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A SURGICAL CARE STUDY OF A PATIENT WITH VESICOUTERINE FISULA
AFOLABI RAFIAT TINUOLA

CHAPTER ONE
❖ Introduction
❖ Aim and objective
❖ Significance of the study
❖ Definition of terms
CHAPTER TWO
❖ Review of literature
❖ Incidence
❖ Anatomy and Physiology of Related Organs
❖ Pathophysiology
❖ Aetiology/predisposing factors
❖ Clinical Manifestations
❖ Prognosis
❖ Complication
❖ Differential diagnosis
CHAPTER THREE
❖ Patient Bio data
[1]

❖ Nursing history
❖ Physical Assessment
❖ Investigation
❖ Medical Management
CHAPTER FOUR
❖ General Nursing management
❖ Nursing Diagnosis
❖ Nursing Care Plan
❖ Observation Chart
❖ Pharmacotherapy
❖ Rehabilitation
❖ Advice on discharge
❖ Follow up care
❖ Summary and conclusion
❖ Recommendation
❖ References

[2]

TOPIC- VESICO UTERINE FISTULA/UTEROVESICAL FISTULA
BY
AFOLABI RAFIAT TINUOLA

1
...
D
...

VESICO-UTERINE FISTULA is an abnormal opening between the bladder and the
uterus
...
Vesico-uterine fistula can also be said to be an
uncommon pathological communication developing between the uterus or the cervix and
urinary bladder
...
e
...

Vesico-uterine fistula and vesico-vaginal fistula (also a genito- urinary fistula) are
perhaps the most feared complication of female pelvic surgery
...
vasavada 2015)
...
It is one of the
least acquired Urogenital fistulae with a prevalence of 1-4% and until recently around
[3]

800cares have been reported in the world literature
...
The triad
of menouria, absence of vaginal leakage of urine and menorrhoea is referred to as youssef
syndrome
...
Clinical
presentation of uterovesical fistula demonstrate variations
...
Besides they can
cause secondary infertility and miscarriage during the first trimester ( porcaro, zikari,
zucchini, antonrollli et al 2002)
...

Diagnosis of uterovesical fistula is made after exclusion of other frequently seen urogenital
fistula and demonstration of fistulous tract between the bladder and the uterus
...
If
uterovesical was made immediately after birth, dwelling of the catheter for 4-8 weeks can
provide a chance for spontaneous closure of the fistulous tract (porcarom et al 2002)

1
...


1
...

This care study intends to point out causes, clinical manifestations, predisposing factors, and
treatment of vesicouterine fistula
It will help to identify the effect it has on the affected women and it will also help to educate
the populace about the disease, lots predisposing factor and prevention hence minimizing
occurrence and stigma associated with it
...
3 DEFINITION OF TERMS
VESICAL: pertaining to the bladder
FISTULA: An abnormal connection/opening or a passage way between organs or vessels that
normally do not connect
CASEAREAN SECTION: Delivery of a baby through incision in the womb
TRANSPRITONEAL: through the peritoneum
HAEMATURIA: Presence of blood in the urine
AMENORRHOEA: Absence of menstrual blood flow
ABORTION: The cessation of pregnancy or foetal development
SYNDROME: A recognisable pattern of signs, symptoms or behaviour

[5]

MENOURIA: presence of blood in the urine
MENORRHOEA: The flow of blood at menstruation

[6]

CHAPTER 2
2
...
1 INTRODUCTION
Utero-vesical fistula is an abnormal communication between the bladder and the uterus
...
The disease presents with vagina urinary leakage, cyclic Heamauria
[menouria] amenorrhoea, infertility and first trimester abortions
...

Uterovesical fistula are rarely seen, fistula which develop between the uterus and bladder
following caesarean section [Rao, Dwivedi, Dalta, Vyas, Nandy Trivedi et al 2006]
...

