Republic OF CAMEROON REPUBLIQUE DU CAMEROUN

Peace- Work- Fatherland Paix- Travail- Patrie

MINISTER OF PUBLIC HEALT MINISTRE DE LA SANTE PUBLIQUE

MINISTER OF HIGHER EDUCATION MINISTRE DE L’ENSEIGNEMENT SUPERIEUR

St LOUIS UNIVERSTY INSTITUTE DOUALA

HIGHER NATIONAL DIPLOMA (HND)

LEVEL 200 CLINICAL INTERNSHIP SESSION CARRIED OUT AT

DISTRICT HOSPITAL BOTA FROM 4TH JULY TO 19TH AUGUST 2023

CLINICAL INTERNSHIP REPORT SUBMITTED IN PARTIAL FULFILMENT

OF THE HIGHER NATIONAL DIPLOMA (HND)

NURSING DEPARTMENT

PRESENTED BY: NGIE BLANCH NJIMCHA NSG/21/0147

2022/2023 ACADEMIC YEAR

i
 DEDICATON

Dedicated to God Almighty.

ii
 ACKNOWLEDGEMENT

My acknowledgement goes to:

The internship supervisor Madame Vusheng Vera and the internship department for all their

administrative support and guidance.

The CEO of the St Louis University Institute for creating for us a conducive, learning

environment.

The Dean and staff of Medical for their academic mentorship, useful suggestions and academic

support.

The director Dr Macus Obase and general supervisor, Mme of District Hospital Limbe[DHL]

for granting us permission to learn as interns.

The staff of DHL, especially the incharge in the main theatre, for her personal follow-up to

ensure I meet up with my internship objectives.

My family and friends for their spiritual, emotional, moral and financial support.

God Almighty for life and protection throughout the internship..

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 TABLE OF CONTENTS

DEDICATON ............................................................................................................................................... ii
ACKNOWLEDGEMENT ........................................................................................................................... iii
TABLE OF CONTENTS.................................................................................................................................... iv
LIST OF ABREVIATONS AND ACRONYMS ......................................................................................... vi
CHAPTER ONE ........................................................................................................................................... 1
1.1. INTRODUCTON .............................................................................................................................. 1
1.2 .INTERNSHIP PERIOD ..................................................................................................................... 1
1.3. INTERNSHIP OBJECTIVES ........................................................................................................... 2
1.4. SIGNIFICANCE OF INTERNSHIP ................................................................................................ 4
CHAPTER TWO .......................................................................................................................................... 5
2.1. DESCRIPTION OF THE HEALTH FACILITY ................................................................................... 5
2.1.1. HISTORY ........................................................................................................................................... 5
2.1.2. Geography ....................................................................................................................................... 5
2.2.ORGANIZATIONAL CHART ....................................................................................................................... 6
2.3.FUNCTIONAL DEPARTMENTS ......................................................................................................... 7
CHAPTER THREE ...................................................................................................................................... 9
3.1. ACTIVITIES CARRIED OUT UNDER SUPERVISION .................................................................... 9
CHAPER FOUR ......................................................................................................................................... 18
4.1. CONCLUSION .................................................................................................................................... 18
4.2. SWOT analysis .................................................................................................................................. 18
4.2.1. Strengths ................................................................................................................................... 18
4.2.2. Weaknesses ............................................................................................................................... 18
4.2.3. Opportunities............................................................................................................................. 18

iv
 4.2.4.Threats........................................................................................................................................ 19
4.3. Recommendation ............................................................................................................................. 19
APPENDICES ............................................................................................................................................ 20

v
vi
LIST OF ABREVIATONS AND ACRONYMS
1. DHL: District Hospital Limbe.

