: PRESENTATION OF THE INTERNSHIP SITE AND SERVICE.....................3
CHAPTER 2:ACTIVITIES REALISED.................................................................................10
CHAPTER 3: NURSING CARE PLAN..................................................................................13
CONCLUSION........................................................................................................................18
1
Compiles by CONFORT NGOSIDINMA UKE
INTERNSHIP REPORT : PAEDIATRIC UNIT
LISTE OF FIGURES
Figure 1: Geographical location of AdLucem Bali Hospital.....................................................4

Figure 2: Administrative organisation of the hospital................................................................5
Figure 3: Department organisation chart....................................................................................6
Figure 4: patient circuit..............................................................................................................9
2
LIST OF TABLES
Table 1:Nursing care plan for the first day of hospitalisation..................................................16

Table 2: NCP for day 2 hospitalisation....................................................................................17
Table 3: NCP for day 2 hospitalisation....................................................................................18
Table 4: Pharmacological table................................................................................................20
3
CHAPTER I: PRESENTATION OF THE INTERNSHIP SITE AND SERVICE
1- PRESENTATION OF THE INTERNSHIP SITE
The history of the medical foundation, its geographical location, philosophy and missions,
the administrative organisation and the department in which the internship was carried out
will be presented here.
1.1 HISTORY
The Ad-Lucem medical foundation, which means "towards the light" in Latin, was founded
in Lille (France) in France) in 1932. Considered to be the very 1st establishment of the
Fondation Médicale Ad-Lucem in the city of Douala, Ad-lucem de BALI was created in 1978
in AKWA under the name of BEBEY EYIDI medical and health centre. In 1990, the centre
was transferred to the BALI site and and was renamed the Bali Developed Health Centre. In
2017, it added a new, modern building to better meet the needs of mothers and children.
1.2- GEOGRAPHICAL LOCATION
The Ad-lucem medical foundation in Bali is located in the Littoral region, Wouri department,
district of Douala 2éme. It belongs to the New-Bell district, in the NKONGMONDO health
area. The Bali hospital is located precisely on Avenue Manga Bell near the Pétrolex service
station, between the Anatole junction and the KAYO Elie junction
4
Figure 1: Geographical location of AdLucem Bali Hospital
1.3 PHILOSOPHY AND MISSIONS
This structure presents itself as a health and social promotion service, with a Christian spirit
open to all and an auxiliary of the church's mission, in its educational task, like all the
Ad-lucem foundations in Cameroon, the Bali hospital's mission is to provide low-cost

healthcare
health care at low cost to the population and to the poor in particular. Relieving, healing and
freeing
suffering and fear by practising preventive and curative medicine with competence
and effectiveness.
5
1.4 ADMINISTRATIVE ORGANISATION
At the head of the Ad-lucem medical foundation we have a committee as shown on the figure
below
ManagementCommittee
Médecin -Head
physi
cian
Conseiller médical
Surveil lant général CSAF

G
Coordonnateurh de soins Chef de service Chef comptable
h
c
Majors Médecins Comptable
Chef d’équipe Responsable caisse -