The main symptom is urinary incontinence in the early post operative period but patient may
present months or years later with cyclic haematuria [menouria], amenorrhoea and urinary
tract infection
...
The patient can
complain of urinary incontinence, amenorrhoea, and cyclic haematuria
...
These problems result in decline in the quality of life of patient [Rao et al 2006]
...
In our case cyclic haematuria and amenorrhoea were present without
urinary incontinence which is the third component of the classical Youssef’s triad [Rao et al
2006]
...
Youssef hypothesized that the cervical
isthmus acts as a sphincter to prevent leakage of urine
...
In
endometriosis, the patient will have Normal Vaginal Menses in addition to cyclic haematuria
...

Diagnosis of uterovesical fistula is made after exclusion of other frequently seen urogenital
fistula and demonstration of fistulous tract between the bladder and the uterus [Porcar et al
2002]
The fistulous tract between the bladder and the uterus can be shown directly by
Hysterosalpingography and Cystography
...
Retrograde pylography and computed tomography scanning
may be necessary in some instance to demonstrate the involvement of other organs especially
when urinary extravasation has been present or inflammation bowel or bladder symptoms
have been noted [Molina, Lynne, Polytano,1989 cited by Fertiat 2003]

[8]

For diagnosis purpose, intravenous urinography [I
...
U], hysterosalpingography,
sonohysterography, cystography, methylene blue test, transvaginal ultrasound , pelvic M
...
I
and cystoscopy have been used[Fenkci, Demirbas, Oztekin et all 2010]
...
Cystography has a diagnostic value in vesicovaginal
fistula however in ureovesical fistula, intrauterine pressure is higher than intravesical
pressure, it may not aid in diagnosis[Goel, Sigh 2012]
...
In
a study performed with 12 uterovesical fistula, 100% diagnostic accuracy of pelvic MRI was
demonstrated [Abou-EL-Ghar, EL-Assmy, EL-Diashy 2012]
...

In the treatment of uterovesical fistula, conservative or surgical Techniques have been used
[Porcaro 2002] [Eogan M, Mckenna 2003]
...

For surgical repair of uterovesical fistula, transperitoneal, transvesical and transvaginal
approach have been described [Porcaro 2002]
...
Then a
patch of supportive tissues is interposed between bladder and uterus, while in the literature
use of free adipose tissue graft prepared from abdominal fat has been described [issa, Schmid,
Stamey 1994]
...
Fulguration with continous catheterization and

[9]

hormonal treatment can be successful for the treatment of vesicouterine fistula with a small
well epitheliazed orifice [Molina et al 1989 in Fertiat 2003]
...


2
...
Since then almost
800 cases have been reported to date [Yip, leung 1998 cited by Waqar et al 2008]
...
Incidence rises with caesarean section ( Nouira, Feki, et al 2005)
...
It is used to be
responsible for 83
...
Spontaneous healing is in 5% of cases
...
3 ANATOMY AND PHYSIOLOGY OF RELATED ORGANS
2
...
1 ANATOMY AND PHYSIOLOGY OF THE UTERUS
According to Ross and Wilson, The Uterus is a hollow muscular pear-shaped organ flattened
antero - posteriorly
...
In

[11]

most women, it leans forward (ante –version) and is bent forward (ante-flexion) almost at
right angles to the vagina, so that it is anterior wall rests partly against the bladder below and
forming the vesico-uterine pouch between the two organs
...
It is about
7
...
5cm thick
...
The parts
of the uterus are the fundus, body and cervix
...

THE BODY
This is the main part
...

THE CERVIX (NECK OF THE UTERUS)

[12]

This protrudes through the anterior wall of the vagina, opening it at the external Os
...

PERIMETRIUM-This is peritoneum which is distributed differently on the various surfaces
of the uterus
...
This fold of peritoneum forms the vesicouterine pouch
...

Laterally,only the fundus is covered because the peritoneum forms a double fold with the
uterine tubes in the upper free border
...

MYOMETRIUM- This is the thickest layer of tissue in the uterine wall
...

ENDOMETRIUM- This consist columnar epithelium containing a large number of mucus
secreting tubular glands
...
If the is not ferterlized and does not implant,this layer is
shed during menstruation
...

