MEDICAL SURGICAL NURSING-I=FEBRUARY 2024
⏩I. Elaborate on: (2 x 15 = 30)
🔸1.Mrs. A, 32 year old women admitted with severe dyspnea and diagnosed having Bronchial Asthma admitted in intensive care unit.
ANSWER:- a) Define Bronchial asthma. Bronchial asthma, commonly referred to as asthma, is a chronic inflammatory disease of the airways characterized by episodes of reversible airflow obstruction. Bronchial Asthma is a chronic inflammatory disease of the airways, characterized by airflow obstruction, bronchial hyperactivity, and a mucous production.These episodes are typically marked by symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The inflammation leads to increased sensitivity of the airways to various stimuli, causing bronchoconstriction, mucus production, and swelling, which restrict airflow and make breathing difficult. Asthma can be triggered by a variety of factors, including allergens, respiratory infections, physical activity, cold air, and stress. Proper management often involves the use of inhaled medications to control and prevent symptoms.
🔸b) List down any four risk factors of Bronchial asthma.
ANSWER:-Here are four risk factors for bronchial asthma:
1.Allergens Exposure to allergens such as pollen, dust mites, pet dander, and mold can trigger asthma symptoms in susceptible individuals.
2.Genetics A family history of asthma or other allergic conditions increases the likelihood of developing asthma.
3.Respiratory Infections Early-life respiratory infections, particularly those caused by viruses, can contribute to the development of asthma.
4.Environmental Factors Exposure to environmental irritants such as tobacco smoke, air pollution, and occupational chemicals can increase the risk of asthma.
🔸c) Discuss nursing care plan of Mrs. A for first 48 hrs.
ANSWER:- A nursing care plan for a patient with bronchial asthma during the first 48 hours focuses on stabilizing the patient’s condition, alleviating symptoms, and preventing complications. Here is a detailed plan:
Assessment
1.Vital Signs Monitor respiratory rate, heart rate, blood pressure, oxygen saturation, and temperature.
2.Respiratory Assessment Observe for signs of respiratory distress (e.g., use of accessory muscles, nasal flaring, cyanosis), auscultate lung sounds for wheezing or diminished breath sounds, and assess peak flow rates.
3.Symptom Monitoring Document the frequency, duration, and severity of wheezing, cough, chest tightness, and dyspnea.
4.Triggers Identify potential environmental or activity-related triggers.
5.Medical History Review the patient’s asthma history, including previous exacerbations, current medications, and allergies.
Nursing Diagnoses
Goals
1.Improve airway clearance and gas exchange.
2.Reduce anxiety levels.
3.Educate the patient about asthma management and trigger avoidance.
4.Stabilize the patient’s condition and prevent further exacerbations.
Interventions
1.Airway Management Position the patient in high Fowler’s position to maximize lung expansion.
Administer bronchodilators as prescribed (e.g., albuterol) via nebulizer or metered-dose inhaler.
Administer corticosteroids as prescribed to reduce inflammation.
Provide supplemental oxygen to maintain oxygen saturation above 92%.
2.Monitoring Continuously monitor vital signs and oxygen saturation.
Perform frequent respiratory assessments to detect changes in lung sounds and breathing patterns.
Monitor peak flow readings to assess the effectiveness of treatment.
3.Anxiety Reduction Use calm and reassuring communication.
Encourage slow, deep breathing techniques.
Provide emotional support and involve the family as needed.
4.Education Teach the patient and family about asthma triggers and how to avoid them.
Instruct on the correct use of inhalers, spacers, and peak flow meters.
Explain the importance of adhering to the prescribed medication regimen.
Discuss the action plan for managing future asthma attacks, including when to seek emergency help.
Evaluation
1.Airway Clearance The patient demonstrates effective coughing and clear lung sounds, with reduced wheezing.
2.Gas Exchange The patient maintains oxygen saturation above 92% and shows improved peak flow readings.
3.Anxiety The patient reports decreased anxiety levels and appears more relaxed.
4.Knowledge The patient and family can verbalize understanding of asthma management, medication use, and trigger avoidance.
Follow-Up
1.Reassess Regularly reassess the patient’s respiratory status and response to treatment.
2.Adjust Modify the care plan as needed based on the patient’s progress and any changes in condition.
3.Plan Develop a long-term management plan in collaboration with the healthcare team to prevent future exacerbations and improve overall asthma control.
🔸d) Explain any six nurse’s role in prevention of Bronchial asthma.
ANSWER:- Nurses play a crucial role in the prevention and management of bronchial asthma through patient education, monitoring, and support. Here are six key roles nurses fulfill in the prevention of bronchial asthma:
1.Patient Education
Trigger Avoidance Educate patients and their families about common asthma triggers, such as allergens (dust mites, pet dander, pollen), irritants (tobacco smoke, pollution), and respiratory infections. Teach strategies to avoid or minimize exposure to these triggers.