2. ANC: Antenatal Care.

3. PACU: Post Anesthetic Care Unit.

4. V/S: Vagina Smear.

5. HIV: Human Immuno Virus.

6. IV: Intravenous.

7. C/S: Cesarean section.

8. MP: Malaria Parasites.

9. LMP: Last Menstrual Period.

10. EDD: Expected Date of Delivery.

11. HbV: Hepertitis b Virus.

12. PPH: Postpartum Hemorrhage.

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 CHAPTER ONE

1.1. INTRODUCTON
This report book is based on a level 200 clinical internship carried out at District Hospital Limbe

[DHL]. Students were expected to carry out certain procedures according to theoretical part and

some practice carried out while in school. We were opportune to various units such as the main

theatre, the minor theatre, antenatal care unit[ANC and the maternity. We were able to carry out

some clinical practice based on the theory learned in school and also as directed by the staff we

worked with. Although certain procedures were restricted for students in some units. This

notwithstanding, it was a good experience.

1.2. INTERNSHIPPERIOD

An internship period is professional learning experience that offers meaningful, practical

work related to a student’s field of study or career interest. This is a period where

students are given opportunities to witness what they have done theoretically and be able

to carry it out practically and also to learn new skills. It is done for particular period of

time as set by the school. The internship took place from the 4th of July to the 19th of

August 2023.

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 1.3. INTERNSHIP OBJECTIVES
SURGICAL NURSING INTERNSHIP [2 WEEKS]

1. Objectives: At the end of the surgical internship, the student must be able to;

2. PREOPERATIVE CARE

3. Differentiate the common purpose and setting of surgery

4. Apply knowledge of the purpose and components of a preoperative nursing assessment

5. Interpret significance of data related to the preoperative patient’s health status and

operative risk

6. Analyze the components and purpose of informed consent for surgery

7. Evaluate the importance of common preoperative laboratory and diagnostic tests

8. Examine the nursing role in the physical, psychological and educational preparation of

the surgical patient.

9. Prioritize the nursing responsibilities related to day-of surgery preparation for the surgical

patient

10. POST OPERATIVE CARE

11. Prioritize the nursing responsibilities in admitting patients to the post anesthesia care

unit[PACU]

12. Prioritize the nursing responsibilities in the prevention of postoperative complications of

patients in the PACU

13. Apply data from initial nursing assessment to the management of the patient after transfer

from the PACU to the general care unit

14. Select appropriate nursing interventions to manage potential problems during the

postoperative period

15. Differentiate discharge criteria from phase 1 and phase 2 post anesthesia care

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MEDICAL NURSING INTERNSHIP [2 WEEKS]

Objective: At the end of the medical internship, the student must be able to:

1. Identify all the patients he is responsible for by using interrogation and nursing and

medical records

2. Identify the basic needs to be met of all patients entrusted

3. Plan nursing care for all the patients she is responsible for

4. Carry out the medical prescriptions and the autonomous nursing care under the

responsibility of a nursing holder

5. Evaluate by the clinical and biological balancies, the state of the patients hospitalized [in

view of situate evolution of their affection]

6. Daily monitoring of the efficacy and safety of treatments administered to patients

7. Ensure the supervision of all medical patients

8. Collect statistical data on morbidity and mortality for the preparation of the monthly

report

9. Ensure continuity of care through the proper maintenance of the care plan

10. Ability to draw up and use of a nursing care plan

11. Dexterity in general nursing procedures [bed making, lifting, admission, discharge, report

writing]

12. Patient teaching in various conditions

MATERNITY

1. Admits assesses and reports a women with indications of labor

2. Participate in monitoring progress in labor

3. Participate in at least six deliveries

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 4. Do examination of the placenta and membranes and report

5. Carries out and report on the physical examination of at least six newborn babies

6. Monitors and reports on the post natal state of at least six mothers

7. Indentifies, draws up care plans, executes and supervise nursing care plan of at least six

women admitted with obstetrical emergencies.

1.4. SIGNIFICANCE OF INTERNSHIP

Internship helps to develop and learn communication skills towards patients and other health

personnel.

It gives a wide knowledge about the medical field, activities carried out and practices that

improves and promotes health in the society.

Exposure to certain situation prepares the mind of student interns, and builds the confidence and

readiness to face the field and to overcome challenges that may be faced while in the field.

