SECTION-1 (37 Marks)

Q.1 Answer the following questions – 6 marks

1. Frequent vomiting put the patient at risk of

A. Metabolic acidosis with hyperkelemia

B. Metabolic acidosis with hypokelemia

C. Metabolic Alkalosis with hyperkelemia

D. Metabolic Alkalosis with hypokelemia

2. A wound through the air passess during inspiration and expiration resulted in

A. Pneumothorax

C. Hemothorax

B. Flail Chest

D. Blunt chest trauma

3. Which of the following complication occur within 24 hours after sustaining an MI

A. Left ventricular aneurysm

B. Ventricular septal rupture

C. Cardiogenic shock

D. Atrial septal rupture

4. Most commonaly thrombosis occur in

A. Vein

B. Artery

C. Lymph

D. Capillary

5. Clinical feature of of chronic renal disease includes

A. Hypertension

B. Anemia

C. Hyperkelemia

D. All of above

6. Electrolyte imbalance seen in hyperthyrodism is

A. Hypocalcemia

B. Hypercalcemia

C. Hyper natremia

D. Hyperkelemia

Q.2 Answer any one assay (10) marks

1. Explain in detail about valvular heart diseases

Definition

Valvular Heart Disease is a condition characterized by damage or a defect in one or more of the heart valves, affecting the flow of blood through the heart. It may involve the mitral, aortic, tricuspid, or pulmonary valves, leading to either stenosis (narrowing) or regurgitation (backflow)

Etiology

Congenital Causes

Bicuspid aortic valve

Congenital stenosis

Valve prolapse syndromes

Acquired Causes

Rheumatic fever

Infective endocarditis

Myocardial infarction

Degenerative changes (aging)

Autoimmune diseases (e.g., SLE)

Radiation therapy

Types of Valvular Heart Disease

Stenosis (Valvular narrowing)

Aortic stenosis

Mitral stenosis

Pulmonary stenosis

Tricuspid stenosis

Regurgitation / Incompetence (Backflow of blood)

Aortic regurgitation

Mitral regurgitation

Tricuspid regurgitation

Pulmonary regurgitation

Mixed lesions

e.g., Mitral stenosis + Mitral regurgitation

Clinical manifestations

Dyspnea on exertion

Fatigue and weakness

Palpitations

Chest pain (angina)

Syncope or dizziness

Orthopnea & PND

Peripheral edema

Heart murmurs

Opening snap

Thrills or clicks

Diagnostic Evaluation

History collection

Physical examination

Chest X-ray

ECG

Echocardiogram (2D/Doppler)

Cardiac catheterization

Blood tests

Stress test

Medical management

Diuretics

↓ Pulmonary congestion & edema (e.g., Furosemide)

ACE Inhibitors / ARBs

↓ Afterload, ↑ cardiac output (e.g., Enalapril, Losartan)

Beta Blockers

Control heart rate, especially in AF (e.g., Metoprolol)

Digoxin

↑ Myocardial contractility, especially in heart failure with AF

Anticoagulants

Prevent thromboembolism in AF or mechanical valves (e.g., Warfarin)

Antiarrhythmics

For rhythm control (e.g., Amiodarone)

Surgical Management

Valve Repair (e.g., commissurotomy, annuloplasty)

Valve Replacement

Mechanical valves – Long-lasting, need lifelong anticoagulation

Bioprosthetic valves – Less durable, no lifelong anticoagulation

Balloon Valvuloplasty – Mainly in mitral stenosis

Nursing management

Decreased Cardiac Output related to altered preload/afterload due to valvular dysfunction evidenced by dyspnea, hypotension, weak peripheral pulses.

Goal :

To maintain adequate cardiac output and tissue perfusion.

Nursing Interventions :

Monitor vital signs, especially heart rate, BP, oxygen saturation.

Assess for signs of decreased perfusion (cool extremities, low urine output).

Administer prescribed medications: diuretics, ACE inhibitors, beta-blockers.

Monitor for arrhythmias using ECG.

Maintain semi-Fowler’s position to reduce preload.

Educate the patient to avoid activities that increase cardiac workload.

Impaired Gas Exchange related to pulmonary congestion secondary to left-sided valve disease evidenced by dyspnea, tachypnea, crackles on auscultation

Goal :

To promote effective oxygenation and prevent respiratory complications.

Nursing Interventions :

Monitor respiratory rate, rhythm, and effort.

Administer oxygen therapy as prescribed.

Elevate the head of the bed to improve lung expansion.

Encourage deep breathing and incentive spirometry.

Monitor for signs of pulmonary edema (frothy sputum, restlessness).

