Documente Academic
Documente Profesional
Documente Cultură
Jitendra Kumar
Deptt. of Commerce & Management
Biyani Girls College, Jaipur
2
Published by :
Think Tanks
Biyani Group of Colleges
While every effort is taken to avoid errors or omissions in this Publication, any mistake or
omission that may have crept in is not intentional. It may be taken note of that neither the
publisher nor the author will be responsible for any damage or loss of any kind arising to
anyone in any manner on account of such errors and omissions.
Course Description
This course will help students understand the concept of disease and disease process.
Student, will be able to gain knowledge and develop understanding of various medical,
surgical disorder and disease. They will be able to give comprehensive nursing care to
patients with these disease.
General Objective
Upon completion of this course the student will able to:
1. Describe the causes, symptom, treatment and prevention of medical surgical
disease.
2. Demonstrate skill in carrying out nursing technique and procedures with the
application of scientific principles.
3. Discuss nursing process and provide nursing care to patients with medical
surgical disease.
Course Content
Unit I Introduction
Health Assessment
Physical examination
Inflammation
Stress adaptation
Nutritional consideration.
Terminology
Unit VI Nurse's role in Management of fluid, electrolyte and Acid base balance
Homeostasis
Concept
Assessment
Types, location
Nursing management
Analgesic management
Analgesic drugs
Theatre Technique
Scrubbing-hand washing
Gowning
Gloving
Cleaning
Packing
Sterilization
Surgical Team
Management of patients with disorders of the chest and lower respiratory tract.
Unit XIII Nursing Management of patients with renal and Urinary Disorders
Renal transplant.
Assessment
Assessment of elderly
Ageing process
Unit I
Ans.
The nursing process is define, problem solving approach too meeting the health
care and nursing needs of a patients. It involves assessment (Date Collection)
nursing diagnoses, planning implemented that promotion the health through the
nursing diagnosis.
Steps in the Nursing Process:1. Assessment: Systematic collection of data to determine the patients health state
and to identify any actual or potential problems.
2. Nursing Diagnosis: Identification of actual or potential health problem that are
amenable to resolution by means of nursing actions.
3. Planning: Development of goals and a plant of nursing care.
4. Implementation: Actualization of the plan of core through nursing
interventions.
5. Evaluation: Determine of the patients responses to the nursing interventions
and of the extent to which the goals have seen achieve.
Nursing Care Plan: Nursing plan one involve from admission to discharge
nursing care. At first assess the complaints of patient and then provide the
nursing core on base of nursing diagnosis.
I.
Nursing Interventions
II.
Evaluation (Outcome)
Q.2
Ans.
A state of the body in which one or more ports of body foul to work.
Courses disease:
1. Hereditary disorder
10
Unit II
Nursing Assessment
Q.1
Ans.
Q.2
Ans.
11
Q.3
Ans.
12
Unit III
Ans.
Immediate response protective's of tissue against any injury, infect chemical and
physical agent than protective response is called inflammation. It is
characterized by pain, heat, redness, sidling and loss of function of the affected
port.
Patho physiology: - The blood vessels of affected port are dilutees and blood
flow fast. The WBC enters in the affected tissue space and engulf the bacteria
and foreign particles and than consumer the dead tissue after that inflamed (Pas)
condition on occur.
Types of Inflammation:
1. Acute inflammation: Redness, swelling
2. Chronic inflammation: (Bacterial infection) pas formed
3. Other's Educative : Inflammation with the accumulation of blood cells and the
serum.
Bacterial: Inflammation produced by the growth of bacteria
Reaction inflammation: Inflammation produced and a foreign body or
dead tissue.
4. Serous inflammation: The inflammation in which the exudates and composed of
serum.
5.
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Stages of Inflammation:
1. Traumatic: After injury the edge of wound are edematous.
2. Destruction: By the macrophages the necrotic material remove and
malformation are started.
3. Proliferation: This stage lasts 14 days. The film of connective and epithelium are
around of wound.
4. Maturation: The dead cell are disappear slowly and wound healing stated.
Q.2
Ans.
The information of blood clot in any port of circulatory system the condition is
called thrombosis.
1. Stasis [stop the blood flow]
2. Pain, redness swelling tenderness, limbis feel heavy, superficial veins
prominent, oedema of the extremities may be present or.
3. Diagnosis : By sign and symptoms
4. Management:
Non pharmacological management
Apply heat
Use of compression device
Adequate bed rest
Pharmacological management
1. Anti coagulant therapy
2. Thrombolytic therapy
Nursing management
Provide bed rest
The legs are elevated of the level of heart.
Provide anti coagulant therapy
Assist in breathing exercise
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15
Unit V
Clinical Pharmacology
Q.1
Define medicines?
Ans.
Q.2
Ans.
16
Q.3
Ans.
Q.9
Ans.
Classification of drugs: Drugs are divided into several types according to their
action on particular system, composition, their purposes & used etc. According
to action drugs are classified into following types.
Anesthetics: Drugs used to sedate patient i.e. loss of sensation.
Analgesics: Drugs used to relieve pain.
Anthdminthics & vermifuges: Drugs used to destroy & expel worms.
17
18
Expectorants: Drugs increase bronchial secretions & aid in the expulsion of the
mucus.
Emnagegues: A drug that improve the menstrual periods.
Emollient: Substances that smoothens, softens & protects the skin.
Galactagogue: Substances that increase the flow of milk.
Hypnotics: that induce sleep
Haemostatics: an agent to check haemorrhage.
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20
21
Unit VI
Ans.
Q.2
Ans.
