MSN-1-2017

Q.1-Mr. Manubhai 70 years old is suffering from Parkinson’s disease. Answer the following Manubhai who is 70 years old has Parkinson’s disease. Answer the following,

Q.1 A.What is Parkinson’s? 02

Definition:- This is a disease in which the level of dopamine decreases. Due to which, obstruction of nerve impulse transmission is seen and this is a neuro degenerative disorder. In which the following symptoms are seen.

• Tremor
• Muscle rigidity
• Echinacea
• Amnesia

B.Write down the sign and symptoms of parkinson’s disease is in detail:- 03

• Muscle rigidity
• Brady kinesia or akinesia
• Postural instability
• Tremor
• Hypotension
• Urinary incontinence
• Myalgia
• Dysphagia
• Mask like face
• Amnesia
• Closed eyelids
• High pitched voice

c. Write down the Nursing Management of Parkinson’s disease. Write the nursing management of Parkinson’s disease. 07

Medical management:-

• Levodopa or carbidopa may be given to the patient
• Anticholinergics are given if Levodopa does not work
• Anti-histamine and anti-viral drugs are also given

Nursing management :-

Impaired Respiratory Function :-

• Giving high fowler position
• Give steam inhalation if necessary
• Check SPO2 and give oxygen if less than 85
• If the patient is unconscious, suction should be done if necessary

Anxiety:-

• A quiet environment should be provided to the patient
• IPR should be maintained with the patient
• If possible, let another similar patient stay with him
• Prior to any procedure the patient should be informed so as to minimize their anxiety

Fluid electrolyte imbalance:-

• IV infusion should be given as per doctor order
• To maintain intake and output chart
• If necessary, give blood transfusion as per doctor’s order
• If needed, give electrolyte as per doctor’s order

Inadequate Nutrition:-

• If the patient has no contraindications, give a high protein and high calorie diet
• Iron supplement should be given to the patient
• Vitamin supplements are also given to the patient.
• Teeth :– vit b complex
• Administer mild laxatives to relieve constipation

In Adequate Rest :-

• Position the patient comfortably
• The patient should be encouraged to get enough sleep
• Use dim light while sleeping at night
• Providing a quiet environment while sleeping at night
• Sedation can be given if needed.

O-2 A. Define the following :- (ANY FIVE) 10 Define the following :- (ANY FIVE)

a.Nursing process :- Nursing process

• Nursing process was introduced by HALL in 1955. This is a systemic decision making process. In which the problem is solved from the steps of assessment, nursing diagnosis, planning implementation, evaluation. This is a continuous process. The patient’s health status and health problems are assessed from time to time. And the nursing care is modified based on the feedback or evaluation received from it. Thus, the nursing process is a continuous cycle. The steps shown above are interrelated and interdependent. is

b. Kernig’s Sign:-

• Kernig’s sign is a physical symptom of meningitis. In which if the hip is flexed to 90 degrees, the leg cannot be straightened due to which severe stiffness is seen in the hamstring muscles. This is an important clinical feature for the condition of meningitis.

C. Gangrene:-

• Tissue death usually occurs due to infection or lack of blood flow. It is called gangrene.
• This usually affects the lower extremities, toes, fingers, and limbs.
• Depending on the condition of gangrene, there are different types of gangrene such as dry, wet and gas gangrene. Diabetes, immunological disorders and other vascular disorders are high risk conditions for gangrene.

d. Cirrhosis of liver

• Liver cirrhosis is a chronic hepatic disease. In which destruction of hepatic cells and scaring of liver cells takes place. This condition can develop due to chronic liver infection, hepatitis, alcoholism etc.
• Liver cirrhosis is a serious disease. It also causes death.

e. Asthma Asthma:-

• This is a medical condition in which breathing difficulty is seen.
• The airway of such a person becomes narrow, extra mucous, as well as swollen, and inflamed due to which breathing difficulty is seen. Spasm is seen in the smooth muscle of these bronchi.

F. Empyema- In empyema

• Accumulation (deposition) of purulent material in the pleural space is called empyema. It is also called pyothorax.