Medication Adherence Instruct patients on the importance of adhering to prescribed asthma medications, including daily controller medications and rescue inhalers. Demonstrate proper inhaler techniques and use of spacers or nebulizers.
2.Developing Asthma Action Plans
Personalized Plans Collaborate with patients to develop individualized asthma action plans that outline daily management strategies, medication schedules, and steps to take during an asthma attack.
Emergency Procedures Ensure patients understand when and how to seek emergency medical help if their symptoms worsen or if they do not respond to usual treatments.
3.Monitoring and Assessment
Regular Check-Ups Encourage patients to schedule regular follow-up appointments to monitor asthma control and adjust treatment plans as necessary.
Symptom Tracking Teach patients to use tools such as peak flow meters to monitor their lung function and recognize early signs of an asthma exacerbation.
4.Promoting a Healthy Lifestyle
Physical Activity Advise patients on engaging in regular physical activity while managing exercise-induced asthma. Provide tips on warm-up exercises and using pre-exercise inhalers.
Nutrition and Weight Management Educate on maintaining a balanced diet and healthy weight, as obesity can exacerbate asthma symptoms.
5.Environmental Control Home Assessments Assist patients in identifying and mitigating asthma triggers in their home environments. This may include recommending air purifiers, allergen-proof bedding, and regular cleaning routines to reduce dust and mold.
Work and School Environment Help patients advocate for asthma-friendly environments at work or school by ensuring that they have access to necessary medications and a clean, smoke-free environment.
6.Psychosocial Support Stress Management Teach patients stress-reduction techniques, such as deep breathing exercises, meditation, and yoga, as stress can trigger or worsen asthma symptoms.
Support Groups Encourage participation in asthma support groups where patients can share experiences, gain support from others, and learn additional management strategies.
By fulfilling these roles, nurses can significantly contribute to the prevention of asthma exacerbations, improve patients’ quality of life, and promote effective long-term asthma management.
🔸2.Mr. L, 24 years old young man diagnosed having Acute Lymphocytic Leukemia and underwent bone marrow transplant admitted in transplant unit.
a) Define Acute Lymphocytic Leukemia. ANSWER:- Acute Lymphocytic Leukemia (ALL) is a type of cancer that originates in the bone marrow and affects the blood. It is characterized by the rapid proliferation of immature white blood cells, known as lymphoblasts or leukemic blasts. These abnormal cells crowd out normal blood cells, leading to a shortage of red blood cells, platelets, and healthy white blood cells. This can result in symptoms such as anemia, bleeding, infections, and general weakness. ALL is most commonly diagnosed in children but can also occur in adults. The disease progresses quickly and requires prompt treatment, which often includes chemotherapy, radiation therapy, and sometimes stem cell transplantation.
🔸b) List down the clinical manifestations of A.L.L.
ANSWER:- Clinical manifestations of Acute Lymphocytic Leukemia (ALL) can vary, but common symptoms include:
1.Fatigue and Weakness Due to anemia caused by a deficiency of red blood cells.
2.Fever and Infections Resulting from a lack of healthy white blood cells, leading to a weakened immune system.
3.Bleeding and Bruising Including frequent or severe nosebleeds, gum bleeding, and easy bruising, due to low platelet counts.
4.Bone and Joint Pain Caused by the overcrowding of leukemic cells in the bone marrow.
5.Swollen Lymph Nodes Especially in the neck, underarm, and groin areas, due to the accumulation of leukemic cells.
6.Abdominal Discomfort From an enlarged liver or spleen.
7.Pallor A pale appearance due to anemia.
8.Frequent Infections Such as repeated bouts of pneumonia or other bacterial or viral infections.
9.Weight Loss and Loss of Appetite Often associated with the general malaise of cancer.
10.Petechiae Tiny red spots on the skin caused by bleeding under the skin.
🔸c) Prepare a Nursing care plan for Mr.L during first 72 hr.
ANSWER:- Assessment
1.Vital Signs Monitor temperature, pulse, respiration rate, blood pressure, and oxygen saturation.
2.Blood Tests Review complete blood count (CBC), electrolytes, liver function tests, kidney function tests, and coagulation profile.
3.Symptoms Assess for fatigue, weakness, fever, bleeding, bruising, pain, and signs of infection.
4.Pain Assessment Use appropriate pain scale to assess the level and location of pain.
5.Psychosocial Assessment Evaluate the patient’s emotional state, anxiety levels, and support system.
Nursing Diagnoses
1.Risk for infection related to immunosuppression.
2.Risk for bleeding related to thrombocytopenia.
3.Fatigue related to anemia and disease process.