22
Active Immunity
Natured
Artificial
Vaccination
Clinical Infection
Subclinical Infection
Live vaccine
Killed
vaccine
Passive Immunity
Natural
Through Placenta
Artificial
Immune Seram
Immune
Cell
Q.3
Ans.
This is the resistance induced by vaccines which are preparations of live or killed micro
organisms or their products.
1. Bacterial vaccines:
[A] Live:
2. Bacteria products
Tetonus foxoid
Dephtheria foxiod
3. Viral vaccines:
[A] Live: Sasin vaccine for palio myelitis or OPV
17D vaccine for yellow fever
MMR
Varicella Zoster.
[B] Killed
Salk vaccine for paliomyclitis
Influenza
Hepatitis A
Hepatitis B
Japanese encephalitis
Q.4
Ans.
1. Age: In general very young and very old are more susceptible to infectious
diseases than persons in other in other age groups.
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24
25
Unit VII
Ans.
The balance between fluid and electrolyte in body that term is called
homeostasis.
Q.2
Ans.
26
Dry skin
Weight loss
Coated tongue
Aligourea
Hypotension
Increased thirst
Diarrhoea
Electrolyte imbalance :
Sodium
Hyponatremia: Leck of sodium in body.
The sign and symptoms of Hyponatremia are:
Abdominal cramps
Convalsion
Tachy cardia
Fever
Potassium
Assessment:
Nursing diagnosis:
1. Activity intolerance related to muscles weakness.
2. Decreased cardiac output.
3. Fluid volume deficit related to diarrhear, vomiting polyurees.
4. Fluid volume excess related to anuria decreased cardiac output.
5. Risk of injury
6. Altered nutrition
7. Risk for impaired skin integrity rebutted to poor skin targor.
27
28
Nursing implementation:
[A] Fluids
1) Dextrose in water
2) Dextrose in Nacl
3) Nacl
4) Ringer solutions manage the dehydration due to vomiting diarrhoea or
inadequate intake.
5) Plasma expends (dextrin and albumin) in use of burn and trauma.
By infusion pump
By volume control
Pharmacologic management
Diuretics
Electrolyte replacement
Provide general care skin care, bed bath sponging mouth wash, hair core
Provide psychological support.
29
Unit VIII
Ans.
No Pain
distressing pain
10
un-bearable pain
Location
Right
Left
Front
Left
Right
Posterior
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Q.2
Ans.
1. Pain related to in tissue injury from on incision, ischemia, tumor, encroachment in organs or
bone.
Goal: Administer the pain reliving medicines.
The route may be: by mouth, rectal, topically sublingually, inhalation or by
injection.
Provide the psychological support in pain condition.
Educate the patient for self management of pain.
Other nursing diagnosis are
Activity intolerance
Anxiety and fear
Sleep pattern disturbance
Knowledge deficit.
Acetaminophen
Non-steroidal anti-inflammation drugs (NSAID)
2. Opioid Drugs:
Codeine
Hydrocodone
Incpridine
3. Side effect of analgesic drugs
Gastric irrigation
Increased clotting time
Constipation
Bleeding
Naused and vomiting
Respiratory depressions
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32
Unit IX
Ans.
O.T. Technique:
Operation theater is as too lated unit of the hospital in which emergency and
planned surgical procedure take place incomplete aseptic environment. There
are also available emergency equipment and life sharing drugs. The of is also
attech with anesthesia, sterilization, post recovery store rooms, changing room
and scrubbing room.
Set up of OT:
1. The wall should be hard and easily washable. The material like tiles or
plaster should be avoided due to risk of Gacks where the micro organisms
can harbor.
2. The floor should be smooth for easily washing and clearing.
3. The ledges or shelven should be avoided.
4. Extension board with rumors wire across the floor should be avoided.
5. Adequate air conditions should be provided is the OT.
6. In the absence of windows there should be adequate facility for lighting.
7. The fire escape should be present as legal requirement.
1. Anesthesia Room: The patient changes from his ward cloth in the OT cloth in
this room. The reduce the contamination the room should be pleasant by
decorated to help the patient pure to dedication.
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2. Sterilization Room: The sterilization room should be present near to the OT.
There should be one window to exchange the articles of operation.
3. Recovery Room: There should be direct connection between the OT and
recovery room. Where the patient is kept is post operative period fill the vital
parameter stabilize.
The recovery room contains central oxygen supply. Suction machine BP
apparatus stethoscope I stand. Roller bandages, gauze piece, cotton swab, mouth
gag, laryngoscope, pharyngeal air way, kidney tray, bed sheet blanket, tornicate,
detribilator, ventilator and ECG machine cardiac monitor and life sharing drugs.
4. Store room: The store room contain extra cylinder N2, additional equipment
and some prepare tray are available is the store room.
5. Changing room: A room should be available for the theatre personnel to
charge the OT clothes, the food wear also provided is this room cap and mask
also kept in this room.
6. Scrubbing room: The surgeon and nurse scrub in this room prior to wearing the
sterile gown this room is also directly open in to the OT.
Nursing is theatre:
The role of nurse is to under stand the process of illness and to contribute, the
skillfully about patient recovery.
A theatre nursing must have special training or knowledge R/T aratomy &
physiology and this order of whole body. She must also have knowledge about the
complete aseptic technology such as scrubbing and growing the nursing process
include following point.
(A) Assessment: In the assessment use include collection of the biodata such as
name of the patient registration number, diagnosis, investigation, any allergic
from any drug or disease like HT, diabetes.
The nurse must provide explanation about the problem related to operation
nature. Its duration anesthesia, safety, complication out come and about the pain
awareness.
