S.Y.GNM-GNC-MSN-II-2022 (PAPER SOLUTION)

Sure, here’s the translation of the information provided:

Q-1 🔸a) Define Radiation Therapy

Radiation therapy is a medical treatment that uses ionizing radiation to destroy abnormal genetic material within cancerous cells and to inhibit their growth. It is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors.

🔸b) Write the types of Radiation Therapy

1. External Beam Radiation Therapy (Teletherapy): In this therapy, machines are used to deliver radiation, such as X-rays and gamma rays, to the cancerous cells.
2. Internal Radiation Therapy (Brachytherapy): This therapy involves placing radioactive isotopes directly into or near the tumor, destroying abnormal cells.

▲ 1) External Beam Radiation Therapy (Teletherapy):

External beam radiation therapy (EBRT), also known as teletherapy, involves using machines to deliver X-rays and gamma rays to apply radiation to cancerous cells. The main advantage of this therapy is that it targets maximum cell depth without affecting the surface area only, making it highly effective.

EBRT is used for the treatment of various types of cancer, including skin lymphoma, breast cancer, colorectal cancer, esophageal cancer, as well as tumors in the head, neck, lungs, brain, and prostate.

(Source: Adapted from a medical source, translated from Gujarati to English)

▲ 2) Internal Radiation Therapy (Brachytherapy):

Internal radiation therapy, also known as brachytherapy, involves directly applying radioactive isotopes within or near the tumor, where they destroy abnormal cells. Brachytherapy is a type of internal radiation therapy used for the treatment of cancers such as those affecting the head and neck, breast, cervix, prostate, and eye. It typically utilizes seeds, ribbons, or capsules.

There are two main types of brachytherapy:

► A) Shielded: In this type, radiation implants are delivered using needle tubes and applicators.

► B) Unshielded: In this type, radiation implantation is done via tablets or injections.

Brachytherapy is a specialized form of radiation therapy tailored to deliver high doses of radiation directly to the cancerous tissue while minimizing exposure to surrounding healthy tissues.

(Source: Adapted from a medical source, translated from Gujarati to English)

🔸c) Write down side effects & nursing management of Radiation Therapy

Side Effects:

• Vomiting
• Nausea
• Diarrhea
• Dysphagia (difficulty in swallowing)
• Fatigue
• Weakness
• Xerostomia (dry mouth)
• Stomatitis (inflammation of the mouth’s mucous membrane)
• Loss of appetite
• Increased risk of infection
• Alopecia (hair loss)
• Body ache
• Leukopenia (low white blood cell count)
• Impaired skin integrity
• Anemia

Nursing Management of Radiation Therapy:

• Educate the patient about covering the radiation area.
• Explain the procedure to the patient.
• Inform the patient about the tools used and the time required for the procedure.
• Instruct the patient and their relatives to stay away during radiation therapy.
• Advise to keep small children and pregnant women away from the radiation area.
• Provide education to the patient to eat a little food and to offer anti-diarrheal medicine.
• Insert a urinary catheter into the patient so that the critical proper reethi tov ( in place

• To inform the patient about the procedure:
• The procedure involves placing a covering over the area of the skin.
• Explain to the patient about the devices that will be used in this procedure and how long the procedure will take.
• Tell the patient and their immediate relatives to stay away from the area when they receive radiation therapy.
• Tell the patient to keep young children and pregnant mothers away from the area where radiation is given.
• Provide education to the patient to take a small amount of food and anti-diarrheal medicine.
• Insert the patient’s urine catheter so that the bladder can be emptied properly.
• Give the patient information that no type of oil or emollient should be used.
• Tell the patient not to go in the sun.
• Keep the mouth in proper hygienic condition.
• Tell the patient and their relatives to talk on the phone.
• If the patient has cancer, do not brush vigorously and keep the mouth in good condition.
• Maintain the hydration status of the patient.
• Maintain the nutritional status of the patient.
• Tell the patient to keep the cancerous area covered.
• Answer all questions correctly to the patient and their relatives.
• Tell the patient that no part of the body should be injured.
• Tell the patient that when they take radiation therapy, the hair on their head is a common thing to come back and the patient does not need any kind of treatment.
• Provide psychological support to the patient.
• Tell the patient to do a little activity in a little routine.
• Provide radiation therapy and mind to the patient.
• Have full conversation with the patient.

• Thus performing this type of nursing management while giving radiation therapy.

🔸OR🔸

🔸a) Define Congestive Cardiac Failure. 03

In congestive cardiac failure, the heart is unable to pump blood effectively due to the accumulation of fluid around the heart. This impairs the heart’s ability to function properly and deliver blood adequately throughout the body. As a result, all parts of the body may not receive sufficient blood supply, leading to inadequate oxygen and nutrition delivery to cells, tissues, and organs.

This condition causes the heart’s function to become altered.

🔸b) Write causes and clinical manifestations of Congestive Cardiac failure. 04

Congestive cardiac failure primarily occurs due to abnormalities in the heart muscles that prevent the heart from functioning properly. These abnormalities can result from various conditions such as:

1. Myocardial infarction (heart attack)
2. Hypertension (high blood pressure)
3. Valvular heart disease
4. Cardiomyopathies (diseases of the heart muscle)
5. Dysrhythmias (abnormal heart rhythms)

Other contributing factors include:

• Chronic lung disease
• Hemorrhage
• Anemia
• Anesthesia
• Surgery
• Physical or emotional stress
• Excessive sodium intake

Risk factors that predispose individuals to congestive cardiac failure include:

• Hypertension
• Hyperlipidemia (high levels of lipids in the blood)
• Diabetes
• Coronary artery disease
• Family history of heart disease
• Smoking
• Alcohol consumption
• Use of cardiotoxic drugs

Clinical manifestations (symptoms) of congestive cardiac failure include:

• Shortness of breath
• Orthopnea (difficulty breathing when lying flat)
• Cough
• Fatigue
• Nocturia (frequent urination at night)
• Insomnia
• Restlessness
• Elevated blood pressure
• Edema (swelling)
• Weight gain
• Upper abdominal pain
• Distended jugular veins
• Abnormal fluid accumulation in the body
• Loss of appetite (anorexia)
• Nausea
• Weakness
• Cardiomegaly (enlarged heart)
• Alterations in pulse

These symptoms and conditions collectively lead to the heart’s inability to pump blood efficiently, resulting in the accumulation of fluid in the body tissues and organs.