BLOOD SUPPLY, LYMPH DRAINAGE AND NERVE SUPPLY
ARTERIAL SUPPLY- This is by the uterine arteries, branches of the internal iliac arteies
...

They supply the uterus and uterine tubes and join with the ovarian arteries
...


[14]

LYMPH DRAINAGE- Deep and superficial lymph vessels drain lymph from the uterus and
the uterine tubes to the aortic lymph nodes and group of nodes associated with the iliac blood
vessels
...

SUPPORTING STRUCTURES
The uterus is supported in the pelvic cavity by surrounding organs, muscles of the
pelvic floor and ligaments that suspend it from the wall of the pelvis
...
They hang down from the uterine tubes as though draped over there and at their
lateral ends, they are attached to the side of the pelvis over them and at their lateral end, they
are attached to the sides of the pelvis
...
The uterine tubes are enclosed in the upper free border and near the lateral ends
...
Blood, lymph vessels and nerves pass to the uterus and uterine tubes and uterine tubes
between the layers of the broad ligament
...
They pass to the side of the pelvis then through the inguinal canal to
end by fusing with the labia majora
UTEROSACRAL LIGAMENTS

[15]

These originate from the posterior wall of the cervix and vagina and extend backward,
one on each side of the rectum to the sacrum
TRANSVERSE LIGAMENT
This extends forward from the transverse cervical ligament on each side of the cervix
and to the side wall of the pelvis

FUNCTION OF THE UTERUS
It helps to receive the fertilized ovum from the fallopian tube
It helps to contain and nourish the embryo and the foetus
It helps to protect the foetus during its development
It expels the fetus at term through the vagina to the outside as a result of the powerful
contraction of the myometrium
It is greatly involved in the menstrual cycle
2
...
2 UTERINE TUBES
The uterine tubes are about 10cm long and extend from the side of the uterus between the
body and the fundus
...
Opening into the peritoneal cavity
close to the ovaries, the end of each tube has finger like projections called fimbriae
...
3
...
It lies in the pelvic cavity and its size and
position vary, depending on the volume of urine it contains
...
The
posterior surface is the base
...
Posteriorly, it surrounds the uterus in the
female and the rectum in the male
The bladder is composed of three layers:

[19]

The outer layer of loose connective tissue containing blood and lymphatic vessel and nerves,
covered on the upper surface of the peritoneum
The middle layer consisting of interlacing smooth muscles fibres and elastic tissue loosely
arranged in three layers, this is called detrusor muscle and when it contracts, it empties the
bladder
The mucosa: composed of transitional epithelium that readily permits distension of the
bladder as it fills with urine, when the bladder is empty, the inner lining is arranged in folds
or rugae which gradually disappear as it fills
...
The upper two orifices on the
posterior wall are the opening of the ureter
...

The urethral sphincter is a thickening of the urethral smooth muscle of the urethra, controls
outflow of urine from the bladder
...
3
...
It is longer in males than in females
The male urethra provides a combined secretion of male reproductive system
...
The prostatic urethra originates at the urethral orifice
of the bladder and passes through the prostate gland

[20]

The membranous urethra is the shortest and narrowest part and extends from the prostate
gland to the bulb of the penis after passing through the perineal membrane
The spongiose or penile urethral lies with the corpus spongiosum of the penis and terminates
at the external urethra orifice in the glans penis
There are two urethral sphincters
...
it runs downward behind
the symphysis pubis and opens at the external urethral orifice just in front of the vagina
...
The muscle layer has two parts, an
inner layer of smooth muscle that is under autonomic nerve control and an outer layer of
striated muscle surrounding it
...
The mucosa is supported by loose fibro elastic connective tissue
containing blood vessels and nerves
...
( Mustapha R
...
4 PATHOPHYSIOLOGY

[21]