4.Acute pain related to bone marrow infiltration and treatment side effects.
5.Anxiety related to diagnosis and treatment uncertainties.
6.Deficient knowledge regarding disease process and treatment regimen.
Goals
1.Prevent infection and monitor for signs of sepsis.
2.Prevent bleeding and monitor for signs of hemorrhage.
3.Manage fatigue and improve energy levels.
4.Alleviate pain and discomfort.
5.Reduce anxiety and provide emotional support.
6.Educate the patient and family about ALL and its treatment.
Interventions
1.Infection Prevention Hand Hygiene Encourage frequent handwashing for patient, staff, and visitors.
Isolation Precautions Implement neutropenic precautions if necessary.
Monitor Signs Check for fever, chills, and other signs of infection regularly.
Antibiotics Administer prophylactic or therapeutic antibiotics as prescribed.
Aseptic Technique Use aseptic technique for all invasive procedures.
2.Bleeding Prevention Monitor Labs Regularly review platelet counts and coagulation profiles.
Minimize Trauma Avoid invasive procedures and use soft toothbrushes and electric razors.
Bleeding Signs Monitor for petechiae, hematuria, epistaxis, and gastrointestinal bleeding.
Transfusions Administer platelets and blood transfusions as ordered.
3.Fatigue Management Energy Conservation Encourage rest periods and balance activity with rest.
Nutritional Support Provide high-calorie, high-protein snacks and meals.
Activity Assistance Assist with activities of daily living (ADLs) as needed.
4.Pain Management
Pain Medications Administer analgesics as prescribed, and monitor for effectiveness.
Non-Pharmacological Methods Utilize heat/cold therapy, relaxation techniques, and distraction.
5.Anxiety Reduction Emotional Support Offer reassurance and a listening ear; encourage the presence of family.
Counseling Provide access to a counselor or support groups.
Relaxation Techniques Teach deep breathing exercises and progressive muscle relaxation.
6.Patient and Family Education
Disease Process Explain ALL, its symptoms, and treatment options in understandable terms.
Medication Instructions Educate about the purpose, dosage, and side effects of medications.
Signs to Report Instruct on recognizing signs of infection, bleeding, and other complications.
Follow-Up Care Discuss the importance of follow-up appointments and ongoing monitoring.
Evaluation
1.Infection Control Patient remains free from signs of infection, with stable vital signs.
2.Bleeding Prevention No signs of active bleeding; stable platelet counts.
3.Fatigue Management Patient reports manageable levels of fatigue and participates in ADLs as tolerated.
4.Pain Relief Patient reports pain at an acceptable level, with effective use of pain relief measures.
5.Anxiety Reduction,Patient verbalizes reduced anxiety and demonstrates coping strategies.
6.Knowledge Patient and family can accurately describe the disease process, treatment plan, and signs to monitor.
Follow-Up
Continuous Monitoring Reassess the patient’s condition and adjust the care plan as needed.
Interdisciplinary Team Meetings Collaborate with the healthcare team to ensure comprehensive care.
Long-Term Planning Begin discussing long-term treatment goals and supportive care needs.
This nursing care plan is designed to address the immediate needs of a patient with Acute Lymphocytic Leukemia during the critical first 72 hours of diagnosis and treatment.
🔸d) Enumerate any four complications of Bone marrow transplant.
ANSWER:-Bone marrow transplants, while potentially life-saving, can have several complications. Here are four major complications:
1.Graft-versus-Host Disease (GVHD) Acute GVHD Occurs within the first 100 days post-transplant. Symptoms include skin rashes, jaundice, and gastrointestinal issues like diarrhea.
Chronic GVHD Can occur anytime after the first 100 days. It may affect various organs, leading to symptoms like skin thickening, dry eyes, and liver dysfunction.
2.Infections Due to the immunosuppression required to prevent graft rejection, patients are highly susceptible to infections. These can be bacterial, viral, or fungal and can affect any part of the body, often requiring prompt and aggressive treatment.
3.Organ Damage Chemotherapy and radiation therapy used before the transplant can cause long-term damage to organs, including the liver (veno-occlusive disease), lungs (interstitial pneumonitis), heart, and kidneys.
4.Graft Failure The new bone marrow may fail to produce enough new blood cells, leading to graft failure. This can result in severe anemia, bleeding issues, and increased risk of infections, requiring another transplant or other medical interventions.
These complications highlight the need for careful monitoring and management of patients undergoing bone marrow transplants.
🔸e) Write down any four nurse’s role in relation to the family counselling.
ANSWER:- Nurses play a crucial role in family counseling, particularly in managing chronic illnesses or complex treatments like bone marrow transplants. Here are four key roles nurses fulfill in this context:
1.Providing Emotional Support
Listening and Empathy Offer a compassionate ear, allowing family members to express their fears, anxieties, and concerns. This helps build trust and provides emotional relief.
