January – 2018 Medical Surgical Nursing (Sau.Uni.gujarat)

SECTION-I

1 Long Essay: (any one) 1×15=15

(1) Mr. Ragava 56 years old man is admitted with gastric carcinoma for surgical management.

💟 (a) Classification of cancer. 03

1. Classification of Cancer:

• Cancer can be classified based on the type of tissue or organ where it originates. Common classifications include:
  • Carcinoma: Cancer that begins in the epithelial cells, which are the cells that line the body’s internal and external surfaces. Examples include breast cancer, lung cancer, and prostate cancer.
  • Sarcoma: Cancer that originates in the connective tissues, such as bones, muscles, or blood vessels.
  • Leukemia: Cancer of the blood or bone marrow, characterized by the uncontrolled production of abnormal white blood cells.
  • Lymphoma: Cancer that affects the lymphatic system, including the lymph nodes, spleen, and bone marrow.
  • Central nervous system cancers: These include brain tumors and spinal cord tumors.

💟 (b) Write clinical manifestations of gastric carcinoma. 03

Clinical manifestations of gastric carcinoma can vary depending on the location, size, and stage of the tumor. Common symptoms may include:
– Persistent abdominal pain or discomfort
– Indigestion or heartburn
– Loss of appetite and unintended weight loss
– Nausea and vomiting, possibly with blood
– Difficulty swallowing (dysphagia)
– Feeling full quickly after eating
– Fatigue and weakness
– Blood in the stool or black, tarry stools (melena)
– Anemia
– Swelling or fluid buildup in the abdomen (ascites)

💟 (c) Explain the pre and post-operative nursing care for Mr. Ragava. 04

Assess the patient’s medical history, including any comorbidities or previous surgeries.

• Perform a comprehensive physical assessment, focusing on nutritional status, hydration, and vital signs.
• Collaborate with other healthcare providers to complete pre-operative tests and evaluations, such as blood tests, imaging studies, and possibly endoscopic procedures.
• Educate the patient about the upcoming surgery, including what to expect before, during, and after the procedure, potential risks and complications, and post-operative care instructions.
• Address any concerns or questions the patient may have, providing emotional support and reassurance as needed.
• Ensure that the patient follows pre-operative fasting guidelines and takes any prescribed medications as directed.

4. Post-operative Nursing Care for Gastric Carcinoma Patient:

• Monitor the patient closely for signs of complications, such as bleeding, infection, or respiratory distress.
• Manage pain effectively using appropriate pain relief measures, such as medication, positioning, and relaxation techniques.
• Assess the patient’s gastrointestinal function, including bowel sounds, passage of flatus, and tolerance of oral intake.
• Gradually advance the patient’s diet from clear liquids to solid foods as tolerated, while monitoring for signs of gastrointestinal intolerance or complications.
• Provide wound care as needed, monitoring for signs of infection or delayed healing.
• Assist the patient with mobility and ambulation to prevent complications such as blood clots and muscle weakness.
• Educate the patient and family members about post-operative care instructions, including medication management, dietary restrictions, activity levels, and signs of complications that require medical attention.

💟 (d) Mention the complications after surgery. 03

• Anastomotic leak: Leakage of fluid or contents from the surgical connection between the remaining stomach or esophagus and the small intestine.
• Dumping syndrome: Rapid emptying of the stomach contents into the small intestine, leading to symptoms such as nausea, vomiting, abdominal cramping, diarrhea, sweating, and weakness.
• Malabsorption: Impaired absorption of nutrients from the gastrointestinal tract, leading to nutritional deficiencies and weight loss.
• Delayed gastric emptying (Gastroparesis): Slowed movement of food from the stomach to the small intestine, resulting in symptoms such as nausea, vomiting, bloating, and early satiety.
• Surgical site infection: Infection of the surgical incision site, characterized by redness, swelling, warmth, pain, and drainage.
• Pulmonary complications: Complications such as pneumonia or atelectasis (collapse of lung tissue) due to impaired lung function or respiratory muscle weakness.
• Deep vein thrombosis (DVT) and pulmonary embolism (PE): Blood clots that can form in the legs (DVT) and travel to the lungs (PE), causing symptoms such as leg pain, swelling, redness, and difficulty breathing.

Each of these complications requires prompt recognition and appropriate management to prevent further complications and promote the patient’s recovery. Regular monitoring, patient education, and collaboration with the healthcare team are essential components of post-operative nursing care.

(2) Mrs. Kinjal 48 years old female got admitted to ICU with end stage renal disease.

💟 (a) Define end stage renal disease. 02

Definition: End-stage renal disease is the final stage of chronic kidney disease where the kidneys have lost almost all of their function, necessitating dialysis or a kidney transplant for survival.

💟 (b) Write the etiology and pathophysiology of end stage renal failure. 04

1. Etiology:*

• Prolonged Hypertension: Chronic high blood pressure can damage the small blood vessels in the kidneys over time, leading to decreased kidney function.
• Diabetes Mellitus: Uncontrolled diabetes can damage the kidneys’ filtering units (nephrons) and cause proteinuria, eventually leading to kidney failure.
• Glomerulonephritis: Inflammation of the glomeruli, which are the filtering units of the kidneys, can lead to scarring and impaired kidney function.
• Polycystic Kidney Disease: Inherited disorder characterized by the growth of cysts in the kidneys, which can progressively impair kidney function.
• Other Kidney Disorders: Various other kidney conditions such as autoimmune diseases, kidney infections, and obstructive uropathy can also lead to ESRD.

1. Pathology:

• Progressive Nephron Damage: Underlying conditions lead to progressive damage to the nephrons, resulting in irreversible loss of kidney function.
• Accumulation of Waste Products: With reduced kidney function, waste products and excess fluids accumulate in the body, leading to uremia.
• Electrolyte Imbalances: Kidney dysfunction disrupts electrolyte balance, leading to abnormalities such as hyperkalemia, hyperphosphatemia, and hypocalcemia.
• Acid-Base Imbalance: The kidneys are responsible for maintaining acid-base balance in the body, and their dysfunction can result in metabolic acidosis.

💟 (c) Write the clinical manifestations and management of end stage renal disease. 04

1. General Symptoms:

• Fatigue
• Weakness
• Nausea
• Vomiting
• Loss of appetite
• Difficulty concentrating

1. Specific Symptoms and Complications:

• Edema (swelling)
• Pruritus (itching)
• Muscle cramps
• Changes in urine output (decreased urine output or increased frequency)
• Anemia (due to decreased erythropoietin production)
• Hypertension
• Bone disease (renal osteodystrophy)
• Cardiovascular disease (e.g., heart failure, pericarditis)

Management of End-Stage Renal Disease:

1. Dialysis:

• Hemodialysis: Involves filtering blood through a machine to remove waste products and excess fluids.
• Peritoneal Dialysis: Uses the peritoneum (lining of the abdominal cavity) as a filter to remove waste and excess fluid.

1. Kidney Transplantation:

• Transplantation of a healthy kidney from a donor to replace the diseased kidney.
• Requires immunosuppressive medications to prevent rejection of the transplanted kidney.

1. Medications:

• Blood pressure medications (e.g., ACE inhibitors, ARBs) to control hypertension and protect the kidneys.
• Erythropoiesis-stimulating agents (ESA) to treat anemia.
• Phosphate binders to control hyperphosphatemia.
• Vitamin D supplements and calcium-based phosphate binders to manage bone disease.

1. Nutritional Management:

• Restriction of dietary sodium, potassium, and phosphorus.
• Monitoring of protein intake to prevent malnutrition while minimizing uremic symptoms.