tarification
Infirmiers
Cashier-tarification
Janitor
Security
men
Figure 2: Administrative organisation of the hospital
6
1.5 INTRODUCTION TO THE SERVICE
1.5.1 DEPARTMENT ORGANISATION CHART
The organisation chart of the paediatric department is as follows:
Internist physician
General practitioners
Ward
charge
Head Nurse
Nurses
Figure 3: Department organisation chart
1.6 HUMAN RESOURCES
The staff of the Bali Hospital consists of:
- 01 Head doctor
- 07 general practitioners, including 02 pre-employment doctors
- 01 Gynaecologist
- 01 internist
- 01 ophthalmologist
7
- 03 Dentists
- 03 qualified anaesthetists and intensive care nurses
- 02 Nurses specialising in ophthalmology
- 01 Physiotherapist
- 05 TMS laboratory including 03 pre-employment
- 02 radiology TMS including 01 pre-employment
- 05 General registered nurses
- 03 Nurse midwives
- 19 State-qualified nurses
- 08 medical/health technicians including 01 pre-employment
- 25 Care assistants
- 04 Health auxiliaries
- 14 Surface technicians
- 06 Security guards
- 03 accountants
- 15 administrative staff including accountants, cashiers and underwriters
1.7 MATERIAL RESOURCES
The FALC offers the following services: reception and orientation, minor surgery, laboratory,
maternity, dental surgery, medicine, paediatrics, operating theatre, accounting/charges,
pharmacy (A, B and C), emergency, ophthalmology/ eye care, neonatology, cardiology,
ultrasound and radiology, cashier, physiotherapy, UPEC.
The paediatric department that we did our internship is attached directly to the medical
department, the 2 form a single department but each has a major at its head. In paediatrics we
have Major MBARGA Marie-Paule and in medicine Major MESSINA Bernadette. The joint
department
8
is equipped with the following infrastructures: it is divided into compartments such as the
 new building, equipped with a restaurant; it has 16 hospital rooms, some of which
have two beds and a bathroom, a single bed in others, with a television, one or two
wardrobes air conditioning system and toilets;
 the old building has building with 12 rooms; the paediatric inpatient ward and the on-
call room, which is still the nurses' room, equipped with a desk (table and chair), a
hospital bed
four trolleys, a box for clean linen, two gurneys, a cupboard with the department's files used
for patients' records, three dustbins, a dirty linen storage area, a washbasin and a water
storage tank.
1.8 ORGANISATION OF CARE SERVICES
The FALC is open 7 days a week, 24 hours a day. The work for the staff on duty starts at
7:30 in the morning and ends at 2pm for some and the shift runs from 2pm to 6pm for others
then comes the rest. On-call staff work from 6 p.m. to 7.30 a.m. and this on-call/on-call/on-
call system takes place every 2 days.
1.9 PATIENT CIRCUIT
The patient circuit is the route taken by anyone accessing the hospital either to receive
treatment for a consultation or to undergo examinations. This circuit is configured as follows:
9
INFORMATION ET
ORIENTATION
CAISSE /ENREGISTREMENT
PRE -CONSULTATION
CONSULTATION
CAISSE/TARIFICATION
LABORATOIRE RADIO ECG ECHOGRAPHIE
CONSULTATION
CAISSE/TARIFICATION
PHARMACIE
HOSPITALISATION
SORTIE
Figure 4: patient circuit
10
CHAPTER 2: ACTIVITIES REALISED
During the internship period, we were versed with several activities which will be discussed
in the subsequent points
 Applying the Care Approach to the hospitalised patient (data collection, nursing
diagnosis (ANADI), care planning, and assessment).
It is detailed in the next chapter
 Welcoming a sick child and guiding him/her according to his/her condition.
In the paediatrics department, the welcome is usually very warm, as the department
receives
 Draw up a monitoring sheet for all sick children and record the various constants:
temperature, weight, pulse, respiratory rate, diuresis, bowel movements, etc
The monitoring sheet, also known as the "temperature sheet", is a tool used to record
vital parameters in order to carry out medical monitoring of the patient, hospitalised
with the aim of observing the progress of the illness.
Here we had a monitoring sheet with several headings (date, time, patient's room and
bed number, temperature, weight, pulse, respiratory rate, diuresis, stool).
To take the vital signs we need:
- A thermometer, to record the temperature with a red pen
- A black pen to record the pulse
- A blue pen for the other parameters
- Temperatures were taken in the mornings, at midday during care, and in the evening
during the on-call period. Exceptionally, under medical supervision, temperatures had
to be taken every three hours in the case of children who had had convulsions or had
entered the hospital with hyperthermia of 40°C..
 Wash and change a soiled child.
Equipment: nappy or change of clothes, wipe; Vaseline or olive oil; warm water.
Procedures:
-wash hands;
- put the child on his back;
- undress the child and remove the used nappy;
11
- Use wipes to clean the child's bottom from top to bottom, or wash the child's bottom
with lukewarm water.
- Dab with a towel
- apply Vaseline or moisturising oil
- Put on a clean nappy;
- dress the child;
- get rid of the used nappy and wash your hands.