34
(B) Implementation: It provide the nursing staff and opportunity to educate the
patient and relieve the anxiety and stress. It also included preparative
preparation technique of anesthesia, intra and post operative monitory with
advareed equipments.
3. Evaluation: The findings of evaluation should be documents on the care plan. It
also help is encouraging the health personnel's.
Preparation of myotroccey:
Retractor
Niddle holder
Scisors
Sutures
Sus force
Bed cock forcep.
Tissue for cep
Kidney tray
Elecro catutory
Haemostate
Dissecting forcep scalpel.
Assisting: Assist the surgeon with fully aseptic technique and stop by step.
Don't give any unassory articles during the time of operations. The mortally
should be clear and bita deen before keeping the articles.
The equipments should provide in such a way that there is noned to surgeon read
justing them.
The ligature are handed to surgeon grasp it with is two finger and between
haemostate.
Q.2
35
Ans.
S.No.
Position
Supine or dorsal re
Eye, nose
Tendelberg
Lelral
Lethiotomy
Neck position
Operation
of
neck
specially
trachiostomy,
thyroidectomy
6
Prone
Sitting
Knee elbow
Jack knee
36
3. Scrubb nurse:
(1) Before operation
Collection of equipment and liner for operative patient with
planning.
Gowning an glowing
Drawing the trathy.
Collection of suture material such as catgat vicryl, niddle cutting
and round, blade gauze piece and cotton etc.
After draping the meytrally prepare the initially requirement
cartides.
Check the patient's identification such as name diagnosis and
case paper.
Ensure the safe positioning of patient.
2. At the time of operation:
Toileting the skin of operative area and swab on the holder to the
surgeon.
Assist is draping of patient expose only needed area.
The position of my table should be set according to the need of
surgeon.
Pass the instrument, gauze piece, spung and suture material to the
surgeon according to need.
Keeping and accurate court of extra instrument and spung and ensure
that they are recorded by circulars nurse.
3. At the end of operation:
Remove the instrument from the myotable.
Collect the dressing from the circular nurse.
Dispose the blade, niddle into the appropriate untainer.
Remove the drap sheet from the patient.
Ensure that the patient gown is clear and dry.
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38
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Unit X
Anesthesia:
Anesthesia is a chemical substance that may be in the form of the gas. It helps in
complete loss of sensation of whole body and any particular part of body,
muscles relaxation and reduction of the reflexes of the body.
Thasthesia: Amnesia analgesia + muscles relaxation + hypnosis
Classification:
(A) General Anesthesia : The agent that desensitize the whole body is called general
anesthesia in this anesthesia the patient will be fally unconsciousness.
It is mainly given by inhalation intravenous and intra rectal route.
1. Inhalation: In this anesthesia the liquid gas mix with the O2 and administer
in to the lungs with respiration the purpose we can use O2 hask or
endotrachial tube eg. Harlothare, ether, no chlsroform cydopropane.
2. Intravenous: These are liquid agent which are given by route.
Barbiturate: theiopantone sodium katamine
Narcotice : eg. Pathidine, morphine salpine
Tranquelizer: Diazapal
3. Rectal anesthesia: These anesthesia are given by the rectal route and the
agent is absorve by rectal mucosa.
(B) Local Anesthesia: In this type of anesthesia the particular part of body
anesthetized. On the basis of administration it also classified in the seven types.
40
(C) Topical: These agents are used on particular area on incession the agent block
the nerve eadings eye, oral carity, and vagina.
Infitration: The agent are procaive, cocaine. These agents are introduce with
help of syringe and niddle eg lignocane.
Field block anesthesia: These are simulate like infiltration anesthesia, but it is
given sub of cataniusal.
(4) Spinal anesthesia: These agent are given by lumbered punctured is sub
archnoid space. This is given for the surgery of lower part such as resistectomy,
LSCS, factor of the factor and pelvic surgery.
Eg. Lox heavy 4%.
(5) Epidural anesthesia: When the local anesthesia is given in the epidural
space is called epidural anesthesia. This agent the neurological complication not
occur.
(6) Caudal Anesthesia: When the anesthetic agent it introduce in the coaloal
space is called . Anesthesia it is given for percheal surgery.
Q.2
Ans.
41
42
Unit XI
Ans.
Definition: ICU is an isolated unit in the hospital set up for caring of critically
ill patient with all emergency equipment and godgets are fully computerized.
The complex completely air conditions with selded to relative of the patient it
should be fuly furniture, and duty for the ICU personnel.
Set Up of ICU:
The ICU should be situated near the operation theater.
The ICU should not open directly in the gallery.
According to norms of WHO and ISD the hundred bedded hospital must contain
10 bedded in the ICU.
The set up of the patient must be around the nursing station.
The ICU have separate laboratory for the emergency investigation.
The floor and walls of ICU should be made with norbal and plaster of Paris.
The ICU should be attached with the changing and utility room.
No visitors should be allowed in the ICU and all the emergency equipment and
life saving available such as :
Dopamine
Dubetamine
43
44
45
Dexona
Lexis
Sodaby carb.
Calcium send
Phenargin forthwin
Xylocan
Diazapin
Nicardia
Q.2
Ans.
46
15. Sens the specimen for investigation riobsy etc with well label.
16. Maintain the patience of ET takes by sickening of interval.
17. Inform the physician as soon as possible for any complication and abnormal
symptoms.
47
Care of ventilator:
Ventilator: It is a mechanical device which is use to maintain the respiratory balance or
who help the patient when he is unable to take the spontaneously breathing.
It also helps to maintain the arterial blood gos with in the normal limit.