B. Write the nurses responsibilities while administering the following drugs. (ANY TWO) Write the responsibilities of a nurse while administering drugs from the following. Any two 06

1.mannitol:-mannitol

• Electrolytes should be carefully monitored while giving mannitol
• Watch for cardiopulmonary complications
• Fluid balance should be monitored
• Intake and output chart should be maintained
• To check patient’s vital signs
• The patient’s weight should be checked and recorded daily
• Checking for hypersensitivity
• Continue to assess for hearing and vision loss
• To check the effectiveness of drug therapy
• Drug therapy should be monitored for side effects

2. Rifampicin Rifampicin:-

• Ask the patient to take the dose of medicine as per the doctor’s order.
• Closely monitor if patient has nephrotic disease
• If the patient is on anti-coagulant therapy, keep checking the prothrombin time
• Liver function should be checked periodically
• If any kind of reaction is noticed, immediately inform the physician in the form:- jaundice, G.I.reaction
• Information about the side effects of the drug should also be given to the patient and his relatives
• Tooth :- Red color urine
• Check for confusion, dizziness, fatigue, and weakness
• Ask to check and monitor vital signs

3. Deriphyllin:-

• If oral drugs are to be given then give with food or milk so as not to cause G.I.upset in the patient.
• To check the response of drugs
• To check patient’s vital signs
• Giving adequate information to the patient about drugs like indication, contraindication, side effects
• The patient should be provided with a quiet environment and rest
• Administer drugs at right time and in right dose as per doctor order
• Ask the patient to take more oral fluids
• Encourage the patient to void
• Providing psychological support to the patient
• Ask to take small frequent meals
• Providing necessary health education to the patient

Q.3 Write down the postoperative complications with its management. Post operative complications including its management lakhs 08

Haemorrhage:-

• Hemorrhages are primary and secondary. In which primary hemorrhage occurs at the time of surgery, while secondary hemorrhage occurs after some time.

Management:-

• Elevate the legs with the client lying upright
• Blood replacement if necessary
• Sometimes surgical intervention is necessary because the blood is coming from the blood vessels. Tooth :- ligature,suture
• The nurse should check the color of the dressing, fluid drainage to determine the amount of blood loss.
• Apply pressure bandage if needed
• Continuous observation of the patient
• Blood transfusion if required as per doctor order

Wound complication:-

Wound complications commonly include wound separation

• 1) wound dehiscence
• 2) Wound Evisceration

Management:-

• Stay with the patient and inform the doctor immediately if any complications occur
• If the intestine is exposed, it should be covered with a sterile, moist, saline dressing.
• Monitor vital signs and observe for shock
• Give bed rest to the patient
• Placing the patient in semi-fowler position to relieve abdominal tension
• Take proper care of the wound
• Apply abdominal binder if heavy patient
• Give the patient enough protein and vitamin C food
• If any complications are found then prepare for surgery

3) Hypotension:-

• Blood pressure usually drops after surgery and systolic blood pressure below 90 is called hypotension.

Management:-

• Keep the leg higher than the level of the heart
• Administer with oxygen mask
• Administer blood or saline if there is no contraindication
• To check pulse, blood pressure, urine output every 15 minutes
• Find the cause and treat it

4) Hypertension:-

Hypertension is seen post-operatively if the patient has a history of hypertension and in some patients it is also seen due to stress.

Management:-

• The cause of stress in the patient should be known and removed
• Complementary and alternative treatments should be done as per doctor orders
• Administer calcium channel blockers, ACE INHIBITORS and DIURETICS drugs as per doctor order

5) Wound infection:-

Wound infection is a post-operative complication that can also occur due to improper care of the surgical site by health care personnel.

Management:-

• Encourage the patient to take proper nutrition
• Minimize pre-operative hospitalization to prevent nosocomal infections
• Operative procedure should be done with strict sterile technique
• Use sterile technique when changing dressings
• Check and note the type, amount of drainage
• One should keep checking for early signs of infection
• If infection is found, give antibiotics as per doctor order and apply wet to dry dressing.

6) shock:-

• After operation shock condition is seen due to reduced blood supply to vital organs and hypovolemia.

Management:

• If blood is required, blood transfusion should be done
• To check the amount of blood loss and to check the intake and output
• To check vital signs as per protocol
• Prevent from infection
• Head low position can also be given if not contraindicated

7) Urinary retention:–

• The patient does not pass urine after the operation and the urine collects in the urinary bladder.

