CHAPTER THREE

3.0 CARE STUDY

This chapter consist of the patient particulars, nursing assessment, concept of care, concept of admission,
physical, psychological as well as a partial care, rehabilitation, home care and diagnosis.

3.1 Patient's Particulars

[Link] - parent

[Link] of hospital - University of Maiduguri teaching hospital (UMTH)

[Link] number - 707618

[Link] - Typhoid perforation

5·Name of patient - Mr. A.M

6·Age. - 11 years

7·Sex/Gender - Male

8·Marital Status - single

9·Occupation - Student

10·Religion - Islam

11·Allergies - no known history

[Link] - completed

[Link] Address. - Dala

[Link] of origin. - Borno State

[Link]. - Nigerian

[Link] of kin. - M.A

[Link]. - . Father

[Link] - PSW

[Link] number. - 10

[Link]. - Fulani

[Link] incharge. - CNO Mairo isa

[Link]. - Dr wabada

23·Date of Admission. - 20/2/2026

[Link] of discharge. - 5/4/2026

3.2 Nursing Assessment

 Past Health History: The parent reported no prior history of chronic illnesses such as hypertension or
diabetes. He had no history of abdominal surgery. He stated he was generally healthy until the onset
of his current illness. He mentioned having a fever about 10 days ago for which he took some
"painkillers" from a local chemist but did not seek formal medical care.
 Present Health History: The patient was brought to the emergency department by his father with
complaints of sudden, severe abdominal pain that started 8 hours prior to admission. The pain began
in the lower abdomen and rapidly became generalized. He had been vomiting for the past 4 hours and
had not passed stool or flatus for the last 12 hours. His father reported that he had a fever for about 10
days before the pain started, which had subsided a day earlier. He had been increasingly lethargic and
weak.
 Family/Social History: Patient is 5th child of the family, he lives in Dala ward with parents and
siblings. They use water from a local well for drinking and domestic use. The family uses a pit
latrine. There is no known family history of similar illnesses.
 History of Medications: Before admission, the patient self-medicated with paracetamol and an
unknown "typhoid medicine" purchased from a patent medicine store. Patient was taking flagyl,PCM
and Diclofenac.

Typology of 11 Functional Health Patterns

1. Health Perception-Health Management: Patient's parents perceived him as healthy until this illness.
The believed the fever would resolve on its own, leading to a delay in seeking care. Currently, he is
totally dependent on healthcare providers.

2. Nutritional-Metabolic: there is slight change in patient nutritional status because of anorexia and fear
of vomiting. He use to eat twice up to 3 time in a day and his favorite meal is rice and stew, before the
onset of illness but on admission the patient cannot tolerate food as usual..

3. Elimination: He has not passed stool or flatus for 12 hours (constipation), which is a classic sign of
peritonitis. He reports no urinary difficulty.

4 Activity-Exercise: The patient is bedridden due to severe pain and weakness, requiring assistance with
all activities.

[Link]/Rest: patient does not sleep in the day time,but he sleeps and rest in the night for 8 - 9 hours but
the patient is unable to sleep due to severe abdominal pain.

[Link]/Perception pattern: Patient is conscious but appears lethargic and in acute pain. He is
oriented to person and place but not to time.
 7 Self-Perception-Self-Concept: He appears anxious and worried about the outcome of the disease and
[Link] was reassured about the case and treatment of his condition.

8 Role/Relationship pattern:. patient is the 5th child family and loved by entire family members.

[Link]/Reproduction pattern : Not assessed, because patient is not sexually matured.

10. Coping/Stress Pattern: patient have high body temperature, which describe as hyperthermia, and
patient usually cope with stress by playing with his peer group.

[Link]/Belief: A devout Muslim, he believes his fate is in Allah's hands and is comfortable with the
spiritual care provided.

3.3 Concept of Care

The nursing care for this patient was guided by Dorothea Orem's Self-Care Deficit Theory. This theory is
highly relevant for a post-operative patient who has a complete self-care deficit due to surgery, pain, and
IV lines and drains. The nurse acts in a wholly compensatory system, performing all activities of daily
living for the patient—including hygiene, feeding (parenteral), and mobility—until he is stable enough to
begin to participate in his own care. As his condition improves, the nurse transitions to a partly
compensatory system, teaching and supporting the patient to gradually take over his self-care, such as
turning in bed, deep breathing, and eventually ambulation.

3.4 Admission

The patient was admitted to paediatric surgical ward (PSW)via emergency paediatric unit (EPU)
department accompanied by a porter and his relatives, they were received warmly, while her folder and
admission slip were given to the ward nurse for proper filling and bed no 10 was given to him.

