MSN-II-GNC-PAPER SOLUTION

Q-1 A. 25 years old Nilamben is admitted in your ward with ulna-radius fracture of Right hand.Doctors have decided for open reduction & internal fixation. Answer for the following :

👀 a. Write pre-operative nursing management of Nilamben.

Pre-operative nursing management for Nilamben includes the following:

Psychological Support for Patient and Family Members:

• Prepare Nilamben mentally for surgery and provide psychological support to her and her family members.

Blood Tests and Documentation:

• Conduct necessary blood tests and document Nilamben’s medical and surgical history.

Review and Provide Positive Reinforcement for Devices Used to Address Skeletal Problems:

• Provide Nilamben with positive reviews and information about the device or devices used to alleviate skeletal problems, enhancing her confidence and positivity.
• If Nilamben has any reactions or questions regarding the device, ensure she feels encouraged to speak up.

Assessment of Hydration, Protein, Calorie, and Nutritional Status:

• Evaluate Nilamben’s hydration, protein, calorie, and nutritional status.
• Administer IV fluids, vitamins, and nutritional supplements as prescribed by the doctor to minimize complications and improve healing post-surgery.

Pre-operative NPO Status:

• Instruct Nilamben to remain NPO (nothing by mouth) 8 to 12 hours prior to surgery to prevent complications during anesthesia and surgical healing.

Physical Preparation and Device Removal:

• Prepare Nilamben physically for surgery, including the removal of any items like jewelry that could interfere during the procedure.

Pre-operative Medication per Anesthesiologist’s Advice:

• Administer pre-operative medications as per the anesthesiologist’s recommendations if necessary.

Advise on Over-the-Counter (OTC) and Herbal Medications:

• Advise Nilamben on medications, including OTC and herbal options, which she should avoid before and after surgery for an appropriate duration.

Documentation of Corticosteroid Therapy and its Impact on Orthopedic Condition and Response to Anesthesia:

• Document Nilamben’s history of corticosteroid therapy and its impact on her current orthopedic condition and anesthesia response.

Limitation on Metformin Administration Due to Risk of Lactic Acidosis in Case of Surgery Complications:

• Withhold metformin administration for 48 hours before surgery to prevent potential complications such as lactic acidosis.

Monitoring for Signs of Infection and Osteomyelitis Development:

• Monitor Nilamben for signs of infection post-surgery, including respiratory, dental, skin, and urinary infections, which could develop into osteomyelitis.

Pre-operative Antibiotics per Doctor’s Advice if Necessary:

• Administer pre-operative antibiotics as advised by the doctor if deemed necessary.

Prepare Nilamben for Chest Check, Frequency Vital Signs, and Response Description:

• Provide Nilamben with information about coughing, frequency vital signs, and response description (recommendation).

Explain the Need for External Fixation Devices for Greater Mobility Confidence:

• Provide Nilamben with information about external fixation devices to increase mobility confidence, ensuring she understands its benefits.

These pre-operative nursing management steps aim to ensure Nilamben’s physical and psychological preparedness for surgery while minimizing risks and complications associated with the procedure.

👀 b. Write immediate post-operative assessment of her.

Immediate post-operative assessment for a patient who underwent open reduction and internal fixation:

1. Monitor the patient’s vital signs post-surgery.
2. Assess the patient’s pain levels following surgery.
3. Check for signs of bleeding or infection as potential complications post-surgery to prevent any injurious complications.
4. Check the patient’s consciousness level for any signs of emergence from anesthesia after surgery.
5. Assess the patient’s nutritional status, and if necessary, provide intravenous fluids based on the doctor’s discretion.
6. Ensure appropriate fixation and stability after fixation.
7. Periodically monitor neurovascular status for circulation and nerve function in the affected limb.
8. Cooperation with the surgical team is important to maintain surgical care guidelines.
9. Monitor neurovascular status post-surgery.
10. Examine tissues for swelling and control bleeding to save the patient from life-threatening complications caused by bleeding and to provide postoperative care to prevent complications due to immobility.