Management:

• Patient privacy should be maintained
• If patient is assisted to sit during voiding
• Warmth should be provided to relax the sphincter
• Notify the health care provider if the patient does not pass urine regularly after surgery
• Catheterization should be done if all measures are unsuccessful

8) Intestinal obstruction:-

• Blockage can occur due to any number of reasons in the intestine which may be mechanical, neurological etc.
• Assess for bowel sounds and abdominal distention after surgery
• N.G. Drainage and characteristics of emesis should be monitored and recorded
• Abdominal distension can be relieved with naso enteric suction
• Replacing fluids and electrolytes
• Monitor the patient closely for shock
• Reassurance to the patient
• Keep checking fluid and electrolyte levels
• Prepare the patient for surgical intervention if the obstruction is continuous

Q-4 Write shortnotes of following (ANY THREE) 12 Write shortnotes of following (ANY THREE)

1. Hypersensitivity – Hypersensitivity Hypersensitivity reaction means that the body overreacts when a foreign antigen enters the body or cannot maintain self-tolerance so that tissue damage occurs.

Autoimmune disease begins when the body’s immune system reacts against its own antigens.

Classification:– Type I, II, III are types of hypersensitivity antigen-antibody reactions. And this is the type of humoral immunity. Type IV is a type of delayed hypersensitivity and is an antigen-lymphocyte reaction and a cell mediated response.

1. Type I – IgE Mediated Response:- Type 1 is anaphylactic reaction (Hypersensitivity). Type 1 is found in people who are sensitive to specific allergens. The body produces IgE in response to an allergen. Along with which there are mast cells and basophils

Allergic symptoms:-

• Hypotension
• increased secretions of mucous,
• itching,
• allergic rhinitis (hay fever), allergic conjunctivitis
• hives and anaphylactic shock
• Bronchospasm
• Breathing difficulty is a common reaction.

2. Type II cytotoxic hypersensitivity:- Type II reaction is caused by an exogenous antigen. This normal structure of the body which perceives the body as a foreign body is called cytotoxic hypersensitivity.

• The reason for this may be cross reactions of antibody. As a result cell and tissue damage is seen.
• In this the IgG or igM antibody wraps around the cell. As a result, an antigen antibody reaction occurs and destroys the cell to which the antibody is bound.
• This type of reaction is seen in Myasthenia gravis, hemolytic anemia, Rh-hemolytic disease of newborn, thyroiditis.

3. Type III Immune Complex Mediated Hypersensitivity:- This type of reaction occurs when the antigen binds with the antibody and forms an immune complex.

This type of reaction is seen in systemic lupus erythematosus and rheumatoid arthritis.

4.Delayed Type (Type IV) Hypersensitivity:-

This hypersensitivity is also known as cellular hypersensitivity. This cellular hypersensitivity is seen 24 to 72 hours after exposure to the allergen.

Tooth :– Contact Dermatitis

Its symptoms include redness, itching, and thickening of the part exposed to the antigen.

Q.4 2. Stages of illness

Stage-1: Symptom Experiences:-In this stage a person feels that something is wrong. It has three aspects. If self-management is not effective, one moves to the next step.

The physical experience of symptoms.:- Pain, rash, cough, fever or bleeding are seen.

The cognitive aspect. (Interpretation of symptoms)

3.The emotional response. (Tooth. Fear or anxiety is seen)

Stage-II: Assumption of the Sick Role:-

This person accepts the seek role and is confirmed by family and friends. During this stage, people tend to blame themselves when symptoms worsen and seek professional help.

Stage III: Medical Care Contact:-

• Sick people seek advice from health care people on their own or at the suggestion of others. They receive three types of information from health care professionals.
• Validation of real illness.
• Explanation of the symptoms in understandable terms.
• Reassurance that they will be all right or prediction of what the outcome will be.
• Then the client accepts the diagnosis.

Stage-IV: Dependent Client Role: After accepting the illness, he becomes dependent on the health care professional for treatment, and decides to relinquish independence from roles such as wage earner, father, mother, student, or chair member. .

Stage-V: Recovery or Rehabilitation: During this stage, the client is expected to leave the dependent role and resume formal roles and responsibilities. People who have long-term illnesses and adjust their lifestyles find it more difficult to rehabilitate. During this final stage the person learns how to adjust and what therapy to use.