 Prevent complications linked to hyperthermia in a hospitalised child (convulsion).
Hyperthermia is when a baby or young child has a fever if his or her rectal
temperature exceeds 38.5°C. We use a thermometer to take the child's temperature.
When the temperature is over 38.5°C, we provide delegated care:
- Wet wrap, warm bath
- Undress the child, monitoring the temperature until it drops.
- Ventilate the room
- Administer an antipyretic treatment.7
 Administer and monitor prescribed medication
Medicines administered in paediatrics are prescribed by a doctor, either orally or by
injection (IV or IM). Before administering a drug, we made sure that the product
purchased by the patient was the same as the one prescribed on the prescription.
Materials: Tray; Bean; Nursing glove; Cotton (dry and alcohol soaked), medicine to
be administered.
Procedures:
- Checks the medicines to be injected or given: dosage, expiry date, method of
administration,
- Hands are washed
- Put on medical gloves
- Administer the products according to the prescribed and calculated doses, depending
on the route.
For example To administer a syrup to a baby,
- Hold the baby in the crook of your arm, as if you were giving him a drink.
- We then place the graduated oral syringe in his mouth, pointing it towards the inside
of his cheek to prevent him choking on the liquid.
- The plunger of the syringe is then slowly pushed to give the baby time to swallow
the medicine.
12
During administration, we check for any side effects, such as pain or inflammation if
the venous line is still open.
 Take aseptic samples of blood, urine, faeces, etc.
Equipment: care gloves, urine jar, urine bag, bean bag
Procedures :
- Wash hands
- Put on the care gloves
- Lay the child on his back with his legs apart, as if you wanted to put a nappy on him.
- Remove the nappy from the child
- Clean the urogenital area
- Remove the protective paper from the adhesive on the pouch
- Fold the pouch in half and stick over the child's urinary orifice
- Place the hollowed-out part over the urogenital area
- When the bag contains urine, peel it off and wash and clean the child
- transfer to the urine jar, then label and send to the laboratory
The bag should not be used for more than one hour to avoid infections in the child.
 Place a nasogastric tube in a child for: gastric sampling, force-feeding, etc.
We performed tube feeding on a premature baby who was already on a nasogastric
tube.
Equipment: sterile syringes, tray, care gloves
Procedures:
- Hands are washed with soap and water before entering the neonatal room.
- Wear a gown
- We use a 10cc syringe to aspirate to remove any residue, which allows us to see if
the baby has digested its previous meal properly.
- We then slowly pour small quantities of extracted breast milk or formula into the
stomach.
- Then we make sure that the baby has burped, and we lay him on his side.
[ ] 13. Place and monitor a blood transfusion in an anaemic child.
[ ] 14. Take the necessary measures to avoid intra-hospital contamination by ensuring
disinfection during and after use.
[ ] 15. Establish, with the family, a menu according to the age, pathology and socio-
economic conditions of the parents.
13
[ ] 16. Correctly dilute and calculate the doses of medicines to be administered to the
child.
CHAPTER 3: NURSING CARE PLAN
DATA COLLECTION
08/06/2023 at 9am
Name: N.N
Age: 4 months
Weight: 9kg
Sex: female
Address: xxxxxxxxxx
Sibling: 3/ 3
Religion: Muslim
Quarter: bali
Tribe: Bamoun
Nationality: Cameroonian
Service: paediatrics
Temperature: 38⁰C
CONSULTATION MOTIVE
Convulsion episodes and grunting respiration
HISTORY OF ILLNESS
She had been having trouble breathing for the past 2 days and been given paracetamol syrup
but a Convulsion episodes and previous Temperature of 39⁰C motivated the present
consultation.
14
PAST HISTORY
Personal
Medical: (-)
surgical: (-)
Immunology: (+)
Hematology: Blood group AB+
Family
high blood pressure: (-)
Asthma: (+)
Lifestyle habits
Feeding: feeds on demand and drinks mineral water
CLINICAL EXAMINATION
Vital signs
Temperature: 38⁰C
Saturation: 86%
Respiratory rate: 40cycles per minute
On Physical examination child had bluish extremities with a visible difficulty to breathe and
fatigue
Presumptive diagnosis
Bronchopneumopathy? Associated to malaria?
PRESCRIBED TESTS
15
Laboratory tests: Full bloodcount (white blood cells: 10.2 ×10^3u/L, Haemoglobin level:
12g/L) thick blood count( 400trophozoites/mm³ of blood), C-Rractive protein test( 96g/mm³
of blood)
Radiology test: chest radiography(a relatively dense region towards the apex of the right
lung)
CONFIRMED DIAGNOSIS
Bronchopneumonia+ simple malaria
MANAGEMENT
An iv line was put up on the child’s and 250ml of 5%glucose solution passed in flash.
Oxygenotherapy of 5litres/ minute
Antibiotherapy of mesporin, metronidazole began after collection of blood for laboratory test.
Artesunate injection H0,H12, H24
Paracetamol 45mg iv of temperature exceeds 38.5⁰C
DATA ANALYSIS AND INTERPRETATION
After proper analysis of the signs.and symptoms presenting, we concluded,
Problems related to patient : anxiety, fatigue
Problem related to the disease condition : intermittent fever, respiratory distress,

