MSN-1-2016

Q-1. 47 years old patient admitted in medical ward with chronic renal failure. A 47-year-old patient is admitted to the medical ward with chronic renal failure.

Q.1 A. Define the chronic renal failure. 02 Define chronic renal failure

Definition :-

• This is an irreversible renal disease. In which renal function is progressively lost. Which is seen due to some other disease.

• In this condition, acute renal disease is a chronic condition seen due to gradual decline in kidney function when not treated on time. In which the kidneys fail to filter the blood and waste products accumulate in the blood.

Q.1 b.Write the signs and symptoms of chronic renal failure. State the signs and symptoms of chronic renal failure 04

• Proteinuria
• Oliguria
• Anuria
• Severe edema
• Retinopathy
• Hyponatremia
• Hyperkalemia
• Hypertension
• Metabolic acidosis
• Cells and crystals in urine
• Uremic breath
• Anemia
• Pulmonary edema
• weakness
• Diarrhea
• Fever
• Unconsciousness or unconsciousness
• Systemic infection

C. Describe the nursing management of patient with chronic renal failure 06

Pain :-

• Analgesics are given to the patient as per the doctor’s order
• A proper position is given to the patient
• Antibiotics are given to the patient at appropriate time
• Providing diversional therapy such as giving a book to reduce pain in the patient
• In case of severe pain, the doctor should be informed and opioid should be given if necessary
• DAT – Morphine Sulphate

Fluids overload and electrolyte imbalance:-

• The patient should be checked for overload or electrolyte imbalance and checked and monitored for inflammation.
• The patient should be given a diuretic as per the doctor’s order
• The patient should be encouraged to drink small amounts of fluids
• Pitting edema should be noted
• A patient intake and output chart should be maintained
• If needed, electrolytes are also given as per the doctor’s order

Teeth :- kcl, mgso4

• Altered nutrition less than body requirement:-
• Check the patient’s blood glucose level regularly
• The patient should be given a high calorie, low protein, low or no salt, low fluid diet
• Vitamin and iron supplements should be given to the patient
• Fiber diet should be given in sufficient quantity

Anxiety:-

• Inform the patient and their relatives about the hospital setup
• If any procedure or test is to be done on the patient, tell about it
• If possible, a relative should be allowed to stay with the patient
• The patient should be called by name
• Every question of the patient should be answered calmly and positively

Restlessness:-

• The patient should be given a comfortable position
• If the patient has difficulty breathing, oxygen should be given
• If the patient is admitted for a long time then air mattress should be given
• The position of the patient should be changed to prevent pressure sores
• Diuretic medicines should be given to the patient only in the morning.

Prevent Complication:-

• All medicines should be given to the patient at the right time
• Vital signs should be checked and recorded
• Every problem of the patient should be heard and if any complication is found then the doctor should be informed immediately
• An emergency tray should be kept ready near the patient.

Unhygienic condition:-

• The patient should be helped to maintain personal hygiene
• Bath should be watered according to season
• The patient should be encouraged to brush daily
• If the patient is not able to brush himself, then mouth care should be done
• The patient’s bed sheet should be changed daily

Knowledge deficiency:-

• The patient should be encouraged to follow the diet as prescribed by the doctor
• The patient should be given a salt restricted diet
• The patient should be encouraged to take each medication at the right time and on time
• The patient should be encouraged to follow up
• Ask to contact the doctor immediately if any complication is found in the patient
• Apart from this, CKD patients should take special care during dialysis and take special care if they have fissures.
• Recording daily weight and explaining to take medicine on time.

Q.2 Write the immediate nursing assessment & nursing management of patient with head injury in Trauma CENTER 06 Write the immediate nursing assessment and management of patient with head injury in trauma center.

Immediate nursing assessment:-

• Conscious level disturbances may be observed in which the patient moves towards delirium
• Headache, vertigo, agitation, and restlessness may occur
• C.S.F. Leakage is seen from the ears and nose
• Skull fracture
• Irregular respiration is seen
• Cognitive function deficient
• Pupillary abnormality
• A neurogenic deficit is seen suddenly
• Auturia shows a posterior basal skull fracture
• Rhinorrhea suggests an anterior basal skull fracture.

