GNM-S.Y-MSN-II-PAPER SOLUTION-2018
⏩Q-1 🔸A Define Tonsilitis and Enlist types of Tonsilitis. 03
Tonsils are masses of lymphatic tissue located at the back of the throat, serving to protect the body from microorganisms and toxic substances.
When the tonsils become infected and inflamed, it is referred to as tonsillitis. This is a painful condition primarily because these tonsillar regions can harbor foreign substances or microorganisms’ toxins, which can lead to increased pain.
Symptoms of tonsillitis include swelling (swollen), redness, and tenderness in the affected area. The appearance of gray and white colors can also be observed in the tonsil region. Around the tonsils, lymph nodes may also swell due to infection.
Tonsillitis typically manifests in two forms:
The main cause of this condition is primarily bacteria and viruses.
The main reasons for developing tonsillitis are primarily associated with microorganisms such as group A beta-hemolytic streptococci.
🔸b. Enlist clinical manifestations of Tonsilitis 04
In this condition, the main symptoms include:
Additionally, individuals may experience general weakness, anorexia, malaise, nausea, abdominal pain, constipation, and other signs and symptoms indicative of tonsillitis.
🔸c. Write nursing management of Tonsilitis. 05
For the management of this condition, here are the recommendations:
🔸OR🔸
🔸a. Define Myocardial infarction. 03
This is a type of medical emergency known as myocardial infarction (heart attack). It occurs due to blockage in the coronary arteries that supply blood to the heart muscles. When the heart muscles do not receive adequate blood supply (myocardial ischemia), it can lead to permanent damage, referred to as myocardial necrosis. This condition is recognized as myocardial infarction, and it is a serious medical emergency due to the potential for mortality.
In this condition, arterial blockage occurs due to thrombus formation and atherosclerosis. Thrombus formation refers to the development of a blood clot (thrombus) within the artery, which can impede blood flow. Atherosclerosis involves the buildup of plaque (comprising fat, cholesterol, and other substances) inside the arterial walls, causing them to narrow and harden over time.
Because of these factors, the myocardium (heart muscle) does not receive sufficient oxygenated blood supply. This inadequate blood supply can lead to myocardial necrosis, where the muscle tissue of the heart dies due to lack of oxygen and nutrients.
This condition is recognized as a type of heart attack. It is considered a significant cause of mortality (death) due to the potential for severe cardiac complications resulting from compromised blood flow to the heart muscle.
🔸b. Enlist clinical manifestations of Myocardical infarction. 04
🔸c. Write nursing management of Myocardical infarction. 05
⏩Q.2 🔸a. Write nursing care plan on left above knee Amputation. 08
(Here care plan is given in continuity for simplicity. Write in format of care plan in exam)
Introduction:
When a body part or limb is surgically removed due to any injury or disease condition, it is called amputation. Here, the amputation of the leg above the knee is done. It is very important for the nurse to know about this for proper care and maintenance of the patient and can use it during the care of the patient.
Amputation is the surgical removal of a body part or limb due to injury or disease conditions where preservation is not feasible. It commonly refers to the removal of a limb from the knee down. For nurses, understanding and caring for patients who undergo amputation is crucial for their proper care and rehabilitation.
Key Considerations for Nursing Care:
Pre-operative Education:
Assessment and Monitoring:
Wound Care and Dressing:
Mobility and Rehabilitation:
Psychological Support:
Nutritional Support:
Prosthesis Education:
Complication Prevention:
By focusing on these aspects of care, nurses play a pivotal role in facilitating the recovery and adaptation process for patients undergoing amputation, ensuring holistic and effective care throughout their journey.
assessment.
In nursing assessment, it is necessary to review the anatomical structure of the patient, to see his range of motion, to check the sensation of that part and to check the integrity of his skin. Apart from this, it is necessary to assess the patient’s emotional and psychological status and knowledge about his condition.
Nursing assessment of a patient undergoing amputation involves a comprehensive review of anatomical structures, range of motion assessment, sensory examination of the affected area, and evaluation of skin integrity. Additionally, it is crucial to assess the patient’s emotional and psychological status and their understanding of their condition.
1. Review of Anatomical Structures:
2. Range of Motion Assessment:
3. Sensory Examination:
4. Skin Integrity Assessment:
5. Emotional and Psychological Status:
6. Knowledge Assessment:
By conducting a thorough assessment encompassing these areas, nurses can develop individualized care plans that address both the physical and emotional needs of patients undergoing amputation, fostering optimal recovery and adjustment to their new circumstances.
Nursing diagnosis.