👀 C . As a nurse, what are the points you will keep in mind while the patient is on Haemotylisis. 06

1. Check the patient’s weight and record it.
2. Obtain written consent from the patient for dialysis.
3. Explain the pros and cons of dialysis to the patient to reduce their concerns.
4. Provide the patient with a comfortable position for relief.
5. Advise the patient to stop antihypertensive and vasodilator medications before dialysis to prevent hypertension.
6. Check vital signs and monitor during dialysis.
7. Ask the patient about any problems during dialysis and inform the doctor immediately if necessary.
8. Regularly check the patient’s fistula site because the use of heparin during dialysis may slow clotting and increase bleeding risk.
9. Keep all emergency medications prepared near the patient.
10. Administer necessary medications to the patient.
11. After hemodialysis is complete, check the patient’s weight again.
12. Administer necessary medications to the patient after hemodialysis.

Q-2 Answer in short for the following:-

👀 A. What are the indications of enucleation of eye? 02

Enucleation refers to the complete removal of the eyeball and optic nerves. It is indicated in several conditions such as:

1. Trauma resulting in painful eye.
2. Blind eye.
3. Intraocular malignancies, leukocoria, and endophthalmitis.
4. Ocular tumors, melanomas, corneal ulcers.
5. Anterior staphyloma.
6. Foreign body granuloma.
7. Suprachoroidal hemorrhage, cosmesis, and other conditions where removal of the entire eyeball is necessary.

👀b. Write the difference between malignant & benign tumer. 04

Benign Tumor

Growth Pattern

1. Benign tumors develop slowly.

Damage

2. Benign tumors damage nearby cells minimally.

Metastasis

3. These tumors remain localized and do not spread to other parts.

Effects

4. Benign tumors are mildly harmful as they do not exert pressure on surrounding tissues until they grow significantly.

Treatment & Follow-up

5. Surgery to remove the tumor is generally curative, and ongoing follow-up care is usually not necessary.

Malignant Tumor

Growth Pattern

1. Malignant tumors develop rapidly and spread to nearby and distant areas.

Damage

2. Malignant tumors cause necrosis (death) of cells.

Metastasis

3. The spread of malignant tumors occurs to neighboring or distant organs.

Effects

4. Malignant tumors are significantly harmful (destructive) because they damage functioning cells.

Treatment & Follow-up

5. Surgery to remove the tumor is followed by necessary treatments like chemotherapy and radiation therapy, and ongoing follow-up care is essential.

👀 C. What health education you will give to prevent cholera in community? 04

Community members should be advised to wash hands frequently to prevent cholera and ensure that food and water are safe for consumption.

Following the simple steps below can greatly reduce the incidence of cholera in endemic areas.

1. Ensure Safe Drinking Water:

• Ensure safe water for drinking and use in cooking, cleaning food, and making ice or beverages.
• Use boiled or chlorinated water for brushing teeth, washing food, and preparing and making ice or beverages.
• Water from pipes, wells, rivers, and bags may not be safe and may contain bacteria and other contaminants. It is necessary to ensure water is safe before drinking.
• Use a filter to remove bacteria and other contaminants from water and make it safe.
• Water filtered should be heated properly or chlorinated or filtered water should be drunk. How to Make Water Safe

A) Chlorine Treatment

Using chlorine tablets in water can make it safe.

B) Boiling Water

If chlorine products are not available nearby, boil water to make it safe.

Water should be boiled for at least one minute.

If this hot water is not stored and kept safe properly, it can become contaminated again.

C) Filter

If water is filtered and can be made safe by boiling it and drinking it.

2. Regular and Safe Hand Washing

Advice the community to wash their hands before preparing food, during and after.

Use the toilet, and then wash your hands.

Feed children before and then wash hands.

After taking care of a person with diarrhea, wash hands.

Use the toilet to pass stool and encourage children to use the toilet.

After going to the bathroom, clean hands with soap and water.

Keep new toilets or old toilets as toilets

4. Clean up Safely

Bathe at least 30 meters away from water sources and wash clothes or diapers.

Clean toilets and contaminated areas.

Prepare and cover food safety food, warm it.

Fruits and vegetables should be peeled and eaten.

Food should be eaten shortly after cooking or where the food is warm.

Raw vegetables and fruits can be peeled off without removing their skin.

