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UTERINE PROLAPSE
The Student 1 Teacher will ------- Define Prolapse
6  DEFINITION:-
will be able to min explain and of uterus.
Uterine prolapse is falling or sliding of the uterus from its normal
define uterine students will
position in the pelvic cavity into the vaginal canal.
prolapse. listen carefully.

7 The Student 2 What are the

 CAUSES:-
will be able to min Teacher will causes of
According to Book According to patient
identify causes explain and ----- uterine
 The ligaments that hold the uterus weakens. Absent
of prolapse of students will prolapse?
Uterine muscles also weaken.
uterus. listen carefully
 A woman with two or more vaginal birth are at Present
great risk.
 Pregnancy at the age of 35 and above is at risk. Absent
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 Pressure on the pelvic Absent
region brought about by
chronic cough and obesity.
 Lack of estrogen hormone Absent
after menopause
 Chronic constipation during pregnancy. Present
 A tumor can
Absent
be a cause of
uterine
prolapse but is
very rare.

 Intense bearing down during childbirth even when

Absent
there are no contractions.
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According to Book According to patient
 Conditions leading to Absent
increased pressure in the
abdomen such as chronic
cough or an accumulation
of fluid in the abdomen

1  DEGREE:-
8 The Student Teacher will Explain degrees
mi Chart
will be able to n According to Book According to patient explain degrees of prolapse of
recognize  Muscle weakness or relaxation may allow uterus Patient has second with the help of uterus.
degree of to sag or come completely out of body in various degree of uterine chart and
prolapse of stages: prolapse. students will
uterus. 1. First degree: The cervix droops into the vagina. listen carefully
2. Second degree: The cervix sticks to the opening
of the vagina.
3. Third degree: The cervix is outside the vagina.
4. Fourth degree: The entire uterus is outside the
vagina. This condition is also called procidentia.
This is caused by weakness in all of the
supporting muscles.

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9 The Student 3  SIGNS AND SYMPTOMS:- Enumerate signs

Flash cards
will be able to min Teacher will and symptoms
According to Book According to patient
list out signs explain with the of prolapse of
 Minor prolapse of the uterus may not cause any
and symptoms help of flash uterus.
problems.
of prolapse of cards and
 More severe prolapse can cause: students will
uterus.
1. Increased vaginal discharge listen carefully
Present
2. Feeling that something is coming out of the
Present
vagina.

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According to Book According to patient
3. Dragging sensation in the lower abdomen and Present
back

 If cystocele is present, symptoms include: Cystocele is not present

1. Difficulty in starting and stoping urination,Urinary in patient
frequency,
2. A feeling that the
bladder needs
emptying again soon
after urination, and
3. Problems controlling
the bladder.
4. Frequent urinary
infections may result
if the bladder never empties properly.

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According to Book According to patient
 Rectocele may cause: Rectocele is not
1. D i f f i c u present
l int patienty e m p t y i n
feeling that
the rectum is
full and needs
to be emptied.
2. Constipation can become a problem.

 Some common Symptoms of Uterine Prolapse :

1. Difficult or painful sexual intercourse.

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 According to Book According to patient
2. Low backache. Present
3. Feeling of rectal fullness. Absent
4. Constipation. Present
5. Sensation of heaviness or pulling in the pelvis. Present
6. Vaginal discharge. Present
7. Sensation of fullness in the vagina. Present
8. Protrusion of pink Present
tissue from the
vagina that may be
irritated or itchy.
9. Frequent urinary tract infections Absent

 DIAGNOSTIC TEST:-

10 The Student 2 According to Book According to patient Teacher will Explain

min 1. HISTORY History is collected explain diagnostic test
will be able to and
 History should be checked from the patient students --- of prolapse of
explain will
diagnostic test for signs and symptoms regarding onset and listen carefully uterus.

of prolapse of of uterine prolapse, cystocele presence of symptoms

uterus. and rectocele.