Altered tissue perfusion, acute pain, impaired physical mobility, activity tolerance, self-care deficit, impaired skin integrity, risk for infection, anxiety, disturbed body image, etc. nursing diagnoses are prepared in above knee amputation patients.
In a patient with above knee amputation, the following nursing diagnoses may be formulated:
These nursing diagnoses will guide the nursing care plan to address the patient’s physical, psychological, and emotional needs following above knee amputation.
Planning and Implementation:
1. Inspect Surgical Site and Assess for Inflammation:
– Perform regular inspection of the surgical site to detect any signs of inflammation.
– Assess for fever as it may indicate infection.
2. Debridement for Dead and Infected Tissue:
– Conduct debridement as necessary to remove dead and infected tissue, facilitating proper healing.
3. Apply Proper Dressing on Wound:
– Apply appropriate wound dressing to promote wound healing.
4. Special Attention to Patient’s Skin and Circulation Improvement:
– Ensure special attention to the patient’s skin integrity and promote circulation improvement.
– Encourage movement to maintain self-care and accept altered body image.
5. Patient Education:
– Provide education on nutrition, infection prevention, healthy lifestyle, and prevention of complications such as constriction.
6. Emotional and Psychological Support:
– Offer emotional and psychological support to reduce anxiety and improve coping mechanisms.
Evaluation:
1.Wound Healing:
A nurse should assess the following aspects to ensure proper care and improvement for the patient:
2.Range of Motion:
3.Activity Level:
4.Vital Signs Monitoring:
5.Anxiety:
6.Emotional and Psychological Status:
7.Nutritional Status:
By evaluating and addressing these aspects effectively, the nurse can facilitate significant improvements in the patient’s overall condition and well-being.
🔸b. Write Plaster cast care – 04
Plaster Cast Application Guidelines:
Purpose of Plaster Cast:
Importance of Assessment:
Precautions and Considerations:
Monitoring and Care Instructions:
Additional Recommendations:
By following these guidelines, healthcare providers can ensure effective immobilization of injured body parts using plaster casts while minimizing risks of complications like skin infections or impaired circulation. Regular monitoring and proper patient education are crucial for successful plaster cast management.
⏩Q.3 Write Short Answers (Any Two) 2X6=12
🔸a. Define Disaster. Write role of Nurse in Disaster Management.
The word disaster is derived from the word disaster or disaster. Which means the people of old times equated it with destruction. These persons believed that disaster was observed due to unfavorable position of planet or earth or due to an unfavorable condition created by God.
According to WHO, a disaster is any extraordinary event in any area of society that causes damage, economic disturbances, loss of human life, health and health services.
It is a condition with high morbidity and mortality, and extensive damage to property, roads, electrical lines and all infrastructure.
A disaster is an unpredictable and sudden threatening condition.
At this time a person’s normal schedule gets disrupted, and this is a major change in a person’s normal life.
Role of Nurse in Disaster Management.
The role of nurse is very important in disaster management. In which it is especially necessary to take steps of multi-disciplinary management as a nurse.
Identifying the affected population during the time of disaster. It has to take care and active participation in disaster planning and management.
Nurses play a key role in maintaining a holistic care approach during disasters. In which he works for the integration of everyone.
A nurse provides care to each person from physiological, psychological and spiritual aspects and maintains collaboration between each team member.
As a nurse, to identify the type of event and the type of damage during a disaster. Then the main task is to identify the needs of the affected population.
After arranging the need in priority setting, setting objectives and goals, resources and activities to fulfill the need helps planning care through a collaborative approach.
During this time contact with government, non-government as well as many agencies also helps to be as helpful as possible.
Nurses themselves need to be physically and psychologically prepared to work in disaster management. He should have the necessary training and professional preparation to perform the task.
In this situation, the nurse tries to be helpful by maintaining communication between each team member.
Nurses also play a very important role in community disaster management plans and disaster prevention strategies.
Necessary strategy and training program should also be implemented for this. Community people can be made aware and informed about this through MockDrill.
A disaster evaluation plan is also prepared. According to which assessment can be done and precautions can be taken in planning and implementation.
Efforts are also made to re-normalize the disaster-affected population through rehabilitation programmes.
At every stage of disaster planning, it is also important to realize the basic needs of the affected persons and fulfill these needs.
🔸b. Write Rule of Nine and Fluid Resuscitation for Burns client.
Burns injury means that any hit source is transferred to the cells and tissues of the body and damages them, it is called a burn injury. These injuries are classified into different categories by conduction, radiation and different types of thermal and chemical substances that damage the cell tissue of the body.