Q.4 3. Total parenteral nutrition – Total parenteral nutrition

• Total parenteral nutrition is also called intravenous feeding.
• This is a method in which gastric bypass feeding is provided through the intestinal track. All the nutrients are provided through the vein as per the requirement of the body

Indication :-

• Injury to the gastro-intestinal track
• Preoperative Mal Nutrition
• There are post-operative complications
• Symptoms like nosia, vomiting are related to CNS injury
• Hyper metabolic rate in trauma
• There is mal absorption

TPN Solution Content:-

• amino acids
• Glucose
• Lipids
• Essential fatty acids
• Electrolytes
• Minerals
• Vitamins

administration:-

• A central venous catheter is used for prolonged periods and sterile technique is used during insertion.
• T.P.N. Do not use the line for any other purpose
• The external tube should be changed every 24 hours
• The dressing should be kept sterile and changed every 48 hours using sterile technique
• A solution of 50% of the requirement should be given containing 5% dextrose for fluid requirement.
• Administer regular insulin according to plasma glucose levels

Complications:-

• Pneumothorax
• hemothorax
• air embolism
• catheter misplacement,
• thromboembolism.
• Infection
• Hyperglycemia-
• Fluid Imbalances
• Electrolyte Imbalances
• Acid-base Imbalances (acidosis)
• Fluid overload → Pulmonary edema, CHF

Nursing Care:-

• Weighing should be done daily
• Infection should be prevented
• Electrolyte balance should be maintained
• Should be anchored for ambulation
• The patient and his relatives should be educated
• Dressing should be changed regularly

Q.4 4. Anesthesia – Anesthesia

Anesthesia is a group of chemical agents that cause partial or complete loss of sensation.

Purpose of Anaesthesia:-

• Obtain patient cooperation.
• To reduce or eliminate pain.
• Keeping body muscles relaxed.
• To make the surgery process comfortable.
• To remove the sensation
• To stop moving
• There are three types of anesthesia.

1)Local Anesthesia:-

• It affects a limited area of ​​the body (local part). This usually affects the same part of the body where the surgery is to be performed or the part that needs to be numbed.
• The following chemicals are used in local anesthesia.
• Xylocaine hydrochloride
• Lignocaine hydrochloride
• Amethocaine Hydrochloride
• Procaine hydrochloride

2) Spinal Anesthesia :-

There are two types of this-

1) Epidural anesthesia:- When anesthesia is injected into the epidural part of the spinal cord, it is called epidural anesthesia.

2)Spinal anesthesia:- When anesthesia is injected into the subarachnoid space of the spinal cord, it is called spinal anesthesia.

Uses of Spinal Anesthesia:-

• Orchidectomy
• Cesarean
• Hernia surgery
• Hydrocele surgery
• Penile surgery
• Prostate surgery etc.

Complication :-

• Urinary retention
• Meningitis
• CSF leakage
• Hypotension
• Paralysis
• Allergies, headaches etc…

3) General Anesthesia:- When sensation is to be lost in the whole body, the person is rendered unconscious. It is called general anesthesia. General anesthesia can be given as follows-

by intravenous

2.by inhalation

By Intravenous:-

• I.V. The following drugs are used in general anesthesia by injection.
• Thiopental sodium 2.5%
• Hexabarbitone 10%
• Methohexital Sodium 1%
• Propofol
• Midazolam
• Fentanyl
• Ketamine hydrochloride
• Droperidol

Inhalation anesthetics:-

• This anesthesia is given through inhalation which renders the patient unconscious.
• Before this anesthesia is administered, the patient is given some sedative, then an endotracheal tube is inserted into the airway, and then it is given by inhalation.
• The following medicines are used in this.
• Sevoflurane
• Nitrous oxide
• Ether
• Cyclopropane
• Methoxyflurane
• Enflurane
• Panthrene

Responsibility of Nurse :-

• Administration of anesthesia is done by anesthesia doctor or anesthetist but nurse helps in it and nurse’s responsibilities are as follows.
• First of all, ask the name of the patient to be given anesthesia
• Obtain written consent.
• Questions asked by the patient about anesthesia should be properly answered by the nurse so that the patient’s anxiety can be reduced.
• Prepare the necessary equipment.
• The nurse prepares the patient for anesthesia and provides gowns, shoe covers, caps, etc.
• Clean the anesthesia site with aseptic technique.
• Medicines required for anesthesia should be kept in proper place.
• Continuous observation of the patient during anesthesia.
• To check patient’s vital signs.
• To check the consciousness level of the patient.
• The nurse should observe for complications due to anesthesia.
• Preparing for surgery after giving anesthesia.
• Maintaining records and reports.
• Clean the anesthesia machine after giving anesthesia.