1. Management of Complications:

• Treatment of anemia with ESA and iron supplements.
• Management of electrolyte imbalances with dietary modifications and medications.
• Control of blood pressure and prevention of cardiovascular complications.

💟 (d) Write down the nursing care plan for Mrs. Kinjal, 05

1. Assessment:

• Monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature.
• Assess neurologic status, level of consciousness, and orientation.
• Monitor intake and output, including urine output and fluid balance.
• Assess for signs of fluid overload or dehydration, such as edema or hypotension.

1. Fluid and Electrolyte Management:

• Monitor electrolyte levels regularly and adjust fluids and medications accordingly.
• Administer intravenous fluids as prescribed to maintain fluid balance.
• Monitor for signs of electrolyte imbalances, such as hyperkalemia or hyponatremia, and intervene promptly.

1. Medication Administration:

• Administer medications as prescribed, including those for blood pressure control, anemia management, and bone health.
• Monitor for adverse reactions and side effects of medications.

1. Dialysis Care:

• Monitor vascular access site for signs of infection or complications.
• Collaborate with the dialysis team to ensure the patient’s dialysis treatments are conducted safely and effectively.

1. Nutritional Support:

• Collaborate with the dietitian to develop and implement a nutrition plan tailored to the patient’s needs and restrictions.
• Monitor dietary intake and provide education on dietary restrictions.

1. Skin and Wound Care:

• Assess skin integrity regularly, especially in areas prone to pressure ulcers.
• Implement measures to prevent pressure ulcers, such as turning and repositioning the patient regularly.

1. Psychosocial Support:

• Provide emotional support and reassurance to the patient and family members.
• Encourage open communication and address any concerns or questions they may have.

1. Patient Education:

• Educate the patient and family about their condition, treatment options, and self-care measures.
• Provide instructions on medication management, dietary restrictions, and signs of complications to watch for.

1. Pain Management:

• Assess pain levels regularly and administer pain medication as prescribed.
• Implement non-pharmacological pain management techniques as appropriate.

1. Discharge Planning:

• Collaborate with the healthcare team to develop a discharge plan tailored to the patient’s needs and resources.
• Arrange for follow-up appointments with the nephrologist and other healthcare providers as needed.
• Provide education and support for the transition to home care or a chronic care facility.

2 .Short Essay: (Any Three) 3×5 = 15

💟 (1) Chronic supportive otitis media.

Chronic Suppurative Otitis Media (CSOM):*

• Definition: Chronic suppurative otitis media is a persistent inflammation and infection of the middle ear and mastoid cavity characterized by the presence of a perforated tympanic membrane and discharge (otorrhea) for more than 12 weeks.

Etiology:

1. Acute Otitis Media (AOM): CSOM often develops as a complication of untreated or inadequately treated acute otitis media.
2. Repeated Infections: Recurrent episodes of acute otitis media can lead to chronic inflammation and damage to the tympanic membrane.
3. Poor Eustachian Tube Function: Dysfunction of the Eustachian tube can impair drainage and ventilation of the middle ear, predisposing to chronic infection.
4. Factors Predisposing to Infection: Factors such as upper respiratory tract infections, allergies, and environmental factors may increase the risk of developing CSOM.

Pathophysiology:

1. Persistent Inflammation: Chronic inflammation of the middle ear mucosa leads to tissue damage and impaired healing.
2. Tympanic Membrane Perforation: Recurrent infections and inflammation can cause perforation of the tympanic membrane, allowing bacteria to enter the middle ear space.
3. Formation of Granulation Tissue: Granulation tissue may form in the middle ear and mastoid cavity as a result of chronic inflammation, contributing to ongoing discharge.
4. Mastoid Cavity Involvement: In severe cases, the infection may spread to involve the mastoid cavity, leading to mastoiditis.

Clinical Manifestations:

1. Otorrhea: Persistent, foul-smelling discharge from the ear, which may be purulent or mucopurulent.
2. Hearing Loss: Conductive hearing loss due to middle ear effusion and tympanic membrane perforation.
3. Ear Pain or Discomfort: Mild to moderate ear pain or discomfort, which may be intermittent or persistent.
4. Tympanic Membrane Perforation: Visualization of a perforated tympanic membrane during otoscopic examination.
5. Granulation Tissue: Presence of granulation tissue in the middle ear or mastoid cavity, visible during otoscopic examination or on imaging studies.
6. Complications: Rarely, CSOM may lead to complications such as mastoiditis, facial nerve paralysis, labyrinthitis, or intracranial complications (e.g., meningitis, brain abscess).

Diagnosis:

1. Clinical Examination: Otoscopic examination to visualize the tympanic membrane and assess for perforation, discharge, and granulation tissue.
2. Audiological Assessment: Pure-tone audiometry to assess hearing loss and determine the degree of conductive hearing loss.
3. Imaging Studies: High-resolution computed tomography (HRCT) may be performed to evaluate the extent of disease, especially in cases of suspected mastoid involvement or complications.

Management:

1. Medical Treatment:

• Topical Antibiotics: Topical antibiotic ear drops (e.g., fluoroquinolones, aminoglycosides) to control infection and reduce discharge.
• Oral Antibiotics: Oral antibiotics may be prescribed in cases of severe or refractory infection, especially if there is evidence of mastoiditis or systemic symptoms.
• Ear Cleaning: Regular cleaning of the ear canal to remove discharge and debris.
• Steroid Drops: Topical corticosteroid drops may be used to reduce inflammation and promote healing.

1. Surgical Treatment:

• Tympanoplasty: Surgical repair of the tympanic membrane to restore its integrity and improve hearing.
• Mastoidectomy: Surgical removal of infected or diseased mastoid tissue in cases of mastoid involvement or complications.

1. Complication Management:

• Prompt recognition and treatment of complications such as mastoiditis, facial nerve paralysis, or intracranial complications.
• Close monitoring and appropriate management in collaboration with otolaryngology and infectious disease specialists.

Prognosis:

• With appropriate treatment, the prognosis for CSOM is generally favorable, especially if complications are promptly recognized and managed. However, untreated or inadequately treated CSOM can lead to persistent infection, hearing loss, and complications. Regular follow-up and monitoring are essential to assess treatment response and prevent recurrence.

Nursing Management :-

1. Assessment:
   • Assess the patient’s history, focusing on ear infections, hearing loss, and other related symptoms.
   • Evaluate the nature, frequency, and amount of ear discharge.
   • Monitor for signs of complications, like fever, pain, or worsening hearing loss.
2. Ear Care and Hygiene:
   • Keep the ear clean and dry to prevent further infection. Use sterile cotton or gauze to gently clean the outer ear.
   • Advise against using cotton swabs inside the ear canal, which can push debris further in.
3. Medication Administration:
   • Administer prescribed ear drops, typically antibiotics or antifungal, as directed by a healthcare provider.
   • Use oral antibiotics if indicated for broader infection control.
   • Ensure proper administration techniques, such as warming ear drops to body temperature and ensuring correct positioning for application.
4. Patient Education:
   • Educate the patient and family on the importance of ear care and avoiding water entry into the ear canal (e.g., during bathing or swimming).
   • Discuss the use of earplugs or shower caps to keep the ear dry.
   • Stress the importance of completing the full course of any prescribed antibiotics.
5. Monitoring and Follow-Up:
   • Regularly monitor the patient’s symptoms, including ear discharge, pain, and hearing changes.
   • Schedule follow-up appointments with an otolaryngologist (ENT specialist) for ongoing care and to assess the need for further treatment, such as surgery (e.g., tympanoplasty or mastoidectomy).
6. Pain Management:
   • Provide analgesics for pain relief if needed, as per healthcare provider instructions.
   • Advise on non-pharmacological pain relief methods, like warm compresses.
7. Hearing Assessment and Rehabilitation:
   • Monitor for signs of hearing loss, which is a common complication of CSOM.
   • Refer the patient to audiology for hearing tests and hearing aids if needed.
   • Educate on communication strategies if hearing impairment is present.
8. Infection Control:
   • Take precautions to prevent the spread of infection if the patient is in a healthcare setting.
   • Practice good hand hygiene and use gloves when managing ear discharge.