Presence of any of the causes including unrecognisable injury during a difficult hysterectomy
or caesarean section may result into the formation of a fistula between the bladder and the
uterus
Fistula resulting from vaginal delivery occurs during prolonged or obstructed labour
...
This may result into
tissue ischaemia, necrosis, and eventually fistula formation (Eogan, McKenna)
...
F
...
The shape and diameter of the isthmus lumen change
during the menstrual cycle
...
No distension of the uterine cavity takes place and the
sphincter of the uterine isthmus fails to relax because the pressure in the uterine cavity does
not increase
...
Conversely, when submitted to high pressure into the bladder, urine leaks through
the fistula from the bladder into the uterine cervix and vagina
...
The symptoms can appear early after surgery or month or even years later (
lenkovsky et al 1988)

2
...
g
...
6 CLINICAL MANIFESTATION
•

Urinary incontinence may or may not be present
[23]

•

Cyclic haematuria or menouria

•

Amenorrhoea

Other atypical presentations include
•

Recurrent urinary tract infections

•

First trimester abortion

•

Urge incontinence

•

Urethral passage of lochia

•

On vaginal examination, urine trickling through cervical os

2
...
8 PROGNOSIS
There is likelihood of uterovesical fistula after its first occurrence in women
...
9 DIFFERENTIAL DIAGNOSIS
•

Endometriosis of the bladder

•

Urge incontinence

•

Vesicovaginal fistula

•

Urethrovaginal fistula

[25]

CHAPTER THREE
3
...
D

AGE:

37years

DATE OF BIRTH:

07/05/1979

SEX:

female

RELIGION:

Christianity

NATIONALITY:

Nigeria

STATE OF ORIGIN:

Kaduna State

ADDRESS:

Lagos state, Nigeria

NAME OF NEXT OF KIN:

Mr H
...


[26]

C
...
O
...
N
...
2

NURSING HISTORY

PAST MEDICAL HISTORY
Patient has been admitted before as a result of polydatism of pregnancy (51 weeks) in a
private hospital where induction of labour was later done but she was unable to deliver in
about 8hours after the induction, after which she was referred to Lagos State University
Teaching hospital, Ifako branch, Lagos and also due to low packed cell volume (PCV) and
unavailability of blood to transfuse patient at the private hospital
...
Few hours after surgery, there was no urinary
output and she was then returned to the Theatre, nature of surgery could not be ascertained
Two days after removal of stitches
...
Site was dressed by nurses and she was transferred to

[27]

the main branch of Lagos State University Teaching Hospital where urethral catheter was
passed and urine stopped draining from operation site but urine was still escaping through the
vagina
She was being managed at the urology Department of LASUTH but she complained of poor
management and decided to present at this facility (University Of Ilorin Teaching Hospital)
Patient also has an history of peptic ulcer of 18 years duration which it cause no discomfort
but after occurrence of present illness, it resurfaced
PRESENT HEALTH HISTORY
Patient presented to this facility on account of Urinary incontinence of about 6months
duration
NUTRITION
Patient eats all kind of food, takes vegetable once in a while
...

Patient takes fruit about five times a week prior illness but intake has reduced since onset
...
Usual sleep time is 9- 10Pm, Usual Wake Time is 5am
COMMUNICATION/SPECIAL SENSES
Patient communicates well in Hausa, Kataf, English, and slightly in Yoruba
...
Parents are dead but relates well with
them when they were alive
...
Usually menstruate for 3days with moderate flow
Patient is not currently sexual active due to the present disease condition
...
3

PHYSICAL EXAMINATION/ASSESSMENT

Patient is neatly dressed with low, well kept haircut, nil physical abnormality, scar on the
lower part of abdomen secondary to caesarean section
...
4 INVESTIGATIONS
[31]