Nursing management:-

• The patient’s intracranial pressure should be monitored and any abnormality should be reported to the doctor immediately.
• The patient’s airway should be maintained
• The patient should be turned every 2 hours
• Anchor the patient for deep breathing and cuffing exercises
• To monitor vital signs
• Maintaining fluid balance
• Firm pressure should be applied to the puncture site
• The depth, rhythm, and pattern of respiration should be checked
• A patient should not be fed early if possible after a head injury
• If the patient is unable to swallow, give enteral feeding
• Regularly monitor the Glasgow Coma Scale
• Elevate the head 30° to 45°
• Keep the patient’s neck in a neutral position
• Using Valsava Menuware
• Do not over suction. Do not do more than 15 sec
• Pain stimulants should be avoided
• The patient should be hyperventilated and SPO2 maintained
• All nursing activities should be avoided simultaneously
• Seizure protection measures should be taken
• Administer histamine, beta blockers as per doctor order to prevent gastric ulceration

Q.2 B. Write the postoperative nursing management of a patient with chest surgery first 24 hours 06 Write the postoperative management of the first twenty four hours after chest surgery

• Maintain the patient’s airway
• To check patient’s vital signs every 2 hours including T.P.R., B.P.,
• Do suction if necessary
• Watch for bleeding at the site of surgery
• Assess for grief
• Do mouth care every 4 hours
• Administer intravenous fluids as per doctor order
• Keep checking the patient for post-operative complications
• Giving medicine as per doctor order
• To raise feet
• Keep the patient changing position frequently
• Assess for drainage if a chest drainage tube is inserted
• Keep checking the patient for complications of anesthesia
• Keep checking the patient’s level of consciousness
• Administer tow oxygen therapy if needed
• Checking his dressing site and dressing daily with aseptic technique
• Taking into consideration his nutritional needs and maintaining nil by mouth stage as per doctor order and maintaining intake output chart
• Keep checking the color and patency of the drainage coming from the chest tube
• Prepare the patient for early ambulation
• Instruct the patient in passive movement of the leg to prevent post-surgical complications.

Q.-3 Answer the following: Answer the notes. 12

• A. Describe ideal OT setup – Describe ideal OT setup
• The operation theater should be of modern style
• The atmosphere of the room should be comfortable
• An infection control system should be in place
• Modern equipment should be used
• The operation theater should be separate from other rooms of the hospital
• There should be different arrangements for different operations
• Artificial ventilation should be arranged to maintain the temperature of the operation theatre
• There should be arrangements for 24 hours electric supply
• All doors in the operation theater should be equipped with hydraulic system
• Mobile x-ray should be arranged
• All rooms should be arranged as required in the operation theatre
• The operation theater should be connected to the hospital by road.
• Operation theater light fittings and drain lines should be underground
• The ground flooring of the Operation Theater should be made of marble or cobblestone.
• The windows and doors of the OT should be of one-way glass and curtained.
• O.T. Furs, walls and furniture should be washable.
• Patient OT There should be arrangements such that he cannot easily see another patient, the operation or staff members after entering.
• Mobile light and saddleless light should also be arranged.
• Staff and attendants working in OT should be well trained.
• An idle operation theater should have the following units. To avoid infection, there should be a facility for the patient to enter from one side and exit from the other side.

Reception room :-

• A separate room should be arranged to receive the patient when he enters the operation theatre.
• The patient area should be comfortable. The walls of this room should be colorful, with posters.
• Reception rooms should be arranged for adults and children. And the room should have a telephone system. This room should be away from the operation theater room. Nursing staff should have duty in this room

Changing room :-

• This room should be away from the operation theater room. Every staff in this room wears OT dress

Anesthesia room :-

• This room should be attached to the main operation room. This room should have a bed, anesthesia trolley and related equipment. This room should have cub board arrangement for keeping anesthetic equipment. Oxygen, suction machine, B. P. Sufficient storage of apparatus, anesthetic drugs, and emergency drugs in the tray. This room should be in such a way that the patient cannot see

Scrub room :-

• Surgeons and staff are scrubbed in this room. Necessary items like anti septic liquid, soap, towel, mirror should be arranged and for hand washing procedure there should be a large size sink and faucet with handle and 24 hour water supply. Accommodation should be arranged and sterilized aprons and gloves should be provided in this room

Main operation room :-

• OT is the main part where the operation is performed. This room should be air conditioned. This room should have all modern equipment like suction machine, mobile light, mobile X-ray, cautery machine, oxygen, anesthesia trolley, emergency injection tray, ventilator etc.