Q-5 Answer the following :- Write the answer to the following

a. Define Hernia. Explain its types and sign and symptoms, 06 Write the definition of hernia. Write its types and signs and symptoms

Definition :- Hernia Etale When an organ protrudes out of its cavity it is called hernia. Due to this structural deformity, the organ protrudes from its original position on the side of the wick structure.

Types :-

Hiatal hernia/diaphragmatic hernia:- This part of the stomach enters the esophagus through the diaphragm.

2.Inguinal hernia:-

Direct Inguinal Hernia:- Inguinal ring is seen due to weakness of abdominal wall

Indirect Inguinal hernia:- Passes into the bowel due to muscular weakness of the wall.

3) Umbilical hernia :- Abdominal pressure causes the internal structure to protrude from the umbilicus. This is commonly seen in obese (thick) people and multiparous women.

4) Femoral hernia:- This is usually found on the femoral ring

5) Incisional hernia :- This is usually seen near the incisions that were previously operated on

Signs and symptoms:-

• Pain at the hernia site
• Protrusion
• Difficulty in walking
• Dyspnoea
• Vomiting
• stress
• Depression
• Hiatal hernia causes AP gastric pain and vomiting
• Peritoneal irritation is observed

b. Define Nephrotic syndrome .Describe it’s nursing management. 06 Define nephrotic syndrome and describe its nursing management

Definition:-

• It is a disease of kidney i.e. in which specific glomeruli defect is observed, which is mainly characterized by the following.
• Proteinuria
• Hypo albuminuria
• Hypercholesterolemia
• Edema
• Hyper lipidemia

Nursing management:-

Fluid overload or electrolyte imbalance :-

• The patient should be checked for overload or electro-light imbalance and checked and monitored for swelling.
• The patient should be given a diuretic as per the doctor’s order
• The patient should be encouraged to drink small amounts of fluids
• Pitting edema should be noted
• A patient intake and output chart should be maintained
• If needed, electrolytes are also given as per the doctor’s order
• Teeth :- kcl, mgso4

Altered nutrition less than body requirement:-

• Check the patient’s blood glucose level regularly
• The patient should be given a high calorie, low protein, low or no salt, low fluid diet
• Vitamin and iron supplements should be given to the patient
• Fiber diet should be given in sufficient quantity

Anxiety:-

• Inform the patient and their relatives about the hospital setup
• If any procedure or test is to be done on the patient, tell about it
• If possible, a relative should be allowed to stay with the patient
• The patient should be called by name
• Every question of the patient should be answered calmly and positively

Restlessness:-

• The patient should be given a comfortable position
• If the patient has difficulty breathing, oxygen should be given
• If the patient is admitted for a long time, air mattress should be given
• The position of the patient should be changed to prevent pressure sores
• Diuretic medicines should be given to the patient only in the morning.

Complication:-

• All medicines should be given to the patient at the right time
• Vital signs should be checked and recorded
• Every problem of the patient should be heard and if any complication is found then the doctor should be informed immediately
• An emergency tray should be kept ready near the patient.

Q.6 A. Fill in the blanks. 05

1. The joint of two hollow structure is known as _. Anastomosis
2. Full form of NSAID is __ NSAID | Full name Non steroidal anti inflammatory drugs
3. Candida albicans causes oral thrush. The disease Candida albicans is called __. Oral thrush
4. Disease caused by animals is known as______zoonosis Diseases caused by animals are called______.

5.__antihistamine class of drug is used to treat allergy. Used to treat drug allergies of class

B. State whether the following statements are ‘True’ or ‘False’. Write the following statements true or false. 05

1. Involuntary loss of urine is known as urinary retention. Involuntary loss of urine is called urinary retention.:- False
2. Aspirin is used to reduce intracranial pressure. Aspirin is given to lower intracranial pressure.:- False
3. Ketoacidosis is seen in Tire – IDM. Ketoacidosis is seen in type IDM.:- True
4. Foley’s catheter should be changed every 2 days. Follis Catheter2 should be changed on 2nd day.:- False

5.Inflammation of stomach is known as stomatitis. Inflammation of the stomach is called stomatitis. :- False

C.Match the following: Join the following Jodka 05

1. Diaphoresis:- Process of perspiration
2. Acromegaly Acromegaly :- Excessive body growth Overgrowth of the body,
3. Anemia – Anemia:- Deficiency of Haemoglobin. Deficiency of hemoglobin
4. Malena – Month:- . Blood in stool – Presence of blood in stool
5. Hypernatremia Hypernatremia :- Increase sodium level