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According to Book According to patient
 2. PHYSICAL EXAMINATION
 The findings depend upon the type of prolapse. By inspection mass
 A negative findings on inspection in dorsal can be seen
position should be reconfirmed by asking the protruding from
patient to strain on squatting position. introitus.
 In second or third degree of prolapse, inspection
can reveal a mass protruding out through the
introitus.
 In first degree of uterine Speculum

descent, the diagnosis is examination is done

made through speculum in patient. By this she

examination when one is diagnosed as

finds the cervical descent having 2nd degree

below the level of ischial uterine prolpse

spines on straining.
 In others, however the external os is visible on
separating the labia.
 To diagnose a third degree prolapse, palpation is
essential.

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According to Book According to patient
 If the thumb placed anteriorly and the fingers Ulceration is not seen
 posteriorly above the mass outside the introitus in patient
are apposed, it is a third degree.
 There may be evidences of decubitus ulceration.
3. BIMENUAL EXAMINATION
 Bimanual examination reveals shallow vaginal Bimanual
fornices and normal length of the vaginal cervix examination is not
with normal size uterine body. done in patient.
 The introduction of a
sound reveals
marked increase in
length of the uterine
cavity. This signifies
elongation of the
supravaginal part of
the cervix.

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11 The Student 10  TREATMENT:- Teacher will Handout Describe briefly
will be able to min According to Book According to patient explain with the regarding
describe EMERGENCY DEPARTMENT CARE: Patient has 2nd degree help of handout treatment of
treatment of 1. Emergency department care consists of the uterine prolapse so and students prolapse of
prolapse of following: Early diagnosis of uterine prolapse she was not will listen uterus.
uterus. 2. Patient education - Risk factors, how to prevent and prescribed carefully
early detect prolapse conservative
3. Early detection and treatment of complications approach.
4. Consultations - Obstetrician/gynecologist (OB/GYN)
for definitive management

CONSERVATIVE
1. Exercise
 Special exercises, called Kegel exercises, can help
strengthen the pelvic floor muscles.

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 According to Book According to patient
 This may be the only treatment needed in mild cases
of uterine prolapse.
 To perform Kegel exercises, ask the patient to
tighten the pelvic muscles as if she is trying to hold
back urine for few seconds and then release, to be
repeated 10 times, up to 4 times a day.

2. Vaginal pessary Not advised for

 A pessary is a rubber or plastic doughnut-shaped patient
device that fits around or under the cervix,
helping to support the uterus and hold it in place.
 Pessaries are available in different varieties
(Smith-Hodge, donut, cube, or inflatable).
 They require the replacement of the uterus and
cervix to their original position in the pelvis
before placement of these devices.
 Pessaries are available in varying sizes and
should be properly fitted to the patient. The
perineum must be capable of holding the pessary
in place, or the pessary will frequently fall out.

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 According to Book According to patient
Proper care includes regular removal and cleaning,
removal before sex, as well as use of vaginal estrogen
cream for postmenopausal women with vaginal atrophy.

 Complications from vaginal pessaries are rare

with proper use, but do include vaginal
infections, bleeding, discomfort, vaginal erosion
or ulceration, and impaction

3. Estrogen replacement therapy Not advied for patient

 Taking estrogen may help to limit further
weakness of the muscles and other connective
tissues that support the uterus

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 According to Book According to patient

 H o w e v e r , s o m e

include an increased risk of blood clots,

gallbladder disease, and breast cancer.

Not done.
4. Surgical
1. Vaginal hysterectomy with a vaginal vault
suspension
 The uterosacral and cardinal ligaments are preserved,
so that they may be used in the support of the vault.

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According to Book According to patient
 The uterosacral ligaments should be sutured together
so that the cul-de-sac is shortened or obliterated.

2. Abdominal hysterectomy Abdominal

 Under hysterectomy is done
certain for patient.

circumstances, like pelvic inflammatory disease

or previous intra-abdominal operation for an
inflammatory process, such as endometriosis, a
vaginal hysterectomy is not advisable.
 Instead, an abdominal hysterectomy may be
performed, followed by a vaginal anterior and
posterior colporrhaphy, if needed.