🔸c) Write down nursing management of patient with Congestive Cardiac 05

For the management of congestive heart failure (CHF), the following nursing interventions are crucial:

1. Obtain complete patient information: Gather comprehensive medical history, including past medical conditions, surgeries, and current medications.
2. Facilitate all necessary laboratory tests: Ensure that all prescribed laboratory investigations are conducted to monitor cardiac function and assess electrolyte levels, renal function, and overall health.
3. Monitor patient’s sleep pattern: Document and assess the patient’s sleep habits and quality to identify any disruptions or conditions affecting sleep.
4. Provide complete bed rest: Ensure the patient receives adequate bed rest as prescribed to minimize cardiac workload and promote recovery.
5. Monitor vital signs: Regularly check and record vital signs such as temperature, pulse rate, respiratory rate, and blood pressure to detect any abnormalities or changes.
6. Assess heart sounds: Perform auscultation of heart sounds to detect any murmurs, irregular rhythms, or signs of heart failure exacerbation.
7. Inspect nails, skin, face, tongue: Examine nails for clubbing or cyanosis, skin for edema or changes in color, face for signs of distress or pallor, and tongue for coating or lesions.
8. Administer prescribed medications: Ensure timely administration of medications as per the doctor’s orders, including diuretics, beta-blockers, ACE inhibitors, or other cardiac drugs.
9. Maintain Fowler’s position: Keep the patient in a semi-upright position to facilitate breathing and reduce pressure on the diaphragm.
10. Listen to lung sounds: Auscultate lung sounds to detect any crackles, wheezes, or diminished breath sounds indicating respiratory distress or fluid accumulation.
11. Monitor respiratory rate and effort: Assess respiratory rate and effort regularly to identify any signs of respiratory distress or abnormal breathing patterns.
12. Change position every two hours: Help the patient change positions every two hours to prevent bedsores and improve circulation.
13. Encourage deep breathing exercises: Instruct the patient to perform deep breathing exercises regularly, emphasizing slow, controlled inhalation and exhalation.
14. Provide small, frequent meals: Offer small meals at regular intervals to minimize the workload on the heart and facilitate digestion.
15. Administer oxygen if necessary: Monitor oxygen saturation levels and administer supplemental oxygen as prescribed to maintain adequate oxygenation.
16. Administer diuretic medication: Ensure that the patient receives diuretics as prescribed to manage fluid overload and reduce edema.
17. Monitor intake and output: Measure and record the patient’s fluid intake and output to assess renal function and fluid balance.
18. Check weight daily: Weigh the patient daily at the same time using the same scale to monitor fluid retention or loss.
19. Provide potassium supplements if indicated: Administer potassium supplements as prescribed to maintain electrolyte balance and prevent hypokalemia.
20. Monitor for any signs of infection: Regularly assess for signs of infection and promptly report any abnormalities to the healthcare provider.
21. Monitor for signs of confusion: Evaluate the patient’s mental status regularly for signs of confusion or changes in cognitive function.
22. Encourage gradual increase in activity: Promote gradual increase in activity levels as tolerated by the patient to enhance physical conditioning and mobility.
23. Educate patient and family: Provide education on CHF, including symptoms, medications, diet, activity restrictions, and when to seek medical help.
24. Psychological support: Offer psychological support and counseling to the patient and their family to cope with the challenges of managing CHF.
25. Plan discharge and follow-up care: Collaborate with the healthcare team to plan discharge and ensure appropriate follow-up care, including medication management and outpatient appointments.

Implementing these nursing interventions effectively helps in managing congestive heart failure comprehensively and improves patient outcomes.

Q-2🔸 a) Write down types of fracture. Explain the nursing management of patient with fructure. 08

Here is the translation of the provided medical content from Gujarati to English:

Types of Fractures:

1) Complete: In this, the bone breaks completely into two parts.

2) Incomplete: The bone is not completely divided into two parts; it is broken into some parts.

3) Communicated fracture: In this, the bone is broken into small parts and remains in the same place.

4) Open fracture: In this, the bone is broken down and involved in the skin. The bone breaks the skin and damages the mucous membrane. Open fracture has three grades.

• Grade 1: In which the wound is clean, and the fracture is less than one centimeter.
• Grade 2: In which the wound is large, and there is not much damage to the soft tissue.
• Grade 3: In which the wound is very contaminated, and there is damage to soft tissue.

5) Closed fracture: In this, the bone is broken, but the skin remains intact. The bone breaks down inside the skin.

According to anatomical placement or fragments:

1) Avulsion fracture: In this, the bone is broken around tendons and ligaments. The bone’s small part is broken because of the tendons and ligaments.

2) Compression fracture: In which the bone is compressed and broken down.

3) Compound fracture: In the fracture, the skin and mucous membrane are involved with the bone.

4) Depressed fracture: It is found mostly in skull bones, in which the bone is pulled inside.

5) Epiphyseal fracture: In this, the bone breaks down at the end of the bone.

6) Greenstick fracture: In this, the bone is broken from one side, and the other side of the bone bends.

7) Oblique fracture: In this, the bone breaks down diagonally.

8) Transverse fracture: In this, the bone breaks down transversely.

9) Impacted fracture: In this, the bone fragment enters into another bone.

10) Pathological: In this, the bone is diseased, and the break occurs due to bone tumors.

11) Simple fracture: In this, the bone is broken, and it is in the same area. The skin is not broken down.