👀 d. Write the risk factors of coronary artery diseases. 04

The risk factors of coronary RTO disease are of three types.

1. Non-Modifiable Risk Factors Genetic Factor Due to hereditary factors, there is an increased chance of developing conditions like atherosclerosis, hypertension, dyslipidemia, diabetes, obesity, and others.
2. Age The chance of developing coronary artery disease (CAD) increases in individuals over 40 years old, but it can also occur in individuals as young as 30 years old.
3. Sex Females have an increased chance of developing coronary artery disease compared to males.
4. Race Black Americans have an increased chance of developing coronary artery disease. Individuals who consume alcohol also have an increased chance of developing CAD.

Modified Risk Factors

1. Urban Living Living in cities increases the risk of CAD compared to living in rural areas.
2. Cigarette and Smoking Both smoking and exposure to nicotine increase the risk of heart attacks. Nicotine can cause vasoconstriction, which can lead to hypertension.
3. Hypertension Hypertension increases the chances of developing cardiovascular disease.
4. High Serum Cholesterol Level (220 mg/dl) Elevated levels of serum cholesterol increase the risk of coronary artery disease.
5. Physical Inactivity Being physically inactive increases the risk of CAD.
6. Menopause Menopausal women also have an increased risk of CAD.
7. Obesity Obesity puts extra burden on the heart, increasing the risk of heart disease.
8. Stress Stress is also a risk factor for CAD.
9. Diabetes

Other Factors

1. Dietary Factors Consumption of oily foods, milk, milk products, eggs, fish, mutton, sugar, and sweets increases the risk of CAD.
2. Sedentary Lifestyle Leading a sedentary lifestyle is a risk factor for CAD.
3. Hormones Hormonal factors, including the use of oral contraceptives, can increase the risk of CAD.

👀 Q.3 A. 40 years Aratiben is admitted with cancer breast. Doctors has decided for Radical mastectomy. How will you prepare her physically & emotionally for Operation.? 06

Physical Preparation:

Preoperative Assessment:

Observe for any adverse effects of radiation therapy such as skin reactions, throat discomfort, cough, nausea, or loss of appetite.

Conduct all necessary laboratory investigations for the patient.

Assess if the patient experiences any side effects from chemotherapy such as bone marrow suppression, hair loss, weight loss, fatigue, depression, anxiety, etc.

Nutrition:

Provide a well-balanced diet.

Exercise:

Encourage mild to moderate exercise to enhance overall physical fitness and improve postoperative recovery.

Provide guidance on appropriate exercises that can be done preoperatively to maintain strength and flexibility.

Other Physical Care:

• Provide psychological support to the woman.
• Engage the woman actively in the treatment process.
• Explain the entire procedure to the woman thoroughly.
• Provide antiemetic medicine to the patient.
• Set up an IV line for the patient.
• Provide IV fluids to the patient.
• Catheterize the patient.
• Maintain the patient’s intake and output chart.
• Prepare the specific body part for surgery properly.
• Obtain consent from the patient and her family members.

Psychological Preparation:

Education:
Provide detailed information about the surgical procedure, potential risks, benefits, and expected outcomes to alleviate any concerns the patient may have regarding the surgery’s impact on her body image and beyond.

Support System:
Encourage Aarti Ben to build a strong support system involving family, friends, and other support groups to ensure she has adequate support throughout her recovery.

Counseling:
Offer psychological counseling to Aarti Ben regarding emotional changes associated with breast cancer diagnosis and surgery, addressing issues such as body image concerns.

Stress Management:
Teach Aarti Ben stress reduction techniques such as deep breathing exercises, mindfulness meditation, or yoga to help alleviate anxiety and stress.

Expectation Setting:
Discuss with Aarti Ben what to expect post-surgery in terms of reduced activities and the timeline for returning to normal activities, addressing potential dissatisfaction with body changes.

Preoperative Visits:
If possible, arrange for Aarti Ben to visit the hospital environment and meet the healthcare team beforehand to familiarize herself with the setting and the healthcare professionals who will be involved in her care.

Communication:
Ensure open and honest communication with Aarti Ben to address any fears or concerns she may have promptly and effectively.