💟 (2) Glaucoma management.

Glaucoma is a group of eye conditions that damage the optic nerve, often due to high intraocular pressure (IOP), leading to progressive vision loss and potential blindness. Proper nursing management plays a crucial role in the care of patients with glaucoma, focusing on early detection, ongoing monitoring, medication adherence, and education. Here are details about glaucoma and key nursing management strategies:

Types of Glaucoma

1. Primary Open-Angle Glaucoma (POAG):
   • The most common form, where the drainage angle in the eye becomes less efficient, leading to gradual increases in IOP.
   • Symptoms develop slowly, often with peripheral vision loss, but are typically asymptomatic until significant damage has occurred.
2. Angle-Closure Glaucoma (ACG):
   • Occurs when the drainage angle closes or becomes blocked, causing a rapid increase in IOP.
   • Considered an emergency, with symptoms like severe eye pain, nausea, headache, blurred vision, and halos around lights.
3. Secondary Glaucoma:
   • Results from other conditions or injuries that increase IOP, such as eye trauma, inflammation, or certain medications.

• Diagnosis:
  • Glaucoma is diagnosed through comprehensive eye exams that measure intraocular pressure, assess the optic nerve, test peripheral vision (visual field), and evaluate the drainage angle.
• Treatment:
  • Treatment aims to lower intraocular pressure to prevent further optic nerve damage. It includes medicated eye drops, laser therapy, and surgery.
  • Common surgical options are trabeculectomy, tube shunts, and minimally invasive glaucoma surgery (MIGS).
• Management and Follow-Up:
  • Glaucoma requires ongoing management and regular follow-up with an ophthalmologist to monitor disease progression and treatment effectiveness.
  • Treatment adherence and regular eye exams are critical to managing glaucoma.
• Prevention and Risk Factors:
  • While glaucoma cannot always be prevented, early detection and treatment can help preserve vision.
  • Risk factors include a family history of glaucoma, high intraocular pressure, age, certain medical conditions (like diabetes), and prolonged use of corticosteroids.

Nursing Management of Glaucoma

1. Assessment and Monitoring:
   • Assess for signs and symptoms of glaucoma, such as peripheral vision loss, blurred vision, or eye pain.
   • Monitor IOP levels as directed by the healthcare team.
   • Observe for medication side effects, such as eye irritation or systemic effects from certain glaucoma medications.
2. Medication Management:
   • Administer prescribed medications, which often include eye drops to lower IOP (e.g., prostaglandin analogs, beta-blockers, alpha-agonists, or carbonic anhydrase inhibitors).
   • Ensure proper administration technique, emphasizing the importance of not touching the eye with the dropper and applying gentle pressure on the tear duct to prevent systemic absorption.
   • Encourage medication adherence, as consistent use of glaucoma medications is critical for controlling IOP.
3. Patient Education:
   • Educate patients and their families about glaucoma, its progression, and the importance of regular eye exams to monitor IOP and optic nerve health.
   • Teach correct techniques for administering eye drops and encourage medication adherence.
   • Discuss lifestyle changes that may help reduce IOP, such as a healthy diet, regular exercise, and stress management.
4. Prevention and Early Detection:
   • Encourage regular eye exams for at-risk populations, such as older adults, individuals with a family history of glaucoma, and those with other risk factors (e.g., diabetes, hypertension, high myopia).
   • Promote awareness of angle-closure glaucoma as a medical emergency, advising patients to seek immediate medical attention if they experience sudden eye pain, blurred vision, or other concerning symptoms.
5. Support and Coping:
   • Provide emotional support to patients dealing with vision loss or the potential for vision impairment.
   • Refer patients to support groups or vision rehabilitation services if needed.
   • Assist with adaptive devices or tools for patients with significant vision loss.
6. Collaboration with Healthcare Team:
   • Work with ophthalmologists, optometrists, and other healthcare providers to coordinate care and ensure timely interventions.
   • Facilitate communication between the patient and healthcare team to address concerns and adjust treatment plans as needed.

💟 (3)Valvular disorders of heart.

Introduction:*

• Valvular disorders refer to conditions affecting the heart valves, impairing their function and disrupting blood flow within the heart chambers. These disorders can lead to symptoms ranging from mild to life-threatening, depending on the severity and progression of the condition.

2. Classification:

• Valvular disorders can be classified based on whether they involve stenosis (narrowing) or regurgitation (leakage) of the valve. Common types include:
• Aortic Stenosis
• Aortic Regurgitation
• Mitral Stenosis
• Mitral Regurgitation
• Tricuspid Stenosis
• Tricuspid Regurgitation
• Pulmonary Stenosis
• Pulmonary Regurgitation

3. Etiology:

• Valvular disorders can be congenital (present at birth) or acquired (develop later in life). Causes include:
• Congenital abnormalities
• Rheumatic fever
• Degenerative changes with aging
• Infective endocarditis
• Connective tissue disorders (e.g., Marfan syndrome)
• Calcification of valves (e.g., in aortic stenosis)

4. Pathophysiology:

• Stenosis: Narrowing of a heart valve obstructs blood flow, causing increased pressure in the chamber before the valve and decreased pressure in the chamber after the valve.
• Regurgitation: Incompetent valves allow backward flow of blood, leading to volume overload and dilation of the chamber before the affected valve.

5. Clinical Manifestations:

• Symptoms depend on the type and severity of the valve disorder but may include:
• Dyspnea (shortness of breath)
• Chest pain or discomfort
• Fatigue
• Palpitations
• Syncope (fainting)
• Edema (swelling)
• Orthopnea (difficulty breathing while lying flat)
• Paroxysmal nocturnal dyspnea (sudden awakening from sleep with shortness of breath)

6. Diagnosis:

• Physical Examination: Listening for abnormal heart sounds (murmurs), palpating for thrills (vibrations), and assessing for signs of heart failure or fluid overload.
• Echocardiography: Imaging test to visualize heart valves, assess their function, and measure the severity of stenosis or regurgitation.
• Electrocardiography (ECG): May show signs of chamber enlargement, arrhythmias, or ischemia.
• Cardiac Catheterization: Invasive procedure to directly measure pressure gradients across valves and assess coronary artery disease.

7. Management:

• Medical Management: Symptomatic relief, prevention of complications, and management of associated conditions may include:
• Medications to control heart rate, rhythm, and blood pressure.
• Diuretics to reduce fluid overload.
• Anticoagulants in certain cases (e.g., atrial fibrillation, mechanical valve replacement).
• Surgical Management: Valve repair or replacement may be necessary for severe or symptomatic valvular disorders, especially in cases of:
• Severe stenosis or regurgitation with symptoms.
• Progressive deterioration of ventricular function.
• Recurrent infective endocarditis.
• Transcatheter Valve Interventions: Minimally invasive procedures such as transcatheter aortic valve replacement (TAVR) or mitral valve repair (e.g., MitraClip) may be options for high-risk or inoperable patients.
• Lifestyle Modifications: Diet, exercise, smoking cessation, and management of comorbidities (e.g., hypertension, hyperlipidemia) can help reduce symptoms and improve outcomes.