• There should be no table accordingly to give position as per operation. And there should be shadowless light above the operation table.

Preparation room :-

• There should be separate arrangements of tubals and ranks for making sets and drums according to different operations

Sterile supply room :- This room should be arranged for keeping and supplying sterilized items

Central sterilization supply unit :–

• This room should be away from the operation room where all the items are sterilized. There should be an autoclave machine for this. This room should have proper ventilation.

Minor operating room :- A separate room should be arranged for minor procedures

Utility room :-

• This room should be arranged to clean and separate the instruments, linen, gloves etc. used and damaged during the operation.

Infectious disease operating room:-

• If there is an infectious patient, a separate operation room should be arranged for them so that it should be separate from the main operation room to prevent the spread of infection and regular fumigation should be done in time.

12) Recovery room :-

• The main purpose of the recovery room is to provide total nursing care to the operated patient. The staff working in this room should have knowledge of post-operative and post-anesthetic complications.

• This room should have resuscitation equipment, suction machine, emergency drugs, as well as oxygen system, modern bed should be arranged for the patient so that proper position can be given to the patient and necessary equipment should be there in post-operative.

OR

Q.3 a. Advantages and disadvantages of spinal anesthesia. Advantages and disadvantages of spinal anesthesia,

Advantages:-

• These are chips
• Patient satisfaction is good
• The risk of respiratory complications is low
• Superior muscle relaxation is observed
• Bleeding is less
• Bowel function returns immediately
• The incidence of coagulation disorders due to surgery is reduced.
• Post-operative stay is also shortened
• Pain control is good
• Nausea and vomiting are reduced
• Post operative recovery is quick

Disadvantage:-

• The duration of this procedure depends on the skill and competence of the anaesthetic
• In some cases it is difficult to find the dural space
• There is a risk of hypo tension
• Cannot give this anesthesia in sedated people.
• Spinal cord herniation can sometimes be seen
• Brain and spinal cord can get infected
• Post anesthesia headache is observed
• Not useful for operations above the diaphragm

Q.3 b. List the complication of diabetes mellitus.- Made a list of complications of diabetes mellitus

Complication:-

• Hyper osmolar hyper glycemic state
• Diabetes ketoacidosis
• Hypoglycemia
• Coronary artery disease
• Atherosclerosis
• Nephropathy
• Retinopathy
• Hearing loss
• Heart diseases
• stroke
• Kidney diseases
• Norway Damage
• Eye damage
• Digestion problem
• Erectile dysfunction
• Skin problem
• Recurrent infection
• Dental problem
• Delay healing

Q.3 c. Write the action and side effect of any two drugs:- Write the action and side effect of any two drugs below.

(i) Aminophylline:-

Action:- Aminophylline drugs are broncho dilators. which relaxes the muscles of the bronchial tubes. So the phlegm is relieved from the bronchi. Due to which breathing is taken easily.

Side Effects:-

• Chest pain
• Dizziness
• Fanting
• Fast, slow, irregular heartbeat
• Urine volume increases
• Persistent vomiting
• Rapid pulse
• Caesar
• Shakeiness

(ii) Paracetamol – Paracetamol

Action:- Paracetamol is a drug of analgesic and antipyretic group. Its primary action is to inhibit prostate gland synthesis. and central analgesic effect due to descending serotogenic pathway.

Side Effects:-

• Stomach pain
• In diazation
• malaise
• Nozia
• Vomiting
• Low blood pressure
• Dizziness
• Drowsiness
• Diarrhea
• Liver damage

(iii) Dexona – Dexona

Action:- It is a steroid and anti-inflammatory and immunosuppressant drug. It is used to relieve the symptoms of various medical conditions like redness, swelling, tenderness and inflammatory conditions.