Improves the knowledge about certain procedures and different techniques on how they are

being carried out and ways to develop new skills in carrying them out.

The internship broadens our knowledge about patients information, how important it is to

maintain confidentiality between health workers and their clients.

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 CHAPTER TWO

2.1. DESCRIPTION OF THE HEALTH FACILITY

2.1.1. HISTORY
The district hospital limbe commonly known as a mother and child clinic “Bota Hospital” was

set up by the Germans during the colonial era and was later managed by the Cameroon

Development Coorperation(CDC) as Mother and Child Clinic. In 1957, the health facility was

handed to the Cameroon government and became an Intergrated District Hospital. Later on in

1996, the status of the health facility was changed to Limbe District Hospital( LDH).

The health facility is one of the 39 Health facilities found in Limbe Health District. The hospital

was contracted under the PBF project in April 2012 and till date it is still ongoing. In Limbe

health district, there are only two health facilities out of the 39 with the Contemplatary Package

of Activity(CPA). The health facilities include; District Hospital Limbe(DHL) and Regional

Hospital Limbe(RHL). Mean while the others run under the Minimum Package of

Activity(MPA).

2.1.2. Geography
Geographically, Limbe district hospital serves as the referral hospital for health care and clinics

within the Limbe health district and it covers a population of about 34,325 people.

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 2.2.ORGANIZATIONAL CHART

DIRECTOR

Board of visitors

Clinical Non-clinical
Support service Administration
departments departments

Kitchen Finance
Medicine Radiology
Laundry Human resources
Surgery Physiotherapy
Medical record
Obst.& Gynae Laboratory
Ambulance
Paediatrics Pharmacy
Engineering
Orthopaedics Nursing
Dermatology
Clinic

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 2.3.FUNCTIONAL DEPARTMENTS
DHL has many functional units with their work schedule and activities distributed as follows;

though some are not very effective.

FUNCTIONAL UNITS WORK SCHEDULE ACTIVITIES

MEDICAL UNIT Monday-Sunday Admission of patients
Morning:7am-5pm Drug administration
Night:5pm-7am Care for in-patients
MINOR THEATRE Monday-Sunday Wound dressing
Morning:7am-5pm Postoperative care
Night:5pm-7am Minor surgeries [circumcition,
nail removal, abscess etc]
MAIN THEATRE Monday -Sunday Main surgeries[c/s,
Morning:7am-5pm appendectomy, herniorrhaphy]
Night:5pm-7am Preoperative care
MATERNITY Monday-Sunday Delivery
Morning:7am-5pm Issuing of birth card/certificate
Night:5pm-7am Care for sick expectant
patients
ANC Monday –Friday Antenatal care
8am-3:30 pm Family planning
EPI Monday – Friday Vaccination
8am -3:30 pm
LABORATORY Monday –Saturday Microscopy
Mornining 8am-5pm Serology
Night 6pm-7am Biochemistry
Hematology

OPD Monday-Sunday Pre-consultation

Morning:7am-5pm
Emergency care
Night:5pm-7am

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 PHARMACY Monday –Saturday Drug dispensing
Mornining 8am-5pm
Night 6pm-7am
PEDIATRIC UNIT Monday-Sunday Medical care for children
Morning:7am-5pm
Night:5pm-7am
PHYSIOTHERAPY UNIT Monday –Friday Physical therapy
8am-3pm
EYE CARE UNIT Monday –Friday Eye consultations
8am-3pm
Eye care
ECHOGRAPHY UNIT Monday –Friday Ultrasonography
8am-3pm
X-RAY UNIT Monday –Friday X-ray scans
8am-3:30 pm
DOCTORS’ OFFICE Monday-Sunday Consultation
Examination
SECRIATARIAT Monday –Friday Issuing and storing of hospital
8am-3pm
documents
ALMONER Monday –Saturday Payment of hospital bills
Morning 8am-5pm
Issuing of receipts
Night 6pm-7am
UPEC Monday –Friday Provide ATR drugs
8am-3:30 pm
HIV testing
Supply HIV test strips
COVID CENTER Monday –Friday Diagnosing of covid 19
8am-3:30 pm
Covid vaccination
CANTEEN Monday – Friday Supply food, drinks, and other
7:30am-9pm items
ECONOME Economic activities of the
hospital