Reassurance Provide reassurance by explaining the treatment process, addressing concerns, and validating their feelings, which can reduce anxiety and stress.
2.Education and Information Sharing Disease and Treatment Education Educate the family about the patient’s condition, treatment options, potential side effects, and expected outcomes. Clear, understandable information empowers the family to make informed decisions.
Care Instructions Teach the family how to care for the patient at home, including medication administration, wound care, and recognizing signs of complications.
3.Facilitating Communication
Healthcare Team Coordination Act as a liaison between the family and the healthcare team, ensuring clear and consistent communication. This helps in addressing concerns promptly and keeps the family informed about the patient’s progress.
Family Meetings Organize and facilitate family meetings with the healthcare team to discuss the patient’s condition, treatment plans, and address any questions or concerns.
4.Providing Resources and Referrals Support Groups Connect the family with support groups and counseling services to provide additional emotional and psychological support.
Community Resources Provide information on community resources, such as financial aid, transportation services, and home health care, to help ease the burden on the family.
These roles help ensure that the family feels supported, informed, and empowered throughout the patient’s treatment process.
⏩ II. Write notes on: (5 x 5 = 25)
🔸1.Nurses role in blood transfusion.
ANSWER:-Nurses play a critical role in ensuring the safety and effectiveness of blood transfusions. Their responsibilities encompass various stages, from preparation to monitoring and follow-up care. Here are key aspects of a nurse’s role in blood transfusions:
Verify Orders and Patient Consent Confirm the physician’s order for the transfusion and ensure that the patient has provided informed consent.
Patient Identification and Education Verify the patient’s identity using two identifiers (e.g., name and date of birth).
Educate the patient about the transfusion procedure, potential benefits, risks, and what to expect during and after the transfusion.
Pre-Transfusion Assessment Assess the patient’s baseline vital signs, including temperature, blood pressure, heart rate, and respiratory rate.
Review the patient’s medical history for previous transfusions and any history of transfusion reactions.
Blood Product Verification Check the blood product’s label against the transfusion order, ensuring compatibility of the blood type and Rh factor.
Inspect the blood product for any signs of contamination or damage, such as discoloration or clots.
Administration Use aseptic techniques to set up the transfusion equipment and start the transfusion as per protocol.
Begin the transfusion slowly for the first 15 minutes while closely monitoring the patient for any adverse reactions.
Monitoring Continuously monitor the patient’s vital signs and observe for any signs of transfusion reactions, such as fever, chills, rash, itching, dyspnea, or hypotension.
Document vital signs at regular intervals as per hospital policy.
Managing Reactions If a transfusion reaction is suspected, immediately stop the transfusion, maintain IV access with normal saline, and notify the physician.
Follow the institution’s protocol for managing and reporting transfusion reactions.
Final Assessments Perform a final set of vital signs and compare them with baseline values to ensure patient stability.
Assess the patient for any delayed adverse reactions or symptoms.
Documentation Accurately document the transfusion procedure, including the type and amount of blood product transfused, the patient’s response, and any adverse reactions observed.
Record the time the transfusion started and ended, and the condition of the patient post-transfusion.
Patient Education Educate the patient on recognizing delayed transfusion reactions and instruct them to seek medical attention if they experience any unusual symptoms.
Monitoring Continue to monitor the patient for signs of delayed transfusion reactions in the hours and days following the transfusion.
Reporting Report any adverse reactions to the appropriate hospital department and ensure that the incident is documented in the patient’s medical record.
🔸2.Types of Fracture.
ANSWER:- Fractures, or broken bones, can vary in type depending on the location, severity, and characteristics of the injury. Here are some common types of fractures:
1.Simple or Closed Fracture The bone breaks but does not pierce the skin. It is considered a straightforward fracture without an open wound.
2.Compound or Open Fracture The broken bone protrudes through the skin, leading to an open wound. This type of fracture is at higher risk of infection due to exposure to the external environment.
3.Comminuted Fracture The bone breaks into multiple fragments or pieces. This type of fracture often requires surgical intervention to realign and stabilize the bone.
4.Greenstick Fracture Common in children, this type of fracture involves a partial break in the bone, similar to how a green stick breaks but remains partially intact.
5.Transverse Fracture The fracture line runs horizontally across the bone, perpendicular to the bone’s long axis.
6.Oblique Fracture The fracture line runs diagonally across the bone, at an angle to the bone’s long axis.
7.Spiral Fracture The fracture line spirals around the bone, often resulting from a twisting or rotational force applied to the bone.
8.Impacted Fracture One end of the fractured bone is driven into the other, causing compression and shortening of the bone. This type of fracture is common in falls from height.