12) Spiral: In this, the bone is broken from the middle part of the bone. It is called a spiral fracture.

13) Stress: In this, stress often occurs on the bone, and bone and muscle recovery does not occur. If the bone is broken, it is called a stress fracture.

14) Impacted: When one bone is more on another bone, it is called an impacted fracture.

Nursing Management of Fracture:

The main principle of fracture management is to mobilize the individual’s normal function.

• Apply bandages and casts to immobilize the patient.
• Elevate the affected leg so that the blood returns to the normal condition or is not affected.
• Ice application for the patient.
• Provide psychological support to the patient.
• Change the patient’s position periodically.
• Give antibiotics like injections such as cefalexin.
• Provide comfortable position to the patient.
• Ask the patient to walk less.
• When we are patient, use aseptic technique.
• Check the patient’s mental status.
• Check the patient’s white sign.
• Give proper medicine to the patient.
• Check the patient’s output. calcium and protein with food.
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► Nursing management of fracture patient :-

• “The main principle of fracture management is to mobilize the individual’s normal function.
• Apply patient’s immobilization bandage and cast.
• Elevate the affected leg to reduce swelling and return to normal position or may be immobilized.
• Instruct the patient to use ice application.
• Provide psychological support to the patient.
• Change the patient’s position periodically.
• Administer antibiotic medicines like Titenacil.
• Provide a comfortable position to the patient.
• When reducing the affected leg or body part to minimize pain.
• Use aseptic technique when attending to the patient.
• Assess the patient’s mental status.
• Check the patient’s vitals signs.
• Administer medications properly.
• Check the patient’s output.
• Provide meals containing protein and calcium.
• Give the patient reassurance.
• See if there is any kind of infection.
• Encourage the patient’s daily routine activity.
• Dress the fracture site properly.”

🔸b) Explain about breast self-examination. 04

“Breast self-examination is done to detect any kind of abnormality in the breast such as normal lumps and masses.

Purposes:
1) To detect any abnormality in the breast.
2) To consider the possibility of breast cancer.
3) To detect any kind of abnormality in the breast.

Frequency:
1) Breast self-examination is generally done once a year in women.
2) If there is breast cancer, it should be done twice a year.
3) During menopause, it should be done once a month.
4) During reproductive age, it should be done once a month.

Steps for Breast Self-Examination (Total 5 Steps):

Step 1:
Stand upright in front of a mirror. Then examine the breast to see if there is any kind of abnormality such as redness, discharge, normal size inverted nipple, or swelling, dimpling, or bulging.

Step 2:
Raise your arms and place them behind your head. Then bend forward and look in the mirror to see if the breast size is symmetrical.

Step 3:
Place your hands on your hips and lean forward. Look to see if there is any lump in the breast.

Step 4:
Lie down on a bed. Then raise your left hand high. Then, palpate the right side of the breast with the three fingers of the left hand. In the first circular motion, palpate. Then, palpate from the outside to the inside. Then, check the nipple. If there is any discharge, see why. Now, in the same way, palpate the right breast side. This step by step.

Step 5:
Afterwards, squeeze the nipple to see if there is any discharge. If there is any discharge, understand why. Through breast self-examination, any kind of abnormality in the breast is considered by this step, and if there is a possibility of breast cancer, it is first considered.

🔸OR🔸

🔸a) Explain about Shock. 08.

Shock is a condition where systemic blood pressure is significantly decreased, leading to inadequate delivery of blood, oxygen, and nutrients to vital organs. As a result, organs cannot function at their optimal capacity and require increased levels of support to work properly. This condition arises when the body enters a state of shock.

☆ Classification:

1) Decreased blood supply:
a) Cardiogenic shock: This condition occurs when the heart is unable to pump enough blood to meet the body’s needs, possibly due to myocardial infarction, angina pectoris, coronary artery disease, structural disease from trauma, or cardiac arrest.

b) Hypovolemic shock: This type of shock occurs when there is a significant loss of blood or fluids from the body, such as from burns, hemorrhage, diarrhea, vomiting, or peritonitis.

2) Abnormal blood supply:
A) Septic shock: This shock results from a systemic infection where bacteria enter the bloodstream, leading to infection in various parts of the body.

B) Allergic shock: Also known as anaphylactic shock, this is triggered by an allergic reaction causing widespread inflammation and a drop in blood pressure.

C) Neurogenic shock: This occurs due to damage to the nervous system, leading to vasodilation and a subsequent decrease in blood pressure.

Etiology:
Various causes include heart malfunction, myocardial infarction, angina pectoris, coronary artery disease, structural disease from trauma, cardiac arrest, abnormality of lungs, lung dysfunction, pulmonary embolism, atelectasis, pneumonia, thoracic injuries, and reduction in blood volume due to burns, hemorrhage, diarrhea, vomiting, or peritonitis.

Clinical Manifestations:
Symptoms include reduced blood supply, anxiety, cyanosis, rapid pulse, nausea, vomiting, cold, pale, and clammy skin, rapid or weak respiration, rapid and weak pulse, pale face, low blood pressure, decreased urine output, and metabolic acidosis.

Medical Management:

• Provide oxygen to the patient.
• Establish IV lines for fluid administration.
• Administer emergency drugs.
• Provide blood supply if significant blood loss has occurred to correct hypotension and anemia.
• Administer platelets and coagulant factors if necessary.
• Insert urinary catheter to monitor urine output.
• Elevate patient’s legs to improve venous return if indicated.

Nursing Management:

• Monitor vital signs.
• Position the patient comfortably.
• Ensure a comfortable environment.
• Maintain oral hygiene.
• Check intake and output.
• Monitor ECG.
• Administer proper antibiotics and cooling environment if the patient is in septic shock.
• Maintain hydration status of the patient.
• Maintain nutritional status of the patient.