💟 (4) Bio medical safety management in blood transfusion.

1. Donor Screening and Testing:

• Donors undergo thorough screening for risk factors such as infectious diseases, recent travel, and medication use.
• Blood samples are tested for infectious agents like HIV, hepatitis B and C, syphilis, and other pathogens.

1. Blood Collection and Processing:

• Sterile techniques are employed during blood collection to prevent contamination.
• Blood components are separated and processed under controlled conditions to maintain quality and prevent bacterial growth.

1. Storage and Transportation:

• Blood components are stored at controlled temperatures to preserve their integrity and prevent bacterial contamination.
• During transportation, temperature control and packaging ensure the safety and viability of blood products.

1. Compatibility Testing:

• Before transfusion, recipient blood is tested to ensure compatibility with donor blood to prevent adverse reactions like hemolytic transfusion reactions.

1. Transfusion Procedure:

• Trained personnel follow strict protocols during transfusion, verifying patient identity, blood compatibility, and monitoring for any adverse reactions.

1. Adverse Reaction Monitoring and Reporting:

• Healthcare providers monitor patients during and after transfusion for any adverse reactions and report them promptly for investigation and preventive measures.

1. Quality Assurance and Accreditation:

• Blood banks and transfusion services adhere to strict quality assurance standards and may seek accreditation from regulatory bodies to ensure compliance with safety protocols.

1. Staff Training and Education:

• Healthcare professionals involved in blood transfusion receive regular training on safety protocols, blood handling procedures, and recognition of adverse reactions.

1. Documentation and Traceability:

• Comprehensive documentation of donor screening, testing, processing, and transfusion procedures ensures traceability and accountability in case of adverse events.

1. Continuous Improvement and Risk Management:
   • Blood transfusion services continuously evaluate and improve safety measures based on feedback, audits, and research findings to minimize risks and enhance patient safety.

By implementing these comprehensive measures, biomedical safety management in blood transfusion ensures the safe and effective use of blood products, minimizing the risk of transfusion-transmitted infections and adverse reactions.

💟 (5) Crisis intervention

1. Assessment: The first step is to assess the nature and severity of the crisis. This involves gathering information about the individual’s situation, including their emotional state, safety concerns, and support systems.
2. Establishing Rapport: Building a trusting relationship with the individual is crucial for effective crisis intervention. This involves active listening, empathy, and validation of the person’s feelings and experiences.
3. Identifying Coping Strategies: Help the individual identify any coping strategies they have used in the past or currently employ. This could include relaxation techniques, social support, or problem-solving skills.
4. Addressing Immediate Needs: Prioritize addressing any immediate safety concerns, such as suicidal ideation, self-harm, or threats to others. This may involve coordinating with emergency services or providing resources for immediate support.
5. Exploration and Understanding: Encourage the individual to explore their thoughts and feelings surrounding the crisis. This helps them gain insight into the situation and identify any underlying issues or triggers.
6. Developing a Plan: Collaboratively develop a plan of action to address the crisis and promote stability. This may involve setting short-term goals, accessing resources, and establishing a support network.
7. Implementing the Plan: Support the individual in implementing the action plan, providing guidance and encouragement as needed. This may involve accessing professional help, engaging in self-care activities, or reaching out to supportive others.
8. Follow-Up and Monitoring: Follow up with the individual to monitor their progress and provide ongoing support. This helps ensure that the crisis intervention remains effective and that any emerging issues are addressed promptly.
9. Referral to Additional Services: If necessary, refer the individual to additional services or resources that can provide ongoing support or address underlying issues. This may include mental health services, support groups, or community organizations.
10. Self-Care for the Provider: Practitioners involved in crisis intervention should prioritize their own self-care to prevent burnout and maintain effectiveness in helping others. This may involve seeking supervision, debriefing after intense interventions, and engaging in self-care activities.

3 .Very Short Essay: (Any Four) 4×2=8

💟 (A) Shock

1. Shock:

• Shock is a life-threatening condition where the body’s organs and tissues do not receive enough oxygen and nutrients.
• It can be caused by various factors such as severe bleeding, dehydration, infection, or allergic reaction.

💟 (B) ABG analysis

ABG analysis is a diagnostic test that measures the acidity (pH) and levels of oxygen and carbon dioxide in the blood, as well as other parameters.

• It helps assess the patient’s respiratory and metabolic status, guiding treatment decisions in conditions such as respiratory failure, metabolic acidosis, or alkalosis.

💟 (c) Glasgow coma scale

GCS is a neurological assessment tool used to evaluate a patient’s level of consciousness based on eye opening, verbal response, and motor response.

• It provides a numerical score ranging from 3 to 15, with lower scores indicating a more severe impairment of consciousness.

💟 (d) Cardiac Tamponade

Cardiac tamponade is a medical emergency where fluid accumulates in the pericardial sac, compressing the heart and impairing its ability to pump blood.

• It can result from trauma, infection, or other medical conditions, leading to symptoms such as shortness of breath, low blood pressure, and decreased cardiac output.

💟 (e) Constipation

Constipation refers to infrequent or difficult passage of stool, often accompanied by abdominal discomfort or bloating.

• It can be caused by various factors including dietary habits, lack of physical activity, certain medications, or underlying medical conditions such as irritable bowel syndrome or bowel obstruction.

SECTION – II

1 Long Essay: (any one) 1×10=10

💟 (a) Define Burns. 02

💟 (b) Write the types of burns. 02

Burns are injuries to the skin and underlying tissues caused by heat, chemicals, electricity, radiation, or friction. These injuries result in varying degrees of damage, depending on the severity of the burn and the area affected. Burns can lead to a range of complications, including pain, infection, scarring, and, in severe cases, life-threatening systemic effects

💟 (c) Explain in detail the pathophysiology of burns.03

Initial Tissue Injury

Burns occur when heat, chemicals, electricity, or radiation cause direct damage to the skin and underlying tissues. The extent of the injury depends on several factors:

• Temperature: Higher temperatures cause more severe burns.
• Duration of Exposure: Longer exposure leads to deeper burns.
• Surface Area: Larger burn areas have more systemic effects.
• Type of Agent: Chemicals and electrical currents can cause deeper tissue damage compared to thermal burns.

Layers of the Skin

The skin has three primary layers, each with distinct characteristics:

• Epidermis: The outermost layer provides protection and contains cells involved in wound healing.
• Dermis: Contains blood vessels, nerves, hair follicles, and sweat glands. Damage to the dermis can impair these structures and cause more significant injury.
• Subcutaneous Tissue: Consists of fat and connective tissue. Burns reaching this level are severe and cause substantial tissue loss.

Inflammatory Response

Following a burn injury, the body’s immediate response involves inflammation and vascular changes:

• Vasodilation: Blood vessels dilate, leading to increased blood flow and redness (erythema).
• Increased Permeability: Blood vessels become more permeable, allowing plasma and proteins to leak into the surrounding tissue, causing swelling (edema).
• Leukocyte Migration: White blood cells (WBCs) are recruited to the injured site to fight infection and remove dead tissue.
• Cytokine Release: Inflammatory cytokines, such as interleukins and tumor necrosis factor (TNF), are released, contributing to the inflammatory cascade.