Collaborate with the physician for diuretic and bronchodilator therapy.

Activity Intolerance related to fatigue and reduced cardiac efficiency as evidenced by dyspnea or fatigue during minimal activity

Goal :

To improve tolerance for daily activities and conserve energy.

Nursing Interventions :

Assess baseline activity level and response to activity.

Schedule rest periods between activities.

Assist with ADLs as needed.

Encourage gradual increase in activity as tolerated.

Teach energy conservation techniques.

Monitor vital signs before, during, and after activity.

1. Explain in detail about chronic obstructive pulmonary diseases

Definition

COPD is a progressive and irreversible lung disease characterized by chronic airflow limitation due to inflammation and structural changes in the airways and alveoli. It includes chronic bronchitis and emphysema.

Etiology

Smoking (most common cause)

Air pollution

Occupational dusts and chemicals

Genetic factors (e.g., α1-antitrypsin deficiency)

Recurrent respiratory infections

Indoor air pollution (biomass fuel exposure)

Pathophysiology

→ Chronic exposure to irritants (e.g., cigarette smoke)

→ Leads to chronic inflammation in the airways and alveoli

→ Causes mucus hypersecretion, airway narrowing, and fibrosis

→ Destruction of alveolar walls (emphysema) and loss of elasticity

→ Results in air trapping and lung hyperinflation

→ Causes ventilation-perfusion mismatch, hypoxia, and hypercapnia

→ Chronic hypoxia → pulmonary hypertension → cor pulmonale

Clinical Manifestations

Chronic cough

Sputum production

Progressive dyspnea

Wheezing

Barrel-shaped chest (in emphysema)

Cyanosis

Clubbing (late stage)

Use of accessory muscles

Fatigue and weight loss

Diagnostic evaluation

History collection

Physical examination

Pulmonary function test

Chest X-ray

CT scan

Alpha 1 antitrypsin level

ABG analysis

CBC

Medical Management :

Bronchodilators

Beta-agonists : Salbutamol, Formoterol

Anticholinergics : Ipratropium, Tiotropium

Methylxanthines : Theophylline

Corticosteroids

Inhaled : Budesonide, Fluticasone

Oral (during exacerbation) : Prednisolone

Antibiotics

During infections/exacerbations

Oxygen Therapy

Low-flow O₂ to maintain SaO₂ ~ 90%

Avoid high O₂ in CO₂ retainers

Pulmonary Rehabilitation

Exercise training

Breathing techniques (pursed-lip)

Vaccination

Influenza and Pneumococcal vaccines

Smoking Cessation

Surgical Management (Advanced COPD)

Lung Volume Reduction Surgery (LVRS)

Bullectomy

Lung Transplantation

Nursing management

Impaired Gas Exchange related to alveolar-capillary membrane changes and airflow limitation

Goal :

Patient will maintain optimal gas exchange as evidenced by normal ABG and oxygen saturation > 90%.

Nursing Interventions :

Monitor respiratory rate, depth, and SpO₂ regularly

Administer supplemental oxygen as prescribed (low-flow if CO₂ retainer)

Position patient in high Fowler’s or tripod position to facilitate lung expansion

Teach pursed-lip breathing and diaphragmatic breathing

Encourage incentive spirometry use

Assess for cyanosis, restlessness, confusion (signs of hypoxia)

Ineffective Airway Clearance related to excessive mucus production and weak cough effort

Goal :

Patient will maintain a clear airway with effective cough and normal breath sounds.

Nursing Interventions :

Encourage fluid intake (if not contraindicated) to thin secretions

Provide chest physiotherapy and postural drainage as indicated

Encourage coughing and deep breathing exercises

Suction airway if necessary (esp. in acute phase)

Administer expectorants or bronchodilators as ordered

Activity Intolerance related to imbalance between oxygen supply and demand

Goal :

Patient will perform activities of daily living (ADLs) without excessive fatigue or dyspnea.

Nursing Interventions :

Assess tolerance to activity and fatigue level

Plan activities with rest periods

Provide assistance with ADLs as needed

Educate energy conservation techniques

Administer medications like bronchodilators prior to activities

Anxiety related to breathlessness and fear of suffocation

Goal :

Patient will verbalize reduced anxiety and demonstrate relaxation techniques.

Nursing Interventions :

Stay with patient during episodes of breathlessness

Use calm, reassuring communication

Teach relaxation techniques (e.g., guided imagery, controlled breathing)

Encourage expression of fears

Avoid sudden changes in care or routine

Q.3 Answer any three short questions.(15)

1. Intraoperative care

Definition

Intraoperative care refers to the nursing interventions, monitoring, and assistance provided to a patient during the actual surgical procedure in the operation theatre, from the moment the patient is brought into the operating room until transfer to the post-anesthesia care unit (PACU).