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 CHAPTER THREE

3.1. ACTIVITIES CARRIED OUT UNDER SUPERVISION

SURGICAL UNIT

Minor theatre/surgical ward

Observed and assisted in wound dressing of surgical, infected, clean, open and closed wounds

Unoccupied postoperative bed making

Drug administration of postoperative medications like, diclofenac, spasforn, trabar,

ceftriazone,metronidazole.

Participated in drug administration

Drawing of treatment guide

Monitoring of postoperative patients. This is done immediately when the patient is received from

the theatre, by monitoring their body temperature, respiration, blood pressure, pulse, drainage,

urine output, bleeding and level of consciousness and charting on the postoperative form.

Monitoring is done immediately, three times after every 15 minutes, then two times after every

30 minutes, two times after every 45 minutes and then hourly. The aim is to ensure safe recovery

from anesthesia and also for early detection and management of potential complications from

anesthesia or incision site. Postoperative medications are also administered to prevent some

complications such as sepsis.

Taking and charting of vital signs on patients’ files and report book

Assisted in setting up of IV line

9
General cleaning, high and low dusting

Take over and handing over shift

Main theatre

Identification of the different parts of the main theatre which includes: nurses’ station, dressing

room, preparatory room, operating room and the recovery room. Signing of the consent form is

done in the nurses’ station.

Preparation of a c/s drum. It is made up of 2 surgeon gowns for the surgeon and the assistant, a

fenetrated linen to expose just the operation site, 2 abdominal mobs, and plain linen to place

forceps and other equipments.

Preparation of a c/s kit. When preparing a kit for a surgery a double of each forcep is kept so that

if a forcep falls in the course of the surgery, the surgeon can easily continue with its substitute. A

cesarean section kit is made up of the following forceps; abdominal and bladder retractors,

toothed and non-toothed dissecting forceps, drape forceps, blade holders, needle holders, curved

and un-curved scissors, ring forceps, sponge forceps and artery forceps. The use of each forcep is

described on the following table:

C/S forceps and their uses

Forceps Use

Bladder retractors Used in protecting the bladder during incision

from injury

Abdominal retractors Used in opening of the abdomen to make a

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 clearer view into the body

Toothed dissecting forceps For holding tissues that can easily be injured if

held with the toothed forcep

Non-toothed dissecting forceps For grasping of tissues during suturing

Drape forceps Used to clamp drapes during the surgery so

that only the surgical site is open with no

interruptions of drapes shifting to the OP site

Blade holders To hold the blade during an incision and also

prevent the surgeon from injuries if held

directly with the fingers

Needle holders For holding of needles/sutures during suturing

Curved scissors To increase the OP site after incision in order

to prevent injuring nearby tissues

Un-curved or straight scissors To cut sutures during suturing

Sponge forceps Used during scrubbing of the OP site to hold

gause

Ring forceps Used in holding the uterus

Artery forceps Used to clamp tissues where there maybe

bleeding

Identification of the different fields in the operating room. The sterile field(the operating table),

the clean(table for gauze and plaster) and unsterile field(below the operating table and floor).

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Patient physical preparation prior to surgery(C/S). The patient is received from the door where

she changes into the shoes in the theatre, then she is taken to the preparatory room where she

changes into the theatre wear. During patient parathion, you explain every step to the patient

before carrying it out in order to have their full collaboration which will ease the procedure and

ask questions to be sure she knows why she is going in for the surgery. After this she is kept on

the preparatory bed where she will be catheterized then shaving done, setting up of IV line and

administration of premedication and loading infusions. From there she is wheeled on the

preparatory bed into the operating room.

Common laboratory tests that carried out before surgery: blood group, hemoglobin levels,

bleeding time, clotting time.