9.Avulsion Fracture A small piece of bone is pulled away from the main bone by the force of a muscle or ligament. This often occurs at the attachment site of a tendon or ligament.
10.Stress Fracture
A hairline crack in the bone caused by repetitive stress or overuse, commonly seen in athletes or individuals engaged in high-impact activities.
🔸3.Prevention of accident and hazards in operation theatre.
ANSWER:- Preventing accidents and hazards in the operating theatre is crucial to ensure the safety of patients, healthcare workers, and the overall success of surgical procedures. Here are key measures to prevent accidents and hazards in the operating theatre:
1.Infection Control:
Hand Hygiene Ensure strict adherence to hand hygiene protocols, including handwashing and use of alcohol-based hand rubs before and after patient contact.
Sterile Techniques Follow aseptic techniques during surgical procedures to minimize the risk of surgical site infections.
Proper Cleaning and Sterilization Thoroughly clean and sterilize surgical instruments, equipment, and surfaces according to established protocols.
2.Fire Safety:
Electrical Safety Regularly inspect electrical equipment, cords, and outlets for damage or malfunction. Avoid overloading electrical circuits.
Fire Extinguishers and Alarms Ensure the availability and proper functioning of fire extinguishers, smoke detectors, and fire alarms in the operating theatre.
Staff Training Conduct regular fire safety drills and provide staff training on fire prevention, evacuation procedures, and the use of firefighting equipment.
3.Hazardous Material Management: Safe Handling and Disposal
Properly handle and dispose of hazardous materials, including sharps, chemical agents, and biological waste, according to established protocols.
Personal Protective Equipment (PPE) Provide appropriate PPE, such as gloves, gowns, masks, and eye protection, to healthcare workers to minimize exposure to hazardous materials.
4.Equipment Safety:
Regular Maintenance Conduct regular maintenance and inspection of surgical equipment, including anesthesia machines, monitors, and surgical instruments, to ensure proper functioning.
Equipment Checks Verify the integrity and functionality of equipment before each surgical procedure, including anesthesia equipment and surgical lights.
Emergency Equipment Ensure the availability and accessibility of emergency equipment, such as defibrillators, suction devices, and emergency medications.
5.Ergonomics and Workplace Safety: Proper Positioning Maintain proper ergonomics and positioning of surgical team members to prevent musculoskeletal injuries during prolonged surgeries.
Slip, Trip, and Fall Prevention Keep operating theatre floors clean, dry, and free from clutter to prevent slip, trip, and fall hazards.
Safe Handling of Patients Use appropriate lifting techniques and mechanical aids to safely transfer and position patients on the operating table.
6.Communication and Teamwork:
Clear Communication Encourage open communication among surgical team members to ensure clear understanding of roles, responsibilities, and patient care plans.
Team Briefings and Debriefings Conduct pre-operative briefings to discuss surgical plans and potential risks, as well as post-operative debriefings to review the procedure and identify areas for improvement.
🔸4.Anaemia.
Anaemia: Definition, Types, Causes, and Management
Definition Anaemia is a condition characterized by a deficiency in the number or quality of red blood cells (RBCs) or a reduction in the amount of hemoglobin, leading to decreased oxygen delivery to the body’s tissues.
Types of Anaemia
1 Iron-Deficiency Anaemia Caused by a lack of iron, leading to reduced hemoglobin production.
2.Vitamin Deficiency Anaemia Includes megaloblastic anaemia, often caused by deficiencies in vitamin B12 or folate.
3.Hemolytic Anaemia Results from the premature destruction of red blood cells, which can be due to inherited conditions like sickle cell anaemia or acquired causes like autoimmune diseases.
4.Aplastic Anaemia A rare condition where the bone marrow fails to produce enough RBCs, white blood cells, and platelets.
5.Anemia of Chronic Disease Associated with chronic illnesses such as kidney disease, cancer, or rheumatoid arthritis, leading to reduced RBC production.
6.Sickle Cell Anaemia An inherited form of hemolytic anaemia where RBCs are abnormally shaped, leading to chronic hemolysis and blood flow obstruction.
Causes
Nutritional Deficiencies Lack of iron, vitamin B12, or folate in the diet.
Chronic Diseases Conditions like chronic kidney disease, cancer, or inflammatory diseases.
Genetic Disorders Inherited conditions like thalassemia and sickle cell disease.
Blood Loss From gastrointestinal bleeding, heavy menstruation, or surgery.
Bone Marrow Disorders Such as aplastic anaemia or leukemia.
Infections and Medications Certain infections and medications can affect RBC production or lifespan.
Clinical Manifestations Fatigue and Weakness General feeling of tiredness and lack of energy. Pallor Pale skin and mucous membranes.