DATE

SAMPLE INVESTIGATION

RESULT

NORMAL

OBTAINED VALUE
18/5/2017

18/5/2017

BLOOD

BLOOD

HB

1
...
43

MCV

79fi

MCH

5
...
26*10

PLATELET

40%

LYMPHOCYTE

56%

MONOCYTE

0
...
4%

BASOPHIL

0
...
0-15
...
0-4
...
9-10
...
2mmol/L

CREATININE

2
...
0mmol/L

1
...
56
...
310
...
015

22/5/2017

BLOOD

AMBER

1
...
025

NORMAL

NORMAL

BLOOD

NEGATIVE ABSENT

NORMAL

PROTEIN

NEGATIVE ABSENT

NORMAL

UROBILINOGEN

NEGATIVE ABSENT

NORMAL

NITRITE

POSITIVE

NORMAL

LENTIVIRAL

NEGATIVE ABSENT

NORMAL

HB,AB

NEGATIVE ABSENT

NORMAL

ANTI-HCV

NEGATIVE ABSENT

NORMAL

PRESENT

24/5/2017

BLOOD

PCV

31%

NORMAL

05/6/2017

BLOOD

PCV

30%

NORMAL

Other investigation:

modified IVU/MCUG which revealed posterior
vesicocervical fistula

3
...
Pre operative drug was prescribed
...
All laboratory investigations were ready e
...

PCV, FBC, urine Analysis
Vital signs done and documented, patient counselled on surgery and consent form signed
...
9c
Pulse- 94b/m
Respiration-24c/m
Blood Pressure: 120/80mmHg
Operation site was observed; clean and dry

POST OPERATIVE ORDER
-

Nil per oral until reviewed

-

I/V fluid 1L N/S alternating with 1L 5% dextrose water 8hourly

-

I/V Augmentin 1
...
Patient was encouraged to ambulate early
...
Patient complained of vomiting and epigastric pain
...
Cannula was removed
...

I/M Metoclopromide 10mg 8hourly * 2 doses, syrup morphine 10mg 4hourly * 4/7 was
commenced
On 30/5/2017, wound dressing was prescribed to be changed
On 31/5/2017, stitches was prescribed to be removed together with liberal fluid intake
On 1/6/2017, consultant reviewed patient, stitches was removed and 4l of fluid intake was
ordered
On 2/6/2017, wound was prescribed to be cleaned with spirit and Genticin Violet to be
applied, awaiting removal of urethral catheter on day 14
...

On 6/6/2017, patient was counselled on the importance of bladder training and other
management continued and bladder training was commenced, to be relieved every 2hours till
7:00pm everyday
On 8/7/2017, commenced bladder training 1/7 days ago and well tolerated, on tab Flagyl,
Augmentin, Paracetamol, Multivite, Fersolate, Folic Acid and liberal fluid intake (4L
DAILY)
...
Urinary catheter was prescribed to be
removed and for possible discharge tomorrow
On 9/6/2017, she was discharged home and to be seen in outpatient clinic in 2weeks having
completed the bladder training and urethral catheter was removed
DISCHARGE DRUGS:

Tab Vitamin C
Tab Folic Acid 5mg daily
Tab Fersolate 200mg daily

[36]

CHAPTER FOUR
GENERAL NURSING MANAGEMENT
4
...
Patient was oriented to the ward and she was duly reassured and her fear
allayed
On Admission, vital signs was done and charted
TEMPERATURE:

37℃

PULSE:

86b/m

RESPIRATION:

20c/m

[37]

BLOOD PRESSURE: 110/70mmHg

4
...
Patient was encouraged to buy all the necessary materials, pay appropriate bills for
surgery
...

At 10pm, Tab Erythromycin 500mg, Tab Ducolax was administered, Rectal Washout was
done also in preparation for surgery and was ordered to be on Nil Per Oral from 10pm
All questions asked by patient concerning the surgery and possible outcome were answered
...
Intravenous line was set up and pre operative medication was
served
...

Patient returned from the operating theatre after surgery (vesicouterine fistula repair)
...
2g 12hourly, I/V metronidazole 500mg
8hourly
...
7℃ PULSE: 94b/m RESPIRATION: 24c/m
BLOOD PRESSURE: 120/80mmHg
POSITIONING: Patient placed in a dorsal position with head turned to left lateral
...