Care of ventilator:
48
1. The ventilator should be check before connecting to the patient for it's functions
such as volume, rate and mode setting.
2. The Humidifier should be is on condition and the water level should be
adequate.
3. The tabbing of venlilator should be use disposable types if reusable tubing & are
using it should be disinfected.
4. The transducer fitter and loms should be disinfected prior to use by 70% phenol.
5. The tube should and dusting of ventilator should be necessary at inteivel
6. The avessuries of ventilator should be kept in arsoblue place.
7. The filtered should be abodave after each patient.
49
Unit XII
Ans.
50
Clinical Features:
1. Asthma: Continuous coughing, chest pain, wheezing, chest tightness,
restlessness, dyspnoe cyanosis and attack may be sudden or gradually.
2. Bronchitis: Productive cough, wheezing sounds & shortness of breathing,
prolonged expiration, cyanosis, manifestations of corpulmonale (right ventricle
failure)
3. Emphysema: Barrel shaped chest, flate cliaphargm dialated lungs, dyspnoea,
tachypnea.
Diagnosis of COPD:
1. Chest X-ray
2. Sputbm test
3. Pulmonary function test
4. ECG
5. ABG
6. Blood investigations
7. Health history with clinical assessment
Management of COPD
Tell the patient to avoid the smoking.
Oxygen should be administered as early as possible.
Brancho-dialators should be use.
Amino phylline
Deri phylline
51
52
Intervention:
Tell him about treatment process
Provide calumn environment to the patient.
If necessary anti anxiety drug may be given.
5. Risk of infection R/T surgery
Patient should have reduce chonees of infection
Intervention: Maintain proper isolation technique proper worked core should be
done.
Q.2
Ans.
Etiology:
Bacterial pneumococcus, streptococcus.
Chicken poxvirus
Fungal pneurmonia cry ptococcosis
Aspiration of fluids
Risk factor:
Malnutrition
Immuno suppression
53
Chonic smokers
Infections
Classification
1. Labor pneumonia: In labour pneumonia one or more lobes are affected. It is commonly
caused by pneumococcus.
2. Brocho pneumonia : In broncho pneumonia there are various patchy area one from. It is
common caused by streptococcus.
3. Aspiration pneumonia :- It is caused by Ingestic of vamits, amniotie fluids, water.
Clinical manifestation: Cough with sputum, chest pain feverwith chills, dyspnoea, grunting.
Diagnosis of pneumonia
Chest X- Ray
Investigation of sputum
Blood instigation
Auscultation duall sound
Unequal chest expansion during inspiration
Management:
Antibiotics are given
Penicilline
Amoxyciline
Gentamycin
Antipyretics Paraeetamol and neumoslicle
Analgesic Diclofenee
Bronechodialators
Nursing Management
1. In effective airway proper position, sectioning, andotraehial ineusation.
54
Q.3
Ans.
Long abscess is a condition in wh ich collection of pas with in the long tissue
There are two type of long abscess:
1. Single long abscess
2.
Actiology :
1. Unaerobic bacteria saehas staphylococcus
2. Bronchial obstruction due to mucus plagging.
3. Aspiration of various materials such as vomits, amniotic
4. Various surgical procedure
5. Various traumatic injuries may also lead long abscess.
Clinical Manifestations
1. Fever with chills
2. Cough with sputum
3. Dyspnoea
4. Cyanosis
5. Haemoptysis
Diagnosis
1. Physical examination
55
2. Chest X-ray reveals pus formation and shows charities so the appearance is
seen like a honey cons.
3. Sputum examination reveals the nature of infection
4. CT scon
5. ABG analysis
Management
Oxygen administration to prevent dispnoees, hypoxemia and maintain
proper tissue perfusion.
Antibiotic theraphy : The antibiotic theraphy should be continue for a lony
time.
Chest physiotherapy and patient drainage should be done by proper
techniques.
Cough expectorant may be use in case of cough.
Antipyretics may also be prescribed to reduce the fever.
Q.5
Define pnecomothorax?
Ans.
pnecomothorax is the accumulation of air in the pleural spa there are following
types of pneinotherus
1. Open pnecomothorax: When air enters through open chest wound or incision
then it is known as open pnecomothorax
2. Close pnecomothorax : When air accumulates in the pleural space through
hole in the internal respiratory structures.
3. Tension pnecomotherax: Tansion pnecomothorax is a con. in which the air
accumulated in pleural spacue is not expelled out by which the pressure or
tension on media stinal contents increase which may lead depr. Of heart
causes decreased cardiac output.
56
Unit XIII
Ans.
Clinical Manifestation:
1. Pain: Pain will be felt in the right epigastric region
2. Nausea and vomiting Patient with gastric weer have decrease appetite and
diet.
3. Bleeding
4. General weakness
5. Burning sensation in the epigestrium region.
6. Burning sensation in the epigestrium region.
57
Investigation:
1. CBS
2. Stool examination
3. Endoscopy
4. EGD oesophago gastro dhodenoscopy This procedure is similar as endoscopy
but by this we can also take biopsy of the lesion.
Management:
1. Medical management
Anti microbial drugs
H2 blockers
Antacids and antisecretory drugs are given.
2. Surgical Management
Vagotomy: Vagotomy is a procedure by which that the acid secreting cell are
eliminated by cating the fibres of vagous nerve.
Heterprobe cautenzation: It is a procedure by which the active bleeding site is
cauterized by using electric current on the affected tissue.
3. Nursing Management
Control the fluid volume deficit
Control the pain (Epigestre pain)
Maintain the adequate nutrition level
Control the diarrhea
Assist in general are of the patient.