Shortness of Breath Especially during physical activity.
Dizziness or Lightheadedness Feeling faint or dizzy, particularly when standing up.
Palpitations Noticeable heartbeats or a rapid heart rate.
Cold Hands and Feet Poor circulation due to reduced oxygen delivery.
Headaches Often due to reduced oxygen supply to the brain.
Diagnosis Complete Blood Count (CBC) Measures levels of RBCs, hemoglobin, and hematocrit.
Blood Smear Examines the shape and size of RBCs.
Reticulocyte Count
Assesses the production of new RBCs.
Iron Studies Including serum ferritin, serum iron, and total iron-binding capacity (TIBC).
Vitamin B12 and Folate Levels
Measures the levels of these vitamins in the blood.
Bone Marrow Biopsy
Evaluates bone marrow function and RBC production.
Management
Dietary Changes and Supplements
Iron supplements for iron-deficiency anaemia.
Vitamin B12 injections or oral supplements for vitamin B12 deficiency.
Folate supplements for folate deficiency.
Medications Erythropoiesis-stimulating agents for anemia of chronic disease.
Immunosuppressive therapy for aplastic anaemia.
Blood Transfusions Used in severe cases to quickly increase RBC levels.
Treating Underlying Causes Managing chronic diseases, controlling sources of bleeding, and addressing infections.
Bone Marrow Transplant Considered for severe aplastic anaemia or other bone marrow disorders.
Nursing Interventions
1.Assessment Regularly monitor vital signs, particularly heart rate and oxygen saturation.
Assess for signs and symptoms of anaemia, such as pallor, fatigue, and shortness of breath.
2.Education Teach patients about dietary sources of iron, vitamin B12, and folate.
Instruct on the proper use of supplements and medications.
3.Monitoring and Support Monitor lab results for changes in hemoglobin and hematocrit levels.
Provide emotional support and address any concerns related to symptoms or treatments.
4.Coordination of Care Collaborate with dietitians, physicians, and other healthcare providers to develop and implement a comprehensive care plan.
🔸5.Benign prostate hypertrophy.
ANSWER:- Benign Prostatic Hypertrophy (BPH):
Definition Benign Prostatic Hypertrophy (BPH) is a non-cancerous enlargement of the prostate gland, commonly occurring in older men. It can lead to urinary symptoms due to the compression of the urethra.
Causes
Aging The primary risk factor, with symptoms typically starting after age 50.
Hormonal Changes Increased levels of dihydrotestosterone (DHT) and estrogen relative to testosterone.
Genetic Factors Family history of BPH can increase the risk.
Lifestyle Factors Obesity, lack of physical activity, and poor diet may contribute.
Clinical Manifestations
Urinary Frequency Increased need to urinate, especially at night (nocturia).
Urgency Sudden, strong urge to urinate.
Weak Urine Stream Difficulty starting urination or a weak stream.
Dribbling Post-void dribbling of urine.
Incomplete Emptying Feeling that the bladder is not completely empty after urination.
Straining Need to strain or push to initiate and maintain urination.
Interrupted Stream Starting and stopping of the urine flow.
Diagnosis
Digital Rectal Exam (DRE) Physical examination to feel the size and shape of the prostate.
Urinalysis To check for infection or blood in the urine.
Prostate-Specific Antigen (PSA) Test
Measures PSA levels, which can be elevated in BPH.
Ultrasound Imaging to assess the size of the prostate and residual urine volume.
Uroflowmetry Measures the speed and volume of urine flow.
Cystoscopy Allows direct visualization of the urethra and bladder.
Management
1.Lifestyle Modifications
Fluid Management Reduce fluid intake, especially before bedtime.
Dietary Changes Reduce caffeine and alcohol intake.
Bladder Training Schedule bathroom visits and practice double voiding.
2.Medications
Alpha-Blockers Relax the muscle fibers in the prostate and bladder neck (e.g., tamsulosin, alfuzosin).
5-Alpha Reductase Inhibitors Reduce prostate size by blocking DHT production (e.g., finasteride, dutasteride).
Combination Therapy Use of both alpha-blockers and 5-alpha reductase inhibitors.
Anticholinergics Help with bladder storage symptoms.
3.Minimally Invasive Procedures
Transurethral Microwave Thermotherapy (TUMT)
Uses microwave energy to reduce prostate tissue.
Transurethral Needle Ablation (TUNA)
Uses radiofrequency energy to shrink the prostate.
4.Surgical Options
Transurethral Resection of the Prostate (TURP)
Removal of prostate tissue through the urethra.
Laser Surgery Laser vaporization or enucleation of prostate tissue.
Prostatectomy Partial or complete removal of the prostate, usually in severe cases.