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 According to Book According to patient
 Under these circumstances, the cardinal and
uterosacral ligaments should be treated as noted
earlier.

3. Colpocleisis Not done

 In elderly women who are no longer sexually active,

a simple procedure for reducing prolapse is a
colpocleisis.

 The classic procedure was

described by Le Fort and
involves the removal of a
strip of anterior and
posterior vaginal wall, with
closure of the margins of
the anterior and posterior wall to each other.

 This procedure may be performed with or without

the presence of a uterus and cervix; when it is
completed, a small vaginal canal exists on either side

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 According to Book According to patient
of the septum. Prognosis for a colpocleisis procedure to
reduce the prolapse and prevent recurrence is generally
excellent. Case series report 91-100% success rates.

4. Sacrospinous fixation Not done

 A special circumstance involves the treatment of
women who wish to maintain their fertility
despite the fact that they have a total uterine
prolapse.
 In the procedure, uterosacral ligaments
bilaterally could be sutured to the sacrospinous
ligaments, thereby reversing the prolapse.

5. Sacrohysteropexy Not done

 This procedure uses a strip of synthetic mesh to hold
the uterus in place.
 The operation is performed abdominally, either
through a 15-cm incision or laparoscopy.
 One end of the mesh is attached to the cervix and top
of the vagina and the other to a sacral bone.

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According to Book According to patient
  Once in place, the
mesh supports the
uterus.
 Recent
publications
suggest that
synthetic meshes
are promising for
vaginal prolapse
repair.

 COMPLICATION:-
12 The According to Book According to patient List out
Student
2 Teacher will
 Operative: No any complication
complications of
will be able to mi explain and ---
1. Haemorrhage developed at the time
n prolapse of
enumerate students will
2. Trauma of operation or after
complications listen carefully uterus.
operation
 Post-operative:
of prolapse of
uterus. 1. Retention of urine due to spasm, oedema and
tenderness of muscle, oedema of urethral wall
2. Haemorrhage

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According to Book According to patient
3. Infection
 4. Sepsis
 Late:
1. Recurrence of prolapse
2. Vesico-vaginal fistula following bladder

injury
3. Recto- Vaginal fistula following rectal injury
Teacher will What are the
13 1 4. Infertility
The Student explain and measures to
mi ---
will be able to n students will prevent uterine
 PREVENTION:-
listen carefully prolase?
 Prenatal and postpartum Kegel exercises help in tightening the pelvic floor
musculature. These exercises also help to strengthen the vaginal muscles.

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identify  For postmenopausal women estrogen replacement therapy is highly
preventive recommended. This will help them maintain their muscle tone including the
measures of pelvic muscles.
prolapse of
uterus.  Try and maintain a healthy weight, this will
help prevent such conditions.

 Cut down on smoking.

 Eat a healthy diet.

 Follow proper and correct lifting techniques, minimize lifting heavy things.

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14 The Student 10  NURSING MANAGEMENT:- Teacher will Cut-outs List out Pre
min
will be able to  PRE-OPERATIVE: explain with the operative and
plan nursing Pain : help of cut-outs post-operative
care of patient  Administered analgesic as prescribed. and students diagnosis.
with prolapse  Provided comfort measures such as backrub. will listen
of uterus.  Provided diversional activities such as guided imagery and socialization. carefully

Constipation :
 Administered stool softeners/laxatives as prescribed.
 Encouraged increase in fluid and fiber intake.
 Encouraged early ambulation.
Urinary Incontinence :
 Determined if client is aware of incontinence.
 Developmental issues/ medical conditions that can impair patient’s
awareness and sensory perception of voiding.
 Determined patient’s particular symptoms (e.g. continuous dribbling).
 Implemented bladder training for incontinence management by providing
ready acces to bathroom or commode, encouraging adequate fluid intake,
and establishing voiding/bladder emptying.
Sexual dysfunction :
 Provided factual information about individual condition involved to

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promote informed decision making.
  Provide for ways to obtain privacy to allow for sexual expression for
individual and/or between partners with out embarrassment and/or objection
of others.
 Established therapeutic nurse-client relationship to promote treatment and
facilitate sharing of sensitive information.
Risk for Infection :
 Observed for localized signs of infection.
 Noted for signs and symptoms for sepsis.