Collaborative Care:

Ensure that Aarti Ben receives comprehensive care from the surgical team, oncologists, nurses, and other healthcare professionals.

👀 B. What points you will keep in mind while talking to hearing impared patient 03

When conversing with a person with hearing impairment, it’s important to communicate clearly and naturally:

1. First, attract the person’s attention.
2. Then initiate the conversation.
3. Approach the person closely and face them directly.
4. Use short sentences and check if they understand.
5. Encourage the use of hearing aids.
6. Be mindful of the surrounding environment during the conversation.
7. If they cannot hear well at once, repeat your message.
8. Cover your mouth when speaking to aid lip-reading.
9. Maintain eye contact during conversation.
10. Speak slowly and clearly.
11. If they can hear better from one side, speak from that side.
12. Avoid shouting as it distorts the voice.
13. Allow more time for responses when listening.
14. Do not avoid talking to individuals who have trouble hearing.
15. Use written messages if unable to communicate verbally.
16. Use appropriate body posture, expressive facial expressions, and a calm, active approach to be heard by the patient.
17. Keep the surrounding environment noise down to make it easier for them to hear.

👀 Q.4 . Define following ANY FIVE 16

👀 Orchitis –

Orchitis refers to inflammation or swelling of one or both testicles.

It can occur due to bacterial or viral infections, with bacteria being a common cause. It may also be caused by sexually transmitted diseases.

Mumps virus can also cause orchitis.

Symptoms of orchitis include:

• Tender, red, or swollen testicles.
• Heavy feeling in the testicles.
• Blood in semen.
• High fever.
• Pain during urination.

👀 Neoplasm –

Normal cell division is a process where cells grow smaller and then grow larger and stop when they come into contact with each other, which is called contact inhibition, but when cells are capable of new growth, they interrupt contact inhibition and new cells are overly grown, this is called neoplasm or cancer cells

👀 Myopia –

Myopia is an eye condition where nearsightedness occurs.

In myopia, close objects are seen clearly but distant objects appear blurry.

Common vision problems of myopia include difficulty seeing distant objects clearly but seeing close objects clearly.

Symptoms of myopia include eye strain, headaches, squinting to see distant objects, and so on.

Myopia occurs when the eyeball grows too long from front to back, causing light rays to focus in front of the retina instead of on it, making distant objects appear blurred.

People who see distant objects blurred from two meters or more are prey to this problem called myopia

👀 4. Psoriasis –

Definition:
Psoriasis is a chronic inflammatory disorder that often occurs non-infectiously.

It involves increased keratin synthesis. It covers red and round plaques, scales, erythematous, and silver white patches.

To remove these silver white scales, bleeding is sometimes seen at the pinpoints, called the ‘auspitz phenomenon.’

Types of psoriasis:
1. Plaque psoriasis
2. Generalized psoriasis
3. Localized psoriasis
4. Erythrodermic psoriasis

Plaque psoriasis is due to streptococcal pharyngitis.

Generalized and localized psoriasis must be admitted to the hospital for symptoms such as fever, cold, hypokalemia, and joint pain. Initially, the history of erythematous and vesicular lesions is found.

Erythrodermic psoriasis shows red colored lesions throughout the body. It is difficult to maintain body temperature with this condition, and hypoproteinemia (low albumin protein in blood), edema, and inflammatory vasodilation cause high cardiac output.

Psoriasis complications include psoriatic arthritis.

Medical Management:

Topical keratolytic agents such as salicylic acid, ammoniated mercury

Topical corticosteroids

Moist dressings to reduce inflammation

Use of emollients (soften and smooth the skin) for patients, which reduce psoriatic plaques and their thickness.
If the patient is allergic to emollients, use of coltar (a product of anthalene).

👀 5. Sinus Arrhythmia –

• Sinus arrhythmia is a type of arrhythmia where there is irregularity in the heart rhythm.
• It originates from the sinus node.
• In sinus arrhythmia, the time between heartbeats can be shorter or longer, based on whether it occurs during inhalation or exhalation.
• During inhalation, the heart rate increases.
• During exhalation, the heart rate slows down.