Nursing Interventions
1.Patient Education
Symptom Management
Teach patients about lifestyle changes to manage symptoms.
Medication Adherence
Educate on the importance of taking medications as prescribed.
Post-Procedure Care Provide information on care following minimally invasive procedures or surgery.
2.Monitoring
Assess Urinary Patterns Monitor frequency, urgency, and volume of urination.
Track Symptoms Use symptom score questionnaires to monitor progression or improvement.
3.Supportive Care
Emotional Support Address concerns and provide reassurance regarding the condition and its management.
Resource Provision Connect patients with support groups and educational resources.
4.Coordination of Care
Referral Coordinate with urologists and other specialists as needed.
Follow-Up Ensure regular follow-up appointments to monitor the condition and adjust treatment.
By understanding the nature of BPH and providing comprehensive care, nurses can help manage symptoms, improve quality of life, and support patients through treatment and recovery.
III. Short answers on: (10 x 2 = 20)
🔸1.List out the types of Shock.
1.Hypovolemic Shock
Definition Caused by significant loss of blood or fluids.
Common Causes Hemorrhage (trauma, surgery, gastrointestinal bleeding), severe dehydration (vomiting, diarrhea, excessive sweating).
2.Cardiogenic Shock
Definition Resulting from the heart’s inability to pump blood effectively.
Common Causes Myocardial infarction (heart attack), severe heart failure, arrhythmias, cardiomyopathy.
3.Distributive Shock
Definition Characterized by abnormal distribution of blood flow in the smallest blood vessels, leading to inadequate supply of blood to tissues.
Subtypes
Septic Shock
Due to severe infection leading to systemic inflammation.
Anaphylactic Shock
Severe allergic reaction causing widespread vasodilation and increased capillary permeability.
Neurogenic Shock
Due to spinal cord injury or damage, leading to loss of sympathetic nervous system tone.
4.Obstructive Shock
Definition Caused by physical obstruction of the great vessels or the heart itself.
Common Causes Pulmonary embolism, tension pneumothorax, cardiac tamponade, aortic stenosis.
5.Endocrine Shock
Definition Resulting from endocrine disorders that affect blood flow and volume.
Common Causes Addisonian crisis (acute adrenal insufficiency), thyrotoxicosis.
Summary of Types of Shock
Hypovolemic Shock Due to loss of blood or fluids.
Cardiogenic Shock Due to heart’s inability to pump effectively.
Distributive Shock Septic Shock Due to severe infection.
Anaphylactic Shock Due to severe allergic reaction.
Neurogenic Shock Due to spinal cord injury.
Obstructive Shock Due to physical obstruction in blood flow.
Endocrine Shock Due to hormonal imbalances affecting circulation.
🔸2.What is Peri-operative Nursing?
ANSWER: Peri-operative nursing refers to the specialized care provided by nurses to patients before, during, and after surgery. It encompasses the entire surgical experience, including the pre-operative, intra-operative, and post-operative phases.
🔸3.Define Emphysema.
ANSWER: Definition: Emphysema is a chronic, progressive lung condition characterized by the destruction of the alveoli (tiny air sacs) in the lungs. This destruction leads to reduced surface area for gas exchange, causing difficulty in breathing and decreased oxygen supply to the bloodstream.
🔸4.What is Myocarditis?
ANSWER: Myocarditis is an inflammation of the myocardium, the muscular layer of the heart. This condition can result from infections (often viral), autoimmune diseases, toxins, or medications. It can impair the heart’s ability to pump blood effectively, leading to symptoms like chest pain, fatigue, shortness of breath, and arrhythmias.
🔸5.Define Diabetes insipidus.
ANSWER: Diabetes insipidus is a disorder characterized by an imbalance in the body’s water regulation, leading to excessive thirst (polydipsia) and the excretion of large volumes of dilute urine (polyuria). It is caused by a deficiency in antidiuretic hormone (ADH) production by the hypothalamus (central diabetes insipidus) or a failure of the kidneys to respond to ADH (nephrogenic diabetes insipidus). This condition is distinct from diabetes mellitus, which involves high blood sugar levels.
🔸6.Write four types of Dermatitis.
ANSWER:-Quarantine is a public health measure used tor separate and restrict the movement of individuals who may have been exposed to a contagious disease but are not yet symptomatic. The purpose of quarantine is to prevent the potential spread of the disease during the incubation period, which is the time between exposure to the pathogen and the onset of symptoms. Quarantine typically involves staying at home or in a designated facility for a specified period, usually determined by health authorities based on the incubation period of the disease. It helps to monitor individuals for the development of symptoms and minimize the risk of transmission to others in the community. Quarantine may be voluntary or mandatory, depending on the severity of the public health threat and the legal framework in place.