Objectives of Intraoperative Care

To ensure patient safety and comfort

To assist the surgical and anesthesia team

To maintain asepsis and sterile environment

To monitor the patient’s vital signs and overall condition

Roles and Responsibilities of the Nurse During Intraoperative Care

Pre-operative Verification

Verify patient identity, surgical consent, site, and procedure.

Ensure that all required investigations are complete and available.

Confirm NPO (nil per os) status, allergies, and prosthesis removal.

Maintain Asepsis

Follow strict aseptic technique to prevent infection.

Assist in scrubbing, gowning, and gloving of the surgical team.

Ensure all surgical instruments are sterile.

Positioning the Patient

Position the patient correctly based on the type of surgery (e.g., supine, lithotomy, prone).

Use pads and supports to prevent pressure sores and nerve injuries.

Ensure circulation, respiration, and body alignment are maintained.

Monitoring the Patient

Observe and record vital signs : heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature.

Monitor for adverse reactions to anesthesia and surgical complications.

Communicate promptly with the surgical and anesthesia team.

Instrument and Sponge Count

Perform and document instrument, sponge, and needle counts before, during, and after surgery to avoid retention.

Assist the surgeon by passing instruments and handling equipment efficiently (scrub nurse role).

Specimen Handling

Collect and label specimens (e.g., tissue biopsies) accurately.

Ensure proper documentation and transport to the lab.

Documentation

Record all intraoperative events, including time of incision and closure, medications administered, fluids infused, and any complications.

Maintain accurate records in the intraoperative nursing notes.

2. Shock

Definition

Shock is a life-threatening medical emergency characterized by inadequate tissue perfusion and oxygen delivery to the cells and vital organs, leading to cellular dysfunction, organ failure, and if untreated, death

Types of shock

Hypovolemic Shock

It occurs due to a significant loss of blood or fluids from the body. Common causes include hemorrhage (internal or external), burns, vomiting, diarrhea, or severe dehydration.

Cardiogenic Shock

It is results from the heart’s inability to pump blood effectively despite adequate volume. It is most commonly caused by myocardial infarction (heart attack), but it can also result from severe arrhythmias, cardiomyopathy, or valve disorders.

Distributive Shock

It is caused by abnormal distribution of blood flow due to widespread vasodilation and increased capillary permeability. This type includes :

Septic Shock: It is caused by severe infection and release of toxins.

Anaphylactic Shock : It is caused by a severe allergic reaction.

Neurogenic Shock : It is caused by spinal cord injury or damage to the central nervous system, leading to loss of sympathetic tone.

Obstructive Shock

It occurs when there is a mechanical obstruction to blood flow in the heart or great vessels. Conditions such as pulmonary embolism, cardiac tamponade, and tension pneumothorax can impede circulation, reducing cardiac output and leading to shock despite normal heart function and volume.

clinical manifestations

Hypotension (low BP)

Tachycardia (↑ pulse)

Cold, clammy skin (except in early septic/anaphylactic shock)

Decreased urine output (<30 ml/hr)

Altered mental status – confusion, anxiety

Rapid, shallow breathing

Weak peripheral pulses

Cyanosis or pallor

Management

Airway, Breathing, Circulation (ABC)

Ensure a patent airway

Provide supplemental oxygen (high-flow or mechanical ventilation if needed)

Establish IV access with large-bore cannulas

Begin fluid resuscitation (NS or RL) – especially in hypovolemic and distributive shock

Medications

Vasopressors (e.g., norepinephrine, dopamine) – for hypotension unresponsive to fluids

Inotropes (e.g., dobutamine) – in cardiogenic shock to improve heart contractility

Antibiotics – early broad-spectrum antibiotics in septic shock

Epinephrine – first-line for anaphylactic shock

Antihistamines and corticosteroids – in anaphylaxis

Anticoagulants or thrombolytics – in obstructive shock due to pulmonary embolism

Fluid Replacement

Crystalloids (Normal saline, Ringer’s lactate) – first choice

Colloids or blood products – if there is significant blood loss

Monitor for signs of fluid overload (especially in cardiogenic shock)

Monitoring

Vital signs: BP, HR, RR, SpO₂

Urine output (goal: >30 mL/hour)

Level of consciousness

Blood gases, electrolytes, and lactate levels

Hemodynamic monitoring if available (e.g., CVP, arterial lines)

Nursing management

Continuous vital signs monitoring

Report deterioration immediately

Administer oxygen and medications as prescribed

Ensure IV fluids and blood products are given timely

Maintain asepsis to prevent sepsis

Reassure the patient and explain procedures

Record intake and output, mental status, and skin changes

3. Liver abscess

Definition

A liver abscess is a localized collection of pus within the liver parenchyma caused by infection. It results from invasion by bacteria, parasites, or fungi and leads to inflammation, necrosis, and cavity formation filled with purulent material.