 Stressed proper hand hygiene.

1. Anxiety:
 Assessed anxiety level of the client.
 Explained about surgical procedure to
the client.
 Given psychological support to the client.
 Explained regarding post operative condition to the client.
 Cleared all doubts of patient.

 POST-OPERATIVE:
1. Acute Pain
 Establishd rapport and assessed pain on pain scale.

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  Emphasized ordered diet

 Monitored vital signs

 Provided comfort measure and comfortable position

 Encouraged deep breathing

 Provided safety measure

 Developed communication

 Reviewed procedures/expectations and told client when treatment will hurt

 Administered analgesics as indicated to maximal dosage as needed

2. Hypothermia

 Established rapport
 Monitored  vital signs
 Removed wet clothing and wraped her in
warm blanket

 Avoided use of heat clamps or hot water

bottles

 Administered medications to prevent shivering

 Administered fluids during rewarming

 Kept client quiet

 Provided well-balance high calorie diet

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  Performed range-of-motion
exercises
 Encouraged to do cough/deep
breathing exercises
 Avoided restrictive clothing
 Protected skin by repositioning,
applyed lotion and avoided direct contact with heating appliance or blanket
 Provided patent airway with humidified oxygen when used
3. Deficient Fluid Volume
 Monitored vital signs
 Assessed signs of dehydration.
 Encouraged increase oral fluid intake
 Provided supplemental fluids as ordered

 Monitored intake and output chart.

4. Fatigue

 Established rapport

 Monitored vital signs

 Evaluated the need for individual assistance and discuss lifestyle changes
imposed by fatigue state

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  Established realistic activity goals with client

 Instructed client in ways to monitor responses to activity and significant

signs and symptoms
5. Risk for Infection

 Monitor vital signs

 Noted signs and symptoms of

sepsis

 Provided wound healing such as

cleaning of wound

 Mainted aseptic technique.

 Provided care, changed dressing as needed

 Encouraged increase intake of Vitamin C

 Encouraged deep breathing exercise.

15 The Student 1  HEALTH EDUCATION:- Teacher will How will u give

min
will be able to  Advised patient to avoid heavy lifting explain and health education
---
give health  Encouraged patient to take high calorie and high protein diet. students will to patient?
education to a listen carefully
 Discussed all the symptoms of menopause and about hormonal replacement
patient with therapy.
prolapse of  Advised patient to modify her life style and to perform exercises.
uterus.
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 Taught patient regarding signs and symptoms of infection and how to
prevent it.

 Given instructions regarding schedule and dosage of medicines.

 Advised to take plenty of fluids.

 Advised regarding follow up after a week.

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 INTRODUCTION:-

I, Miss Karishma Shroff, student of 1 st year M.sc. Nursing

have selected Mrs. Zarinabanu Sabbirbhai Khokhar for my clinical presentation.
She is diagnosed having uterine Prolapse. I have given pre-operative as well as
post-operative care to this patient for 5 days. History and other useful data are as
below:
The Student Teacher will What is the
1. 1 Case file of
will be able to min  IDENTIFICATION DATA: explain with the diagnosis of my
patient
recognize help of case patient?
o Name: Mrs. Zarinabanu Sabbirbhai Khokhar
patient having paper and
o Age: 38 years
prolapse of student will
uterus. o Sex: Female listen carefully.
o Diagnosis: Uterine Prolapse

o Date of admission: 31/12/2010

o Dr’s unit: Dr. Rajal

o IP No: 10744

o Bed No: 16

o Ward No: Gynaec Ward

o Address: 1, Silver park, Behind A Ward, Juhapura, Ahmedabad.