Local Effects

The local effects of burns depend on the depth of the burn and the extent of tissue damage:

• First-Degree Burns: Affect only the epidermis, resulting in redness, pain, and mild swelling. These burns typically heal without complications.
• Second-Degree Burns: Extend into the dermis, causing blistering, intense pain, and potential loss of skin integrity. Healing may require more extensive care to prevent infection and scarring.
• Third-Degree Burns: Damage the full thickness of the skin, destroying hair follicles, sweat glands, and nerve endings. The skin appears white, charred, or leathery, with minimal sensation. These burns require surgical intervention and pose a high risk of complications.
• Fourth-Degree Burns: Extend into underlying tissues, including muscle and bone. These burns are life-threatening and require significant surgical and medical management.

Systemic Effects

Severe burns can lead to systemic effects due to extensive tissue damage and the body’s inflammatory response:

• Burn Shock: Extensive burns can cause significant fluid loss from increased vascular permeability, leading to hypovolemia (reduced blood volume) and shock. This can result in decreased cardiac output and organ perfusion.
• Hypermetabolic State: Severe burns trigger a hypermetabolic response, increasing the body’s energy and protein requirements. This can lead to muscle wasting and malnutrition if not managed appropriately.
• Immune Suppression: The systemic inflammatory response can suppress the immune system, increasing the risk of infection and sepsis.
• Respiratory Complications: Inhalation injuries or large burns on the chest can impair respiratory function, leading to respiratory distress or failure.
• Other Complications: Burns can lead to renal dysfunction, gastrointestinal complications, and other systemic issues.

Healing and Scarring

Burn healing involves complex processes of tissue repair, including:

• Epithelialization: Re-epithelialization occurs from surviving cells in the epidermis and hair follicles.
• Fibrosis and Scarring: Deep burns can cause significant fibrosis, leading to scarring and contractures, which may affect mobility and function.
• Granulation Tissue: Formation of granulation tissue, consisting of new blood vessels and connective tissue, is crucial for healing deeper burns.

💟 (d) Discuss the emergency management of patient with 45% of burns. 03

Emergency management of a patient with 45% total body surface area (TBSA) burns is a critical and complex process, requiring immediate attention to prevent life-threatening complications and minimize damage. This guide outlines key steps in managing a patient with extensive burns in an emergency setting, emphasizing the initial assessment, stabilization, and early interventions.

Immediate Assessment and Stabilization

1. Primary Survey (ABCDE Approach):

• Airway: Ensure the airway is clear. Look for signs of inhalation injury, such as soot in the mouth or nose, singed nasal hairs, or hoarseness. Intubation may be necessary if airway compromise is suspected.
• Breathing: Assess respiratory rate, effort, and oxygen saturation. Administer supplemental oxygen and prepare for intubation if needed.
• Circulation: Check heart rate, blood pressure, and capillary refill. Look for signs of shock due to fluid loss from burns.
• Disability: Assess neurological status using the Glasgow Coma Scale (GCS). Look for signs of head injury or altered consciousness.
• Exposure/Environment: Expose the patient to assess the extent of burns, but avoid hypothermia. Cover the patient with sterile dressings or warm blankets.

1. Estimation of Burn Surface Area:

• Use the “Rule of Nines” or the Lund and Browder chart to estimate the total body surface area (TBSA) affected by burns. This guides fluid resuscitation and treatment priorities.

Fluid Resuscitation

1. Parkland Formula:

• Use the Parkland formula to calculate the initial fluid requirements. The formula is: 4 mL x TBSA (%) x body weight (kg).
• Administer half of the calculated volume in the first 8 hours from the time of burn injury, and the remaining half over the next 16 hours.
• Use lactated Ringer’s solution for fluid resuscitation.

1. Monitor Fluid Status:

• Closely monitor urine output, blood pressure, and heart rate to assess fluid resuscitation adequacy.
• Aim for a urine output of 0.5-1 mL/kg/hr in adults.

Wound Care and Infection Prevention

1. Sterile Dressing:

• Cover burns with sterile, non-adherent dressings to protect the wound and reduce infection risk.
• Avoid applying ointments or creams in the initial emergency phase.

1. Tetanus Prophylaxis:

• Administer tetanus prophylaxis if the patient’s immunization status is uncertain or outdated.

1. Infection Control:

• Implement strict infection control measures to minimize the risk of infection. Use aseptic techniques when handling the patient and changing dressings.

Pain Management

1. Analgesia:

• Administer appropriate analgesics to manage pain. Intravenous opioids are commonly used for severe burns.

Respiratory Management

1. Inhalation Injury:

• If inhalation injury is suspected, consider bronchoscopy to assess the extent of injury.
• Monitor for signs of respiratory distress and prepare for mechanical ventilation if needed.

Early Consultation and Transfer to Burn Center

1. Consultation with Burn Specialist:

• Involve a burn specialist or burn team early in the process for guidance on advanced management.

1. Transfer to Burn Center:

• If possible, transfer the patient to a specialized burn center with experience in managing extensive burns.

Addressing Associated Injuries and Comorbidities

1. Trauma Assessment:

• Conduct a thorough assessment for other injuries or trauma that may have occurred alongside the burns.

1. Comorbid Conditions:

• Consider the patient’s medical history and manage any comorbidities that could complicate burn treatment.

(2)

💟 (a) Define cerebrovascular accident. 02

A Cerebrovascular Accident, commonly known as a stroke, refers to the sudden loss of blood circulation to an area of the brain, leading to tissue damage and neurological deficits. Strokes can be ischemic, caused by a blockage in a blood vessel, or hemorrhagic, caused by bleeding into the brain tissue.

💟 (b) Discuss the pathophysiology of CVA.04

Ischemic Stroke

Ischemic strokes account for approximately 85% of all strokes. They occur when a blood clot or other blockage obstructs an artery supplying blood to the brain. There are two main subtypes:

• Thrombotic Stroke:
  • This type occurs when a thrombus (blood clot) forms in a cerebral artery, often at a site of atherosclerotic plaque buildup. Atherosclerosis involves the accumulation of fatty deposits, cholesterol, and other substances in the arterial walls, leading to narrowing and reduced blood flow. If a clot forms and blocks the artery, brain tissue downstream suffers from ischemia (lack of oxygen).
• Embolic Stroke:
  • This type happens when an embolus, a clot or debris from elsewhere in the body (often from the heart or carotid arteries), travels through the bloodstream and lodges in a cerebral artery. Common causes include atrial fibrillation, heart valve disease, or recent cardiac procedures.

In both thrombotic and embolic strokes, the lack of blood flow leads to tissue hypoxia, causing brain cells to undergo necrosis and apoptosis (programmed cell death). As cells die, the affected brain region’s function deteriorates, leading to neurological deficits such as paralysis, speech difficulties, or loss of vision.

Hemorrhagic Stroke

Hemorrhagic strokes account for about 15% of strokes but tend to be more severe with higher mortality rates. They occur when a blood vessel in the brain ruptures, causing bleeding into brain tissue or the surrounding spaces. Hemorrhagic strokes have two main subtypes:

• Intracerebral Hemorrhage (ICH):
  • This occurs when a blood vessel within the brain ruptures, leading to bleeding into the brain tissue. Common causes include hypertension, aneurysms, arteriovenous malformations (AVMs), or brain trauma. The increased pressure from the blood buildup can lead to brain tissue compression and subsequent damage.
• Subarachnoid Hemorrhage (SAH):
  • This type happens when bleeding occurs in the subarachnoid space, typically due to a ruptured aneurysm or AVM. The accumulation of blood increases intracranial pressure, leading to sudden, severe headaches, neck stiffness, and potential loss of consciousness.