How much tissue is damaged in the body due to burns. Its different classifications are given. In which the area of body burns is calculated by Rule of Nine.
The Rule of Nine is a very important method for quickly calculating the damage done by burns on the body, as well as for calculating the total body surface area of burns.
According to this method, the different surface areas of the body are divided into certain percentages and are calculated accordingly.
According to the rule of nine, each part of the body is calculated as 9 percent to calculate the surface area of total burns.
This part of the perineum is calculated to be 1%. Also this method cannot be applied completely as per rule of nine for infants and children.
This method is very important for total body surface area burn calculation in adults.
Management of the Burns Patient
After establishing airway and ensuring stability in a burn patient’s management, the next critical priority is to maintain circulation. Burn injuries can lead to significant fluid loss from the body due to increased capillary permeability, resulting in both intracellular and extracellular fluid shifts and edema formation. This phenomenon is known as edema, where fluid moves from the intravascular space into the interstitial space.
To manage this fluid imbalance immediately after burn injury, the process is termed fluid resuscitation. Severe burns can lead to hypovolemic shock, necessitating rapid administration of fluids. Initial fluid resuscitation involves administering colloids, plasma, electrolytes, Ringer’s solution, sodium chloride, Hartmann’s solution, and dextrose solutions in varying amounts based on calculated fluid requirements.
Fluid replacement calculations are based on the patient’s total body surface area (TBSA) affected by burns. The rate of fluid administration is divided into two phases: the first 24 hours. During the first phase, 50% of the calculated fluid volume is administered over the initial 8 hours, and the remaining 50% is given over the next 16 hours. After the initial 24 hours, fluid administration is adjusted based on ongoing assessments of the patient’s fluid and electrolyte status.
To ensure complete fluid replacement, a Foley catheter may be inserted to accurately monitor urine output and assess fluid balance based on urine output. This comprehensive approach helps maintain fluid and electrolyte balance in burn patients during the critical early stages of management, supporting optimal recovery and minimizing complications associated with fluid shifts and shock.
🔸c. Define Chemotherapy and write nursing management during chemotherapy.
Chemotherapy is a treatment that uses drugs to kill cancer cells or stop them from growing. It’s sometimes used with radiation therapy or before surgery to shrink the size of a tumor. Chemotherapy affects the entire body and can disturb the reproduction of abnormal cancer cells and their cellular functions.
This therapy is particularly crucial for malignant cancer cells, and combining chemotherapy agents with other agents often yields very effective results. During chemotherapy, nursing management of the patient is essential and requires careful attention to several issues:
Chemotherapy, though effective, requires careful handling and management to ensure it is administered safely and effectively.
⏩Q.4 Write Short notes (ANY THREE) 3X4=12
1. Definition: Glaucoma is a disorder of the eye characterized by increased intraocular pressure (above 25 mm Hg), optic nerve damage, and peripheral visual field loss. If untreated, it can lead to blindness.
2. Etiology: Glaucoma can be influenced by genetic factors, age, thin corneas, nearsightedness, prolonged use of steroids, anemia, previous eye surgery, myopia, hypertension, diabetes mellitus, headaches, and migraines.
3. Types of Glaucoma:
– Congenital Glaucoma: Present at birth or within a few years. Often associated with defects in the angle of the anterior chamber leading to aqueous humor outflow obstruction.
– Acquired Glaucoma: Develops later in life due to various reasons such as trauma, intraocular hemorrhage, surgery, diabetes, tumors, or prolonged use of steroids.
4. Clinical Features:
– Elevated intraocular pressure (24 mm Hg or higher).
– Peripheral vision loss.
– Difficulty in color perception.
– Visual field defects.
– Difficulty seeing in dim light or at night.
– Pain or discomfort.
– Redness of the eye.
– Nausea, headache, and vomiting in some cases.
– Dilatation of the pupil.
– Blurred vision.
5. Diagnosis: Includes eye examination, medical history review, tonometry to measure intraocular pressure, ophthalmoscopy to examine the optic nerve, gonioscopy to assess the angle of the anterior chamber, perimetry to assess visual fields, and slit-lamp examination for further evaluation.
6. Treatment: Typically involves medication (eye drops), laser therapy, or surgery depending on the severity and type of glaucoma.
Glaucoma requires regular monitoring and early intervention to prevent vision loss. If you have specific questions or need more detailed information on any aspect, feel free to ask!
Clinical features..
Secondary Glaucoma: This type of glaucoma develops in the eye due to various other conditions such as inflammation in the eye, trauma, intraocular hemorrhage, any past eye surgeries, diabetes, presence of a tumor, or use of steroid medications, among other conditions.