🔸b) Write the types of Disaster 04

D: Destruction
I: Incidents
S: Suffering
A: Administrative, financial failure
S: Sentiments
T: Tragedies
E: Eruption of communicable disease
R: Research program and its implementation

Introduction: A disaster refers to events where extensive damage occurs, leading to economic instability, reduced human life, significant impact on health, and substantial harm to natural resources, causing widespread devastation. Therefore, a disaster is an emergency.

Types:
1) NATURAL:

• Events involving natural calamities such as:
  • Floods
  • Cyclones
  • Droughts
  • Earthquakes
  • Cold waves
  • Thunderstorms
  • Heat waves
  • Mudslides
  • Storms

2) MANMADE:

• Disasters caused by human actions or negligence, categorized into technological and sociological factors:
  • Technological disasters: Engineering failures, transport accidents, environmental disasters
  • Sociological disasters: Criminal activities like war, terrorism, accidents on the road, and social issues like pollution and so on

In this way, disasters are classified into two types based on their origin: natural and manmade.

2) MANMADE:

Manmade disasters are caused by human actions or negligence, resulting in adverse consequences. These disasters can be divided into technological and sociological categories:

Technological disasters:

• Engineering failures
• Transport disasters
• Environmental disasters

Sociological disasters:

• Criminal activities such as wars, terrorism
• Riots
• Civil disturbances

Examples of manmade disasters include:
1) Setting of fire (Arson)
2) Epidemics (Pandemics)
3) Deforestation
4) Pollution due to industrial activities (Industrial pollution)
5) Chemical pollution
6) Wars
7) Road/train accidents
8) Food poisoning
9) Industrial disasters
10) Environmental pollution

These disasters are predominantly caused by human activities and are classified into two main types: technological and sociological disasters.

Q-3 Write short answers (Any Two) 2×6 = 12

🔸a) Explain about Triage.

A) Triage:

Triage is a system used during disasters to manage patient care in hospitals or emergency settings by prioritizing them based on the severity of their condition and their likelihood of survival.

TRIAGE=SHORT/MINIMISE.
(USED DURING DISASTER)
S=SHORT
T=TRIAGE
A=AND
R=RAPID
T=TRANSPORT

In triage, patients are categorized into three color codes, and then after prioritizing, they are given to hospital for. system. explained

Sure, here is the explanation of the color codes used in triage:

1. Emergency 😡 (Red color):

• Patients assigned to this category require immediate treatment and are in critical condition.
• Examples include severe respiratory depression, brain hemorrhage.
• These patients need to be transported to a higher-level hospital for intensive care.

1. Urgent 🙁 (Yellow color):

• Patients in this category do not require immediate treatment like those in the red category.
• They can wait up to 1-2 hours for treatment.
• Examples include mild to moderate respiratory distress, broken bones.
• These patients should receive treatment within 1 to 2 hours.

1. Delay 🤢 (Green color):

• Patients in this category have minor injuries or illnesses.
• They can wait for treatment up to 3-4 hours.
• Examples include minor cuts, bruises, or mild illnesses.
• These patients are stable and can wait for medical attention for several hours.

1. Death ⚰️ (Black color):

• Patients in this category have severe injuries or medical conditions that are not compatible with life.
• They are either deceased or are expected to die imminently.
• No immediate medical intervention is provided for patients in this category.

These color codes help healthcare providers prioritize patients during disasters or mass casualty incidents, ensuring that those with the most urgent medical needs receive care first, thereby maximizing the efficient use of limited medical resources.

Certainly! Here’s the explanation of the system used in triage:

System:

1.Identification of Victim:

• This involves identifying the victim by obtaining their name, surname, and understanding their medical needs.
• This information is crucial for providing appropriate medical care.

2.Relief Work:

• In this phase, the immediate medical needs of the victim are addressed.
• This includes performing necessary medical interventions such as ECG (Electrocardiogram), RBS (Random Blood Sugar), CPR (Cardiopulmonary Resuscitation), etc.
• The goal is to stabilize the victim’s condition and prevent further deterioration.

3.Rehabilitation/Recovery:

• Once initial medical treatment is provided, the focus shifts to rehabilitation and recovery.
• The patient undergoes further treatment to rehabilitate and restore their health to its pre-emergency condition.
• This phase aims at ensuring the patient’s overall well-being and recovery from the initial trauma or medical crisis.

In conclusion, the triage system ensures that individuals requiring medical attention receive it promptly based on the severity of their condition. It involves systematic identification, immediate relief efforts, and subsequent rehabilitation to optimize outcomes for patients during emergencies.

🔸b) Write about sex hygiene & menstrual hygiene for girls.

Sex Hygiene:

1. Comprehensive education is provided in sex hygiene to women and men about the reproductive system.
2. Health education for sex hygiene teaches women or girls how to bathe properly.
3. Girls should be mindful of how to wash genital organs correctly.
4. Girls should be educated on how to maintain vaginal cleanliness and that maintaining cleanliness can prevent bacteria from entering the body.
5. When a girl reaches puberty, education is provided for changes such as:
   A) Growth of breasts.
   B) Visible hair at the genital organ.
   C) Onset of the menstrual cycle.
6. It is essential for girls to be aware of reproductive organs.
7. Married women should avoid sexual activity because there is a chance of unintended pregnancy and the possibility of reproductive organ infection.
8. There is a chance of infection such as AIDS, syphilis, gonorrhea, etc.
9. Women should be aware that after marriage any kind of menstrual disorder or discharge from the reproductive system should be immediately checked.
10. Girls should be educated that genital organs should be washed with water after urination.
11. Women should be educated to change undergarments daily.
12. Women should be educated that most genital tract infections are due to improper hygiene and maintaining proper cleanliness is very important.
13. Women should avoid sexual activity during periods.
14. Avoid multiple sex partners.
15. Avoid extra-marital relationships because they can increase the risk of genital organ diseases.
16. Every woman should get a pap smear test done after the age of 50 to detect cancer at an early stage.
17. Women should be educated about contraceptive methods and adopt permanent methods of family planning when they have two children.
18. Sexual activity before and after washing the genital organs should be avoided.
19. Whenever there is more discharge from the vaginal, consult a gynecologist.
20. If the husband has any type of urinary tract infection, then he should consult a specialist and take appropriate care and treatment for infection, then only sexual activity should be engaged.
21. After delivery or abortion, vaginal cleanliness should be maintained.