Signing of the consent form. It is done in the nurses’ station, the nurse explains the surgical

procedure to the client and the reason for the surgery. Informed consent is purposed for any

unforeseen circumstances. The form is composed of: the name, signature and national identity

number of the client, type of surgery and anesthesia, name of surgeon, name of the assistant

surgeon and the anesthetist. Here, there may also be psychological and educational preparation.

General cleaning, it is done every morning duty and after every surgery in the operating room

Drug administration during surgery

MEDICAL UNIT

Drawing of treatment guide

Carry out drug administration of drugs like ceftriazone, artesunate, gentamycin, metro and
infusions like RL, glucose 5%, normal saline, perferalgan.

Bed making, principles of bed making and reasons for bed making, bed accessories(bed raise,

side raises, drip stand, bedside cupboard,

12
Monitoring and charting of vital signs of admitted patients

Patient admission and discharge, the patient is admitted as required by the doctor after

confirmation of lab tests. The patient is received at the nurses station along with their carer. The

nurse examines the patient’s book to check if it’s a patient for admission, if yes, she presents the

various wards to them if they have not paid for any yet. The nurse then places an IV catheter as

need be and administer the medication as prescribed and rightly. Then the patient is taken to the

ward for continues care and treatment provided they meet the required needs.

In the discharge procedure, first the patient must to show to have been responding to treatment

positively and must have met up with their financial requirement. After a confirmation of

recovery by the doctor, the patient may be discharged.

Drug dosage calculation (artesunate 60mg: 2.4 * patient’s body weight) for example, if a

patient’s weight is 50kg, his dose will be 2.4*50= 120 . therefore the patient will take two vials

of artesunate which is equivalent to 12ml given IV, H0, H12, H24 and 24 hours after.

Monitoring of Bp with a manual blood pressure machine

Identification of the various parts of a sphygmomanometer (manometer guage, pressure cuff,

tubes, pressure bulb, air valve) and stethoscope(tubes, ear piece, diaphragm, bell)

Patient presentation ( name, age and sex, diagnosis or reason for admission, current medication ,

vitals of the previous shift)

Went on rounds with the doctor and nurses on duty

Taking and handing over duty

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MATERNITY

The maternity is divided into different sections such as; the nurses’ station, dressing room, 2

delivery rooms, labour room, neonatal beds with over head lamp warmer, sink for cleaning of

forceps and other equipments used during a delivery, post delivery ward, malaria in pregnancy

ward.

Activities observed/ carried out under supervision

Baby’s bath: to carry out a baby’s bath, first seek the consent of the mother, assemble bathing

requirements (soap, hand towel, towel, warm wrapper (heat warmer bulb), bathing bowl, warm

and cool water, oil) and baby’s dresses with the carer or mother’s help. Use warm water and

when diluting hot water, put the cold one in the bowl first to prevent burns. Undress the baby in

the mother’s presence and explain every step to her as the procedure carries on. Limit explosion

of the baby, while the baby is undressed, take her weight, head circumference, trunk

circumference, length and mid upper arm circumference. Star by washing the baby’s face, then

the head and wash out of the water on clean towel, then rinse thoroughly. Wipe her

systematically, one part after the other. Apply eau de colygne if available and oil. Start dressing

from the head, the extremities, inner wear, diaper, then use citheal and gauze to clean the

umbilical cord, start from the top, sideward and round. Use only one side of the gauze at one

point in a time then complete dressing and take the baby to the ward with all left over materials.

Drawing of treatment guide

Observed and assisted in assessment of a woman in labor. Head – to – toe examination, blood

pressure, pulse, fetal heart rate, vaginal examination, abdominal circumference, pelvic grip,

uterine contraction.

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Observed delivery ( second stage of labor). When crowning and descent takes place fully, the

woman bears down with contractions for expulsion of the baby.

Assessment of progress of labor. Examine for regular uterine contraction, cervical dilatation,

molding, descent.