👀 6. Myocarditis –

• Myocardium is the middle layer of the heart.
• Inflammation in the myocardium is known as myocarditis.
• Myocarditis can occur in a limited area or involve the entire layer.
• When there is inflammation in the heart, it cannot pump effectively because its cells may be damaged and swelling may occur.
• It can be acute or chronic and can occur at any age.
• Symptoms that may be seen include fatigue, difficulty breathing, rapid heartbeats, and in some cases, fatal arrhythmias due to myocarditis.

Q-5 Write the short notes on ANY FOUR the following 16

👀 1. National Blindness Control Program

The National Blindness Control Program was launched in 1976.

Its main goal in India is to control cases of blindness and reduce them.

India is the first country to launch this program.

Cataract is a major cause of blindness.

Causes of blindness:

• Cataract
• Refractive error
• Corneal blindness surgical complications
• Glaucoma, among others

Objectives of NPCB:

• Reduce the number of blindness cases due to NPCB.
• Provide high-quality eye care in affected populations.
• Cover all over affected areas.
• Provide services even in poor areas.
• Reduce blindness numbers by identifying affected areas and providing appropriate services.
• Increase capacity for each institute’s eye care.
• It can be provided with equipment, materials, and medical personnel for the institute.

Strategies of NPCB:

1. Surveillance

• Investigate the distribution of affected geographic areas under the program.
• Examine cases of blindness and find suitable fields where blindness can be controlled.
• Diet and nutrient supplements can prevent nutritional deficiencies causing eye disorders.
• Provide primary eye care
• PHC (Primary Health Center) and Sub-Center-Level Health Worker provide Contactivity, Optomiotomy Sodium, Super Facial Force and Zero Pathology, etc. give proper treatment so

3. Screening of the Case

To provide early identification and treatment of eye disorders among school children during routine check-ups.

Identifying cases that can be addressed through separate camps organized in various campuses.

4. Strengthening the Infrastructure and Training of Manpower

Provide adequate resources in the institute and training to ophthalmologists who should be at PHC, CHC, or district level to provide appropriate training to treat various eye disorders.

5. Vitamin A prophylaxis

Provide vitamin A to children up to 6 years of age according to the schedule.

6. Occupational Eye Services

Provide appropriate eye services for eye diseases or disorders caused by any occupation.

Activities under NPCB

• Training the NPCB Eye Care Person to improve the quality of eye care services.
• Also provide modern equipment in the institute.
• Increase in contract surgery.
• Organize campaigns in different areas at appropriate intervals.
• NGOs should also be included in this program.
• Show ILO (Inter Ocular Lens) implantation with contract surgery.
• Provide devices for such eye.
• School eye screening.
• Treat other disorders of the eye, such as glaucoma, cataracts, etc.
• Provide eye donation and eye banking services.
• It is easy to provide training in this program as well.

👀 2. Signs & Symptoms of Rhinitis

At the onset, when exposed to allergens or infections, symptoms can be seen within minutes, such as:

• Patient feels itching sensation in the nose leading to sneezing.
• Frequent sneezing.
• Rhinorrhea (runny nose).
• Nasal congestion and generalized fatigue.

Symptoms that can appear four to eight hours after exposure to any allergens or infection include:

• Fever, malaise, body pain, and symptoms of toxemia.

Nasal secretions become mucopurulent within two days.

Eye tearing (lacrimation), dark circles around the eyes, violent sneezing.

Running and dripping from the nose, nasal congestion, stiffness, headache, pneumonia, sore throat, puffy eyelids.

Decreased sensation of smell, taste.

Blocked or plugged ear.

Slow thinking.

👀 3. ‘Rule of Nine’ for Burns –

Burns Injury refers to damage caused to body cells and tissues by any heat source. This injury is classified based on different categories such as conditions, radiation, and various types of thermal and chemical substances affecting the body’s cellular tissue.

Under burns, the amount of tissue damage in the body is classified in different ways. It is calculated by the Rule of Nine for body burns areas.

The rule of nine is a very important method for calculating the damage caused by burns and the total body surface of the burn area. This method divides various surface areas of the body into a percentage and calculates it accordingly.

According to the Rule of Nine, each part of the body is divided into 9% and calculated to calculate the total burns surface area. This is calculated by calculating the total surface area of the burns area at 9%. It is calculated to apply.