These points emphasize the importance of education in sex hygiene and menstrual hygiene to promote women’s health and well-being.

Menstrual hygiene:

1) It is essential for girls between the ages of 12 to 16 years, when they start menstruating every month, to maintain proper hygiene. This includes changing sanitary pads every 4 to 6 hours.

2) Girls attending school should have complete information about menstrual cycles.

3) Use sanitary pads when periods start.

4) Change sanitary pads every 4 to 6 hours.

5) Shower twice a day during periods.

6) Take adequate rest during periods.

7) Drink more water during periods.

8) Eat iron and vitamin C-rich foods.

9) Wash hands properly before and after using sanitary pads.

10) Change sanitary pads frequently.

11) Wrap used pads in paper or plastic before disposing of them in the dustbin.

12) Wash hands properly after using pads.

13) Maintain proper cleanliness during periods.

14) Shower at least once or twice daily and wear clean clothes regularly.

15) Wash private parts properly with water after using the toilet.

16) Always use cotton underwear.

17) Avoid synthetic underwear.

18) After using sanitary pads, wrap them properly and dispose of them in a dustbin.

19) If not using sanitary pads and using cloth instead, change it frequently.

20) Clean cloth with soap and water.

21) Dry it properly in sunlight.

22) Use the same cloth afterward.

23) When it dries, wash it with clean water properly.

It is essential to maintain proper hygiene during periods in this way.

🔸c) Explain about retinal detachment.

1) Definition:
Retinal detachment is a disorder in which the pigmented cell layer of the retina detaches from the sensory cell layer. If not properly treated, it can lead to complete retinal detachment, resulting in vision loss and blindness.

2) Types:
a) Rhegmatogenous: This type occurs when there is a hole in the retina through which vitreous humor fluid can pass, causing detachment of the retina. It is often caused by a tear in the retina.
b) Tractional: In this type, the retina detaches due to the pulling force exerted on the retina and choroid by fibrous tissue or scar tissue. This pulling can occur due to conditions like tumors or injury.
c) Exudative: This type occurs when fluid accumulates under the retina due to infection or inflammation, leading to detachment of the retina from the underlying retinal pigment epithelium (RPE).
d) Both rhegmatogenous and tractional: This refers to cases where detachment occurs due to both a tear in the retina (rhegmatogenous) and tractional forces pulling on the retina (tractional).

3) Etiology:

• Trauma
• Aging
• Cataract extraction
• Degeneration of the retina
• Injury
• Severe myopia
• Family history
• Systemic disorders

4) Clinical Manifestations:

• Flashes of light (photopsia)
• Curtain sensation
• No pain, loss of vision
• Sensation of foreign material in the eye
• Blurred vision

5) Diagnostic Evaluation:

• Electroretinogram (ERG)
• Fluorescein angiography
• Intraocular pressure determination
• Ophthalmoscopy
• Retinal photography
• Visual acuity
• Slit lamp examination
• Ultrasound of the eye

6) Surgical Management:
1) Photocoagulation: Uses argon laser to seal holes in the retina, preventing fluid discharge and allowing the detached retina to reattach.
2) Cryotherapy: Freezing is used to create a scar, which helps the detached retina to reattach.
3) Electrodiathermy: Electrical needle is used to disperse fluid and draw the detached retina back into place from its subretinal space.
4) Vitrectomy: Removal of vitreous humor to access the subretinal space and remove any tractional forces pulling on the retina, allowing it to reattach.

7) Patient Position:

• Supine position if detachment is central.
• Semi-prone position if detachment is on the side, with the patient’s head facing downward.

8) Nursing Management:

• Communication and providing a comfortable environment for the patient.
• Educating the patient about the surgery.
• Advising the patient not to lie on their back frequently due to increased risk of infection.
• Instructing the patient to wear an eye shield.
• Advising the patient to avoid activities that increase intraocular pressure.
• Advising the patient to avoid rubbing the eye.
• Instructing the patient to maintain proper hygiene of the eye.
• Advising the patient to wear glasses.
• Advising the patient to avoid exposure to dust or sunlight.
• Avoiding heavy lifting or strenuous work.

9) Post-Operation Nursing Management:

1. Providing a comfortable environment for the patient.
2. Encouraging daily routine activities as appropriate.
3. Administering eye drops as prescribed.
4. Applying warm and cold compresses as indicated.
5. Using safety measures such as side rails to prevent falls.
6. Advising against head jerking to avoid strain.
7. Educating on how to perform eyelid hygiene to prevent complications.
8. Limiting activities to prevent strain, especially in the first few weeks post-surgery.
9. Avoiding rubbing or touching the eye or forehead excessively.
10. Monitoring for any drainage or signs of infection.
11. Ensuring proper follow-up care and compliance with medications.
12. Instructing on the proper care of eyeglasses, if needed.
13. Advising on avoiding bright lights or excessive sunlight.
14. Avoiding strenuous activities until cleared by the healthcare provider.
15. Instructing the patient to take medications as prescribed.
16. Ensuring regular follow-up appointments for assessment and further management.

Q-4 Write short notes (Any Three) 3×4 = 12

🔸a) Deep Vein Thrombosis –

Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, typically in the legs. The formation of this clot can occur due to various factors such as prolonged immobility, surgery, injury, or certain medical conditions that affect blood clotting. When the clot forms in the deep veins of the legs, it can obstruct blood flow and cause swelling, pain, and potentially serious complications if the clot dislodges and travels to the lungs (pulmonary embolism).

Therefore, while blood clots can form anywhere in the body, when they specifically occur in the deep veins of the legs, it is termed as deep vein thrombosis (DVT). Early detection and appropriate management are essential to prevent complications and ensure optimal outcomes for patients at risk of or diagnosed with DVT.