restlessness
The nursing care plan below will explain better the nursing Intervention process.
Table 1:Nursing care plan for the first day of hospitalisation
Date Patient Nursing Objective Intervention Time Evaluation

needs. diagnosis
08/06/202 Breathe Ineffectiv Help Reassure 9am At 1the end

3 normally e airway restore parent of the of the the
clearance proper shift by 4
16
(Grunt-like related breathing child grunting

breathing obstructio pattern had
sound n of within 24 Teach mother significantl
bronchi by hours of to.carry baby y reduced
mucus nursing in a sitting
interventio position.
n
Constantly
monitor her
pulse oximeter
value
Increase
baby’s fluid
intake through
iv lines
Administer
oxygenotherap
y as prescribed
Maintain Fever of Bring Eliminate 12a Patient’s

temperature 38.7⁰c patient’s excess covers m temperature
within the related to temperatur and bed linen has been
normal infection e to 37 stabilised.
range. and within 3 Give
presence hours of antipyretics as
of the interventio prescribed
malaria n
Temperatur parasite in Continuous
e of 38.7⁰C the blood surveillance
Subsequent data collection
Day 2 hospitalisation at 7am
Vital signs
Temperature: 36.3⁰C
Saturation: 95%(under oxygenotherapy)
Respiratory rate: 30cycles per minute
Complaints: baby is restless and refusing to eat
17
Table 2: NCP for day 2 hospitalisation
Date Patient need Objective Intervention Time Evaluation
09/06/2023 Eat and Restore Assess the baby 7am Baby

drink eating for signs of developed
adequately pattern to malnourishment more
about 6 appetite
daily Teach mother after her
to clean baby’s mouth was
(Difficulty mouth before cleared
feeding) feeding before
feeding at
Encourage the end of
mother to feed the day.
her baby in
small but
consistent
portion
Preview enteral
nutrition if the
above don’t
work
Day 3 hospitalisation at 9am
Vital signs
Temperature: 37⁰C
Saturation: 95% without Oxygen
Respiratory rate: 35 cycles per minute
Complaints: baby is breathing well and no longer crying though convulsed in the night and
mother is worried
18
Table 3: NCP for day 2 hospitalisation
Date Patient Objective Intervention Time Evaluation

need
10/06/2023 Learn and Give mother Oxygenotherapy 10am At end of

satisfy a better is stopped shift,
curiosity understanding mother was
of the child’s Proper health satisfied
pathology education to with care
mum and other and
(Visibly family members teaching
worried
mother)
The child was discharged on 11/06/2023 with relay antibiotic medications and multivitamins
to keep boosting her appetite. Also health education was given principally to the mum to
prevent reoccurrence of the bronchopneumonia.
19
CONCLUSION
At the end of our document, we are pleased to have completed an academic internship at
FALC Bali, during this internship which ran from the 15th May to 11 th June 2023, we were
able to put into practice the theoretical knowledge we had learnt during our training, and
study clinical cases where we were able to support care approaches, we were confronted with
the real difficulties of the job as well as the smooth running of the hospital's activities, which
is now a rewarding and encouraging professional experience that offers preparation for the
future, as it was an enriching experience for us that reinforces our desire to work as nurses.
Finally, we would like to express our satisfaction at having been able to work in good
conditions and we will always be grateful to all our various trainers to whom we owe our
learning during this internship
Table 4: Pharmacological table
Drug Class Presentat Indication Posology Contraindica Sde

ion tion effect
Injectables
Ceftriaxone Cephalospor Vial of Gram.nega 1g every History of Nausea,

in antibiotics 1g and a tive 6 hours hypersensiti mild
solution bacterial dependin vity to abdomi
for infections, g on the cephalospori nal
dilution septicaemi severity ns crampin
a of g,
infection serum
sickness
like
reaction
TMetronida Nitroimidaz Clear Analgesic 500mg Patients with Headac

zole ole yellow for mild to every 8 a blood he,
liquid in moderate hours disease, nausea,
small abdominal lactating vomitti
bottle pain. mothers ng,
20
diarrhea
Gentamycin Antibiotics Vial with Gram 3mg/ Neurotoxicit Hearing