Patient and her relative(mother)was introduced on the geography of the ward, near by patient, general
condition of the patient is fair and was reviewed by doctor as the time of admission prescribed drugs from
EPU were served, while various investigation was carried out and sent to the laboratory for microscopic
examination. Vital signs of the patient on admission were recorded as follows;

Temperature. - 38.2°c

Pulse rate. - 163b/m

Respiration. - 46c/m

Weight. - 16.5kg

The admission procedure included:

1. Emergency Assessment: A rapid head-to-toe assessment by the surgical team to confirm the diagnosis.

2. Immediate Intervention: Insertion of two large-bore IV cannulas and initiation of IV fluids (Ringer's
Lactate).
3. Diagnostic Tests: Blood was drawn for CBC, cross-matching, and culture. An urgent erect chest X-ray
was ordered.

4. Preparation for Surgery: The patient was made NPO (nil per os) immediately. An NG tube was inserted
to decompress the stomach. A bladder catheter was inserted to monitor urine output.

5. Informed Consent: The surgeon explained the procedure and its risks, and consent was obtained from
the patient and his brother.

6. Ward Transfer: After initial stabilization, the patient was transferred to the surgical ward to be prepared
for the operating room.

3.5 Physical Care

Post-operatively, the physical care provided included:

· Wound Care: The surgical incision was assessed daily for redness, swelling, or discharge. Aseptic
technique was used for dressing changes.

· Mouth Care: Oral swabs were used to moisten the mouth and prevent sores, as the patient was NPO.

· Hygiene: The patient received a daily bed bath to maintain cleanliness, comfort, and skin integrity.
Pressure area care was provided every 2 hours to prevent bedsores.

· Grooming: The patient hair was cleaned.

3.6 Physical Measurement

On admission, the patient's physical measurements were:

· Height: 1.22c m

· Weight: 16.5kg kg

.Head circumference :42cm

.Arm circumference: 12cm

. Abdominal Grith:65-85cm

3.7 General Examinations (Head to Toe)

1. General Appearance: Ill-looking, diaphoretic, lying supine with knees flexed.

.Hair: patient is black in color.

.Eye: the eyes of the patient are normal.

.Thorax: respiration is normal.

.Abdomen: the patient has abdominal distension.

2. Palpation: there are no palpable lymph nodes on either side of the body,both the groin [Link]
tenderness of mass felt on the hypochondriac region or upper abdomen

3. Percussion: the chest is clear,no abnormalities heard but dull heard at the lower abdomen due to
accumulation of urine.

4. Auscultation: Normal heart sound and no bowel sound.

· Vital Signs (On Admission):on observation the vital signs include;

Temperature. 38.2°c

Pulse rate. 163b/m

Respiration. 46c/m

.Upper and lower extremities: no abnormalities were detected on patient body.

3.8 Baseline Investigations

S/N Blood Normal value Value

Chemistry Obtained

1 Bicarbonate 20-30mmol/L 21mmol/L

2 Chlorine 95-110mmol/L 108mmol/L

3 Potassium 3.0-5.0mmol/L 3.3mmol/L

4 Sodium 135- 146mmol/L

145mmol/L

5 Urea 2.2-2.7mmol/L 3.4mmol/L

6 Creatinine 44.132mmol/L 15.6mmol/L

3.9 Psychological Care

The patientand his parents were extremely anxious about the surgery and his survival. I provided
psychological care by:

· Active Listening: Allowing him to express his fears and concerns without interruption.

· Clear Communication: Explaining all procedures and what to expect post-operatively in simple,
understandable terms to reduce fear of the unknown.

· Family Involvement: Encouraging his parents to stay with him, providing emotional support.

· Reassurance: Providing reassurance of constant monitoring and care

3.10 Spiritual Care

In collaboration with the hospital's chaplaincy services, the patient's spiritual needs were met by:

· Facilitating Prayer: Allowing him to pray in bed, facing Mecca, as his condition allowed.

· Reading the Quran: His brother was allowed to read verses from the Quran for comfort.

· Respecting Beliefs: His spiritual beliefs were integrated into the care plan, and his autonomy was
respected.

3.11 Rehabilitation

Rehabilitation began early post-operatively. It included:

· Early Ambulation: Assisted out of bed to a chair on day 2, then short walks in the ward to prevent DVT
and promote bowel function.

· Nutritional Support: Gradual progression from clear fluids to a soft, high-protein diet to promote wound
healing.

· Education: Teaching the patient and his family about the importance of taking his drugs on time,a
nutritious diet, hygiene, and signs of wound infection to watch for at home.

3.12 Nursing Diagnosis

Based on the assessment, the following nursing diagnoses were identified for this surgical case.

Pre-operative Nursing Diagnoses (3):

1. Acute Pain related to abdominal cramp and headache as evidenced by patients verbalization.

2. Deficient Fluid Volume related to vomiting and diarrhea as evidenced by sign of dehydration(socken
eye)

[Link] related to sepsis as evidenced by elevated body temperature of about 38.2°c.

Post-operative Nursing Diagnoses (3):

1. Risk for Infection (Surgical Site and Intra-abdominal) related to contamination during perforation and
surgical incision.

2. Impaired Skin Integrity related to surgical incision and presence of drains.

3. Imbalanced Nutrition less than Body Requirements related to increased metabolic demands of sepsis
and post-operative NPO status.