OBSERVATION: Vital signs done and recorded, operation site remain clean and dry, urinary
catheter in situ draining clear urine
...
Patient was commenced on oral graded sip
which was well tolerated
OBSERVATION: Vital signs done and charted, operation site remain clean and dry, urethral
catheter draining clear, normal urine
DRUGS: due drugs were served
Patient noticed to react to tramadol injection hence withheld and I/V Ranitidine commenced
stat and tramadol was replaced with syrup morphine
...
Also I/M Metochlopramide 10mg 8hourly *2doses was commenced
3RD DAY POST OPERATIVE (26/5/2017)
PHYSICAL CARE: Assisted bed bath done, bed linen straightened and patient made
comfortable in bed
IMPAIRED SKIN INTEGRITY: Surgical site cleaned and dressed aseptically
All intravenous drugs changed to oral, I/V Cannula was removed
[40]

OBSERVATION: Vital signs done and charted
DRUGS: All due drugs served and intravenous fluids discontinued

4TH-7TH DAY POST OPERATIVE (27-30/5/2017)
PHYSICAL CARE: Bed linen straightened, assisted bathroom bath and oral care done
OBSERVATION: Vital signs observed and documented
DRUGS: Due drugs served
IMPAIRED SKIN INTEGRITY: Surgical site cleaned and dressed aseptically

9TH DAY POST OPERATIVE (31/5/2017)
PHYSICAL CARE: patient had her bath and oral care in the bathroom
DIET: Patient was encouraged to take high protein and vitamin diet, liberal fluid intake
encouraged
IMPAIRED SKIN INTEGRITY: stitches were removed
DRUG: due drugs were administered
OBSERVATION: Vital signs checked and documented

10TH DAY POST OPERATIVE (01/2/2017)
PHYSICAL CARE: Due physical care was rendered
[41]

Wound dressing and genticial violet was applied
OBSERVATION: Vital signs done and recorded, catheter still draining clear urine
DRUGS: due drugs served

11-13th DAY POST OPERATIVE (03-05/3/2017)
Physical care rendered
IMPAIRED URINARY ELIMINATION: Urinary catheter to be removed tomorrow
OBSERVATION: Vital signs checked and recorded
IMPAIRED SKIN INTEGRITY: Wound cleaned and dressing done

14th DAY POST OPERATIVE (6/6/2017)
Necessary physical care rendered
OBSERVATION: Vital signs done and charted
Patient counselled on the importance of bladder training and bladder training was
commenced
...
Nil nocturia
Urinary catheter was removed and for possible discharge next day

17th DAY POST OPERATIVE (9/6/2017) (DISCHARGE)
Patient was discharged home and to be seen in outpatient clinic in two weeks ( 22/6/2017)
having completed the bladder training
Patient was encouraged on good general hygiene, balanced diet and liberal fluid intake and to
report back promptly to the facility if any anomaly is noticed
Discharge summary was neatly written by medical doctor and all bills were paid
Next appointment date – 22/6/2017
...
All due document were signed and patient’s folder was transferred to the record
office
Drugs given on discharge were Tab Folic Acid 5mg daily, Tab Vitamin C 100mg daily, Tab
Fersolate 200mg daily

4
...
D’s

Assess Mrs M
...
D’s f

7:00AM

prognosis of

facial

of anxiety

for comparison and

relief from a

disease condition

expression will

monitoring

of nursing in

evidenced by

demonstrate

patient's

relief from

educate her about

expression and

anxiety within

disease process and

To broaden her knowledge

verbalization

45minutes of

possible intervention

about the disease

2

EVALUATI

nursing
intervention

Encourage her to ask
questions

To clear doubt and
misconceptions

Assess patient’s level of
understanding by

To ascertain level of

asking questions about

understanding

the disease

Provide diversion
therapy e
...
chatting

To take her mind off the

with her

disease

22/5/201

Disturbed body

Mrs M
...
g
...
D

S/N DATE

NURSING

NURSING

NURSING

SCIENTIFIC

EVALUATION SIGNATURE

DIAGNOSIS OBJECTIVE INTERVENTION RATIONALE
3

23/5/17 Acute pain

Mrs M
...
g
...
D’s

Assess

To serve as

9:00pm

skin

wound will

operation site

baseline data

integrity

heal by first

related to

intervention

Dress wound

To

surgical

within 5- 7

aseptically

encourage

incision

days post

granulation

evidenced

operative

and prevent

by break in

infection

continuity

Encourage

of the skin

balanced and

It aids

adequate diet

healing
process

Encourage
early
ambulation

This increase
blood supply
to the
surgical site

Give

and to

supplementary

prevent

drugs e
...