o Education: 9th std pass

o Religion: Muslim
SR SPECIFIC TI CONTENT TEACHING A. V. EVALUA-
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o Surgery done: Abdominal Hysterectomy
o Date of surgery: 3/1/2011

2 The Student 5  PRESENT HISTORY:

min Teacher will Case file of What are the
will be able to
Mrs. Zarinabanu, 38 years old came with the complaint of explain by patient symptoms my
identify history
something coming out per vagina, burning micturation and painful intercource asking patient By asking patient was
of patient
from 3 months. She was also having constipation. History collected and bimanual and student will questions to giving when she
having prolapse
examination done. She was diagnosed as having 2nd degree uterine prolapse. No listen carefully patient came to
of uterus.
symptoms of cystocele and rectocele were found. Pre-operative investigation done hospital?
and patient was advised Abdominal hysterectomy on 3rd January 2011.

At present patient has abdominal incision. Dressing is advised on

alternative days. Folley’s catheter present. Patient is ambulatory. Full diet is
advised for patient. Breathing Exercise is advised for patient. No signs of infection
were found. No any complication arised during surgery.

 PAST HISTORY:

1. MEDICAL:- Patient has no past history of any major illness like diabetes
mellitus, hypertension, jaundice, heart disease etc.
 2. SURGICAL:- No history of any surgeries.

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 GYNAECOLOGICAL HISTORY:-
Patient has no any past history of gynaecological complain. She had
menstruation at the age of 14 years. She was having regular periods 28 days cycle.
Flow was heavy. L.M.P. is on 18/12/2010.

 FAMILY HISTORY:-

Patient belongs to joint family. She lives

with her 5 family members. There is no history of any
communicable disease or genetic disorders among the family members.

FAMILY CHART

SR Name Relation Age S Educa Occupation Health

No
with head of in e tion
the family year x

1. Mr. Salauddin Head 65 M 9th std Shopkeeper Healthy

2 Mrs. Halimabi Wife 62 F 2nd std Housewife Healthy

3 Mr. Rahil Son 41 M B.com Shopkeeper Healthy

 4 Mrs. Zahira Daughter in 38 F 9th std Housewife Patient
law

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SR Name Relation Age S Educa Occupation Health
No
with head of in e tion
the family year x

5 Miss Grand- 14 F 9th std --- Healthy

. Rubana . daughter . . . . .

6 Mast. Aarif Grandson 12 M 7th std ………….. Healthy

7 Mr. Yasin Son 35 M B.A. Shopkeeper Healthy

8 Mrs. Zeba Daughter in 32 F B.A. Housewife Healthy

. . Law . . . . .

9 Miss Kamila Grand- 8 F 3rd std -------------- Healthy

. . daughter . . . . .

10 Mast. Yasin Grandson 5 M --- -------------- Healthy

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 SOCIOECONOMIC HISTORY:-
The patient belongs to lower middle class
family. They are having cloth shope. Their family
income is Rs. 20,000 per momth which is adequate for
them. They are having good relationship with
neighbours and society.

 PERSONAL HISTORY:-

She has not any bad habits like smoking, tobacco chewing etc.
Her sleep pattern is adequate. She likes travelling and cooking.

 NUTRITIONAL HISTORY:-

She is non-vegetarian. She used to eat two times a day.

24 Hours Dietary Recall

Breakfast: 1 glass tea and 2 chapati

Lunch: 1 bowl sabji, 3 chapati, 1 bowl rice and 1 bowl dal

Evening : 1 cup tea and 4-5 buiscuits

 Dinner : 1 bowl khichadi and 1 bowl curry

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3 The Student 10  PHYSICAL EXAMINATION:- Teacher will Demonstra- What are the
min
will be able to demonstrate tion on symptoms we
1. General Appearance:-
perform physical patient have seen in
 Body Built: Moderately Nourished
physical examination on genitourinary
examination of  Look: Anxious patient and system of
patient having  Height: 162 cm student will patient?
prolapse of  Weight: 62 kg watch it
uterus. carefully
2. Vital Signs:-