Causes

Pyogenic Abscess – due to bacterial infections (e.g., E. coli, Klebsiella) from biliary tract infections, appendicitis, or trauma.

Amoebic Abscess – caused by Entamoeba histolytica via fecal-oral contamination (contaminated food/water).

Fungal Abscess – seen in immunocompromised individuals (e.g., Candida species).

Pathophysiology

Pathogen reaches the liver via portal circulation, biliary tract, or hematogenous spread

Local immune response → inflammation

Tissue necrosis → formation of cavity

Accumulation of pus → abscess formation

If untreated → rupture → peritonitis or pleural involvement

Clinical manifestations

Right upper quadrant (RUQ) pain

Tender hepatomegaly (enlarged liver)

Right shoulder referred pain (phrenic nerve irritation)

Mild jaundice (in some cases) Fever with chills and rigors

Nausea, vomiting, and anorexia

Malaise and fatigue

Night sweats

Diagnostic Evaluation

Blood Tests : WBC (leukocytosis), ESR, CRP

Liver function tests

Positive serology for Entamoeba histolytica (in ALA)

Ultrasound (USG)

CT scan / MRI

Aspiration

Medical Management

Antibiotic Therapy (Pyogenic Abscess)

Broad-spectrum IV antibiotics → then tailored based on culture

E.g. Ceftriaxone + Metronidazole

Duration : 2–6 weeks

Anti-amoebic Therapy (Amoebic Abscess)

Metronidazole is the drug of choice (7–10 days)

Followed by luminal agents (e.g., Diloxanide furoate) to eradicate intestinal cysts

Surgical Management

Percutaneous needle aspiration under ultrasound or CT guidance

Percutaneous catheter drainage if abscess is large or unresponsive

Surgical drainage – rare, used if rupture or multiple abscesses

Nursing Management

Assessment

Monitor vital signs, pain level, signs of rupture or peritonitis

Assess for dehydration, jaundice

Interventions

Administer IV fluids, antibiotics, and antipyretics as prescribed

Monitor liver function tests

Maintain strict asepsis during drainage

Provide high-protein, easily digestible diet

Educate about personal hygiene and food safety (esp. for amoebic abscess)

4. Diabetes mellitus

Definition

Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by high blood glucose levels (hyperglycemia) due to deficiency or resistance to insulin action.

Types

Type 1 DM :

Insulin-dependent, usually in children

Autoimmune destruction of beta cells

Type 2 DM :

Non-insulin-dependent, common in adults

Due to insulin resistance and relative insulin deficiency

Gestational Diabetes :

Occurs during pregnancy

Usually resolves after delivery

Secondary Diabetes :

Due to other diseases (e.g., pancreatitis, Cushing’s syndrome)

Signs and Symptoms

Polyuria – frequent urination

Polydipsia – excessive thirst

Polyphagia – increased hunger

Weight loss (mostly in Type 1)

Fatigue and weakness

Delayed wound healing

Blurred vision

Diagnostic evalaution

Fasting Blood Sugar (FBS) ≥ 126 mg/dL

Random Blood Sugar (RBS) ≥ 200 mg/dL

Oral Glucose Tolerance Test (OGTT)

HbA1c ≥ 6.5%

Management

Diet control

low sugar, balanced diet

Exercise

regular physical activity

Medications

Oral hypoglycemics (e.g., Metformin) for Type 2

Insulin therapy for Type 1 or uncontrolled cases

Monitoring blood glucose regularly

Nursing management

Check blood glucose levels regularly

Monitor vital signs and signs of hypo/hyperglycemia

Administer insulin or oral hypoglycemics as prescribed

Provide a diabetic diet (low sugar, high fiber, controlled carbs)

Encourage small, frequent meals

Monitor for side effects (e.g., hypoglycemia)

Teach about medication compliance

Instruct on foot care to prevent ulcers

Explain signs of hypoglycemia/hyperglycemia

Encourage regular exercise

Promote weight control

Advise stress reduction techniques

Q.4 Answer any three very short questions.(06)