thrombosis

vitamin C, folic
acid, fersolate

It aids
healing of

[48]

wound

[49]

4
...
D

DATE

TIME

TEMP

RESPIRA

(℃)

TION

PULSE

BLOOD

REMARKS

PRESSURE(M
mHg)

21/5/17

22/5/17

23/5/17

24/5/17

25/5/17

6pm

37

86c/m

20b/m

110/70

Satisfactory

6am

36
...
4

84c/m

18b/m

110/70

Satisfactory

2pm

36
...
8

82c/m

20b/m

110/70

Satisfactory

6am

36
...
6

84c/m

18b/m

100/70

Satisfactory

6pm

36
...
5

90c/m

20b/m

110/70

Satisfactory

10am

36
...
4

84c/m

24b/m

110/80

Satisfactory

6pm

36
...
8

84c/m

20b/m

120/70

Satisfactory

10am

36
...
3

84c/m

22b/m

120/70

Satisfactory

6am

36
...
9

80c/m

24b/m

110/70

Satisfactory

2pm

36
...
7

84c/m

24b/m

110/70

Satisfactory

6am

35
...
8

88c/m

26b/m

120/70

Satisfactory

2pm

36
...
6

82c/m

22b/m

100/60

Satisfactory

6am

36
...
4

82c/m

22b/m

110/80

Satisfactory

2pm

36
...
2

84c/m

20b/m

120/80

Satisfactory

6am

36
...
8

82c/m

18b/m

120/80

Satisfactory

6pm

37

88c/m

20b/m

110/80

Satisfactory

6am

36
...
6

86c/m

20b/m

130/70

Satisfactory

2pm

36
...
7

88c/m

20b/m

120/80

Satisfactory

6am

36
...
5

88c/m

22b/m

120/80

Satisfactory

2pm

36
...
8

86c/m

24b/m

110/80

Satisfactory

6am

36
...
6

82c/m

28b/m

110/70

Satisfactory

2pm

36
...
4

86c/m

20b/m

120/70

Satisfactory

6am

36
...
6

82c/m

24b/m

110/80

Satisfactory

2pm

36
...
4

88c/m

20b/m

110/70

Satisfactory

6am

36
...
7

82c/m

24b/m

120/80

Satisfactory

6pm

36
...
5

86c/m

20b/m

110/70

Satisfactory

10am

36
...
8

88c/m

18b/m

120/80

Satisfactory

6pm

36
...
8

84c/m

20b/m

110/70

Satisfactory

10am

36
...
2

84c/m

18b/m

120/80

Satisfactory

6pm

36
...
7

86c/m

20b/m

100/70

Satisfactory

10am

36
...
6

86c/m

20b/m

120/80

Satisfactory

6pm

37

82c/m

18b/m

120/80

Satisfactory

6am

36
...
4

86c/m

20b/m

110/80

Satisfactory

2pm

36
...
3

86c/m

20b/m

110/80

Satisfactory

6am

36
...
7

82c/m

26b/m

110/70

Satisfactory

2pm

36
...
7

88c/m

20b/m

100/70

Satisfactory

6am

36
...
5

86c/m

22b/m

110/80

Satisfactory

2pm

36
...
5

88c/m

20b/m

120/80

Satisfactory

6am

36
...
5

84c/m

20b/m

120/80

Satisfactory

[53]

