SCHOOL OF NURSING SCIENCES AND RESEARCH

SHARDA UNIVERSITY

SUBJECT ADVANCED NURSING PRACTICE

CARE PLAN
ON
APPLICATION OF THEORY ( FAYGLENN ABDELLAH’S
NEED ORIENTED THEORY)
(PRIMARY AMENORRHOEA with HEMATOCOlPoMETRA)

SUBMITTED TO SUBMITTED BY
Ms. Anushi Singh Bhawna Joshi

Associate Professor MSc. Nursing- 1st yr.

CHN, Department SNSR,

SNSR,
APPLICATION OF THEORY ( FAYGLENN ABDELLAH’S NEED ORIENTED THEORY)
MAJOR ASSUMPTION
1. PERSON
Miss. Varsha Mohan Dubda is at age of 13 years. She is diagnosed as primary amenorrhoea with
cryptomenorrhoea with hematometracolpos. Patient is having physical, Emotional and sociological needs.

2. ENVIRONMENT
Person’s surrounding environment is Hospital, Nursing Staff, Family member other patients.

3. HEALTH
Patient is having primary amenorrhoea with crypyomenorrhoea with hematometracolpos. Patient is having
small vaginal pouch.
4. NURSE
- Preoperative diagnosis
 Pain related to distention of vagina and uterus as evidence by pain scale 7/10 and verbalization
 Anxiety related to surgical procedure as evidenced by verbalization and anxious look.
 Imbalance nutrition less than body requirement related to poor economy as evidence by verbalization
- Postoperative diagnosis
 Pain related to surgical incision as evidence by pain scale 8/10 and verbalization.
 Self care deficit related to pain and surgery as evidence by verbalization
 Knowledge deficit related to lack of exposure as evidence by verbalization.
 Risk for infection related to lack of information and presence of surgical incision & I.V. intraceth.

SUMMARY
Patient is having congenital cryptomenorrhoea with hematometrocolpos. She is having acute pain. Patient is
in preoperative phase and she is planned for surgery that is drainage of hematocolpos under general
anesthesia.
- Reduce the patient and parents fear and anxiety related to surgery and outcome of disease condition.
- explained about future requirement for reference.
 THEORY APPLICATION
PERSON
Name – Miss. Varsha Mohan, Age- 13 yrs
Diagnosis- Primary amenorrhoea with
cryptomenorrhoea with Colpohematometra
ENVIRONMENT
Ward ,Father, nurses, doctors, other patients

Comfort, Hygiene and Safety Physiological changes Psychological and social factor Sociological and community
1. Hygiene and Physical comfort 1. Nutrition 1. Response to Disease factor E
Health – Patient is not able to Health- Patient has poor Health – Patient is anxious and tense 1. Emotions and illness
E N
sleep because of pain at surgical nutritional status. as she is alone in hospital and she is Health – Patient is not talking
N site. Nurse – advice the patient unknown about the condition much. Patient is alone in ward. V
- Bleeding from vagina to take High protein, Iron Nurse – Advice the patient to take worried about the disease
V Nurse – Advice the patient to containing nutritious diet. help of staff member whenever condition. I
take rest and gave analgesic 2. Elimination needed. Advice her mother to be with Nurse – Informed her about
I drugs. her. Explain about menstruation and disease condition in her language R
Health - Patient has risk of
Activity and rest urinary tract infection. its hygiene. and gave information about
R O
Health – Patient do not able to Nurse- given perineal care 2. Regulatory mechanism menstrual cycle.
O perform activity because of pain. changed pad and advice to Health – normal outflow of menstrual 2. Therapeutic Environment N
Nurse – help patient in her daily Maintain good perineal can be achieved as vaginal canal is Health – Patient is taking
N activity. Kept required things hygiene. formed. treatment from the hospital. M
near to her. 3.Fluid and electrolyte - Pain can be reduced with analgesic. Nurse – Nurse, Doctor and her
M 3. Safety Nurse – check the amount of blood. Father is providing care to the E
Health – Patient’s fluid and
Health – Patient at risk of electrolyte balance is 3. Feeling and Reaction patient.
E N
infection because of surgery, maintained. Health – Patient is having fear and
N presence of intracath and low anxiety related to disease condition. T
nutritional status. Nurse – Reduce the fear and anxiety
T Nurse- Advice the patient to keep of the patient by explaining positive
perineal area clean. Wear clean effect of treatment.
pads and change it frequently.
Administer antibiotic

ENVIRONMENT (ward, Family member, hospital, nurses, doctors )