1. Alopecia

Alopecia is the partial or complete loss of hair from areas of the body, especially the scalp, where hair normally grows. It can be temporary or permanent, and caused by genetic, autoimmune, nutritional, hormonal, or stress-related factors

Common Types :

Androgenetic Alopecia – Hereditary pattern baldness

Alopecia Areata – Autoimmune, patchy hair loss

Telogen Effluvium – Temporary shedding due to stress or illness

2. Pain

Definition

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. (Defined by the International Association for the Study of Pain – IASP)

Types of Pain

Acute Pain : Short-term, sudden onset (e.g., injury, surgery)

Chronic Pain : Persistent pain lasting >3 months (e.g., arthritis)

Referred pain : Felt in a location different from the source (e.g., chest pain in arm during heart attack)

3. SLE

SLE is a chronic autoimmune disease in which the body’s immune system attacks its own cells, tissues, and organs, leading to widespread inflammation and damage, commonly affecting the skin, joints, kidneys, heart, and brain.

Key Features

Butterfly-shaped rash on face

Joint pain, fatigue, fever

Photosensitivity and renal involvement

4. Lung abscess

A lung abscess is a localized collection of pus within the lung tissue caused by bacterial infection, leading to necrosis and formation of a cavity filled with purulent material. Usually occurs due to aspiration of infected material, especially in unconscious or debilitated patients. Common organisms include Staphylococcus aureus, Klebsiella pneumoniae, and anaerobes

SECTION-II (38 Marks)

Q.5 Answer the following MCQs.(07)

1.Type-II diabetes mellitus is also known as

A. Juvenile diadetes

B. Adult onset diabetes mellitus

C. Gestational diabetes

D. Diabetes with infection

2. Hyperthyroidism leads to

A. Weight loss

B. Sweating

C. Irritability

D. All of above

3. Blood cell which is responsible for coagulation is…

A. RBC

B. WBC

C. Platelet

D. Neutrophil

4. The most common direct cause of sudden death is

A. Cardiomyopathy

B. Pulmonary hypertension

C. Heart failure

D. CAD

5. Which of the following drug is proton pump inhibiter

A. Ranitidine

B. Cimetidine

C. Cetrizine

D. Omeprazole

6. Calcium channel blocker which are used in the treatment of hypertention include

A. Parazocine

B. Enapril

C. Captopril

D. Nifedipine

7. The procedure which involve giving synchronized counter shock to convert an undesirable rhythm to stable rhythm is

A. Defibrillation

B. Cardiac stimulator

C. Pacemaker

D. Cardio version

Q.6 Answer any one essay (10) marks

1.Explain in detail about intestinal obstruction

Definition

Intestinal obstruction is a blockage in the intestinal tract that prevents the normal flow of gastric contents, either partially or completely. It can affect the small or large intestine, leading to distension, fluid accumulation, and compromised blood supply.

Types of Intestinal Obstruction

Mechanical Obstruction – Physical blockage

Examples : Hernia, tumors, adhesions, volvulus, intussusception, strictures

Non-mechanical / Functional Obstruction (Paralytic Ileus) – Absence of peristalsis

Causes : Post-operative state, electrolyte imbalance, infection, drugs

Etiology

Mechanical Causes

Post-surgical adhesions (most common cause)

Incarcerated hernia

Tumors (e.g., colorectal cancer)

Intussusception (common in children)

Volvulus (twisting of bowel)

Foreign bodies or impacted feces

Non-Mechanical Causes

Paralytic ileus (post-operative or due to infection)

Neurological disorders (e.g., Parkinson’s)

Electrolyte imbalance (especially hypokalemia)

Medications (e.g., opioids, anticholinergics)

Clinical Features / Symptoms

Abdominal pain and cramping

Abdominal distension

Nausea and vomiting (may be fecal-smelling in severe cases)

Constipation and obstipation (no flatus or feces passed)

Hyperactive bowel sounds (early) or absent bowel sounds (late)

Signs of dehydration and electrolyte imbalance

Diagnostic Evaluation

X-ray Abdomen (erect) – shows air-fluid levels

CT scan – identifies the site and cause of obstruction

Ultrasound – especially useful in intussusception

CBC – shows leukocytosis in infection

Electrolyte panel – to assess imbalances

Lactate levels – to detect ischemia or perforation

Initial (Conservative) Management

NPO (Nil per oral) – Rest the bowel

IV fluids – Correct dehydration

Electrolyte correction – Especially potassium

Nasogastric tube (NGT) – For decompression

Analgesics & Antiemetics – For pain and vomiting

Antibiotics – If infection or perforation suspected

Surgical Management (if needed)