Four types of dermatitis include:
Contact Dermatitis Caused by contact with irritants or allergens, leading to redness, itching, and rash at the site of contact. Examples include poison ivy, nickel, and certain cosmetics.
Atopic Dermatitis (Eczema): A chronic inflammatory skin condition characterized by dry, itchy, and inflamed patches of skin. It often runs in families and is associated with allergies and asthma.
Seborrheic Dermatitis A common, chronic inflammatory condition that primarily affects areas of the body with high sebaceous gland activity, such as the scalp (dandruff), face, and chest. It presents with red, greasy, and scaly patches of skin.
Nummular Dermatitis Characterized by round or coin-shaped patches of irritated, itchy, and inflamed skin. It is often triggered by dry skin, environmental factors, or skin injuries.
🔸7.What is Quarantine?
ANSWER:-Quarantine is a public health measure used tor separate and restrict the movement of individuals who may have been exposed to a contagious disease but are not yet symptomatic. The purpose of quarantine is to prevent the potential spread of the disease during the incubation period, which is the time between exposure to the pathogen and the onset of symptoms. Quarantine typically involves staying at home or in a designated facility for a specified period, usually determined by health authorities based on the incubation period of the disease. It helps to monitor individuals for the development of symptoms and minimize the risk of transmission to others in the community. Quarantine may be voluntary or mandatory, depending on the severity of the public health threat and the legal framework in place.
🔸8.What is Cardio Pulmonary Resuscitation?
ANSWER:- Cardiopulmonary resuscitation (CPR) is an emergency lifesaving procedure performed to manually maintain circulation and breathing in individuals experiencing cardiac arrest or respiratory arrest. It involves a combination of chest compressions and rescue breathing to deliver oxygenated blood to the vital organs, particularly the brain and heart, until further medical intervention can be administered. CPR aims to restore spontaneous circulation and breathing in order to prevent brain damage and death. It is typically performed by trained individuals, including healthcare professionals, first responders, and bystanders, following standardized protocols and guidelines established by organizations such as the American Heart Association (AHA) and the International Liaison
🔸9.Any four role of a nurse in prevention of Acquired Immune Disease Syndrome (AIDS).
ANSWER:- Four roles of a nurse in the prevention of Acquired Immune Deficiency Syndrome (AIDS) include:
1.Education and Counseling Provide comprehensive education to individuals and communities about HIV transmission, prevention methods (such as condom use and pre-exposure prophylaxis), and the importance of regular testing and early diagnosis.
Offer counseling and support to individuals at risk of HIV infection, including those engaging in high-risk behaviors or living in areas with high HIV prevalence.
2.Promotion of Safe Practices Advocate for and promote the adoption of safe sexual practices, such as using condoms consistently and correctly during sexual intercourse.
Encourage harm reduction strategies, including needle exchange programs and substance abuse treatment, to reduce the risk of HIV transmission among people who inject drugs.
3.Antenatal and Perinatal Care Provide HIV testing and counseling to pregnant women as part of routine antenatal care, with the aim of identifying HIV-positive mothers and preventing mother-to-child transmission of the virus.
Offer guidance on antiretroviral therapy (ART) adherence and the importance of viral suppression during pregnancy and breastfeeding to reduce the risk of vertical transmission.
4.Community Outreach and Advocacy Engage in community outreach activities to raise awareness about HIV/AIDS, combat stigma and discrimination, and promote access to HIV testing, treatment, and support services.
Advocate for policies and programs that prioritize HIV prevention, including funding for prevention initiatives, access to HIV testing and treatment, and support for vulnerable populations such as sex workers, men who have sex with men, and transgender individuals.
🔸10.List down any four clinical manifestations of a Cirrhosis of Liver.
ANSWER:- Four clinical manifestations of cirrhosis of the liver include:
1.Jaundice Yellowing of the skin and sclerae (whites of the eyes) due to the buildup of bilirubin, a pigment produced by the liver. Jaundice can occur when the liver is unable to process bilirubin effectively, leading to its accumulation in the bloodstream.
2.Ascites Accumulation of fluid in the abdominal cavity, leading to abdominal swelling and discomfort. Ascites occurs as a result of increased pressure in the portal vein (portal hypertension), which leads to fluid leakage from blood vessels into the abdominal cavity.
3.Variceal Bleeding Development of varices (enlarged and swollen blood vessels) in the esophagus or stomach due to portal hypertension. Varices are prone to rupture and can cause life-threatening bleeding, manifested by symptoms such as hematemesis (vomiting of blood) or melena (black, tarry stools).
4.Hepatic Encephalopathy Neurological dysfunction caused by the buildup of toxic substances, such as ammonia, in the bloodstream due to impaired liver function. Hepatic encephalopathy can manifest as confusion, altered mental status, personality changes, and even coma in severe cases.