 List of nursing diagnosis

- Preoperative diagnosis
 Pain related to distention of vagina and uterus as evidence by pain scale 7/10 and verbalization
 Anxiety related to surgical procedure as evidenced by verbalization and anxious look.
 Sleep disturbance related to hospitalization and pain as evidenced by verbalization.
 Imbalance nutrition related to anorexia as evidenced by less body weight secondary to
hospitalization.
- Postoperative diagnosis
 Pain related to surgical incision as evidence by pain scale 8/10 and verbalization.
 Self care deficit related to pain and surgery as evidence by verbalization
 Knowledge deficit related to lack of information as evidence by verbalization.
 Risk for infection related to surgical incision and presence of I.V. intracath.
 Theory
applied Assessment Diagnosis Objective Interventions Implementations Evaluation
For Miss. Varsha Sub. data : Pain related to Patient will - assess the general condition of - Assessed the general conditions Sub evaluation :
Mohan I am Patient distention of experience patient of the patient. Patient verbalizes that
going to provide complaints vagina and less pain as - assess the pain and discomfort. - Assessed the pain, tenderness & she is felling little
care by applying. about pain in uterus as evidenced by - explain about reason and its discomfort. Pain scale was 7/10 comfortable after
Fayglenn lower verbalization management - Explained the reason at her providing warm
evidence by
abdellah’s theory abdomen. of decreasing - provide the comfortable understanding level and inform applications
pain scale 7/10
Obj data : pain levels. position, assist in her work about complete recovery from -pain is not reduced
Visible and - provide non pharmacological much.
pain after surgery.
swelling at the verbalization Measures. - Provided the sideline position as
suprapubic - Use diversional activities patient is feeling some comfort in Objective evaluation :
area. - administer antispasmodic drugs this position. Patient is look little
- On palpation as per doctors order. comfortable than
- Use diversional activities such as
tenderness is before but still
watching TV or talking to other
present at tenderness is
patient and family members.
suprapubic present.ing
area and uterus
- Provided back massage
comfortable.
is palpable - Administered Inj Buscopan 20
upto below the mg I.V.at 10:00 am
umbilicus.
For Miss. Varsha Sub. data : Anxiety related Patients will - provide clear information about - provide information about Subjective evaluation
Mohan I am Patient is to surgical verbalize of surgery and ascertain for cope up surgery and its duration in her Patient verbalizes for
going to provide asking about procedure as less anxiety - accompany patient language and at her understanding reduced level of
care by applying. type of evidenced by - advice mother to be with her. level. anxiety.
Fayglenn surgery, its - give consolation - ascertain for patients Objective evaluation
verbalization
abdellah’s theory duration etc. - advice to clear doubts from understanding for outcome of her Parents and patient still
Obj data :
and anxious doctor or staff nurse. surgery. have some anxiety.
Patients looks look. - accompany patient upto O.T. and
anxious and introduce her to O.T. staff of
verbalize that I preoperative area.
am having too - advice mother to be with her till
much fear she will go for surgery.
about surgery. - Gave psychological support and
allow her to cope by her own
manner
- Advised to consult obstetrician or
staff nurse if any doubt about
surgery is there in their mind.
Theoryapplie Assessment Diagnosis Objective Interventions Implementations Evaluation
d
For Miss. Varsha Sub. data : Sleep Patient will - observe for underlying cause - pain is the reason in my patient Subjective evaluation
Mohan I am Patient disturbances not sleep of disturbed sleep for sleep disturbance. Patient verbalize for
going to provide complaints of related to during day - determine level of pain - provided information about getting good sleep
care by applying. not getting hospitalization time and looks - provide measure to assist her surgery and reason for pain during yesterday night.
Fayglenn fresh. Objective evaluation
sleep during and pain as with sleep to reduce anxiety
abdellah’s theory Patient looks fresh in
night because evidenced by - keep environment quiet -advice patient to verbalize her morning. Patient is not
of pain. patients -give sleep protocol anxiety and use diversional feeling sleepy during
Obj. data verbalization therapy. daytime.
Patient - explained effect of not
complaints of sleeping on her health.
improper - try to provide quiet
sleep at night environment by reducing noise
because of producing events in ward.
pain. patient - advice patient to take short nap
does not look before routine working hours of
fresh in wards.
morning and - advice patient to take luke
feel sleepy warm milk if possible.
during day
time.
For Miss. Varsha Subjective Imbalance - patient will - determine healthy body - Patients weight is 36 Kg which Objective evaluation
Mohan I am data: nutrition less progressively weight for age and height. is less according to her height. Patient eats given food.
going to provide Patient than body gain weight - Provide companionship at -provided food in attractive She shows interest in
care by applying. complaints of requirement mealtime manner and advice mother to be eating with companion.
Fayglenn weakness and Oral hygiene
related to - weigh client weekly under with her and if possible feed
abdellah’s theory not feeling to improved. Appetite
anorexia as same condition her.
eat food improved.
Objective evidenced by - monitor food intake. Consult - Patient is taking less food than
data: less body dietician for actual calorie requirement. So advice mother
Patient is not weight requirement. to give small feed in between.
eating secondary to - monitor state of oral cavity - Took diet plan from dietician
adequate food. hospitalization. - advice for environment and hand over to mother.
weight is 36 change. - oral hygiene is poor. So advice
Kg. only to maintain oral hygiene.
- advice mother to take her out
 for meal with permission of
staff..
Post- operative care plan
Theory
applied Assessment Diagnosis Objective Interventions Implementations Evaluation
For Miss. Varsha Sub. data : Pain related to Patient will - assess the general condition of - Assessed the pain & discomfort. Sub evaluation :
Mohan I am Patient surgical incision experience patient Pain scale was 8/10 Patient
going to provide complaint of as evidence by less pain as - assess the pain and discomfort. - Provided the semifowler position verbalizes that
care by applying. pain at surgical pain scale 8/10 evidenced by - provide the comfortable with additional pillows. patient is pain reduced after
Fayglenn site. verbalization position provide extra pillows feeling comfortable in this 1 hour
and verbalization
abdellah’s theory Objective of decreasing - , assist in her work position. Objective
data pain levels. - Use diversional activities - Assist he in changing perineal evaluation :
Patient is not - give consolation. pad. Patient is
allowing for - administer analgesics drug as - use diversional activities such as allowing to assess
any per doctors order. watching TV or talking to other for amount and
examination. patient and family members. type of bleeding.
look little
- Provided information that this
comfortable than
pain will be for short time and
before but still
reduce gradually.
tenderness is
- Administered Inj Voveran 30 mg present.ing
I.M. at 1:00 pm
comfortable.
For Miss. Varsha Sub. data : Self care deficit Patient will - assess the client’s ability to - patient can perform activity Sub evaluation :
Mohan I am Patient related to pain perform her perform within bed with help Patient verbalize
going to provide verbalize that I and surgery as activity with - help to perform daily - help the patient in brushing, for feeling fresh.
care by applying. can not evidence by assistance of activities bathing, changing clothes Objective
Fayglenn perform my caregiver. evaluation :
verbalization - explain importance of combing of hair and other
abdellah’s theory routine work.. Patient looks
Objective
hygiene activities. clean and fresh.
data - provided perineal care with all - Patient assures
Patient has not aseptic measures. that she will
change the - explained the importance of maintain good
clothes or cleanliness for good health and hygiene.
perineal pad. for prevention of infection at
surgical site.
 Theory
applied Assessment Diagnosis Objective Interventions Implementations Evaluation
For Miss. Varsha Sub. data : Knowledge Patient’s - determine mother’s - assess Knowledge available Subjective evaluation
Mohan I am Patient’s deficit related mother knowledge. with patient’s mother. She has Patient’s mother
going to provide mother ask to lack of verbalize for - determine the mother’s incomplete information about verbalize for decreased
care by applying. question information as understanding understanding level her daughter’s management. tension about her
Fayglenn of daughter.
about her evidence by - use pictures to explain - mother can understand with
abdellah’s theory information. Objective evaluation
treatment and verbalization. treatment and outcome simple explanation. Patient’s mother
outcome of - help the family to identify - used picture for her doubt thanked for providing
surgery resources for continuing clearing. information.
Obj. data information and support - advice them to meet looks less worried.
Patients obstetrician of ward staff for
mother looks their doubts or problem and take
tense and their help.
worried.