 Temperature:

 Pulse:

 Respiration:

 B.P.:
3. Head and Neck:-

 HAIR: Thick, Normal hair distribution

 SCALP: No dandruff or no any mark of injury

 FACE:
 EYES: Eyes are symmetrical in
size and shape
 Visual activity normal
Pupils are reacting to light
Conjunctive is pale in colour

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Eyebrows and eyelashes normal

No discharge from the eye.
 NOSE: No septal deviation
No abnormal discharge from the nose
External nares normal
Sence of smell normal
 EARS: Earwax is present in external auditory canal in both ears
No any abnormal discharge from ears
No any readness or inflammation
Hearing
activity normal
 MOUTH: Lips are pale
Teeth are mormal
Gums are weak
Tongue is pale
No any signs of any kind of infection in mouth
 Halitosis present
 THROAT: No tonsillitis
No dysphagia

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 NECK: Full range of motion

No any palpable lymphnodes
No jugular vein distention
4. Chest:-

 Symmetrical in size and shape

 Equally chest expansion
 Brest are normal, equal in size and shape, no
signs of infection

 No any abnormal lung sound heard during

auscultation

 Respiration rate is 22/ min

5. Abdomen:-

 Slight abdominal distention

 Symmetric in size and shape

  No any mark of previous
surgery

 No any organ like liver, spleen

or kidney palpable

 Bowel sounds diminished

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6. Extrimities:-

 Full range of motion of all joints with full strength.

 No edema, numbness or
pain
7. Back:-

 Normal curvature of spine

 No kyphosis, scoliosis or
lordosis

8. Genitalia:-

 2nd degree uterine prolapse present

 Redness present

 Vaginal discharge present

  No
other
signs
of

infection

 SYSTEMWISE EXAMINATION:-
1. Central Nervous System:

 Patient is conscious, oriented to time, place and person

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 All reflexes and responces are normal

 No headache, dizziness etc

2. Cardiovascular system:

 Heart rate: 80 beats/min

 No palpitation, tachycardia etc.

 S1 and S2 heard normally

 No any abnormal sound like murmur

heard on auscultation

 Blood pressure: 130/90 mm of Hg

  No cynosis
3. Respiratory system:
 Normal Respiratory pattern
 Respiration: 24/ min
 No cough or Dyspnea
 No any abnormal breath sound or
lung sound heard on auscultation
4. Digestive System:

 No dysphagia or heart burn

 No abdominal pain or distension

SR SPECIFIC TI CONTENT TEACHING A. V. AIDS EVALUA-

No. OBJECTIVE ME LEARNING TION
ACTIVITY

 No nausea or vomiting
 Sometimes constipation present
 Normal passage of stool

5. Musculo-skeletal System:
  Full range of motion of all joints

 No joint pain or swelling

 Normal posture
6. Genito urinary system:

 Uterine body is outside the vagina

 Burning micturation present

 Driblling of urine occurs

 Vaginal discharge present

 No other signs and symptoms of

infection

SR SPECIFIC TI CONTENT TEACHING A. V. EVALUA-

No OBJECTIVE ME LEARNING AIDS TION
. ACTIVITY
4 The Student 5  INVESTIGATION:- Teacher will Reports of List out the
min
will be able to explain with the patient investigations
1. COMPLETE BLOOD COUNT
list out help of done in my
DATE INVESTIGATION PATIENT’S NORMAL
investigation of VALUE VALUE investigation patient
patient having reports and
1/1/11 Hb 14.4 G/dl M-11.0-17.0 G/dl
prolapse of . . F-12.3-15.3 G/dl student will
uterus. Red Cell Count 4.97 M- 4.5-5.9 listen carefully
. million/cumm million/cumm
. . F- 4.5- 5.1
. . millon/cumm
 Blood Indicies
Hematocrit 43.7% M- 41.5-50.4 %
. . F – 35.9-44.6 %
MCV 88 FL 80-96 FL
MCH 29.1 PG 27.5-33.2 PG
MCHC 33.1 gm/dl 33.4-35.5 gm/dl
RDW 16.1% 11.6-14.7 %
WBC 9430 /cumm 4400-11000/cumm
Differential Count
Neutrophills 78% 50-70 %
Lymphocytes 15% 20-40 %