In hemorrhagic strokes, the bleeding not only disrupts normal blood flow but also causes direct tissue damage and increased intracranial pressure. This pressure can lead to further brain injury and may require surgical intervention to relieve pressure.

💟 (c) Explain in detail the treatment options available for a patient with cerebro vascular accident. 04

Thrombolytic Therapy:
– Thrombolytic drugs such as tissue plasminogen activator (tPA) are administered intravenously to dissolve blood clots in ischemic strokes, restoring blood flow to the affected area. Time-sensitive administration is crucial, typically within a few hours of symptom onset, to maximize effectiveness and minimize risks.

b. Mechanical Thrombectomy:
– In cases of large vessel occlusion ischemic strokes, mechanical thrombectomy is performed using specialized catheters and devices to physically remove the clot from the blocked blood vessel. This procedure is often utilized alongside or as an alternative to thrombolytic therapy and can extend the treatment window beyond the typical time frame for tPA administration.

c. Antiplatelet and Anticoagulant Therapy:
– Medications such as aspirin, clopidogrel, or heparin may be prescribed to prevent the formation of new blood clots and reduce the risk of recurrent strokes. The choice of medication depends on factors such as the type of stroke, underlying medical conditions, and bleeding risk.

d. Surgical Interventions:
– Surgical procedures may be necessary in cases of hemorrhagic strokes or when conservative treatments are ineffective. These interventions may include craniotomy to remove blood clots, repair of damaged blood vessels, or placement of a shunt to divert excess cerebrospinal fluid and relieve intracranial pressure.

e. Rehabilitation Therapy:
– Following the acute phase of treatment, rehabilitation therapy plays a crucial role in helping patients recover and regain lost functions. Physical therapy, occupational therapy, speech therapy, and cognitive therapy are tailored to address specific deficits and improve overall quality of life.

f. Secondary Prevention Measures:
– Lifestyle modifications such as smoking cessation, regular exercise, maintaining a healthy diet, and managing chronic conditions like hypertension, diabetes, and high cholesterol are essential for reducing the risk of recurrent strokes. Additionally, monitoring and medication adherence are crucial components of long-term stroke management.

2 .Short Essay (Any Three) 3×5=15

💟 (1)Pelvic inflammatory disease

1. Definition:

• Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, including the uterus, fallopian tubes, ovaries, and surrounding pelvic tissues. It is typically caused by bacteria, most commonly sexually transmitted infections (STIs) such as chlamydia and gonorrhea, but can also result from other types of bacteria.

1. Risk Factors:

• Unprotected sexual activity, especially with multiple partners or a partner who has multiple partners.
• History of sexually transmitted infections (STIs), particularly chlamydia or gonorrhea.
• Previous episodes of PID or other pelvic infections.
• Intrauterine device (IUD) use, particularly in the first few weeks after insertion.
• Douching, which can disrupt the natural balance of bacteria in the vagina and increase the risk of infection.

1. Pathophysiology:

• PID typically begins as an infection of the cervix (cervicitis) and can spread to the upper reproductive organs, including the uterus, fallopian tubes, and ovaries.
• Bacteria enter the reproductive tract through the cervix and can ascend into the upper genital tract, causing inflammation, swelling, and scarring of the pelvic organs.
• Inflammation and scarring can lead to complications such as chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of future episodes of PID.

1. Symptoms:

• Lower abdominal or pelvic pain.
• Abnormal vaginal discharge, which may be foul-smelling or unusual in color or consistency.
• Pain during urination or sexual intercourse.
• Irregular menstrual bleeding or spotting.
• Fever, chills, nausea, and vomiting (in severe cases).
• Symptoms may vary in severity and can range from mild discomfort to severe pain and systemic illness.

1. Diagnosis:

• Diagnosis of PID is based on a combination of clinical findings, medical history, and diagnostic tests.
• Physical examination may reveal pelvic tenderness, cervical motion tenderness (pain with movement of the cervix), and adnexal tenderness (pain in the area of the ovaries and fallopian tubes).
• Laboratory tests, including urine tests, cervical cultures, and blood tests, may be performed to identify the presence of infection and assess for signs of inflammation.
• Imaging studies such as ultrasound or pelvic MRI may be used to evaluate the pelvic organs and rule out other possible causes of symptoms.

1. Treatment:

• Antibiotic therapy is the mainstay of treatment for PID and aims to eradicate the underlying infection.
• Empiric antibiotic therapy is typically initiated based on the suspected pathogens and severity of symptoms, with coverage for common organisms such as chlamydia, gonorrhea, and anaerobic bacteria.
• In severe cases or cases of treatment failure, hospitalization and intravenous antibiotics may be necessary.
• Sexual partners should also be tested and treated to prevent reinfection and transmission of the infection.

1. Complications:

• Untreated or recurrent PID can lead to serious complications, including chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of pelvic adhesions and tubal scarring.
• Long-term complications may require surgical intervention, fertility treatments, or other medical interventions to address.

1. Prevention:

• Prevention of PID involves practicing safe sex, using barrier methods such as condoms, and seeking prompt treatment for STIs.
• Routine screening for STIs and prompt treatment of infections can help prevent the development of PID and reduce the risk of complications.

Early recognition, diagnosis, and treatment of PID are essential for minimizing complications and preserving reproductive health in affected individuals. Regular gynecologic exams and screening for STIs can help identify and address risk factors for PID before complications arise.

💟 (2) Nursing management of tonsillitis

1. Assessment*:

• Conduct a thorough health history to identify any predisposing factors or underlying conditions that may contribute to tonsillitis, such as recent upper respiratory infections, exposure to infectious agents, or immune system disorders.
• Assess the patient’s current symptoms, including sore throat, difficulty swallowing, fever, swollen tonsils, enlarged lymph nodes, and presence of white patches or pus on the tonsils.
• Evaluate the patient’s overall condition, including vital signs, hydration status, and signs of systemic illness.

1. Patient Education:

• Educate the patient and their family about tonsillitis, its causes, symptoms, and potential complications.
• Provide information on the importance of completing prescribed treatment, including medications and home care measures, to alleviate symptoms and prevent recurrence.
• Instruct the patient on proper hygiene practices to reduce the spread of infection, such as frequent handwashing, covering coughs and sneezes, and avoiding close contact with others, especially during the acute phase of illness.

1. Pain Management:

• Administer analgesic medications as prescribed to alleviate sore throat pain and discomfort.
• Encourage the use of non-pharmacological pain relief measures, such as warm saltwater gargles, throat lozenges, or cold compresses applied to the neck.

1. Hydration and Nutrition:

• Encourage the patient to maintain adequate hydration by drinking plenty of fluids, such as water, herbal teas, or clear broth, to soothe the throat and prevent dehydration.
• Offer soft, easy-to-swallow foods that are gentle on the throat, such as soups, yogurt, applesauce, and mashed potatoes, to ensure adequate nutrition and promote healing.

1. Rest and Comfort:

• Advise the patient to get plenty of rest and avoid strenuous activities to support the body’s immune response and promote recovery.
• Provide a comfortable environment conducive to rest, with adequate bedding, quiet surroundings, and appropriate temperature control.

1. Antibiotic Therapy:

• If tonsillitis is caused by bacterial infection, administer antibiotic therapy as prescribed by the healthcare provider to eradicate the underlying infection and prevent complications.
• Educate the patient about the importance of completing the full course of antibiotics, even if symptoms improve before the medication is finished, to ensure effective treatment and reduce the risk of recurrence or antibiotic resistance.