Exploratory laparotomy – To identify and relieve obstruction

Resection and anastomosis – For necrotic bowel

Colostomy/Ileostomy – In selected cases

Reduction of volvulus or intussusception

Pre-operative Nursing Management

Assessment and Monitoring

Monitor vital signs (especially temperature, pulse, BP, respiration)

Assess abdominal distension, bowel sounds, and pain

Monitor intake-output chart, watch for dehydration

Gastrointestinal Rest

Keep patient NPO (Nil Per Os = nothing by mouth)

Insert and maintain nasogastric (NG) tube for decompression

Monitor NG output: color, amount, consistency

Fluid and Electrolyte Balance

Start IV fluids (e.g., Normal saline with KCl)

Correct electrolyte imbalances (especially sodium, potassium)

Medication Administration

Administer antibiotics, antiemetics, and analgesics as prescribed

Avoid opioid overuse (as it slows bowel motility)

Psychological Support

Provide emotional reassurance to reduce anxiety

Explain the need for surgery and procedure in simple terms

Pre-op Preparation

Assist in obtaining informed consent

Ensure pre-op investigations are completed: CBC, ECG, LFTs, X-ray, CT

Perform skin preparation (abdominal area shaved and cleaned)

Check for NPO compliance and remove dentures/jewelry

Post-operative Nursing Management

Monitoring and Assessment

Regularly monitor vital signs, especially for signs of shock, bleeding, infection

Assess surgical site for redness, discharge, swelling

Observe for return of bowel sounds and flatus

Pain Management

Administer analgesics as prescribed

Encourage early reporting of severe pain or abdominal tightness

Wound and Drain Care

Perform dressing changes under sterile technique

Monitor surgical drains or stoma, if present

Early Ambulation and DVT Prevention

Encourage deep breathing exercises, leg movements, and walking as early as possible

Use compression stockings or low-dose heparin if prescribed

Nutrition and Fluids

Gradual reintroduction of oral fluids → soft diet → regular diet

Continue IV fluids until bowel function resumes

Elimination and NG Tube Care

Continue NG suctioning if needed

Monitor for signs of ileus (no bowel movement after surgery)

Patient and Family Education

Educate about wound care, diet, medication adherence

Teach signs of complications like infection, hernia, constipation

2.Explain in detail about tuberculosis and nursing care of TB patient

Definition

Tuberculosis (TB) is a chronic, contagious bacterial infection caused by Mycobacterium tuberculosis, mainly affecting the lungs (pulmonary TB), but it can also affect other organs (extrapulmonary TB).

Causative Organism

Mycobacterium tuberculosis – an acid-fast bacillus

Other species: M. bovis, M. africanum

Mode of Transmission

Airborne droplets released when an infected person coughs, sneezes, or speaks

Close and prolonged person-to-person contact

Types of TB

Pulmonary TB – Lungs

Extrapulmonary TB – Lymph nodes, bones, kidneys, brain, spine

Miliary TB – Widespread TB throughout body via bloodstream

Latent TB – Infection present but no active disease or symptoms

Clinical manifestations

Persistent cough (>2 weeks)

Fever with evening rise of temperature

Night sweats

Weight loss, loss of appetite

Hemoptysis (blood in sputum)

Chest pain and difficulty in breathing

Diagnostic Evaluation

Sputum AFB smear (Ziehl-Neelsen stain)

CBNAAT / GeneXpert test for rapid TB DNA detection

Chest X-ray

Mantoux test (Tuberculin skin test)

Blood tests: ESR, CBC

CT Scan/MRI in extrapulmonary TB

Medical Management

Under DOTS (Directly Observed Treatment Short-course) program:

Intensive Phase (2 months):

H = Isoniazid

R = Rifampicin

Z = Pyrazinamide

E = Ethambutol

Continuation Phase (4 months):

H + R (Isoniazid and Rifampicin)

Nursing care of TB patient

Assessment

Monitor vital signs regularly (especially temperature and respiratory rate)

Observe for cough characteristics (productive, blood-tinged)

Assess for weight loss, fatigue, appetite loss

Check for compliance with treatment (DOTS)

Medication Administration

Administer anti-tubercular drugs (ATT) as prescribed
(e.g., Isoniazid, Rifampicin, Ethambutol, Pyrazinamide)

Watch for side effects (e.g., liver toxicity, visual disturbances)

Ensure Directly Observed Treatment Short-course (DOTS) for compliance

Infection Control & Isolation

Place patient in a well-ventilated room or isolation if infectious

Use N95 mask or triple-layer surgical mask

Practice cough etiquette and hand hygiene

Educate family on infection prevention

Nutritional Support

Provide high-protein, high-calorie diet

Encourage vitamin-rich foods (Vitamin A, C, B-complex)