1. Older age
2. Major surgery
3. Cancer, especially in bones, brain, and pancreas
4. Limited movement
5. Pregnancy and postpartum period
6. Antiphospholipid syndrome (where the body’s immune system mistakenly attacks its own proteins, promoting blood clot formation)
7. Nephrotic syndrome (due to kidney’s glomerular permeability changes leading to conditions like hypoalbuminemia, hyperlipidemia, and hypercoagulability)
8. Obesity
9. Infection
10. HIV
11. Polycythemia vera (a type of blood cancer characterized by overproduction of red blood cells, leading to increased risk of blood clot formation)
12. Chemotherapy
13. IV drug use

These factors contribute to the development of deep vein thrombosis (DVT) by various mechanisms affecting blood flow and clotting processes in the body.

=inherited:-

1. Antithrombin deficiency
2. Protein C deficiency
3. Protein S deficiency
4. Factor V Leiden mutation (a genetic mutation that increases the risk of blood clotting)
5. Dysfibrinogenemia (abnormal fibrinogen, a protein involved in blood clotting)
6. Non-O blood type

Clinical manifestations of deep vein thrombosis (DVT) typically include:

1. Pain in the affected limb, often described as cramping or soreness.
2. Tenderness when touching or applying pressure to the affected area.
3. Swelling of the affected limb, which may be sudden and without an obvious cause.
4. Warmth over the area where the clot is located, compared to the surrounding skin.
5. Redness or discoloration of the skin, often in the affected area.
6. Skin over the affected area may appear pale, reddish, or bluish in coloration, depending on the severity and location of the clot.

These symptoms can vary in intensity and may not always be present in every case of DVT. It’s important to recognize these signs early to prevent complications such as pulmonary embolism.

Diagnostic Evaluation:

1. D-dimer: A blood test that measures the presence of a substance released when a blood clot breaks up.
2. Doppler Ultrasound: An imaging technique that uses sound waves to create pictures of blood flow in veins and helps detect blood clots.
3. CT Scan (Computed Tomography): Imaging test that uses X-rays to create detailed cross-sectional images of the body to detect clots in the lungs (pulmonary embolism) or other areas.
4. Venography: A procedure where contrast dye is injected into a large vein and X-rays are taken to visualize blood flow and detect clots.
5. MRI (Magnetic Resonance Imaging): Imaging technique that uses magnetic fields and radio waves to create detailed images of organs and tissues to detect blood clots.
6. Fibrinogen Uptake Test: A laboratory test to measure how well fibrinogen (a protein involved in blood clotting) is taken up by blood cells, which can indicate the presence of abnormal clotting.

Treatment:

Medical:

1. Low Molecular Weight Heparin: Injected under the skin to prevent further blood clotting by inhibiting certain clotting factors.
2. Vitamin K Antagonist (e.g., Warfarin): Oral medication that reduces the blood’s ability to clot by inhibiting vitamin K-dependent clotting factors.
3. Anticoagulant Drugs (e.g., Rivaroxaban, Apixaban): Oral medications that directly inhibit specific clotting factors to prevent clot formation and growth.
4. Streptokinase (STK): A thrombolytic medication given intravenously to dissolve blood clots by activating plasminogen to plasmin, which breaks down fibrin clots.

These treatments aim to prevent the existing clot from growing larger, prevent new clots from forming, and reduce the risk of complications such as pulmonary embolism. The choice of treatment depends on various factors such as the location and severity of the clot, patient’s overall health, and risk factors.

Nursing management:

1. Use of elastic stockings
2. Encourage daily routine exercises
3. Massage calf muscles
4. Early and frequent walking
5. Provide bed rest and elevate the foot end above heart level
6. Manage pain with analgesics
7. Administer appropriate antibiotic therapy
8. Assess for presence of swelling
9. Inspect affected area for shiny, white skin
10. Check for positive Homan’s sign
11. Provide complete bed rest
12. Elevate the affected leg
13. Apply hot compression to affected area
14. Monitor patient for any chills, fever, or increased temperature
15. Position patient comfortably
16. Advise on performing gentle movements or light exercises
17. Monitor vital signs when administering anticoagulant medications and observe for signs of internal bleeding

These nursing interventions aim to manage symptoms, prevent complications, and promote recovery in patients with deep vein thrombosis.

🔸b) Tracheostomy –

Tracheostomy (ટ્રેકિયોસ્ટોમી) involves creating an artificial opening (ઓપનીંગ) in the trachea (ટ્રેકિયા) through which a tube is inserted. This procedure is performed to provide artificial ventilation (oxygen) to patients who are unable to breathe naturally. It is done when a patient’s airway is compromised and needs to be maintained patent (open) for medical reasons.

Classification of tracheostomy is based on the duration or type of tube inserted into the trachea. Here are the common classifications:

1. Temporary vs Permanent: Tracheostomies can be temporary, intended for short-term respiratory support until the patient’s condition improves, or permanent, for long-term or permanent respiratory assistance.
2. Single vs Double Cannula: Based on the number of tubes inserted into the trachea, tracheostomies can be single cannula (one tube for both ventilation and airway clearance) or double cannula (separate tubes for ventilation and airway clearance).
3. Fenestrated vs Non-Fenestrated: Some tracheostomy tubes have openings (fenestrations) in the outer cannula near the distal tip to allow airflow through the upper airway when the inner cannula is removed, facilitating speech and swallowing.

These classifications help medical professionals choose the appropriate type of tracheostomy based on the patient’s condition and long-term needs.

1) According to situation:

A) In emergency:
When a patient experiences respiratory distress, tracheostomy is performed to establish an opening in the trachea to relieve the distress.

B) Prophylactic:
When a patient is at risk of developing respiratory distress, tracheostomy is performed preemptively to prevent the patient’s condition from worsening to a severe state.