Delivery of the placenta: after expulsion of the baby and administration of oxytocin, monitor for

signs of seperation of the placenta which are uterine contraction, gorge out of blood from the

vagina, lenghthening of the cord. Rap the cord on the forcep and do cord traction, then role out

the placenta gently.

Placenta examination: after the planta is expulsed, examine for missing lobes on the maternal

side, the uterine revision is done.

Delivery through episiotomy and suturing with local anesthesia

Delivery with 2nd degree tear and management by suturing with local anesthesia

Carry out cleaning after deliveries

Monitoring of fetal heart rate with a doppler

Administration of vitamin k for the mother and baby to prevent bleeding and erythromycin on

the neonate’s eyes

Observed neonatal asphyxia management, through back massage to activate the lungs and

robbing of the feet, then administration of oxygen.

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Essential care of a newborn; skin-to-skin contact with mother, clamp the cord, assess breathing,

prevent infection by administering tetracycline eye ointment, keep the neonate warm with

clothing and/or lamp warmer, initiate breastfeeding.

Management PPH; identify the cause and manage, the pph was caused by retained tissue

(placenta), manual removal of the placenta was carried out, suctioning of bleeding, resuscitation

of fluid was done using normal saline. Due to persistent bleeding with no progress after the

intervention, the case was referred for better management at a referral hospital.

ANC/FAMILY PLANNING(FP)

General cleaning, carried out every morning before the activities begin

Clerking of pregnant women

Booking clinic. This is the first visit a pregnant woman attends. During this visit, she is supposed

to do an echography and carry out tests like; HbV, Blood group, toxo, Hb, Urinalysis, V/S,

TPHA, HIV, Mp. Where, HIV and MP are done for free. Her EDD and gestational age is also

calculated based on her LMP.

Examination: A head – toe exam is performed and the abdominal circumference, fundal height,

fetal heart rate and pelvic grip are also taken down.

Danger signs to report in a pregnant woman. They include; fever, dizziness, convulsions, intense

permanent headaches, oedema of the face, hands and legs, blurred vision, continuous vomiting

after the first three months of pregnancy with deterioration of general condition of a woman,

intense stomach pain, abnormal vaginal discharge, uterine hemorrhage.

16
Consultations for family planning. This is to educate the client on the various FP methods and to

know the past or current FP method she has used. After selection of the appropriate

contraceptive, she is supposed to do a pregnancy test and ensure its negative before she can be

placed on any contraceptive.

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 CHAPER FOUR

4.1. CONCLUSION
Conclusively, the internship recorded a success as we were opportune to observe and assist in

some procedures not witnessed before, for example assisted in a normal vaginal delivery which

was new like PPH, and episiotomy. Some staff were willing to help n developing new skills and

ameliorating some, though some unwilling to teach interns. Despite the challenges faced, with

the poor weather condition being a contributive factor, the internship carried on successfully.

4.2. SWOT analysis

4.2.1. Strengths
The hospital s large and made up of many functional departments and most of the departments

work 24 hours, t s also well supplied with staff. We started the internship on time and also ended

on time with no complications.

4.2.2. Weaknesses
There was no post anesthetic care unit (PACU) at the hospital, thus my objectives in the PACU

were not attained.

Due to the presence of so many other schools, there was over population n the hospital which

made learning so difficult. Also, n some units, there was no set place for students to keep their

bags, as a result, students had to keep bags n the corridors which led to so many thefts.

4.2.3. Opportunities
We were opportune to see some deal characteristics of a theatre, also had the opportunity to

witness the D&C procedure, episiotomy, postpartum hemorrhage and second degree tear. We

equally had the chance to see some machines used n the theatre to ease surgery like the pulse

oximeter that could ease Bp, oxygen saturation and pulse monitoring.

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4.2.4.Threats
The working conditions were mostly under pressure from some staff which made learning very

difficult. The caps provided to us by the school along with the hospital wear was rejected and a

different one was proposed which was mandatory, forcing interns to get new caps which was not

planned for.

4.3. Recommendation
Before going on internship, findings should be done on the dressing code of interns in that

hospital and what they may need in addition to what they have.

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APPENDICES

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