Side effects:-

• Weight gain
• Indigestion
• Sleep problem
• Mild mood changes
• Fluid retention
• Increases appetite
• Nogia
• Vomiting
• Upset Stomach
• headache
• Dizziness
• Resh
• Increase swatting
• Hyperglycemia

Q-4 Write shortnotes on ANY THREE of the following :- 12 of the following. Write a short note on any three,

Q.4 A.Respiratory Acidosis – Respiratory acidosis

• Respiratory acidosis occurs when the body cannot remove the carbon dioxide it produces from the lungs. Due to which the alveolar ventilation decreases.

• Respiratory acidosis has a pH less than 7.35 and a PaCO2 greater than 42 mm Hg. which disturbs the acid-base balance of the body.

• This can be acute or chronic. Acute acidosis occurs when ventilation fails. Chronic acidosis occurs when there is a long-standing pulmonary disease.

CAUSE:-

• By using drugs, such as narcotics, anesthetics, hypnotics
• Central nervous system (CNS) trauma, such as medullary injury
• Chronic metabolic alkalosis
• Guillain-Barre syndrome
• myasthenia gravis,
• Muscular dystrophy
• Poliomyelitis
• Kyphoscoliosis
• After thoracoplasty
• Chronic Obstructive Pulmonary Disease (COPD)
• Asthma
• Chronic bronchitis
• Pneumothorax
• Pneumonia and pulmonary edema
• Respiratory distress syndrome

Clinical Manifestation :-

• Signs and symptoms depend on the severity of the disease. Mild to moderate hypercapnia that develops slowly usually has few symptoms.
• Breathlessness
• Shortness of breath
• Fatigue
• Chronic cough
• whizzing
• Confusion
• erity bility
• Lethargy

Diagnostic Evaluation:-

• Checking the level of Co2 in Blood Gas analysis
• Checking the level of Serum Carbonic acid.
• Paco2 increases. And the amount of Pa02 decreases
• ECG is done to see Cardia Condition
• Medical management:-
• Administer Bronchodilator drugs.
• Giving antibiotics for respiratory infections.
• Clear the airway
• suctioning
• giving oxygen.
• If necessary, keep the patient in a mechanical ventilator
• Giving in semi fowlers position.
• To check and maintain vital signs
• Maintaining intake output chart.

Q.4 b. Factors affecting on dose of drug – Factors affecting on dose of drug

• Edge
• Sex
• Body weight
• Route of Administration
• Time of Administration
• Environmental Kefter
• Emotional Kefter
• Accumulation
• Additive effect
• Synergism
• Antagonism
• idiosyncrasies
• Tolerance
• Tachyphylaxis
• Metabolic disturbances

Q.4 C Pain Management – ​​Pain Management

• Pain management includes the following points:
• Pharmacological treatment
• Non pharmacological treatment
• Analgesic
• Adjuvant

Other

• Pharmacological Treatment:-
• Drugs are used pharmacologically.
• Tooth :- NSAID, PCM, Ibuprofen,
• Sometimes local anesthetic, intra spinal is also given

Nonpharmacological Treatment:-

• Exercising
• Weight reduction
• Counseling
• Smoking Cessation
• Massage and relaxation therapy
• Hit and cold application
• meditation
• Distraction
• Acupuncture

Analgesics:- Non opioids are given

Tooth :- Aspirin, Paracetamol

• Opoids are given
• Tooth codeine, morphine
• Adjuvant is given

Tooth :- muscle relaxant, antidepressant, anti-epileptic

Q.4 d. Systemic lupus erythematosus- Systemic lupus erythematosus

• Systemic lupus erythematosus is a multi-system, inflammatory autoimmune disorder.
• This is usually more common in young females and can occur in both male and female females of any age.

Etiology:-

• Main cause unknown
• Genetic factor
• Environmental factors
• Hormonal factor

Clinical Manifestation :-

• Fever
• weightloss
• Arthralgia
• Arthritis
• Anorexia
• malaise
• Red butter fly rashis
• Photo sensitivity
• Maculo papular rash
• Alopecia
• Caesar
• Memory deficit
• headache
• Depression
• Proteinuria
• Glomerular Nephritis
• Anorexia
• Nozia
• Abdominal pain

Diagnostic Evaluation:-

• E.S.R.
• Blood test
• Renal biopsy if required

Medical management:-

• NSAIDs are given
• Corticosteroids are given
• Immunosuppressive therapy is given

Nursing management:-

• Ask the patient to avoid sun exposure
• Evaluating the patient’s activity
• Advise the use of non-pharmacological techniques for pain management
• Aseptic technique should be used while inserting I.V.line or foley’s catheter.