Burns Patient Management

After establishing priority in the airway, breathing, and circulation management for burns patients, maintaining circulation is of utmost importance. Burns injuries often lead to significant fluid loss from the body, primarily due to extracellular and intracellular fluid shifts.

This fluid loss needs immediate management, termed fluid resuscitation. Severe burns can result in hypovolemic shock, necessitating prompt initiation of fluid resuscitation.

Rapid fluid administration is also provided within the first 48 hours to maintain circulation in the body.

Fluid resuscitation includes colloids, plasma, electrolytes, Ringer’s solution, sodium chloride, Hartmann’s solution, and sometimes dextrose solution in various quantities.

Calculating fluid replacement involves multiplying the total body surface area of burns by a coefficient and administering ring-tailed solution with 4 ml. Calculating the initial 24 hours of fluid replacement is important. 50% of the fluid is administered within the currents Dhabi , also even though. The En administered After undertaken Burns fluid Circulation

👀 4. Side effects of chemotherapy:

1. Bone Marrow Suppression: Most chemotherapy drugs suppress bone marrow function, leading to decreased production of blood cells.
2. Fatigue: It is a common side effect, causing low energy levels, weight loss, disrupted sleep patterns.
3. Nausea and Vomiting: This is one of the most common side effects.
4. Infection: Sites become toxic due to chemotherapy drugs, which can lead to septicemia.
5. Cardiac Toxicity
6. Alopecia: Hair loss occurs.
7. Changes in Taste and Smell: It is possible to see changes.
8. Leukemia
9. Skin Changes: Including hyperpigmentation, infection, nail discoloration, ulcers, and photosensitivity.
10. Pulmonary Toxicity
11. Diarrhea and Constipation, no hunger.
12. Renal Toxicity: Including nephrotoxicity and renal failure.
13. Neurotoxicity: Including CNS damage and peripheral nerve damage.
14. Testicular and Ovarian Dysfunction
15. Weakness, fatigue, and weight loss.

👀 5. Care of tracheostomy tube:

Irritation around Tracheostomy Site: Rubbing of the tracheostomy tube and flange can cause irritation to the surrounding skin.

Daily Care of Tracheostomy Site: To prevent infection and skin breakdown where the tracheostomy tube attaches, daily care of the tracheostomy site is essential. It should be cared for once or twice a day, or more if necessary.

Dressing if Irritation or Drainage at Tracheostomy Site: If there is irritation or drainage around the tracheostomy tube at the site, dressing should be applied.

1. Maintenance of Patency of Tracheostomy Tube:

• Regular suctioning may be required to maintain patency.
• Humidification of inspired air and oxygen.

1. Fowler’s Position: To aid breathing.
2. Maintain Fluid Intake: Keep fluid intake adequate.
3. Regular Mouth Care: Provide mouth wash frequently.
4. Perform Sputum Displacement Every Hour: If necessary, take the breath.
5. Prevent Infection and Complication:

• Maintain aseptic tube function, handling, and tube changes.
• Provide prophylactic antibiotics.
• Displace the calf every five minutes.

1. Avoid Touching the Posterior Tracheal Wall Tube: Touch the tube at intervals.
2. Other Appropriate Care to be taken to Tracheostomy Tube.

👀 Q-6 A. Fill in the blanks: 06

1…………..drug is used to constric: the pupil. Myotics

2. Inflamation of cornea is called ……….. Keratitis

3. Kaplik’s spot is a positive sign of…………Measles)

4. Encephalitis means ………Inflamation of brain

5. Drooping if eye lid is called………ptosis

6. Causitive organism of chicken pox is……… vericella Zoster virus)

👀 B . State whether following statements are True or Flase. 06

1 .Mastopexy means removal of whole breast. (false)

2.Uncongugated billirubin is converted to congugated billirubin in hepatitis Patient (correct)

3.Fever is a sign of inflammation (correct)

4.Anuria means increased plicturition (false)

5.Haemophilia is a hereditary haemmorrhagic diseases transmitted to male (correct)

6.Herpes Zoster is caused by herpes simplex virus.(false)