Diagnostic Evaluation for Glaucoma:
Management of Glaucoma:
Surgical Management:
Nursing Management:
1.Managing Intraocular Pressure (IOP) Increase-Related Pain:
2.Educate the Patient:
3.Address Patient’s Fear and Anxiety:
4.Prevent Injury:
5.Maintain Patient’s Comfort and Ensure IPR:
6.Provide Knowledge About the Disease Condition:
7.Post-Surgical Care:
8.Handling Eye Protection Post-Surgery:
🔸b. Anaemia –
1.Iron Deficiency Anemia:
Iron deficiency anemia is the most common type of anemia. The main cause of this anemia is a lack of iron in the body. It occurs when there is inadequate absorption of iron in the intestine during intrauterine life, and hence the child does not receive sufficient iron. Even during pregnancy, if there is maternal anemia, the child may not get enough iron. Twins pregnancy or multiple pregnancies also predispose the child to iron deficiency anemia. Furthermore, poor nutrition, lack of a balanced diet, and certain diseases such as diarrhea, malabsorption syndrome, and worm infestation can also lead to iron deficiency anemia in children.
2.Megaloblastic Anemia:
Megaloblastic anemia occurs due to deficiency of folic acid and vitamin B12. It results in impaired production of red blood cells (RBCs), which have enlarged size (macrocytic). The size of RBCs increases due to the abnormal maturation of erythroblasts. The reasons for developing this type of anemia are as follows:
3.Sickle Cell Anemia:
Sickle cell anemia is an autosomal recessive disorder caused by a genetic abnormality. It leads to abnormal synthesis of hemoglobin. RBCs are shaped like a sickle (C shape) due to this abnormality. These sickle-shaped RBCs get stuck in small capillaries, blocking blood circulation and reducing oxygen saturation in the blood. Children with sickle cell trait can also develop sickle cell anemia during conditions such as dehydration, infection crisis, or when exposed to certain chemicals or medications. This type of anemia may lead to the development of infarction.
4.Aplastic Anemia:
Aplastic anemia occurs due to depression of bone marrow. The bone marrow does not produce enough blood cells. It is identified by a very low count of all types of blood cells. It can be recognized as pancytopenia. If only the count of RBCs decreases due to this condition, it can be identified as hemolytic crisis or a severe crisis. This type of anemia may also be genetic and chromosomal abnormalities.
🔸c. Tetanus-
Tetanus is a condition caused by the Clostridium tetani bacteria, which spreads its toxic effects throughout the nervous system.
In tetanus, severe and uncontrolled muscle spasms are observed in the body.
These muscle spasms can be so severe that they can lock a person’s jaw shut, hence it is also known as lockjaw.
Due to muscle spasms affecting the respiratory muscles, breathing may become difficult, and in severe cases, it can lead to death.
All muscles in the body can experience uncontrolled spasms. This condition can be prevented by vaccination and immunization.
Causes for tetanus…
The causative organism for tetanus is found in the soil. It can reside in a dormant state in the soil and can enter the body through any wound or injury, affecting the body’s nervous system, leading to its signs and symptoms.
Mainly, this microorganism enters the body through a cut in the skin.
Clinical manifestations…
Diagnostic evaluation… Diagnosis can be made based on history, physical examination, and clinical manifestations.
Management…
Prevention and home care…
🔸d. Bone Healing Process-
The bone healing process is a series of events that aims to restore the normal structure of a bone following an injury. It involves the regeneration of bone tissue to repair and restore the affected area. The process generally proceeds through the following stages:
Stage 1: Inflammation
After the injury occurs, inflammation begins within a few hours and peaks around 24 hours. Within 7 days, the hematoma formed in the injured area is organized, and cells start forming in the affected part.
Stage 2: Soft Callus Formation
This stage lasts from 2 to 3 weeks. During this time, connective tissue grows into the fractured bone ends. This connection is not yet strong.
Stage 3: Hard Callus Formation
This stage lasts from 3 to 12 weeks. After the development of soft callus, over time, the area becomes hard and undergoes a transformation into hard callus. Clinically, union of the broken bone can be observed, but complete healing does not occur until cellular volume and matrix increase.
Stage 4: Remodeling
This process takes 2 to 3 weeks, but complete completion may take years. In this stage, the lamellar structure and medullary canal of hard callus are developed. Hard callus is resorbed by osteoclast cells and bone’s lamellar part is developed by osteoblast cells. Remodeling is easily seen in young people.