Q-5 Define the following :- (ANY SIX) Write the definition (ANY SIX) 12

1.Hemorrhoids-

• Hemorrhoids are also known as piles. In which the rectum and anus area and the blood vessels there become swollen and inflamed, causing discomfort and bleeding.

• Haemorrhoid is characterized by straining during bowel movement which is commonly seen in obese people, chronic constipation, pregnancy. It can be seen internally or externally.

2.Nursing process-

• This is a systemic decision making process. In which the problem is solved from the steps of assessment, nursing diagnosis, planning implementation, evaluation. This is a continuous process. The patient’s health status and health problems are assessed from time to time. And the nursing care is modified based on the feedback or evaluation received from it. Thus the nursing process is a continuous cycle. The steps shown above are interrelated and interdependent. is

3.Hematemesis-

• Blood is seen in the vomit and is usually coffee colored. In this condition there is bleeding in the upper gastrointestinal tract which comes out with vomiting.
• This can be seen in conditions like peptic ulcer, esophageal varices and poisoning etc.

4.Anaphylactic shock –

• This is an acute hypersensitivity reaction. Occurs seconds to minutes after exposure to various foreign substances.

• This is a life threatening condition. Symptoms like severe itching, hypotension, breathing difficulty, shock, tachycardia, cardiac arrest etc. can be seen.

• This is an emergency condition in which immediate treatment can reduce complications.

Teeth:- This type of condition is seen in medication, insect bite etc.

5.Angiography:-

• Angiography is a type of X-ray that is used to check blood vessels. A specific dye is used so that the blood vessels can be seen easily.

• After a specific dye is introduced into the blood circulation, images of the blood vessels are taken to examine their inner lining.

• Blood vessel related problems like thrombosis, blockage etc. can be diagnosed.

6.Nystagmus:-

• This is an in voluntary eye movement. In which the eye moves rapidly side by side and up and down. Blurred vision is seen in this.

• Usually this condition is associated with neurological and internal ear disorders.

7.Graft versus host disease–

• It is a systemic disorder in which the graft immune cells recognize the host as a foreign substance and then attack the recipient body cells.

• Graft means to donate and host means tissue of the recipient.

• In this case, the reaction of the host’s body towards any graft is seen which can be immediate and rejection can also be seen in the later stage.

• This sign of rejection is similar to an antigen antibody reaction.

Q.6 Fill in the blanks: Fill in the blanks. 05

a. Lack of oxygen in arterial blood is called Hypoxemia

B. Coverings of brain & spinal cord are called meninges.

C.Normal range of random blood sugar level is lower than 140 mg/dL The normal range of random blood sugar should be lower than 140

D. Paralysis of lower limb is called Paraplegia If there is paralysis in the lower limb (below the waist) it is called paraplegia.

E.Blood pressure in hypotension is below around 90/60 mm of hg or less

Q.6 B. State whether statement is true or false

1.Deficiency of calcium called hypokalemia. Calcium deficiency is called hypokalemia false

2.PH of urine is more than 7,5 Urine PH is more than 7.5. False

3.Stuture I no.is thicker than 1.0 no.A number 1 suture is thicker than a number 1 suture.True

4.Cholecystolithiasis can cause obstetrical Jaundice True

5.Giantism is seen in adults. Giantism is seen in adults. False

Q.6 C.Match the following :- Connect the following pairs

answers :-

1.Inflammation of stomach :- Gastritis Gastritis inflammation of stomach

2. Inflammation of nerve :- Neuritis Neuritis inflammation of the nerve
3. Difficulty in swallowing :- Dysphagia Difficulty in swallowing
4. Inflammation of gallbladder:- Cholecystitis
5. Inflammation of urinary bladder :- Cystitis Cystitis inflammation of urinary bladder

Thank you