eLsayed abdelgaleel

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Gouna technical nursing institute

Technical diploma in nursing

Nu 201 family focused nursing practice

Elsayed. Abdelgaleel

Narrative assignment
eLsayed abdelgaleel

Word count:1090 word

Date of submission:22/3/2020

A- Clinical narrative:
The situation took place on Wednesday, in March 4, 202 in the Obstetric
department at Hurghada general hospital and Dr. Nagwa was my clinical instructor with
me in this rotation.
After I took my case that I will assess, I went to the nurse station and I
said good morning to the staff then I washed my hands and then I asked the nurse to
give me the file to get some data about my case then I went to assess my case.
I have received a postpartum woman; her initial name was A.M, she was
26years old, admitted in 3/3/2020, gravida:2, para:2, TPAL: 2002, I checked the safety
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and I found that the patient didn’t have any allergy, she had ID bracelet, the area around
the patient was clean and there wasn’t any noise , while I was assessing her I found
that she had pain in the abdominal incision and this related to cesarean delivery so I
preformed pain assessment and I found that the pain score was 5out of 10 in the
abdominal incision, the quality of pain is like burning, the non-verbal cues was
grimacing facial expression, the pain relieve by relaxation and administration of
analgesic “ketolac 250mg/6hrs” and the pain increase by movement or any effort. As
the pain increase the nervous system stimulation I assessed the vital signs and I found
that the PR was 89bpm, RR:20b/m regular, CRT<3second, T:37c “axillary” Apical pulse:
97bpm, BP: 90/60mmHG this abnormal” hypotension as the normal range is
120/80mmHg”, I also assessed the airway and it was patent airway, I assessed the
patient ability to move and I found that she wouldn’t able to move so because of the
pain.
According to the postpartum mother have C.S not normal deliver
that indicate the mother have abdominal incision. So, I should have assessed the
wound. At first, I should have assessed the wound dressing beside complete
assessment of skin as the mother have abdominal incision. So, I inspect the color of the
skin that was pink as normal no signs of infection because there are no ischemia or
discoloration of skin. But the skin in the incision was integrate because of healing
process. So, I assess the skin turgor but I found it wait for retrained back immediately
that indicate integrity of skin. In addition to skin assessment, I assess the wound
characteristic and I didn’t found any sings of infection like increase the temperature and
increase the level of WBCs. Also, the date of the dressing and the signature of the
nurse that applied the wound dressing. I should be assessing any drainage “odor and
color” to detect any infection, I should assess the wound: pre-area, wound bed, and the
sutures. I assessed the lab tests and I found that the WBCs 7.3 this was normal range
is from “4.5-11” that indicate free from infection, RBCs: 4.15 normal as the normal range
is “4-5.2”, Hgb: 13.3normal as the normal range is 12.1-15.1 that indicate free from any
sings of physiological anemia, Hct: 37.6% normal as the normal range 37%-47%,
platelets: 191normal as the normal range 150-450, I preformed abdominal assessment
and I found that the last bowel movement was in the first day.
In the first part of the day, while interacting with the patient, I found that
the patient is anxious related to the hospitalization and that affect the physiologic
status, so while asking her what make to upset you today? The nurses and
the physicians are treated the patient with uncivilized behavior as while she was in the
surgery she wasn’t well sedated so she felt the pain of the incision while the doctor
make the incision and she told the doctor and the doctor told he that “he was happy for
that for purpose that she wouldn’t come to surgery again.”. So, the patient seems upset,
so I intervene with explaining the procedures and my role toward the care to her, so I
reduced the anxiety of the patient with my intervention, so I reduced the anxiety and
promote the physiologic status. 
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While I was with Dr. Nagwa and we started to give the health teaching
for the postpartum woman and she asked us about the baby feeding and the Dr. Nagwa
told her that the breast feeding is very useful for the baby as it gives the baby passive
immunization and for the postpartum woman also as it helps to decrease the risk of
occurrence of breast cancer for the postpartum woman. This attracted me and I started
to search about how the breast feeding decreases the risk of occurrence of breast
cancer.

B- Identify clinical question:

What the impact of compliance of breastfeeding and occurrence of breast cancer for the
postpartum women.
P: occurrence of breast cancer
I: compliance of breastfeeding
C: the postpartum women who are compliance of breastfeeding and who are not
O: lower the risk of occurrence of breast cancer

What is the evidence based mentioned about that?

The breast feeding became a protective factor to decrease the risk of

occurrence of breast cancer. The breast cancer is related to estrogen and progesterone
receptors and they subtype of breast cancer and via breastfeeding decrease the risk of
getting breast cancer via this subtype. (Anstey, E. et al. 2017)

The breastfeeding has a role to decrease the risk of occurrence of hormone receptor
negative breast cancer and after experiments they found that the woman that
compliance of apply the breast feeding, has decreased the risk of occurrence of
hormone negative breast cancer. (Fortner, R., Sisti, J., Chai, B. et al.2019)

The breastfeeding is very useful for the postpartum woman as it prevents the post birth
hemorrhage and the breastfeeding also decreases the occurrence of breast cancer and
the breast feeding reduces the woman exposure to estrogen and progesterone those
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promote the breast cancer cell growth and as the breast feeding decrease the ovulation
and this decrease the exposure to estrogen that promote and develops new cancer
cells. (Pechlivani,F.et al.2018)

References:

Anstey, E. H., Shoemaker, M. L., Barrera, C. M., O'Neil, M. E., Verma, A. B., & Holman, D.
M. (2017). Breastfeeding and Breast Cancer Risk Reduction: Implications for Black
Mothers. American journal of preventive medicine, 53(3S1), S40–S46. Retrieved from:
https://doi.org/10.1016/j.amepre.2017.04.024

Fortner, R., Sisti, J., Chai, B. et al. Parity, breastfeeding, and breast cancer risk by
hormone receptor status and molecular phenotype: results from the Nurses’ Health
Studies. Breast Cancer Res 21, 40 (2019).retrieved from: https://doi.org/10.1186/s13058-
019-1119-y

Pechlivani,F. Vivilaki,V. Breastfeeding and breast cancer. Health Science Journal.2018.

retrieved from: https://www.hsj.gr/medicine/breastfeeding-and-breast-cancer.php?
aid=3155