4. Dietary Management:
Avoid spicy and only foods
Avoid alcohol, excessive tea, and coffe
Diet should be in small and frequent meals
58
Q.2
Ans.
Acute gastritis
2.
Chronic gastritis
Etiology:
1. None steroidal anti inflammatory drug
2. Steroids
3. Chemotherapeutic agent
4. Coff, tea, excessive oil and spicy food.
5. Alcoholism
6. Food poisoning
Sign and symptoms: Eprigastric pain, tenderness, malaise
Belching (expulsion of stomach air from mouth and nose)
Regurgitation
Nausea, vomiting
Anorexia
Weakness
Burning sensation in the epigastric region.
Clinical Diagnosis
Investigation of gastric contents
Endoscopy
EGD (oesophage gastro - duodenoscopy)
Blood investigations
Complete history of dictory habits
Management
Antacids
Omeprazole
59
H+ inhibitors ranitidine
4. In case of non steroidal anti inflammatory drug (NSAID) ingestion of PGE
(Prostaglandin
E) should be given.
Q.3
Ans.
Clinical manifestations:
1. Temperature, normal but high pulse rate
2. Nausea and vomiting
3. Electrolyte imbalance
4. Abdominal pain in cramps
5. Tenderness
6. Peristaltic wave are visible on abdominal distention
7. Respiratory distress due to pressure on diaphragm.
8. Dehydration
9. Weakness and dryness
Clinical Diagnosis
1. X-ray Barium X- ray shows site of perforation and obstruction
60
2. Blood investigation
3. Electrolyte estimation
Management
1. Removal of fluid by using intestinal tube.
2. Decompression Decompression in a procedure in which.
The abdominal contents are decompressed by using CO2 or other gasic to se the clear
picture of obstructed part then after surgical removal of that part may also be
performed.
Nursing Management:
1. Administer prescribed analgesics
2. To relieve air fluid lock syndrome turn the patient from sup to prone position
every 10 minutes.
3. Measure and record all intake and output.
4. Administer IV fluids.
5. Monitor vital signs
6. Save all stools to test for occult blood.
7. Record amount and consistency of stools.
8. Keep the patient in fowler position to promote ventilation and relive abdominal
distention.
9. Detect early signs of peritonitis, suchas rightly and tenderness
10. Avoid enemas
11. Observe for signs of shock pallor, tachycardia, hypotension
12. Provide psychological support, offer counseling , if desired.
Q.4
Ans.
Jaundice the yellow discoloration of skin and mucus membrane due to excessive
accommodation of bilirusin in the blood.
Normal tatal bilirusin level = 0.1 1.0 mg %
61
Clinical diagnosis
1. Liver diagnosis
2. Blood investigation
3. Electrolyte estimation
Management:
1. Removal of fluid by using intestinal tube.
62
Nursing Management
1. Administer prescribed analgesics
2. To relieve air fluid lock syndrome turn the patient from sup. To prone position
every 10 minutes.
3. Measures and record all intake and output
4. Administer IV fluids
5. Monitor vital signs
6. Save all stools to test for occult blood.
7. Record amount and consistency of stools.
8. Keep the patient in fowler position to promote ventilation and relive abdominal
dictation.
9. Detect early signs of peritonitis such as rightly and tendering
10. Aviod enemas
11. Observe for signs of shock pallor, tachycardia, hypotension
12. Provide psychological support, after counseling, if desired.
Medical Management
A complete history of the patient should be taken and determine the real cause
of jaundice
Anit histamine should be givento relieve itching.
It skin lesions develop and become infected than antibiotics should be given.
Symptomatic drugs should be given for fatigue, fever and weakness
Nursing Management
Provide comfortable position to the patient to prevent to bed.
Maintain the fluid and electrolyte balance
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Q.5
Ans.
Hepatitis is the inflammation of liver. Hepatitis may be viral, toxic and alcoholic
hepatitis.
1. Hep. A : It is caused by hep. A virus. The cause of epidemics are infected water,
milk, food. It spread through faelo-oral route.
2. Hep.B- It occurs world wide. It occurs in multiple blood transfusion,
homosexual ..people who ..
3. People who under going and drugs users.
4. The virus also found in saliva and semer, so parental sexual intercourse and
liplock kissing are major route of the transmission.
5. Incubation period 30 120 days.
Clinical Features :
1. Pain in the right hypochondric region mainly but is may radiate in the other
regions of abdomen.
2. Anorexia, nausea and vomiting
3. Abdominal pain is also caused by stretching of glissions capsule surrounding the
liver the to the inflammation
4. Fever
5. Fatigue and malase
6. Dark urine and stool
7. Muscles termers chue to encephalopathy
64
8. Bleeding tendency
9. Heputomegaly
10. Hypergly caemia
Management:
Bed rest should be given to minimize the daily activities.
Low fat and balance carbohydrate diet should be given to the patient.
When the patient is unable to take orally them IV fluid should be given.
Alcohol should be restricted
Antiemetic should be given for nausea and vomiting
Paentral vitamin K should be given.
Good personal hygiene should be maintained.
Proper screening of sex workers, prostitution, call girls and home sexual is
necessary.
Screening of donor blood for HBC Ag and HBS Ag antibodies
Proper sterilization of artides
Safe disposable hospital waste should be maintained
Q.6
Ans.
Clinical manifestation:
Onset is insiders may take years to develop
Early complaints include fatigue, anorexi
Edema of the onkles in the evening
Epistaxis and bleeding glems
Weight loss
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Chronic dyspepsia
Constipation or diarrhoea
Splenomegaly
Amemia, weakness
Depression
Diagnosis Evaluation :
Liver biopsy
Liver scan shows abnomed thickening and liver mass
Parenthesis
Laproscopy
Liver friction test
Management:
Minimize further determination of liver foretion through the withdrawal or toxic
substances, alcohol and drugs.