Monitor weight gain or loss weekly

Ensure adequate hydration

Health Education

Educate patient and family about:

Importance of drug adherence

6–9 months therapy duration

Prevention of drug resistance

Avoiding alcohol and smoking

Follow-up and sputum testing

Psychosocial Support

Provide emotional support (due to stigma and isolation)

Encourage expression of fears and concerns

Support continuation of work/school with precautions

Documentation

Record medication given, response, side effects

Document patient education and family teaching

Maintain DOTS records if applicable

Complication Prevention

Monitor for signs of hepatotoxicity, drug resistance, hemoptysis

Ensure prompt referral if complications arise

Q.7 Answer any three short questions (15) marks

1. Osteoporosis

Definition

Osteoporosis is a chronic, progressive metabolic bone disease characterized by low bone mass, deterioration of bone tissue, and increased bone fragility, leading to a higher risk of fractures — especially in the hip, spine, and wrist.

Causes / Risk Factors

Aging (postmenopausal women at higher risk)

Hormonal imbalance (↓ Estrogen, ↓ Testosterone)

Calcium or Vitamin D deficiency

Sedentary lifestyle

Long-term corticosteroid use

Smoking and alcohol consumption

Family history of osteoporosis

Clinical manifestations

Back pain (due to vertebral compression)

Loss of height over time

Stooped posture (kyphosis)

Fragile bones and frequent fractures

Often asymptomatic until a fracture occurs

Diagnostic Evaluation

History collection

Physical examination

Bone Mineral Density (BMD) Test – DEXA scan

X-rays (may show fractures or bone thinning)

Blood tests – calcium, vitamin D, thyroid levels

Medical Management

Calcium and Vitamin D supplementation

Bisphosphonates (e.g., Alendronate, Risedronate) – to reduce bone loss

Hormone Replacement Therapy (HRT) (for postmenopausal women)

Calcitonin, Selective Estrogen Receptor Modulators (SERMs)

Weight-bearing exercises to strengthen bones

Nursing Management

Educate patient on fall prevention and home safety

Promote calcium-rich diet (milk, leafy greens, tofu)

Encourage regular exercise like walking or yoga

Monitor for signs of fracture or mobility issues

Ensure adherence to medication and supplement regimen

2. Meningitis

Definition

Meningitis is an inflammation of the meninges, the protective membranes covering the brain and spinal cord, usually caused by bacteria, viruses, fungi, or other microorganisms.

Etiology

Bacterial : Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae

Viral : Enteroviruses, Herpes simplex virus (HSV), Mumps virus

Fungal : Cryptococcus neoformans (common in immunocompromised patients)

Others : Tuberculous meningitis, parasitic causes, drug-induced

Clinical manifestations

High fever and chills

Severe headache

Neck stiffness (nuchal rigidity)

Nausea and vomiting

Photophobia (sensitivity to light)

Altered level of consciousness or confusion

Seizures (in severe cases)

Positive Kernig’s and Brudzinski’s signs

Diagnostic evaluation

History collection

Physical examination

Lumbar puncture – CSF analysis (gold standard)

CT or MRI brain (if raised ICP suspected)

Blood cultures

CBC, CRP, ESR

Medical Management

Antibiotics : Ceftriaxone, Vancomycin (for bacterial meningitis)

Antiviral drugs : Acyclovir (for HSV meningitis)

Antifungals : Amphotericin B (for fungal meningitis)

Corticosteroids : To reduce inflammation

Antipyretics and analgesics for symptom relief

IV fluids and oxygen therapy if required

Nursing Management

Monitor neurological status and vital signs

Maintain isolation precautions (especially for bacterial meningitis)

Ensure quiet and dim environment

Administer medications as prescribed

Provide fluid balance and prevent complications like seizures

Educate family on vaccination and follow-up

3. Deamatitis

Definition

Dermatitis is a general term for inflammation of the skin, characterized by redness, itching, swelling, and sometimes blistering or oozing. It may be acute or chronic, and caused by allergic, irritant, or autoimmune factors.