1. Monitoring and Follow-up:

• Monitor the patient’s symptoms, vital signs, and response to treatment regularly to assess for improvement or complications.
• Arrange for follow-up appointments with the healthcare provider as needed to evaluate the patient’s progress, adjust treatment if necessary, and address any concerns or questions.

1. Complications and Referral:

• Monitor for signs of complications, such as difficulty breathing, severe pain, high fever, or dehydration, and intervene promptly to prevent further deterioration.
• Refer the patient to a specialist, such as an otolaryngologist (ENT), if complications arise or if recurrent tonsillitis requires further evaluation for potential surgical intervention, such as tonsillectomy.

💟 (3) Contact lens

Definition*:

• Contact lenses are thin, curved lenses placed directly on the surface of the eye to correct vision or for cosmetic purposes. They are designed to correct refractive errors such as nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and presbyopia.

1. Types of Contact Lenses:
   a. Soft Contact Lenses:
   • Made of flexible plastic materials that allow oxygen to pass through to the cornea.
   • Available in various wearing schedules, including daily disposable, bi-weekly, and monthly replacement.
   • Offered in different designs, including spherical lenses for basic vision correction, toric lenses for astigmatism, and multifocal lenses for presbyopia.
   b. Rigid Gas Permeable (RGP) Contact Lenses:
   • Made of durable plastic materials that allow oxygen to pass through.
   • Provide crisp, clear vision and are suitable for individuals with astigmatism or irregular corneas.
   • Typically require a longer adaptation period compared to soft lenses but offer excellent visual acuity and durability.
   c. Hybrid Contact Lenses:
   • Combine the features of both soft and RGP lenses, with a rigid center surrounded by a soft outer skirt.
   • Offer the comfort of soft lenses with the clear vision of RGP lenses, making them suitable for individuals with irregular corneas or specific vision needs.
   d. Scleral Contact Lenses:
   • Large-diameter lenses that vault over the entire cornea and rest on the sclera (white part of the eye).
   • Used for individuals with irregular corneas, such as those with keratoconus, or for patients with severe dry eye syndrome.
2. Fitting and Prescription:

• Contact lenses require a prescription from an eye care professional, such as an optometrist or ophthalmologist, who will perform a comprehensive eye examination to determine the appropriate lens parameters.
• The prescription includes specifications such as lens power (measured in diopters), base curve (corneal curvature), diameter, and wearing schedule.
• Proper fitting is essential to ensure comfort, visual acuity, and corneal health. It involves selecting the correct lens size, shape, and material based on the patient’s ocular anatomy and lifestyle.

1. Insertion and Removal:

• Patients must practice proper hygiene when handling contact lenses to reduce the risk of infection and irritation.
• Before handling lenses, wash hands thoroughly with soap and water, and dry them with a lint-free towel.
• Use recommended techniques for inserting and removing lenses, such as holding the lens on the tip of the finger and avoiding contact with fingernails or sharp objects.
• Follow the recommended cleaning and disinfection procedures for the specific type of contact lenses used.

1. Maintenance and Care:

• Regular cleaning and disinfection of contact lenses are essential to prevent microbial contamination and maintain ocular health.
• Use recommended contact lens solutions for cleaning, rinsing, and storing lenses, and avoid using tap water or saliva as substitutes.
• Replace lenses according to the prescribed wearing schedule to minimize the accumulation of deposits and ensure optimal vision and comfort.

1. Safety Precautions:

• Follow proper wearing schedules and avoid wearing lenses beyond the recommended replacement interval.
• Remove contact lenses before swimming or showering to prevent exposure to waterborne pathogens and potential eye infections.
• Avoid sleeping in contact lenses unless approved by an eye care professional, as extended wear increases the risk of corneal complications.

1. Routine Eye Exams:

• Schedule regular eye examinations with an eye care professional to monitor ocular health, evaluate contact lens fit and prescription, and address any changes in vision or discomfort.

💟 (4) Cosmetic surgeries

Cosmetic surgery, also known as aesthetic surgery, encompasses a range of procedures designed to enhance or alter a person’s appearance. Here’s a breakdown of cosmetic surgery in detail:

1. Consultation: The process typically begins with a consultation with a board-certified plastic surgeon. During this meeting, the surgeon evaluates the patient’s concerns, discusses goals, and determines the most suitable procedures.
2. Pre-operative Evaluation: Before surgery, patients undergo a thorough medical evaluation to ensure they are healthy enough for the procedure. This may include blood tests, imaging studies, and other assessments.
3. Anesthesia: Cosmetic surgery procedures are usually performed under either local anesthesia (with sedation) or general anesthesia, depending on the complexity of the surgery and the patient’s preferences.
4. Procedure Selection: There are numerous cosmetic surgery procedures available, targeting different areas of the body. Some common ones include:

• Rhinoplasty: Nose reshaping surgery.
• Breast Augmentation: Enhancing breast size and shape using implants or fat transfer.
• Liposuction: Removing excess fat from specific areas of the body.
• Facelift: Tightening sagging skin on the face and neck to reduce wrinkles and improve overall appearance.
• Eyelid Surgery (Blepharoplasty): Correcting droopy eyelids or removing excess skin and fat around the eyes.
• Abdominoplasty (Tummy Tuck): Removing excess skin and fat from the abdomen to create a firmer, flatter stomach.
• Breast Reduction: Reducing the size of overly large breasts to alleviate physical discomfort and improve aesthetics.
• Botox and Dermal Fillers: Non-surgical procedures to reduce wrinkles, add volume, and rejuvenate the face.

1. Surgical Procedure: The surgeon performs the chosen procedure according to the predetermined plan, utilizing specialized techniques and instruments to achieve the desired outcome.
2. Recovery: Following surgery, patients undergo a period of recovery, during which they may experience swelling, bruising, discomfort, and restricted activity. The duration of recovery varies depending on the type and extent of the procedure.
3. Post-operative Care: Patients receive instructions for post-operative care, including wound care, medication management, activity restrictions, and follow-up appointments with the surgeon to monitor healing progress.
4. Results: The final results of cosmetic surgery become apparent as swelling subsides and the body heals. Patients can expect improvements in their appearance, which may boost self-confidence and overall well-being.
5. Long-term Maintenance: While cosmetic surgery can produce long-lasting results, it’s essential for patients to maintain a healthy lifestyle and skincare regimen to prolong the benefits of their procedures.
6. Risks and Complications: Like any surgical procedure, cosmetic surgery carries risks, including infection, bleeding, adverse reactions to anesthesia, scarring, asymmetry, and dissatisfaction with results. It’s crucial for patients to understand and weigh these risks before undergoing surgery.

💟 (5) Principles of emergency nursing

Emergency nursing involves a set of principles aimed at providing timely and effective care to patients in urgent situations. Here are some key points:

1. Triage: Prioritizing patient care based on the severity of their condition, ensuring those in critical condition receive immediate attention.
2. Assessment: Conducting rapid and thorough assessments to identify and prioritize patient needs.
3. Stabilization: Providing interventions to stabilize patients’ conditions, such as administering medications, controlling bleeding, or managing airways.
4. Communication: Maintaining clear and concise communication with patients, their families, and other healthcare team members to ensure coordinated care.
5. Teamwork: Collaborating with other healthcare professionals, including physicians, technicians, and support staff, to deliver comprehensive care.
6. Critical Thinking: Applying critical thinking skills to make rapid decisions and adapt to evolving situations.
7. Patient Advocacy: Advocating for patients’ needs and ensuring their rights are respected during their emergency care.
8. Safety: Prioritizing patient and staff safety, including infection control measures, proper handling of equipment, and maintaining a safe environment.
9. Documentation: Accurately documenting patient assessments, interventions, and responses to treatment for continuity of care and legal purposes.
10. Continuing Education: Engaging in ongoing education and training to stay updated on best practices and advancements in emergency nursing care.