Correction of nutritional deficiencies with vitamins.
Treatment of ascites and fluid and electrolyte imbalance.
Bed rest to aid in divers is
Abdominal peracentesis is done
Symptomatic relief measures such as pain medication and automatics.
Encourage and assist with gradually increasing periods of exercise.
Suggest small frequent feeding
Encourage oral hygiene before meals.
Administer or teach self administration of medication for nausea, vomiting
diarrhea or constipation.
Advise patient to keep fingernails short
Observe stools and emesis for color, consistency and amount.
Protect from sepsis intake and out put and seram electrolyte level to prevent
dehydration.
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67
Unit XIV
What do you under stand by diabetes mellitus? And explain the nursing
management in details?
Ans.
Path physiology/Etilogy
1. Absolute or relative lack of insulin produced by the beta cell resulting in hyper
glycemia
Clinical manifestation:
[A] Hyperglycemia
Blurred vision
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Diagnosis evaluation
1. Random, fasting or 2 hour post prondial glucose test
2. Glucose Folerence Test (GFT)
Management
1. Dict: Dietary control with coloric restriction of corbohych and saturated fak to
maintain ideal body weight.
The goal of meal planning is to control blood glucose and lipid level.
Exercise: Regularly scheduled exercise to promote the utilization of carbohydrates, assets with
weight control enhance the action of insulin, and improve cardio vascular fitness.
Q.2
Ans.
Etiology:
1. Over functioning of entire gland
2. Toxic malfinodular goiter
3. Emotional upset
Management
1. Antithyroid medicines methamazole
2. Radio Iodine therapy for middle age.
3.
Provide comfort
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70
Q.3
Ans
Management :
1. IV flick
2. IV insulindrip
3. Electrolyte replacement
4. Provide comfort to the patient
5. Improve personal hygiene
6. Prevent the patient form infection
7. Maintenance body temperature
8. Provide psychological support
9. Provide the knowledge about the disease process and treatment
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Unit XV
What is acute renal failure? Describe is etiology, sign and symptoms treatment
and nursing management?
Ans.
Causes :
1. Prerenal cause: Result from condition that decrease renal blood flow.
2. Postrenal causes: Arises from obstruction to urine flow anywhere along the
urinary fract.
3. Intracranial causes: Result from injury to renal tissue and is usually associated
with intracranial is chemia, tosins, immbnology process.
Clinical menifestations
1. Prerenal: Decreased tissue turgor, dryness of mucus mem. Weight loss,
hypotension, aliguria, or anuria.
2. Postrenal: Difficulty in voiding charge in urine flow.
3. Intrarenal: Fever, skin rash, edema.
Diagnostic evaluation:
Urinalysis: Reveals & protenuria, haemauria
Rising serum creatinine and BUN level
Urine chemistry examination
Renal ultra sonography
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Management:
Corrective/supportive measures: Correct any reversible cause of acute renal
failure.
Be alert for an correct underlying fluid excess or deficits.
Correct and control biochemical imbalances
Restore/maintain blood pressure
Maintain natritein
Initiate hemodialysis, peritonent dialysis or continuous ronal replacement
therapy for patient with progressive azotemia .
Nursing Management
Identify patients with pre existing renal disease
Initiate adequate hydration before, during and after operative procedures.
Avoid expose to various nephrotoxins
Avoid exposure to various neurotoxins
Avoid chronic analgesic drug causes interstitial nephritis and papillary
neerosis.
Prevent and treat shock with blood and fluid replacement
Prevent prolonged periods of hypotension
Monitor urinary output.
Pay special attention to draining wounds, burns etc which can lead to
dehydration and sepsis and progressive renal damage
Avoid infection
Take every precaution to ensure that the right person receive the right blood.
Maintaining adequate nutrition.
After high carbohydrate feedings
Prepare for dialysis which may help prevent mueologic complications.
Provide health education about persent hygiene, disease process treat.
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Q.2
Define renal stones, etiology sign and symptoms and management in detail?
Ans.
Nephralithiasis refers to renal stone disease stones and calcite are formed in the
urinary treat from the kidney to bladder by the crystallization of substance
excreted in the urine. The majority of stones (60%) are composed of calcium
oxalate crystals.
Etilogy :
Clinical diagnosis
1. IVP = Intra venous pyelography
2. KUB (Kidney ureter, Bladder) X- Ray
3. Urine analysis for hoemalumia, pyaress PH
Clinical Features:
1. Pain
2. Obstruction of urine painful maturation
3. Inflammatory symptoms fever, vomiting nausea, chills
4. Anorexia, Abdominal discomfort
5. Hypothermia Mild shock
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Management:
Medication:
1. Alopurinal
2. D-Penicillomine
3. Antibiotics
Dietary Management
Avoid milk and milky product
Use green leafy vegetables
Avoid coffee tea cabbage, brinjal tomato , citous food
Use acidic food meat, fish ego, chocolate
Surgical Management
PCNL Percutoneous nephralithtomy
Open surgery : - Cystolithotomy, Nephrecotomy
Nursing Management
1. To relieve pain
Assess the site and nature and pain
Provide suitable position
Provide analgesic as doctors order prescription
2. To maintain urine flow
Maintain fluid and electrolyte balance
Maintain intake and out put chart.
3. To prevent from infection
Administer antibiotics
Maintain personal hygiene
Use aseptic techniques in every process
4. To maintain fluid volume
5. To provide knowledge knowledge about, diseae, complication, treatment
exercise, diet and personal hygiene
Q.3
Ans.