For Miss. Objective Risk for patient will - assess wound line -Assessed the general conditions No signs of infection
Varsha Mohan I data: infection show no signs - monitor vital signs of the patient and Monitor present as patients
am going to Patient has related to of infection as - assess for signs of infections patient’s vital signs. vitals ESR, WBC are
provide care by surgical wound surgical evidence by - monitor WBC and ESR count -WBC and ESR count compared within normal limit.
applying. and intracath vitals, ESR, Patient verbalize for
incision and - Administer prescribed with previous report.
Fayglenn for I.V. and WBC reduction in pain.
presence of antibiotic -Administered Inj. C-tri1gm, Inj.
abdellah’s theory injection. within normal
I.V. intraceth. limit and no - maintain aseptic technique for Metrogyl 500 mg I.V. at 11:00
increase in all nursing procedure am
pain and - advice to maintain personal -Advice to take daily bath and
discomfort. hygiene maintain perineal hygiene &
wear clean clothes
BIBLIOGRAPHY:

1. Dr Dawn C. S.. Textbook of Gynaecology, contraceptives & reproductive & demography

.16th edition. Kolkata: Smt. Arati Dawn, Debabrata Dawn
publishers;2004.chapter.10.p.77

2. Dutta D.C., Textbook of Gynaecology, 6th Edition, India: published by new central book
agency; 2004. Page no.413-415.
3. Howkins & Bourne, Textbook of Gynaecology, 13th edition, Reed Elsevier Private
Limited, Delhi; 2006. Page no. 279-80
4. Jeffcoate’s, Principles of Gynaecology. 7th edition, Jaypee Brothers medical
publication; 2008 .
Page.no.579

5. Padubidri V.G. Prep manual for Undergraduates of Gynaecology, Reed Elsevier Private
Limited, Delhi; 2005. Page no. 33.

Internet sources:

http://kidshealth.org/amenorrhoea/ cryptomenorrhoea.html

http://www.nlm.nih.gov/medlineplus/ency/article/000810.htm