4
...
2g b
...
Children, 2 12months= ½ teaspoon *4 daily
ROUTE OF ADMINISTRATION: orally, suppository, intravenously
SIDE EFFECT: Gatrointestinal disturbance, unpleasant taste, hypersensitivity reaction,
darkening of urine, drowsiness, peripheral neuropathy
CONTRAINDICATION: CNS disease, blood dyscrasias, pregnancy, hepatic encephalopathy
NURSING RESPONSIBILITIES: it should not to be administered to pregnant and lactating
mothers or patients with hypersensitivity
...
m or I
...
m/i
...
50-100mg (2-4tab) every 3-4hours
ROUTE OF ADMINISTRATION: orally, intramuscularly, intravenously, and
subcutaneously
SIDE EFFECT: dizziness, nervousness, nausea, euphoria, hallucination, headache, sedation
CONTRAINDICATION: hypersensitivity reaction, children less than 12, head injury,
hypertension
NURSING RESPONSIBILITIES: warn patient not to operate machinery or car and warn
patient to avoid movement 15minutes after administration
...

MODE OF ACTION: It diminishes gastric motility and help to depress the vomiting centre in
the medulla oblongata
...

DOSAGE: 5-10mg B
...

ROUTE OF ADMINISTRATION: Orally, intramuscularly
...

CONTRAINDICATION: Hypersensitivity reaction
...


FERSOLATE
GROUP: Haematinic
...

INDICATION: Iron deficiency anaemia, acute or chronic blood loss, mal absorption
syndrome, patient on dietary restriction
...

ROUTE OF ADMINISTRATION: orally in tablet form
...

CONTRAINDICATION: Patient receiving blood transfusion, polycythaemia
...
It should be withheld during tetracycline therapy
...

MODE OF ACTION: It inhibits basal and nocturnal gastric acid secretion by inhibiting the
action of histamine H2 receptors of the parietal cells
...

DOSAGE: usual dose= 150mg tab twice daily
...

SIDE EFFECT: rarely and mild including: bradycardia, cardiac arrest, hallucination, severe
headache, rash, hepatotoxicity
...

NURSING RESPONSIBILITIES: do not give to hypersensitive patient and reduce dosage in
patient with renal or hepatic dysfunction
...

MODE OF ACTION: conversion of folate into tetrahydrofolic acid in the body which is
required for purine synthesis for manufacture of red blood cell
...

DOSAGE: 5-20mg daily
...

SIDE EFFECT: allergic sensitization, nausea, vomiting
...

NURSING RESPONSIBILITIES: it should not be used alone to treat megaloblastic anaemia
due to vitamin B12 deficiency
...

MODE OF ACTION: Converts collagen fibres to proper fibre hence strengthening wound
healing
...

DOSAGE: 20-30mg as daily dietary intake or 100mg thrice daily as a maintenance dose
...

SIDE EFFECT: Very rare
...

NURSING RESPONSILBLITY: serve the correct dose
...
5

REHABILITATION

Rehabilitation of Mrs M
...
Patient was health educated on the possible causes, prevention,
treatment and possible complication that may arise from the condition
Patient was actively involved in her management; early ambulation was encouraged to which
she responded to positively
...
She was also health educated on strict adherence to treatment regimen,
precautionary measures and appointment date with the hospital
4
...

Discharge drugs: explanation was given on discharge drugs as to how to use them and
possible side effect
...
7

FOLLOW UP CARE

Mrs M
...
8

SUMMARY AND CONCLUSION

Mrs M
...
vesicouterine fistula repair was done on the 23rd,
june 2017
...
She was closely observed and drugs were served when due
Her condition remains stable throughout period of hospitalization
...
On discharge, she was advised on diet, hygiene and use of prescribed
drugs
...

In conclusion, vesicouterine fistula is a rare genitourinary fistula characterized by an
abnormal communication between the bladder and the uterus with the main signs and
symptoms being urinary incontinence, menouria, infertility
...
9 RECOMMENDA TION
1
...
Government should organize awareness programs to sensitize citizens, to enlighten
them about the disease and the importance of early presentation to the hospital
3
...
Necessary emergency resources should be available in all facilities to be used in
emergency delivery of an obstructed labour hence preventing complications like this (
vesicouterine fistula)
5

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