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Clinical Feature: Fever with chills, flank, pain, tenderness, nausea, vomiting, headeale,
muscular, pain
Management :
Provide symptomatic treatment as prescribed by the doctor.
Provide antibiotics for bacterial infection.
Maintain fluid volume
Provide the general core
Provide nutritional diet
Maintain nutritional hygiene
Assist in activities of daily living (ADL)
Provide comfortable position
Provide knowledge about continuous treatment, tests and personal hygiene
Provide psychological support
Q.4
Define and stage renal disease (ESRD). It sign and symptoms and
management in details?
Ans.
ESRD is also called CRF. Chronic renal failure is a progress detoriation of renal
function. Which ends fatally in uremia for it complication unless dialysis or a
kidney transplant is perform
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Etilogy:
Hyprtension Prolonged and sever
Diasetes mellitus
Glomeralo nephritis
Hereditary renal disease
Obstructive uropathy
Development/congenital disorder
Clinical manifestation:
1. Gastrointestinal : Anorexia, nausea, vomiting
2. Cordiovascular: Hyperkalemic ECG changes, hypertension, pericorditis
3. Respiratory : Pulmonary edema, plural effusion
4. Neuro muscular : Fatigue, sleep disorder head aahe, lethargy seizures, coma
5. Metabolic oral endocrine : Glucose intalerenee, sex hormone distrasene causing
decreased libido.
6. Fluid electrolyte acid base disturbance
7. Dermatologic: Pallor praritus
8. Haematologic: Anemia, defect in quality of platelets
9. Psychosocial functions: Personality and behavior changes.
Diagnostic evaluation:
1. Complete blood fount (CBC)
2. Elevated serum keratinize, BUN, phosphorus
3. Decreased serum calcium
4. ABG Lowblood PH, low CO2 bicorbonate (HCO3)
Management
1. Detection and treatment of reversible couses renal failure
2. Dietary regulation
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78
Unit XVI
Define head injury with sing and symptoms and nursing management?
Ans.
Head injury also known as brain injury is the disruption of normal brain function
due to trauma related injury resulting in compromised neurologic factions.
Clinical Features
Disturbance in consciousness confusion to coma
Headache, vertigo
Rest lessness
Respiratory irregularities
Cognitive deficits
Sudden onset of neurologic deficit
Diagnosis Evolution
CT scanning of head
Skill and cervical spine film
EEG
Neurologic assessment
Management :
Management of increased ICP
Antibiotics to prevent infection
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80
Q.2
Ans.
Clinical manifestation:
Headlache, baekaehe, fever, leuckeytosis, changes in patient mental status
photophosia, nuchal rigidity.
Diagnostic evaluation
CBC, blood calture, CSF culture, MRI, CT scan.
Management
Antibiotics, steroids , and osmotic dibretics to reduce cerebral edema.
1. Reducing fever
Provide antipyretics and monitor temperature frequently
2. Maintaining fluid balance
Administer IV fluids, monitor intake and out put chart.
3. Assess level of consciousness vital sign
Maintain quiet and calm environment
4. Reducing pain
Administer analgesic
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Q.3
Ans.
Treatment
Acylovir (xovirax) given IV if caused by herpes simiplex virus
Anti conversant to prevent and treat seizures
Sedatives and analgesics
Supportive core
Maintain quiet eminoment and provide are gently.
Maintain seizure precautions with side rails padded.
Monitor neurologic status closely, watch for subtle changes such as behavior or
personality changes, wealness.
Monitor temperature and vital sign frequently
Administer antipyretics
Monitor intake and out put charting
Monitor for other complication such as comes, frequently fatal, orinary freat
infection and pneumonia.
Explain the effects of the disease process and treatment
Encourage follow up for evaluation of deficits and rehabilitation potential.
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Q.4
Ans.
Seizures close know as epileptic seizures and, if recurrent emilepsy are thought
to result form disturbances in the cell of the brain that cause than to give off
abnormal, recurrent controlled electrical discharges.
Causes:
Idiopathic
Hypoxemia
Vascular Insufficiency
Fever
Head injury
Hypertension
Infection of a
Metasalic changes
Bran tomour
Drug withdraw
Clinical Manifestation:
1. Impaired consciousness
2. Excess or loss of muscles tone or movement
3. Disturbance of behaviour, mood sensation and perception
4. Disturbance of the automatic fanetions of the body.
Diagnostic Evaluation:
1. ECG with or without video monitoring
2. MRI or CT scan to identify lesion that may be cause of seizure.
3. Neuro physiological studies to evaluate for behavior changes
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Treatment :
Pharmacotherapy drug selected according seizure to
Carbamazepine, phonation, Phenobarbital
Surgical correction of effected of brain
Nursing intervention :
Ensuring on adequate airway
Protecting the patient from injury
To maintain tissue perfusion to occurrence of seizers
To reduce the stress
Provide psychological support
Educate the patient and patient's relatives about disease
Q.5
Ans.
Clinical Menifastation:
Tremor, rigidity, akinesia (loss of muscles function)
Automatic disorder sleeplessness salivation, suieating
Depression, psychiatric distransences, dementia etc.
Management:
Anticholinergics drugs, amentadine, levodopa, bromociptine etc.
Combination drug therapy and rehabilitation techniques
Maintain reparation
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85
Unit XVII
Ans.
Etiology :
1. Immunologic process result in inflammation of synovial producing antigens and
inflammatory by products ederra and production of a granular tissue called
panes.
2. The etiology & unknown but is probably a combined effect of environmental,
demographic infections and genetic factors.