SR SPECIFIC TI CONTENT TEACHING A. V. EVALUA-

No OBJECTIVE ME LEARNING AIDS TION
. ACTIVITY
DATE INVESTIGATION PATIENT’S NORMAL
VALUE VALUE

Monocytes 2% 2-6 %
Eosinophils 5% 1-6 %
Basophils 0 0-2.5 %
Platelet count 3,14,000/cumm 1,50,000- 4,50,000
/cumm

2. COAGULATION AND HAEMOSTATIC TESTS

 DATE INVESTIGATION PATIENT’S NORMAL
VALUE VALUE

1/1/11 Prothrombin time 11.4 sec 9.5-14.1 sec

3. SERUM ELECTROLYTES

DATE INVESTIGATION PATIENT’S NORMAL

VALUE VALUE

1/1/11 Potassium 5.2 meq/L 3.5- 5.5 meq/L

Sodium 13.0 meq/L 137-148 meq/L
Chloride 98 meq/L 97-108 meq/L

SR SPECIFIC TI CONTENT TEACHING A. V. EVALUA-

No OBJECTIVE ME LEARNING AIDS TION
. ACTIVITY
4. SERUM BIOCHEMISTRY TEST

DATE INVESTIGATION PATIENT’S NORMAL

VALUE VALUE

1/1/11 RBC 87 mg/dl 70-140 mg/dl

Urea 16 mg/dl 15-45 mg/dl
S. Creatinine 0.54 mg/dl . M – 0.7-1.5 mg/dl
. . F – 0.6- 1.5 mg/dl
SGPT 27 U/L 0-55 U/L
 S. Alkaline Phosphatase 53 U/l 50.0-150 U/L
S. Billirubin Total 0.8 mg/dl 0.2- 1.2 mg/dl
0.0- 0.5 mg/dl

5. X-RAY

DATE IMPRESSION

1/1/11  Bi-lateral lung field normal

 Bi-lateral CP angles clear
 Heart size normal
 Bony Thorax Normal
 Bi-lateral domes of diaphragm normal
SR SPECIFIC TI CONTENT TEACHING A. V. AIDS EVALUA-
No. OBJECTIVE ME LEARNING TION
ACTIVITY

6. URINE EXAMINATION

DATE INVESTIGATION PATIENT’S VALUE

 1/1/11 Physical
Quantity 8 ml
Colour Yellowish
Transparency Clear
Chemical
Reaction Acidic
Sp-Gravity QI
Albumin Nil
Sugar Nil
Acetone Nil
Bile Salt Ab
Bile Pigment Ab
Microscopic
Pus cells 1-2 /HPF
Epithelial cells 1-2 / HPF
R.B.C Nil
Casts AB

SR SPECIFIC TI CONTENT TEACHING A. V. AIDS EVALUA-

No. OBJECTIVE ME LEARNING TION
ACTIVITY

DATE INVESTIGATION PATIENT’S VALUE

Crystals Ab
 Others Ab

 MEDICATION:-
The Student Teacher will Patient’s Enumerate
5 2
will be able to min  Pre-operative explain with the medication drugs which
enumerate 1. Tab. Doxy 100 mg orally bd help of s was given to the
medication of 2. Tab Metro 400 mg tds medications and patient?
patient having 3. Tab. Rantac 150 mg bd student will
prolapse of listen carefully
4. Inj Ampoxine 1 gm IV stat
uterus.
5. Inj TT 0.5 ml IV stat

 Post-operative
1. Inj Ampoxine 1 gm IV bd
2. Inj Genta 80 mg IV bd
3. Inj Rantac 50 mg IV bd
4. Inj Metrogyl 100 mg IV tds