For bone healing, age, nutritional status, presence of any disease, hormonal activity, presence of a bad habit or not, etc. Keeping all these things in mind.
⏩Q.5 Write Definition (ANY SIX) 6X2=12
🔸a. Osteoporosis –
This is a type of bone disease characterized by porous and brittle bones that can fracture easily.
It can occur due to hormonal imbalance in the body, as well as deficiencies in vitamin D and calcium.
In this disease, there is a decrease in bone density, leading to fragile bones and an increased risk of fractures.
There is an increase in the activity of osteoclast cells and a decrease in the activity of osteoblast cells in the bone, resulting in bone resorption being greater than bone formation.
🔸b. Acne vulgaris –
This is a skin condition characterized by the obstruction of hair follicles and sebaceous glands in the skin.
It manifests as papules, pustules, nodules, and cysts on the skin. This condition can be inflammatory or non-inflammatory.
Primarily, it is found on the face, chest, and back.
🔸c. Blepharitis –
This is a type of inflammation that affects the eyelid margin and eyelashes.
It occurs due to inflammation in the glands located on the margin of the eyelid. It can also occur due to allergies or skin infections.
This condition can affect one or both eyes. Symptoms may include eyelid swelling, redness, and watery discharge.
🔸d. Cellulitis –
This is a type of bacterial infection that affects the deeper layers of the skin.
Cellulitis occurs when bacteria enter the skin through a break or crack, spreading toxins that cause inflammation.
In cellulitis, inflammation appears as redness, swelling, warmth, and pain at the affected site. It can spread to involve subcutaneous tissues as well.
🔸e. Meniere’s Disease –
Meniere’s disease is an internal ear disorder characterized by dilation of the endolymphatic sac in the inner ear, leading to difficulties in drainage of endolymph fluid. Due to dysfunction of the vestibular function in the inner ear, normal balance of the body is affected, resulting in symptoms such as dizziness and tinnitus. As the condition progresses, hearing loss may also gradually occur. This discomfort is more commonly observed on one side of the ear.
It is also referred to as endolymphatic hydrops.
The name Meniere’s disease is derived from a French physician’s name.
🔸f. Phantom limb pain –
Phantom limb pain is a type of pain or discomfort experienced, particularly after extremity amputation. It occurs when an extremity has been removed, yet the individual perceives sensations of pain in that area.
This type of pain can persist for days to weeks after amputation. The mechanism of this pain is not clearly understood, whether it is solely perceived by the individual’s sensation or actually experienced through brain and spinal cord sensation according to some theory.
🔸g. Hospice care –
Hospice care is implemented when a person is in the terminal stage of illness or nearing the end of life, and disease treatment is no longer an option. It focuses on reducing the person’s pain and suffering, as well as supporting their journey.
The primary focus of hospice care is on the individual’s comfort level and their quality of life. It does not aim to cure the disease but rather manages symptoms to enhance quality of life.
Hospice care also addresses the person’s emotional and spiritual needs. It is a concept that remains relevant in cases of cancer and other chronic illnesses.
🔸h. Cataract –
Cataract is a common eye disorder that typically occurs with age. It affects the lens of the eye, which is normally transparent and essential for clear vision.
When the lens becomes opaque and prevents light rays from reaching the retina, blurred vision is experienced.
The lens acquires a cloudy appearance due to the aggregation of proteins over time, impairing its transparency. This milky-white appearance in the lens, visible from the outside of the eye, indicates cataract.
Surgery can remove the affected lens and replace it with another to restore proper vision.
⏩Q-6 A. Fill in the blanks : 05
Normal WBC count___—— (4000 થી 10000)
Intraocular pressure measured by____instrument Tonometer
Rheumatic heart disease is a complication of____ Rheumatic fever
______organism causes filariasis _______ Wuchereria bancrofti
Peritonsilar Abscess is called____ quinzy
⏩B. State whether following statement are True or False 05
Alopecia is a side effect of chemotherapy. correct
Herpes zoster is caused by Herpes Simplex. wrong
3 Keratoplasty is modern treatment of Catract. wrong
Thalassemia is a hereditary disease. correct
Zoonosis is a disease spread by fomites. wrong
C. Match the following 05
1.vertigo i. A small fluid filled sac
2.Cynosis ii. Near Sightedness
3.Vessicles iii. Ringing sound in ear –
4.Myopia iv. Abnormal sensation of movement
5.Tinnitus v. Bluish discoloration of skin –
vi. Ulcer
Answer
1 – iv
2 – v
3 – i
4 – ii
5 – iii
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