Clinical Manifestation:
1. Arthritis
2. Skin manifestations
Rheumatoid modules, elbow & occipal, sacrum
3. Cardiac manifestations
Acute pericorditis
Conduction defects
Cormory orteritis
4. Pulmonary manifestations
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Pleural effusion
Asymptomatic pulmonary disease
Laryngeal obstruction
5. Neurologic manifestations Corpal tannel, syndrome
Wrist drop, foot droop
6. Systemic manifestations
Fever
Faitgue
Weight loss
Q.2
Ans.
Pharmacologic
NSAIDS
Corticosteroids to reduce inflammatory process
Local comfort measures
Application of heat oral cold
Use splints
No pharmacologic modalities
Behavior modification
Relaxation techniques
Surgery
Synovectomy
Arthrodesis Joint fusion
Total joint Replacement
Nursing diagnosis
1. Chronic pain related to disease process
2. Impaired physical mobility related to pain and limited joint motion.
3. Self care deficit related to & llimitations.
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Nursing interventions
Controlling pain
Optimizing mosicity
Promoting self core.
Strengthening copying
Instract patient and fomily in the nature of disease
Education about pharmacological agents.
Medication must be taken consistently to achieve maximum benefit.
Reinforce to patient the need for life long fragment.
Q.3
Ans.
Pathophysialogy
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Clinical features/classification
(A) Acute govty arthritis
Generally affects one joint often the first metatorso phalange joint called
podagra.
Other joints can be affected such as on fasals, knee.
Pain, wormth, crythema and swelling of tissue surrounding the affected
joint
Fever may occur
Onset of symptoms is sudden, intensity serve.
(B) Chronic to apiaceous goat
Occurs if acute goat is inadequately treaty or goes antreated.
Characterized by development of tophi or deposits of uric acid in and
around joints cartilage and soft tissue.
Arthritis is more chromic in nature with disease atlocks less common.
(C) Renal disease
Caused by hyperuricemia (persistent elevation of uric acid in the blood)
Kidney stones are composed of uric acid deposition of uric acid in
kidney tissue.
Q.4
Ans:
(A) Pharmacologic
NSAIDS for acute attacks to relieve pain and swelling
Corticosterocls: Intra articulor if attack combined to one joint.
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Nursing diagram
Pain related to acute arthritis
Impaired physical mobility related arthritis.
Nursing Implantation
Relieving pain administer and teach self administration of pain relieving
medications as prescribed.
Encourage adequate fluid intake to assist with exertion of uric and decrease
likelihood of stone formation
Facilitation mobility assist in activities of of daily
Encourage exercise and maintenance of routine activity in chronic government,
except during acute attacks.
Encourage to avoid alcohol.
Avoid medications known to increase uric acid levels.
Instruct in sign and symptoms of allopourinol hyper sensitivity syndrome and
need to report promptly.
Educate the patient about personal hyofiere, balance diet, exercise and
treatment.
Q.5
Ans.
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Clinical manifestation:
Inflammatory arthritis
Asymmetric arthritis involving a few joints tips, knees, onkles, and unit.
Spinal arthritis approximately 20% to 40% of patients
Skin imaheement : Pboriasis may be mild or severe
Arthritis may precede the development of skin disease.
Nail disease is present in the large majority to patients with proratic arthritis
Extra orticular menifestations
Eye inflammation conjunctivitis
Pulmonary fibrosis
Aortic insufficiency
Diagnosis evaluation
CBC
ESR
Synovial fluid analysis
X-ray
Skin Biopsy shown choroetersite hhper keratosis and other changes
91
Unit XVIII
Ans.
Growing old (aged) is an inevitable process in every one life. The persons
above 65 years are considered as aged. As we grow old, the health needs also
very. Geriatrics is the branch of medicine dealing with the problem of the ageing
and the disease of the elderly. An important part of the aged to live happy and to
their satisfaction.
The ageing process is complex. The body continuously replaces the worm out
cells & all through the life of the individual. As years pass, the rate of
replacement slows down. This the functions of the each system of the body is
impaired and give rise to disorders. The process of aging may also hastened by
environment, disease, emotional stress fautly life styles malnutrition etc.
Q.2
Ans:
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9. Nail disease present in the large majority of patients with psoniatic arthritis
Diagnostic Evaluation
CBC
ESR
Synovial fluid analysis
X-ray
Skin biopsy shows choraetorsite hyper keratosis and other changes.
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Unit XIX
Emergency Management
Q.1
Ans.
Emergency core can be defined as the episodic and crisis oriented are provided
to patients with serious or potentially life threatening injuries or illness. The
philosophy of emergency core includes the concept that can emergency is
whatever the patient or family considers it to be.
Q.2
Ans.
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Expose undress the patient to look for clues to injury or illness, such as
wounds or skin lesions.
Reproductive : Female: Cenical cancer, breast cancer male: prostate cancer.
Q.3
Ans.
Nursing diagnosis:
1. Self core deficit related to ageing process
2. Risk for injury
3. Altered nutrition
4. Alterations in visual and auditory activities
5. Social Isolation
6. Alfred tissue perfusion
Nursing interventions
95
Q.3
Explain the sign and symptoms with treatment end nursing core?
Ans.
96
Urgent II ; Patient who present as stable but whose condition requires medical inter
immediate threat to life or lins for these patients
Conditions:
Fever
Minor burns
Dizziness
Laeerations
Minor masculosketatal injury
Nonemergent III :
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Patient who present with chronic or minor injuries. There is no donger to life or lims by
having these patient wait to be seen. These patients are in no obvious distress.