2) According to duration:

A) Temporary:
Tracheostomy is performed for a short period to provide respiratory support temporarily.

B) Permanent:
Tracheostomy is performed for a lifetime to maintain a patent airway for the patient.

3) According to incision:

A) High:
The incision is made above the isthmus of the thyroid gland.

B) Low:
The incision is made below the isthmus of the thyroid gland.

These classifications help medical professionals choose the appropriate type and approach of tracheostomy based on the patient’s clinical situation and needs.

Sure, here’s the translation of indications for tracheostomy:

1) Any obstruction in the air passage due to a tumor.
2) If there is stenosis or narrowing in the trachea or larynx.
3) If there is any foreign body in the trachea.
4) For any unconscious patient.
5) When a patient is in respiratory distress and needs to keep the airway patent.
6) When a patient has undergone surgery on the mouth or neck.
7) When a patient has suffered trauma to the larynx and trachea or is paralyzed.
8) When a patient has undergone radiation therapy.
9) When a patient has difficulty breathing over a long period of time.
10) When there is accumulation of secretions in the lower respiratory tract of the patient.
11) When a patient has been intubated for a long period of time after surgery.
12) When a patient is unable to breathe naturally and needs external oxygen supply.
13) When there is any type of obstruction in the airway.

These are various medical conditions or situations where tracheostomy may be considered necessary to manage or support the patient’s respiratory needs effectively.

Here’s the translation of complications (કંપ્લિકેશન્સ) and general instructions (જનરલ ઇન્સ્ટ્રક્શન્સ) for tracheostomy, as well as nursing responsibilities (નર્સિંગ રીસ્પોન્સિબિલિટીઝ):

Complications:

1) Ventilation can be reduced due to the insertion of a tracheobronchial tube.
2) Tube displacement can occur during coughing, sneezing, and suctioning.
3) Infection of the lower respiratory tract.
4) Infection can occur at the site where the tube exits the trachea.
5) There is also a chance of developing pulmonary infections.
6) There is a chance of developing tracheo-esophageal fistula.
7) Prolonged suctioning can lead to hypoxia and even cardiac arrest.
8) Hemorrhage can occur at the tracheostomy site, entering the respiratory tract.
9) The patient can also become choked because food water has

Here’s the translation of the general instructions and nursing responsibilities for tracheostomy:

General Instructions:

1) Always remember that tracheostomy is an emergency procedure, so time should not be wasted.
2) Strictly adhere to aseptic technique both before and after performing tracheostomy.
3) Ensure that the tracheostomy tube is of proper size and length.
4) Clarify all doubts of the patient and their relatives and explain the procedure.
5) Monitor the patient closely before and after the procedure.

Nursing Responsibilities:

1) Monitor and observe the patient closely.
2) Do not leave the patient alone for the first 48 hours.
3) Be attentive if the patient experiences any difficulty in breathing.
4) Ensure that it is noted if the tube does not come out and remember.
5) When the tube comes out, keep the 6) Prepare the suction catheter.
7) Maintain aseptic technique.
8) Place the patient in Fowler’s position.
9) If anyone has a respiratory infection, do not attend to the patient.
10) Monitor the patient for any complications that may arise.
11) Ensure the patient is inspired using humidified or filtered air.
12) Maintain proper fluid intake and electrolyte balance for the patient.
13) Administer medications to the patient as prescribed.
14) Pay proper attention to the patient’s oral and vitals hygiene.
15) Dress the patient properly.
16) Provide a conducive and comfortable environment for the patient.
17) Answer all questions from the patient and their immediate family members.

🔸c) Warning Sings of Cancer-

Warning signs of cancer:

1) C – Change in bowel and bladder habits:

• Normal bowel habits involve having bowel movements once to twice daily.
• Changes could include increased frequency (more than 3 to 5 times a day) or decreased frequency (less than 3 times a week).
• Normal bladder habits involve passing urine 5 to 10 times a day. Changes may include needing to urinate more frequently (10 to 20 times a day).

2) A – A sore that does not heal:

• A sore that persists and does not show signs of healing.
• It may become larger over time or bleed.

3) U – Unusual bleeding or discharge:

• Unexplained bleeding from any body orifice (e.g., blood in urine or stool).
• Abnormal discharge from body openings (e.g., nipple discharge).

4) T – Thickening or lump in breast or any other part of the body:

• A lump or mass that feels harder or thicker than usual.
• Any new lump or mass that persists and grows over time.

5) I – Indigestion or difficulty swallowing:

• Persistent difficulty in swallowing or indigestion that does not resolve.
• It may be accompanied by pain or discomfort when swallowing.

6) O – Obvious change in a mole:

• Any change in the size, shape, color, or texture of a mole or pigmented spot.
• This includes new moles or spots that appear unusual or different from others.

7) N – Nagging cough or hoarseness:

• Persistent cough that does not go away.
• Hoarseness or changes in voice that persist.

These are all warning signs that could indicate the presence of cancer. It’s important to seek medical attention promptly if any of these symptoms occur and persist.

These are signs that could indicate cancer:

1) Voice changes: A persistent change in voice, such as hoarseness or other noticeable differences in how your voice sounds.

2) Persistent throat irritation or feeling of something stuck in the throat: This can include difficulty swallowing or persistent discomfort in the throat.

3) Coughing up blood or blood in the phlegm: Any instance where blood is present in the cough or phlegm.

These signs should be taken seriously and prompt medical evaluation is recommended if any of these symptoms persist or worsen.