Etiology

Irritants : Soaps, detergents, acids, or chemicals

Allergens : Plants (e.g., poison ivy), cosmetics, jewelry (nickel), dust mites

Infections : Fungal or bacterial infections

Autoimmune conditions : Eczema, seborrheic dermatitis

Genetic predisposition (e.g., in atopic dermatitis)

Types of Dermatitis

Atopic Dermatitis (Eczema)

Contact Dermatitis (Irritant or Allergic)

Seborrheic Dermatitis

Nummular Dermatitis

Stasis Dermatitis (related to poor circulation)

Clinical manifestation

Redness and rash

Itching and irritation

Swelling and pain

Dry, flaky, or scaly skin

Blisters or oozing lesions (in acute phase)

Cracking or thickened skin (in chronic phase)

Medical Management

Topical corticosteroids (e.g., Hydrocortisone)

Antihistamines (e.g., Cetirizine) to relieve itching

Moisturizers and emollients for hydration

Antibiotics (if secondary infection present)

Avoidance of known irritants/allergens

Nursing Management

Educate the patient on skin care and avoiding triggers

Monitor for secondary infection

Encourage cool compresses for symptom relief

Administer prescribed topical and oral medications

Promote psychological comfort due to appearance concerns

4. Pneumonia

Definition

Pneumonia is an inflammatory condition of the lung parenchyma, primarily affecting the alveoli, caused by infection with bacteria, viruses, fungi, or other organisms.

Causes

Bacterial: Streptococcus pneumoniae, Haemophilus influenzae

Viral: Influenza virus, Respiratory syncytial virus (RSV)

Fungal: Pneumocystis jirovecii (especially in immunocompromised patients)

Aspiration: Inhalation of food, fluid, or vomitus

Types

Community-acquired pneumonia (CAP)

Hospital-acquired pneumonia (HAP)

Aspiration pneumonia

Ventilator-associated pneumonia (VAP)

Clinical manifestations

Fever and chills

Productive or dry cough

Chest pain (pleuritic)

Dyspnea (difficulty breathing)

Fatigue, weakness

Crackles or decreased breath sounds on auscultation

Diagnostic evaluation

History collection

Physical examination

Chest X-ray

Complete blood count (CBC)

Sputum culture

Pulse oximetry

Arterial Blood Gas (ABG)

Management

Antibiotic Therapy (for bacterial pneumonia):

First-line: Amoxicillin, Azithromycin, Ceftriaxone, Levofloxacin

Based on sputum culture sensitivity

Antiviral Therapy (for viral pneumonia):

E.g., Oseltamivir for Influenza

Symptomatic management for mild cases

Antifungal Therapy:

E.g., Amphotericin B, Fluconazole (for fungal pneumonia)

Supportive Medications:

Antipyretics (Paracetamol) – for fever

Bronchodilators (Salbutamol) – to ease breathing

Mucolytics/Expectorants (Ambroxol) – to loosen mucus

Corticosteroids (in severe inflammation)

Oxygen Therapy

Administered if SpO₂ < 92%

Nasal cannula or face mask, depending on severity

Continuous monitoring of oxygen saturation

Nursing management

Monitor vital signs (especially temperature, respiratory rate, and oxygen saturation).

Assess for breath sounds (crackles, wheezes, decreased sounds).

Evaluate cough characteristics (productive/non-productive, sputum color).

Observe for signs of hypoxia (cyanosis, confusion).

Administer Medications as Prescribed.

Administer oxygen as per doctor’s order if SpO₂ < 92%.

Encourage oral fluids (2–3 L/day) to loosen secretions.

Maintain IV fluids if patient is unable to take orally

Position in semi-Fowler’s or high Fowler’s to promote lung expansion.

Encourage frequent position changes to prevent hypostatic pneumonia.

Promote rest and limit strenuous activity.

Teach and encourage deep breathing and coughing exercises.

Q.8 Answer any three very short questions (6) marks

1. Leprosy

Leprosy is also called Hansen’s Disease. It is a chronic infectious disease caused by Mycobacterium leprae that primarily affects the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. It spreads through prolonged close contact via nasal droplets. Early diagnosis and multi-drug therapy (MDT) are essential to prevent deformities and transmission.

2. BLS

Basic Life Support (BLS) is an emergency medical procedure used to maintain airway, breathing, and circulation in a person experiencing cardiac arrest, respiratory failure, or choking. It includes CPR (cardiopulmonary resuscitation), rescue breathing, and use of an AED (automated external defibrillator) until advanced care is available.

3. Traction

Traction is a therapeutic method used to align and stabilize fractured bones or dislocated joints by applying a steady pulling force. It helps in reducing pain, correcting deformities, and maintaining proper bone position during healing. Types include skin traction and skeletal traction.

4. Hernia

A hernia is the protrusion of an organ or tissue through a weak spot in the surrounding muscle or connective tissue. It commonly occurs in the abdominal wall, especially in areas like the inguinal, umbilical, or femoral region. Symptoms may include a visible bulge, pain, or discomfort, especially while lifting or coughing.