3 .Very Short Essay: (Compulsory) 6×2=12

💟 (1) Define uveitis

Uveitis is an inflammatory condition affecting the uvea, which is the middle layer of the eye. The uvea consists of the iris, ciliary body, and choroid, and inflammation can occur in any of these structures. Uveitis can also involve adjacent eye tissues, such as the retina, optic nerve, and vitreous humor.

There are several types of uveitis classified based on the part of the uvea affected and the duration of symptoms:

1. Anterior uveitis (iritis): Inflammation of the iris and/or ciliary body. It is the most common form of uveitis and typically presents with symptoms such as eye redness, pain, light sensitivity, and blurred vision.
2. Intermediate uveitis (pars planitis): Inflammation of the ciliary body and/or vitreous humor. Symptoms may include floaters (spots or cobwebs in vision), blurred vision, and mild eye discomfort.
3. Posterior uveitis: Inflammation of the choroid and/or retina. This form of uveitis can present with symptoms such as floaters, blurred vision, and visual field loss.
4. Panuveitis: Inflammation affecting all parts of the uvea. It can cause a combination of symptoms seen in anterior, intermediate, and posterior uveitis.

💟 (2) List out movement disorders

1. Parkinson’s disease: Characterized by tremors, bradykinesia (slowness of movement), rigidity, and postural instability.
2. Essential tremor: Involuntary trembling of the hands, head, voice, or other parts of the body, often worsened by movement or emotional stress.
3. Dystonia: Involuntary muscle contractions that cause repetitive or twisting movements and abnormal postures.
4. Huntington’s disease: A genetic disorder causing involuntary movements (chorea), cognitive decline, and psychiatric symptoms.
5. Tourette syndrome: Characterized by involuntary, repetitive movements and vocalizations called tics.
6. Restless legs syndrome (RLS): An uncomfortable urge to move the legs, often accompanied by unpleasant sensations, typically worse at night.
7. Ataxia: Impaired coordination of movement, resulting in unsteady gait, difficulty with balance, and slurred speech.
8. Wilson’s disease: A rare inherited disorder causing copper accumulation in the body, leading to neurological symptoms such as tremors, dystonia, and ataxia.
9. Myoclonus: Sudden, brief involuntary muscle jerks or twitches.
10. Progressive supranuclear palsy (PSP): A neurodegenerative disorder causing difficulties with balance, eye movement, and voluntary muscle control.

💟 (3) List out special equipment in CCU

1. Ventilators: Used to assist or control a patient’s breathing.
2. Cardiac monitors: Monitor heart rate, rhythm, and other cardiac parameters.
3. Intravenous (IV) pumps: Administer medications and fluids intravenously.
4. Hemodynamic monitoring devices: Measure parameters like blood pressure, cardiac output, and oxygen saturation.
5. Defibrillators: Used to deliver electric shocks to restore normal heart rhythm in case of cardiac arrest or arrhythmias.
6. Pulse oximeters: Measure oxygen saturation levels in the blood.
7. Continuous renal replacement therapy (CRRT) machines: Provide continuous dialysis for patients with kidney failure.
8. Feeding pumps: Administer enteral nutrition to patients unable to eat orally.
9. Patient beds with integrated monitoring systems: Monitor vital signs and allow easy access to patients.
10. Specialty beds: Such as air-fluidized beds for patients with severe pressure ulcers or low air loss beds for patients at risk of skin breakdown.

💟 (4) Define multiple sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, including the brain and spinal cord. It occurs when the immune system mistakenly attacks the protective covering of nerve fibers, called myelin, leading to inflammation and damage. This can result in a wide range of symptoms, including fatigue, muscle weakness, numbness or tingling, mobility issues, and problems with coordination and balance. The severity and progression of MS vary widely among individuals.

💟 (5) List out industrial health disorders

1. Respiratory disorders: Such as occupational asthma, pneumoconiosis (e.g., coal worker’s lung, silicosis), and chronic obstructive pulmonary disease (COPD) due to exposure to dust, fumes, and chemicals in industries like mining, construction, and manufacturing.
2. Dermatological disorders: Including contact dermatitis, eczema, and skin cancers due to exposure to irritants, allergens, and radiation in industries like agriculture, healthcare, and chemical manufacturing.
3. Musculoskeletal disorders (MSDs): Such as repetitive strain injuries, carpal tunnel syndrome, and back injuries due to repetitive movements, poor ergonomics, and heavy lifting in industries like manufacturing, construction, and agriculture.
4. Noise-induced hearing loss (NIHL): Caused by exposure to loud noises over time in industries like construction, manufacturing, and transportation.
5. Mental health disorders: Such as stress, anxiety, and depression due to high-pressure work environments, long hours, and job insecurity in various industries.
6. Chemical exposure-related disorders: Including poisoning, organ damage, and cancer due to exposure to hazardous chemicals in industries like manufacturing, agriculture, and mining.
7. Infectious diseases: Such as tuberculosis, hepatitis, and HIV/AIDS, which can be contracted in healthcare, sanitation, and laboratory settings.
8. Heat-related disorders: Including heat exhaustion, heat stroke, and dehydration due to working in high-temperature environments, such as foundries, construction sites, and agriculture.
9. Vision-related disorders: Such as eye strain, cataracts, and vision loss due to exposure to bright lights, radiation, and hazardous materials in industries like welding, manufacturing, and construction.
10. Cardiovascular disorders: Such as hypertension, heart disease, and stroke, which can be exacerbated by stress, poor diet, and lack of physical activity in various industries.

💟 (6) List out team members in disaster management.

1. Emergency Medical Services (EMS) Personnel:* Paramedics and emergency medical technicians (EMTs) provide medical care and transport for injured individuals during disasters.
2. Physicians and Nurses: Medical professionals, including doctors, nurses, and other healthcare staff, play a crucial role in triaging, treating, and stabilizing injured individuals in disaster situations.
3. Firefighters: Firefighters are trained in rescue operations, fire suppression, and hazardous materials handling, making them essential for search and rescue efforts during disasters.
4. Law Enforcement Officers: Police officers and other law enforcement personnel help maintain public safety, enforce evacuation orders, manage crowds, and secure disaster areas.
5. Emergency Managers: Emergency managers coordinate disaster response efforts, develop emergency plans, and liaise with government agencies, non-profit organizations, and the public.
6. Public Health Officials: Public health professionals monitor and address public health concerns during disasters, such as disease outbreaks, food and water safety, and mental health support.
7. Volunteers: Volunteers from various organizations, such as the Red Cross, community groups, and faith-based organizations, provide support in areas such as shelter management, distribution of supplies, and emotional support for survivors.
8. Search and Rescue (SAR) Teams: SAR teams specialize in locating and extracting individuals trapped in collapsed structures, remote areas, or hazardous conditions during disasters.
9. Emergency Communication Specialists: Communication specialists ensure effective communication among response teams, government agencies, and the public through various communication channels, including radio, social media, and emergency alert systems.
10. Logistics and Supply Chain Specialists: These professionals manage the procurement, distribution, and tracking of essential resources such as medical supplies, food, water, and shelter materials during disaster response and recovery efforts.