🔸d) Prevention of HIV & AIDS-

HIV is a sexually transmitted disease.
AIDS := acquired immune deficiency syndrome.
Precautions and precautions for prevention:
1) For prevention of HIV and AIDS during coitus act, use a barrier method of contraceptive (condom).
2) Do not use razors used by others.
3) Do not use toothbrushes used by others.
4) Do not use needles and syringes used by others.
5) Use disposable needles and syringes.
6) If you have to use needles and syringes again, sterilize them properly before using them again.
7) If a woman has AIDS or an infection, she should avoid pregnancy because there is a chance of transmitting AIDS and HIV to the newborn baby.
8) Which pages can be used for prevention of AIDS and HIV.
9) Use of all kinds of media and technology can prevent HIV and AIDS.
10) A person should not donate blood and body organs, as they are at high risk of AIDS and AIDS.
11) When blood is transfused or blood is taken, HIV and AIDS screening is performed.
12) Use sterile sterilization techniques in hospitals and clinics.
13) Use disposable needles and syringes there.
14) If possible, use a sterilized needle and series.
15) Use Zidovudine tablets for preventive measures.
16) Infected blood and body fluids are not in contact.
17) When blood and body fluids come in contact, medical personnel should pay attention to universal precautions and use personal protective equipment (PPE) kits.
18) When injections and skin piercing are done, take care.
19) Sterilization and disinfection should be used effectively.
20) Educate people properly about sexual relationships.
21) Tell people about AIDS.
:A=Avoidable,
:I=Incurable,
:D=Disease,
:S=Syndrome. Provide health education about these.

22) Students should be properly educated about AIDS (Acquired Immuno Deficiency Syndrome).
23) Educate people that AIDS is not transmitted by any type of mosquito or insect bite but through unprotected sexual contact.
24) Educate people that AIDS cannot be transmitted through casual contact like sharing clothes, but it can be transmitted through blood and body fluids.
25) Hospital staff who do not have HIV and AIDS should be provided with proper precautionary measures.
26) Educate people that HIV and AIDS are not transmitted through food or water.
27) Provide antiretroviral therapy to individuals who have HIV and AIDS.
28) Provide psychological support to individuals who have HIV and AIDS.
29) Ensure that individuals who have HIV and AIDS do not transmit it to others.
30) Eliminate any stigma surrounding HIV and AIDS among people.
These are all measures for preventing HIV and AIDS.

Q-5 Define Following (Any Slx) 6×2=12

🔸1) Tinea -Tinea is a fungal infection of the skin. Tinea is also known as ringworm because it appears in a ring shape due to patches on the skin. It occurs due to various types of fungi. Tinea spreads from skin to skin contact or through contaminated towels and clothing.

• 1) Tinea pedis (athlete’s foot)
• 2) Tinea corporis (ringworm of the body)
• 3) Tinea capitis (ringworm of the scalp)
• 4) Tinea cruris (ringworm of the groin)
• 5) Tinea unguium (onychomycosis, ringworm of the nail)

🔸2) Osteomyelitis –
Osteomyelitis: Osteomyelitis is an infection and inflammation of the bone and bone marrow, usually caused by Staphylococcus bacteria. This infection can lead to conditions such as bone pain, sepsis, and swelling.

🔸3) Blepharitis –
Blepharitis: Blepharitis is inflammation of the eyelid, often involving the eyelashes as well. It commonly occurs when the oil glands near the eyelid become swollen. Symptoms may include dry eyes, burning, itching, and swelling of the eyelid.

🔸4) Isolation –
Isolation: Isolation involves separating individuals with contagious diseases from healthy individuals to prevent the spread of the disease. It includes keeping all their belongings that they use separate. Hence, healthy people can be kept away from contact and can prevent the spread of the disease.

🔸5) Glaucoma –
Glaucoma: Glaucoma is a condition of the eye caused by increased intraocular pressure. It damages the optic nerve, which transmits images to the brain. If left untreated, it can cause vision loss. Types of glaucoma include closed-angle glaucoma, open-angle glaucoma, congenital glaucoma, and absolute glaucoma.

🔸6) Presbycusis –
Presbycusis: Presbycusis is age-related hearing loss, affecting both ears equally. It is commonly observed in individuals aged 70 years and above.

🔸7) Leukemia –
Leukemia: Leukemia is a malignant (cancerous) disease that affects blood and blood-forming organs such as bone marrow, lymph nodes, and spleen. It involves abnormal increase in the production of leukocytes (white blood cells), affecting normal red blood cell formation and causing conditions such as anemia.

🔸8) Aneurysm –
Aneurysm: An aneurysm is the dilation or ballooning of the wall of an artery or vein at the weak point. It forms a sac-like structure and can occur in any blood vessel with increased pressure of the blood. One example is a bulging aorta where there is increased blood pressure in the blood vessels.

Classification:

1) Fusiform:
In this type, the entire wall of the blood vessel bulges out.

2) Saccular:
In saccular aneurysms, a sac-like formation occurs in the wall of the blood vessel. It doesn’t involve the entire vessel wall.

3) Dissecting:
Dissecting aneurysms involve all three layers of the vessel wall:

• Tunica intima
• Tunica media
• Tunica adventitia
  Dissection refers to a condition where there is a tear in one of these layers, leading to dilation.

4) According to cause:

• True Aneurysms: Form due to diseases that cause weakening of the vessel wall, such as hypertension and arteriosclerosis.
• False Aneurysms: Occur when there is trauma to the vessel wall without all three layers being involved. These are also known as pseudoaneurysms.

These classifications help in understanding the different types and causes of aneurysms based on their structure and underlying conditions.

Q-6🔸(A) Fill in the blanks. 05

1) Rose spot on belly & Chest is seen in________disease (Typhoi diseases

2) Lock jaw is a sign of _________. Tetanus

3) Scabis is caused by_____. (Sharkopti sakabi var hominis)

4) Intra ocular pressure measured by_________instrument. tone meter

5) Phulcn’s test is done to rule out . (Carpal Tunnel Syndrome)

🔸(B) State whether following statement are true or false. 05

1) Pacemaker machine used for the patient of bradycardia. correct

2) leukocytosis is a condition that causes too many white cells. correct

3) Dryness of mouth is called Xerostomia, correct

4) Montous test is used to diagnose typhoid. wrong

5) Psoriasis is an autoimmune disorder. correct

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