oily negative kg/day y, loss,
liquid bacteria every 8 respiratory weak or
infection hours paralysis shallow
breathin
g
Azithromyci Aminoglyco Oral Bronchitis, 10 Patients Diarrhe

n side suspensio pneumonia taking a,
mg/kg
antibiotics n , sexually antipsychoti nausea,
transmitted PO qDay c vomitti
infections,e medications ng,
for 3
ar and and patients stomach
throat days OR with pain
infections hypersensiti
10
vity to any
mg/kg of its
ingredients
PO x 1
dose on
Day 1
followed
by 5
mg/kg
on Days
2-5
21
BIBLIOGRAPHIC REFERENCES
https://reference.medscape.com/drug/zithromax-zmax-azithromycin-342523
https://pillintrip.com/medicine/trabar
https://www.mims.com/malaysia/drug/info/nefopam?mtype=generic
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1161
https://www.webmd.com/drugs/2/drug-76035/hydrogen-peroxide/details
22

Adlucem Bali Paediatric Internship - 104109

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Adlucem Bali Paediatric Internship - 104109

Uploaded by

Copyright:

Available Formats

INTERNSHIP REPORT

CHAPTER I: PRESENTATION OF THE INTERNSHIP SITE AND SERVICE.....................3

CHAPTER 2:ACTIVITIES REALISED.................................................................................10

CHAPTER 3: NURSING CARE PLAN..................................................................................13

Figure 1: Geographical location of AdLucem Bali Hospital.....................................................4

Table 1:Nursing care plan for the first day of hospitalisation..................................................16

CHAPTER I: PRESENTATION OF THE INTERNSHIP SITE AND SERVICE

1- PRESENTATION OF THE INTERNSHIP SITE

1.2- GEOGRAPHICAL LOCATION

Figure 1: Geographical location of AdLucem Bali Hospital

1.3 PHILOSOPHY AND MISSIONS

Ad-lucem foundations in Cameroon, the Bali hospital's mission is to provide low-cost

1.4 ADMINISTRATIVE ORGANISATION

Surveil lant général CSAF

Chef d’équipe Responsable caisse -

Figure 2: Administrative organisation of the hospital

1.5 INTRODUCTION TO THE SERVICE

1.5.1 DEPARTMENT ORGANISATION CHART

The organisation chart of the paediatric department is as follows:

Figure 3: Department organisation chart

1.6 HUMAN RESOURCES

The staff of the Bali Hospital consists of:

- 07 general practitioners, including 02 pre-employment doctors

- 03 qualified anaesthetists and intensive care nurses

- 02 Nurses specialising in ophthalmology

- 05 TMS laboratory including 03 pre-employment

- 02 radiology TMS including 01 pre-employment

- 05 General registered nurses

- 08 medical/health technicians including 01 pre-employment

- 15 administrative staff including accountants, cashiers and underwriters

1.7 MATERIAL RESOURCES

1.8 ORGANISATION OF CARE SERVICES

1.9 PATIENT CIRCUIT

LABORATOIRE RADIO ECG ECHOGRAPHIE

Figure 4: patient circuit

CHAPTER 2: ACTIVITIES REALISED

It is detailed in the next chapter

 Welcoming a sick child and guiding him/her according to his/her condition.

CHAPTER 3: NURSING CARE PLAN

Convulsion episodes and grunting respiration

Hematology: Blood group AB+

high blood pressure: (-)

Feeding: feeds on demand and drinks mineral water

Respiratory rate: 40cycles per minute

Bronchopneumopathy? Associated to malaria?

Bronchopneumonia+ simple malaria

Oxygenotherapy of 5litres/ minute

Artesunate injection H0,H12, H24

Paracetamol 45mg iv of temperature exceeds 38.5⁰C

DATA ANALYSIS AND INTERPRETATION

After proper analysis of the signs.and symptoms presenting, we concluded,

Problems related to patient : anxiety, fatigue

Problem related to the disease condition : intermittent fever, respiratory distress,

Table 1:Nursing care plan for the first day of hospitalisation

Date Patient Nursing Objective Intervention Time Evaluation

08/06/202 Breathe Ineffectiv Help Reassure 9am At 1the end

(Grunt-like related breathing child grunting

Maintain Fever of Bring Eliminate 12a Patient’s

Subsequent data collection

Day 2 hospitalisation at 7am

Saturation: 95%(under oxygenotherapy)

Respiratory rate: 30cycles per minute

Complaints: baby is restless and refusing to eat